ISSN: 0029-6473 eISSN: 1744-6198 |
nurses and nursing
Published by John Wiley & Sons
No Issue Number
- Gottlieb, L. (2013). Strengths‐based nursing care: Health and healing for person and family. New York: Springer Publishing.
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- Health Coaching: A Concept Analysis
Purpose Variations in the use of health coaching documented in the literature indicate a lack of conceptual clarity. The purpose of this article was to clarify the meaning of health coaching and propose an operational definition. Conclusions Seven attributes were identified and used to propose an operational definition of health coaching as a goal‐oriented, client‐centered partnership that is health‐focused and occurs through a process of client enlightenment and empowerment. Practice Implication This operational definition and the proposed empirical measures of each attribute can be used to validate the presence of health coaching, develop theory‐based applications, and consistently test the effectiveness of interventions using this concept.
- A Review of Potential Muslim Organ Donors' Perspectives on Solid Organ Donation: Lessons for Nurses in Clinical Practice
Background Transplantation is increasingly being used to treat patients with end‐stage organ disease. However, when potential organ donors involved are Muslims, religious beliefs and culture have a strong influence on clinical decision making and nursing care. Purpose To establish basic aspects that nurses working with potential Muslim organ donors need to know in order to provide culturally sensitive care. Methods Studies were retrieved from four databases (Cumulative Index to Nursing and Allied Health Literature, SCOPUS, Medline, and PubMed). Results Findings of available studies show that health education, family involvement, and collaboration with religious leaders are good strategies for ensuring culturally sensitive care for Muslim patients in this situation. Conclusion Nurses need to know that organ donation is compatible with Islam and that religious leaders, family, sociocultural beliefs, legal requirements, informed decision making process, and Ramadan are important aspects that need to be considered in order to be able to provide culturally senstive care.
- Stress: A Concept Analysis
Purpose To analyze the concept of stress and provide an operational definition of stress. Conclusions Literature review revealed that stress is a commonly used, but often ambiguous, term. Findings supported a definition of stress entailing an individual's perception of a stimulus as overwhelming, which in turn elicits a measurable response resulting in a transformed state. Practice Implications This analysis adopts a dynamic definition of stress that may serve to encourage communication, promote reflection, and enhance concept understanding. This definition may provide direction for future work, as well as enhance efforts to serve patients affected by stress.
- Presentation Rubric: Improving Faculty Professional Presentations
Purpose This article describes the content of a presentation evaluation rubric for use in the development and improvement in faculty performance to enhance learning. Conclusions Lectures or professional presentations require skills that can be learned through the use of evidence‐based practices for all forms of public speaking. Practice Implications A core competency of nursing faculty is to serve as a role model in skilled oral communication. The use of an evaluation presentation rubric can increase faculty competency in this area.
- Deployment and PTSD in the Female Combat Veteran: A Systematic Review
Background The number of females serving in the Gulf War has risen and continues to be a rapidly growing group. Females occupy a wide range of roles and face a myriad of challenges as they serve alongside their male counterparts in almost every role. Females are also facing redeployment, multiple deployments, and/or extended deployments. The stressors of war and deployments may be putting them at risk for posttraumatic stress disorder (PTSD). If left untreated, PTSD can have devastating and debilitating consequences for veteran's functioning and relationships, their families, and society. Objective To examine the literature over the past 10 years to determine if there is a relationship between deployments and the incidence of PTSD in female combat veterans as compared with male veterans. Method Systematic review. Results The numbers of veterans screening for PTSD are increasing. Those who have experienced extended or multiple tours have higher screening rates. Females report slightly less combat exposure than males but higher exposures to other stressors of war such as military sexual trauma. Females were at higher risk for depression while males were at higher risk of substance abuse. Females and lower rank were associated with greater utilization of Veterans Administration services.
- Eating, Activity, and Supportive Environment (EASE) for Nursing Students
Purpose The feasibility study was designed as a potential model for prevention of obesity at a large college of nursing in the Southwest. Conclusions Pretest median body mass index was 30.4 in the intervention group and 30.5 in the control group, indicating obesity in the student sample. There were no significant changes in posttest measures in the small sample. The thigh circumference change in the experimental group trended toward change with significance of .06. Implication The American Nursing Association launched a Healthy Nurse program in 2012, as healthy nurses are role models for a healthy nation. Updating nursing curriculum and active participation of students in weight management programs will promote their own health and positive role modeling.
- Virtual Collaboration in the Online Educational Setting: A Concept Analysis
Breen Purpose This study was designed to explore the concept of virtual collaboration within the context of an online learning environment in an academic setting. Method Rodgers' method of evolutionary concept analysis was used to provide a contextual view of the concept to identify attributes, antecedents, and consequences of virtual collaboration. Findings Commonly used terms to describe virtual collaboration are collaborative and cooperative learning, group work, group interaction, group learning, and teamwork. A constructivist pedagogy, group‐based process with a shared purpose, support, and web‐based technology is required for virtual collaboration to take place. Consequences of virtual collaboration are higher order thinking and learning to work with others. Conclusion A comprehensive definition of virtual collaboration is offered as an outcome of this analysis. Clarification of virtual collaboration prior to using it as a pedagogical tool in the online learning environment will enhance nursing education with the changes in nursing curriculum being implemented today. Further research is recommended to describe the developmental stages of the collaborative process among nursing students in online education and how virtual collaboration facilitates collaboration in practice.
- Diabetes Knowledge and Self‐Management Effects on Physiological Outcomes in Type 2 Diabetes
Purpose The purpose of this study was to determine whether Asian Pacific Islanders with type 2 diabetes who have better knowledge and self‐management would have better baseline hemoglobin A1c (HbA1c) and total cholesterol values. Signicant relationships were found among (a) general diet on HbA1c (p < .030), (b) medications on HbA1c ( < .009), and (c) diabetes knowledge on HbA1c (p < .001). Participants with active self‐management regimens were expected to demonstrate better laboratory values than those who did not implement self‐management. However, persons with knowledge may for other reasons still lack self‐management. Practical Implications Future studies comparing baseline results to post‐additional education sessions may yield better comparisons.
- A Descriptive Analysis of the Impact of Moral Distress on the Evaluation of Unsatisfactory Nursing Students
Background Nurse educators assume a difficult role when evaluating unsatisfactory students, including those at risk for failure in clinical and classroom settings. While the decisional dilemma inherent in evaluating unsatisfactory students has been well documented in literature, little is known about how moral distress impacts the nurse educators′ decisions regarding whether to pass or to fail unsatisfactory students. Purpose This article aims to provide a descriptive analysis of the moral dilemmas and the potential impact of moral distress experienced by nurse educators when evaluating the performance of unsatisfactory students in clinical and classroom courses. Methods Nathaniel's theory of moral reckoning guided the descriptive analysis of six studies to understand how nurse educators work through moral dilemmas, make decisions, and provide justification for their decisions when evaluating the performance of unsatisfactory students. Findings Nathaniel's theory has been shown to be helpful in discussing the dilemma of evaluating unsatisfactory students, and it is a suitable framework for nurse educators in working through their dilemmas as a form of structured reflection. Practice Implications The outcomes of this descriptive analysis highlight the need for educational administrators to provide support to undergraduate nurse educators experiencing moral distress in this type of situation.
- Health Literacy Challenges in the Aging Population
Mullen Purpose The purpose of this paper is to discuss the impact of low health literacy and discuss interventions to minimize its effect on the elderly population. Conclusion Low health literacy combined with the physiological changes of aging put the elderly in a vulnerable position. It can negatively affect health behaviors and health outcomes, and can lead to economic burden, not just on the individual but on the society as a whole. Practice Implication Clinicians need to recognize the indicators of low health literacy and utilize the available assessment tools. To improve clinician–patient communication, interventions must be tailored to the patients' literacy level.
- An Exploration of the Concept of Connect
Aim The purpose is to explore the concept of connect in multiple disciplines for further development of knowledge and theories in nursing and to establish a clear understanding of this construct. Background Connect has meanings rooted in the discipline of business, technology, and transportation which influence how the term is defined in nursing. Several definitions have been established that demonstrate the concepts of connect in other disciplines. Design A concept exploration design was used for the identification and explication of the term connect to describe, explain, and predict this interprofessional phenomenon. Review Methods The databases CINAHL, MEDLINE, PRO‐Quest, and EBSCO were searched for articles through title and abstract screening using connect, connectedness, and connectivity. Results Three specific components were identified in the exploration: (a) respect, (b) trust, and (c) mutuality. Current literature validated the need for an empirical concept analysis. Conclusions This concept exploration provides the first step in understanding the context and meaning of connect in nursing profession. By determining if connections exist and quantifying the level of connections, a level of congruency between the nurse and the patient can be established to determine the best plan of care and goals. An empirical measure of connect will benefit nursing and other disciplines.
- Nurse Attitudes Toward Childbirth: A Concept Clarification
Aim To clarify the concept of “nurse attitudes toward childbirth.” Background It has been suggested that the international trend of escalating cesarean birth rates can be attributed to attitudes that perceive childbirth as an illness. Nurses' attitudes about childbirth direct their nursing care and may influence patient outcomes like cesarean birth. However, the concept “nurse attitudes toward childbirth” must be clarified to inform future research. Data Sources An English‐language literature review, from 1990 to present, was performed using CINAHL, PubMed, and Ovid. Review Methods Norris's model of concept clarification was used. Results Although the nursing literature poorly defined “nurse attitudes” and rarely used a conceptual framework, the discipline of psychology has been refining this concept for over 40 years. Psychologists have established that attitude can predict behavior as demonstrated through testing of the theory of planned behavior. Various types of “nurse attitudes toward childbirth” were identified through our literature review, and five central beliefs were noted. This resulted in the development of a preliminary model using theory of planned behavior as a foundation. Finally, potential research hypotheses were generated. Conclusions This paper clarifies “nurse attitudes toward childbirth” and supports its use for research. Nurse scholars have demonstrated that labor and delivery nurses do have individual attitudes toward childbirth, and the measurement of these attitudes may predict nursing care intentions and behavior. This concept is appropriate, important, and may be used as a means of exploring relationships between nursing care and the rising primary cesarean birth rate.
- Risk: A Multidisciplinary Concept Analysis
McNeill Purpose To analyze the concept of risk utilizing Walker and Avant's method of analysis to determine a conceptual definition applicable within nursing and nursing research. Conclusion The mental constructs and consequences of risk have a proactive connotation compared with the negative behaviors often identified as illustrations of risk. Practice Application A new conceptual definition of risk provides insight into an understanding of risk regardless of discipline. Its application to the metaparadigm of nursing should be the impetus for action and education. Formalizing the mental constructs of the concept of risk in a clear manner facilitates the inclusion of its latent constructs in nursing research.
- A Global Service‐Learning Experience for Nursing Students in Tanzania: A Model for Collaboration
Purpose This article addresses a model for creating a short‐term global service‐learning program. The Global Standards for the Initial Education of Professional Nurses and Midwives guided the development of a collaborative program involving a school of nursing in the Midwestern United States and one in Tanzania. Conclusions Evaluation of the school of nursing and subsequent collaborative planning led to development and implementation of a 3‐week global service‐learning experience for nursing students. Practice Implications International academic partnerships, developed in accordance with WHO standards, will enhance educational experiences for nursing students both in the United States and abroad.
- Posttraumatic Stress Disorder in the Nursing Population: A Concept Analysis
Purpose This article is a report of an analysis of the concept of posttraumatic stress disorder (PTSD) and its application to the nursing population. Background Nurses are at an increased risk for work‐related stress resulting in retention issues and impaired functioning in work and home environment. The nursing discipline has been inconsistent with the concepts used to describe the distress and resultant discussions related to the comprehensive nature of the distress experienced, heavily focusing on existing medical language that emphasizes disorders and psychopathology. Review methods Walker and Avant's strategy for concept analysis was used in this analysis. A literature review for 1994–2011 was conducted for the following keywords: secondary traumatic stress, compassion fatigue, vicarious traumatization, posttraumatic stress disorder, and nurse. Results The concept of posttraumatic stress disorder in the nursing population is best described within the context of the Nurse as Wounded Healer theory. Essential attributes include intrusions, avoidance, and hyperarousal. The consequences include worldview changes, retention issues, sleep disruption, and social network disturbances. Conclusion This concept analysis viewed through The Nurse as Wounded Healer lens, offers clarity to the concept of PTSD within the nursing population and identifies limitations to prior conceptualizations.
- Differences in Beliefs About the Causes of Health Disparities in Black and White Nurses
Purpose To determine whether Black and White nurses' beliefs about causes of health disparities differ. Conclusions Analyses reveal that overall Black nurses perceived external factors to contribute significantly more to health disparities than White nurses. Black nurses considered four specific causes dealing with physician and societal factors, such as “discrimination in society,” to be more significant contributors to health disparities than White nurses, whereas White nurses considered genetic factors to be a greater contributor. Practice Implications Different views of the causes of health disparities are discussed, particularly in light of cultural competency training and other efforts to ameliorate health disparities.
- A Nurse‐Led Wellness Program for Migrant Backstretch Workers
Problem Migrant workers working at the back stretch of Philadelphia Park Racetrack are faced with healthcare challenges. This vulnerable population experiences health disparities as a result of lack of resources and increased exposure to risk. Method A needs assessment of backstretch workers was conducted to identify the healthcare needs of this unique population. Findings The analysis revealed several areas of need for this vulnerable population primarily, effective bilingual communication, increasing access to healthcare services, implementing measures to address women's health issues, and improving nutritional status of workers. Conclusion Through multi‐agency collaboration, continued development, and revision of strategies, health enhancement and disease prevention are accessible to vulnerable migrant workers. Faculty, students, and staff work with clients to provide quality health education programs, screenings, and referrals to improve their health.
- Rescindment of the Wooden Spoon Award
- Measuring Asian Nurses' Organizational Commitment: A Critical Analysis of the Psychometric Properties of Two Organizational Commitment Instruments
Purpose To analyze and compare the psychometric properties and cultural attributes of the Organizational Commitment Questionnaire and the Organizational Commitment Scale to determine their appropriateness for measuring commitment of Asian nurses, the biggest portion of international nurses. Conclusion The Organizational Commitment Questionnaire was cross‐culturally cross‐validated when compared with the Organizational Commitment Scale. Both instruments were not tested on Asian nurses. More studies are needed to validate the cultural properties of the Organizational Commitment Scale. Practice Implication Healthcare administrators can use culturally validated instruments, which concern cultural context, including languages and cultural values, to understand Asian nurses' organizational commitment and further lower turnover behavior among them.
- A Death With Dignity: A Nurse's Story of the End of Life of Her Mother
Purpose Recognizing and accepting when someone is within the palliative care trajectory is often a challenge, particularly for nursing students. In sharing this story of a nurse's experience of caring for her mother, it is hoped that the reader will gain insight into ways to enhance comfort and improve the quality of life of family members, friends, and patients. Through the lens of this lived experience, the challenges associated with honoring the wishes of a loved one during the palliative care trajectory through the end of life are shared. Practice Implications Exploring a person's perceptions about their quality of life is an important component of a nursing assessment. Nurses need to be prepared to maximize opportunities with patients and provide resources and information about options on their quality of life issues. Understanding and respecting another's choice develops with awareness and utilization of evidence‐based knowledge in planning interventions. This article provides information on evidence‐based resources and standards of practice in the context of a lived experience. Conclusion Experiencing the death of loved ones is always difficult. Accepting their wish to not seek medical treatment and the provision of end‐of‐life care is a challenge. Nurses who become comfortable and knowledgeable about the palliative care trajectory and the end of life experience will be able to provide a higher level of support and thus improve the quality of life for those they encounter.
- Coping With Mental Illness: A Family's Struggle for Peace
Problem Families struggle with the day‐to‐day worrying about behaviors of acting out at school and work, and the loss of normalcy that they used to have in their everyday lives. Families with a loved one with mental illness live in an almost constant state of uncertainty due to the unpredictability of the illness. Conclusions This article addresses the challenges inherent to the acute psychiatric admission process of a patient and family.
- From Frontline Nurse Managers to Academic Program Directors: Research, Strategies, and Commonalities
Problem Frontline nurse managers, whether in service or academia, are facing very similar stressors related to the ever‐expanding job duties that also include providing a positive nurturing work environment for employees. Publications supporting these two administrative positions are referenced in either nursing administration or nursing education journals. Yet much can be shared and learned when both sets of rich research and commentary are merged. Method This article compares the recent research across these two areas of critical nursing management from a role analysis perspective. Conclusion Recommendations for encouraging healthy work environments, enhancing personal growth, leadership development, encouraging succession planning, and innovatively partnering toward the future are included.
- Nursing Student Resilience: A Concept Clarification
Purpose The purpose of this article is to clarify the concept of resilience for the nursing student population. Methods A selective review of the literature was conducted, with 26 sources found to be cogent to this concept clarification, including four recently published concept analyses. The Norris method of concept clarification is used to analyze and clarify the concept of resilience to enhance its practical application. The phenomenon is described according to its antecedents, attributes, and consequences, along with a proposed operational definition and conceptual model. Practice Implications The clarification of the concept will assist nurse researchers and nurse educators in developing interventions and educational strategies aimed at fostering resilience in nursing students.
- Professional Comportment: The Missing Element in Nursing Practice
Purpose The aim of this concept analysis of professional comportment is to elucidate the dimension of nursing practice that fosters cooperation, collaboration, effective communication, and team cohesion among nurses. Background Professional comportment is a concept that has not been developed or analyzed, and its integration into nursing practice is unclear and not specified. The body of knowledge concentrating on the spectrum of professional comportment, civility, and lateral violence is presently incomplete. Analyzing and developing the concept of professional comportment will satisfy a gap in the literature. A concept analysis of professional comportment will clarify for the nurse the power of words, behaviors, and communication needed to achieve effective communication and civility. Source The Walker and Avant framework for concept analysis was used to analyze the concept of professional comportment. An electronic review of the literature through the Cumulative Index to Nursing and Allied Health Literature, Health Sources, Medical Complete, and ProQuest was conducted. This review rendered approximately 300 articles, of which 85 were reviewed. Eighteen articles informed comportment as a definition and are utilized in this analysis. The individual nurse is the level of focus in the analysis, not the organizational culture. Conclusion Comportment is defined as a dignified manner or conduct. Professional comportment is critical in determining a nurse's effectiveness in relating, communicating, and collaborating with colleagues and members of the healthcare team. In the absence of professional comportment, a culture of incivility, nurse aggression, and compromised patient safety will emerge. Self‐regulation and individual accountability are sequelae to professional comportment. The personal assimilation of professional comportment promotes mutual respect, harmony, commitment, and collaboration. The nurse, patient, and healthcare team are the beneficiaries of a nurse who demonstrates professional comportment.
- Faculty Roles: Dilemmas for the Future of Nursing Education
Methods Literature review and analysis. Findings Recent reports emphasized the need for the development of nursing classroom education that is more rigorous and coordinated with clinical experiences. Faculty roles in research universities in nursing have increased the number of clinical and part‐time faculties, and have increased the requirements for funded research for tenure‐track faculty over the last decade. These changes have led to various groups of faculty with different roles and responsibilities, some of whom teach a great deal and others who teach very little. Conclusions This article reviews the development of these faculty roles and reviews the dilemmas that they present for the future of nursing education.
- A Concept Analysis of Patient‐Centered Care
Backround Patient‐centered care (PCC) has moved to the forefront of health care over the last decade as a healthcare improvement recommended by the Institute of Medicine. Yet the term lacks clear definition among healthcare professionals. Purpose The purpose of this article is to describe a concept analysis using Walker and Avant's method as an organizing framework. In this review, nursing and interprofessional literature, including psychology, medicine, social science, physical therapy, and occupational therapy, are examined. Using research articles to delineate variables, multiple terms inherent to PCC are explored. Findings Findings suggest that PCC is integral to the provision of quality care, promoting positive outcomes for patients, organizations, and healthcare professionals. An operational definition of PCC, including attributes, antecedents, and consequences, is developed, and this definition correlates with Jean Watson's caring theory in nursing practice today. Model and contrary cases illustrate the concept. Practice Implications Defining measurable variables can link associated nursing care with improved patient outcomes. The need for further inquiry is discussed.
- Preparing for Change
- An Investigation of the Effects of a Nonprofit Agency's Investigations on Quality of Care in Nursing Homes
Problem This study examined whether an agency's investigation of complaints in 40 nursing homes is positively correlated with the quality of nursing home care. Methods A quantitative methodology design using quantitative and qualitative data was used to assess the relationship between Agency X's investigation of consumers' nursing home complaints and the quality of nursing home care. Findings Results showed fewer violations after the agency's interventions, indicating improvement in the nursing care. Analysis showed on average 0.14 fewer violations. This decrease is statistically significant (p = .015), indicating that this agency's intervention improved nursing home care. Conclusions Additional studies are needed to further explore the quality of care given in nursing homes. Nurses may propose to the Centers for Medicare & Medicaid Services to establish a new innovative system for ensuring high quality nursing home care by requiring the establishment of outside agencies, such as Agency X, to monitor care in addition to the annual surveys conducted by the Department of Health and Human Services.
- Nurse Manager Succession Planning: A Concept Analysis
Purpose The current nursing leadership pipeline is inadequate and demands strategic succession planning methods. This article provides concept clarification regarding nurse manager succession planning. Conclusion Attributes common to succession planning include organizational commitment and resource allocation, proactive and visionary leadership approach, and a mentoring and coaching environment. Strategic planning, current and future leadership analysis, high‐potential identification, and leadership development are succession planning antecedents. Consequences of succession planning are improved leadership and organizational culture continuity, and increased leadership bench strength. Practice Implications Health care has failed to strategically plan for future leadership. Developing a strong nursing leadership pipeline requires deliberate and strategic succession planning.
- Concept Analysis: Prenatal Obesity, a Psychoneuroimmunology Perspective
Purpose To analyze the concept of prenatal obesity within a psychoneuroimmunology framework. Conclusion By considering the psychosocial, neurological, endocrine, and immunological contributions, a psychoneuroimmunology framework maintains a holistic focus. Identifying the multidirectional mechanisms linking these systems will provide valuable insight into the mechanisms by which prenatal obesity increases the rate of adverse pregnancy outcomes. Practice Implications Utilization of the concept of prenatal obesity within a psychoneuroimmunology framework will facilitate multidisciplinary research to identify underlying mechanisms by which prenatal obesity leads to adverse pregnancy outcomes, as well as the development of interventions to treat obesity before, during, and after pregnancy.
- Iris Young's Five Faces of Oppression Applied to Nursing
Purpose. To explore Iris Young's Five Faces of Oppression as a framework for understanding oppression of nurses. Conclusions. Nursing's gendered status is implicated in nursing's status as a profession. Young's framework clearly lays out the ways in which nurses are oppressed in today's healthcare system. Practice Implication. Understanding the structure of nursing's oppression allows nursing to begin to formulate a thoughtful response to oppression and helps nursing find its voice in the larger world of the healthcare system.
- “RN Means Real Nurse”: Perceptions of Being a “Real” Nurse in a Post‐LPN–BN Bridging Program
Purpose Explore the perceptions of licensed practical nurses (LPNs) in a post‐LPN–BN bridging program related to the label “real nurse.” Conclusions The labels that LPNs are given significantly impact them. As LPNs progress through the post‐LPN–BN program, they take on new and more empowering labels. Practice Implications Seeing and celebrating both LPNs and registered nurses as “real nurses” may assist in healing the rift that has been present between registered nurses and LPNs for almost 50 years. Nursing may be better served by replacing the label “real nurse” with a label that all nurses can aspire to—that of an exemplary nurse.
- The Effect of a Five‐Part Intervention to Decrease Omitted Medications
Problem. Nursing administrators reported that medication administration errors had continued despite the use of bar code medication administration, especially in terms of omitted medications. Nurse administrators within the study hospital identified a need to add back up safety systems in order to reduce the number of omitted medications. Interruptions and distractions were identified as leading constraints to accurate medication administration. Methods. This pre‐post quality improvement study used a convenience sample of nurses on one medical surgical unit to observe the effect of specific protocols to decrease interruptions and distractions during medication administration. Nurses′ were observed during medication administration cycles, and the medication time was measured in hours and minutes using a stop watch. The number of distractions and interruptions was counted by category. A participant survey was used to determine nurses perceptions of distractions and interruptions experienced. Findings. The five‐part intervention decreased nurses interruptions and distractions by 84% compared with the control group. The results indicated the type of distractions and interruptions nurses typically experience during medication administration was highest from conversation in the environment (M = 5.0 ± 3.4) and by other personnel (M = 6.38 ± 2.6). Conclusion. This process improvement project determined that a five‐part protocol would reduce distractions and interruptions for nurses, save time in the process, and reduce omitted medications. Other visible symbols such as a vest with wording may show different results when combined with the other elements of the protocol. Anecdotal comments from nurses during and after observations divulged workplace issues surrounding medication delivery that may need investigation.
- Revisiting Quality of Life for Elders in Long‐Term Care: An Integrative Review
Purpose To review the literature on quality of life (QOL) among elders in long‐term care settings, specifically focusing on measurement of QOL, influencing factors, and interventions to improve QOL. Conclusion Multiple instruments were used to measure QOL with little overlap and limited ability to compare across studies. Categories of influencing factors included physical function, environment, social support, and mood/spiritual. Interventions targeted changes in environment, physical activity, and meaningful interaction. Practice Implication Knowledge of the factors influencing QOL and findings from research on interventions will assist nurses in individualizing care approaches to improve QOL among elders in long‐term care settings.
- The Bully Within and Without: Strategies to Address Horizontal Violence in Nursing
Problem Pervasive horizontal violence in the nursing profession has bred the aphorism “nurses eat their young.” Nurses must make a concerted effort to advocate for change in the existing professional culture. Such change can begin with embracing helpful tips in overcoming bullying and modeling successful positive behaviors. This paper defines horizontal violence in nursing and explores strategies to address it based upon shared information. Method Multiple workshops across the country have allowed nurses to exchange information about their experiences with horizontal violence. Nurses have examined their roles as bystander, perpetrator, and victim in discussing contemporary perspectives, employing methods of engagement, promoting debate, and using practical resource advice in dealing with the experience and prevention of horizontal violence. Findings Workshops, evaluated through pretests/posttests and written evaluations, revealed increased knowledge about concepts of horizontal violence and their application to the workplace, recognition of horizontal violence, and methods of dealing with horizontal violence in nursing. Conclusions Across the profession, nurses need exposure to practical approaches to curtailing horizontal violence in nursing. A similar workshop approach could be adapted across educational programs and workplaces based on the individual needs of each environment.
- The Clinical Nurse Leader: Prepared for an Era of Healthcare Reform
Problem Passage of the 2010 Patient Protection and Affordable Care Act will require change in the healthcare systems. The clinical nurse leader must be prepared to lead and shape the changing environment to achieve maximum outcomes for patients and families. Movement toward integrated care delivery across the care continuum, the transition of the Centers for Medicare & Medicaid Services to a value‐based funding model, and accountability for high‐quality, cost‐effective care are just some of the drivers of this new integrated healthcare system. Implications Reimbursement models that reward those health systems that are able to meet benchmark performance standards will result in major shifts in how health systems operate. Expertise in care coordination across the healthcare continuum is essential for maximum reimbursement. Payment for value instead of volume delivered is a major reimbursement transition coming to the acute care setting, necessitating increased attention to mining data necessary to capture quality patient outcomes for maximum reimbursement. Conclusions The clinical nurse leader is ideally suited to function within these integrated systems of the future, and possesses the skills needed to assist healthcare systems to meet this challenge.
- Said Another Way: Asking the Right Questions Regarding the Effectiveness of Simulations
Applying simulations in healthcare practice and education is increasingly accepted, yet a number of recent authors have questioned the effectiveness of these technologies. The contention is that while high‐fidelity simulators may contribute to educational gains, their gains compared to low‐tech alternatives are often “not significant.” That assessment, however, and the evidence it is based on, may be a consequence of asking the wrong questions. Typical studies often compare a measure for “average success” for one group's members versus another's on some criteria, but this can mask important information about the “tails” of the distribution for how trainees are performing. An alternative approach, adapted from quality control, compares error rates for each group in the experiment, in aggregate. The statistical results of evaluations can change if this method is used, as illustrated by a recent study showing that simulation training can significantly reduce the frequency of medication administration errors among student nurses on placement. The paper includes a case study to tangibly demonstrate how the way we frame our evaluation test question can reverse the apparent statistical finding of the significance test.
- Introducing . . .
- Creative Controversy
- A Talk for All Times
- Combat‐Related Blast‐Induced Neurotrauma: A Public Health Problem'
The purpose of this article is to raise nurses' awareness of the significance and potential public health impact of combat‐related blast‐induced neurotrauma (BINT) in U.S. troops returning from Afghanistan and Iraq. A comprehensive review of the current literature on BINT was completed by the author, based primarily on combat‐related blast exposure in the military population. She found that it is necessary to theorize about potential etiologies for mild traumatic brain injury in the military population since the literature suggests that neurological and psychological trauma resulting from military duty may be linked to exposure to blasts. Identification of potential risk factors for BINT in the military population provides direction for scientific inquiry into this emerging phenomenon. Gaps in current knowledge and its health implications for future scientific study in nursing are presented.
- Preparing for Tomorrow's Challenges
- The Future of Baccalaureate Degrees for Nurses
PROBLEM. Unlike other professional healthcare disciplines, the profession of nursing has multiple levels of entry. Recently, several states have proposed legislation to mandate completion of baccalaureate education after 10 years of nursing licensure.METHODS. This article examines the proposals, statistics, strategies, and other relevant literature on baccalaureate education for nurses and the positive outcomes associated with a more highly educated nursing workforce.FINDINGS. The proposal recognizes the entry level preparation provided by associate degree nurses and is an innovative solution that offers a balance between multiple entry levels into practice and continued educational preparation.CONCLUSIONS. Through a combination of the entry level preparation of associate degree nurses and baccalaureate education, a stronger nursing workforce can be created and patient outcomes and quality of care improved.
- Concept Analysis of Risk in Relation to Coronary Heart Disease Among Filipino‐Americans
PURPOSE. To analyze the concept of risk in relation to coronary heart disease (CHD) among Filipino‐Americans (FAs) and provide a new definition of risk.SOURCE. Published literature.CONCLUSION. This concept analysis provided a new meaning of risk in relation to CHD among FAs and shed light on further understanding of risk. Risk has been laced with negativity in health care, but based on the current literature, risk can be conceptualized in a positive perspective, especially in the area of chronic health disease such as CHD. However, further research is needed in the conceptualization of risk related to CHD for consistency, adequacy, and meaning.
- Teaching Research to Graduate Nursing Students: A Strategy Using Clinically Based Research Projects
This article describes an approach to teaching advanced practice nursing students the research process through the application of the research process to clinical problems. In the course, students propose solutions to clinically based research projects through conceptualizing the problem, identifying an appropriate theoretical framework, conceptualizing the intervention or clinical guidelines, and designing a project that includes the research design, sampling strategies, procedures for implementation of the project, and plans for data collection and analysis. These strategies challenge the advanced practice nursing student to apply research concepts to problems encountered in clinical practice and reinforces the skills needed to critique the literature, to summarize the published findings on a problem, to conceptualize a research study, and to disseminate their findings in oral presentations.
- Is the DNP the Answer to the Nursing Faculty Shortage' Not Likely!
The DNP is being touted as the answer to the faculty shortage. There is no evidence that DNP graduates are any more willing to embrace the low salaries of nursing faculty than PhD graduates. The idea of the DNP as the answer to the faculty shortage is challenged.
- Physical Assessment: A Continuing Need for Clarification
PROBLEM. Physical assessment skills are a mainstay of the nursing process and are taught to pre‐licensure learners. Little research has been conducted on the skills that are actually used in practice compared to those that are taught in pre‐licensure education.METHOD. This article provides an integrated literature review regarding physical assessment skills and their practical application.FINDINGS. Physical assessment skills are consistently referred to as part of the first step of the nursing process, but further clarification about which skills are included in the definition is needed.CONCLUSIONS. Further research is needed to clarify if what is taught is actually used and to what extent in clinical practice.
- Introducing . . .
- The Trifecta of Nursing
- Nurse Reports From the Frontlines: Analysis of a Statewide Nurse Survey
BACKGROUND. Registered nurses on the frontlines of care are increasingly burdened by changes in staffing, increased turnover, demands on their time and the continual need for advanced knowledge and training. We identify employment and environmental characteristics that may ultimately affect the quality of careMETHODS. Surveys were mailed to a random sample of all registered nurses licensed and residing in large southeastern US State. Responses from 10, 951 nurses providing direct patient care were compared to national findings. Descriptive statistics were used to examine demographics, the practice environment, nurse outcomes and the quality of care.RESULTS. Nurses in this state are more racially diverse and less educated when compared to nurses nationally. Theses nurses report high levels of burnout and job dissatisfaction, and almost one‐quarter intend to leave their jobs within the next year. The majority of nurses report good working relationships with physicians, but perceive problems with workplace management.CONCLUSION. Nurses report inadequate resources and the administrative support necessary to provide quality care. The proportion of nurses with baccalaureate and graduate education qualifications is less than is needed now and certainly insufficient for the future. Policy efforts must address these issues to retain our nurse workforce and improve the quality of patient care.
- A Redesign
- The Image of Male Nurses and Nursing Leadership Mobility
Research consistently reveals that white men maintain an advantage over other status groups such as women in positions of authority pertaining to human capital. This paper examines male underrepresentation in the nursing profession, including difficulties such as discrimination and advantages for them determined by their gender. The literature suggests that men are given fair, if not preferential, treatment in hiring and promotion decisions, are accepted by supervisors and colleagues, and are well integrated into the workplace subculture.
- Defining and Assessing Organizational Culture
PROBLEM. Using theories from several disciplines, the concept of organizational culture remains controversial. Conflicting definitions, lack of semantic clarity, and debate over the most appropriate methods for assessing organizational culture have led to disagreement over the value and validity of such inquiry.METHODS. This paper reviews development of the concept of organizational culture and methods for assessing organizational culture, focusing on the healthcare environment.FINDINGS. Most work on organizational culture concerns the traditional corporation. Therefore, some adaptation to the central goals and focus of a human services organization are necessary before application to healthcare settings.
- Evidence‐Based Practice: Issues, Paradigms, and Future Pathways
Evidence‐based practice (EBP) has become a real buzz word, not only in the discipline of nursing, but in all healthcare professions. EBP has been identified as the foundation of accountable, professional nursing practice and it would seem that few could argue with the apparent benefits; however, debate does exist in the literature about whether EBP can realistically be attained. As such, a critical discourse regarding the future of EBP for nursing needs to occur. One of the key questions to be addressed through this discourse is, “what counts as evidence?” A review of the nursing literature on the concept of EBP will be presented in this paper along with a discussion of several of the issues associated with EBP within the discipline of nursing. I will also present some ideas about the implications of the EBP movement in nursing and examine the future pathways for nursing.
- Family Nursing: Walking the Talk
This article discusses a study exploring the lived experience of family nursing for novice registered nurses. There has been an increased emphasis on including family content in Canadian nursing education curricula. Literature on family nursing is ambiguous about differentiating family nursing at the generalist and specialist level, and acknowledges that there is a blurring of lines between the two. The study utilized a phenomenological approach to examine how nurses with 2 years or less in practice experience family nursing in a variety of settings. Following ethical approval, invitations were sent to all nurses employed in two health authorities, who met the study criteria. Five nurses were interviewed using a semistructured interview. Participants shared how they practice family nursing in the current nursing situation of shortages and constraints. This study adds to our understanding of what happens at a beginning level of family nursing, how nurses understand and experience caring for families in the everyday enactment of their professional role, and barriers and facilitators to including family in nursing care. The findings provide important information for nurse educators in grounding the teaching of family nursing in the real world of nurses.
- LETTER TO THE EDITOR: Teaching Nurses to Delegate and Supervise at the Point of Care: An Open Request of Educators
- Becoming a Nurse Faculty Leader: Practices of Leading Illuminated Through Advancing Reform in Nursing Education
PURPOSE. The purpose of this study was to explore the lived experience of becoming a nurse faculty leader.BACKGROUND. In a recent study of 24 nurse faculty leaders across the United States about their experience of becoming a leader, many of the participants hesitated to call themselves leaders.METHODS. This interpretive phenomenological study explored the meaning and significance of nurse faculty leadership. Exemplars of participant leadership development experiences are provided to assist readers in determining how the findings relate to their own practice.FINDINGS. The data revealed that leadership emerges as an embodied practice when nurse educators become involved in advancing reform. Practical leadership strategies for advancing reform in nursing education are presented.CONCLUSION. Leadership is learned through three everyday practices of advancing reform in nursing education: being involved with others; struggling to serve as a symbol and preserve authenticity; and creating an environment for change. This study offers new insight on leadership development, with practical implications for how leadership is taught in nursing curriculum and how nurses can more effectively own leadership roles.
- Experiences of a Taiwanese Nurse in the United States
PURPOSE. To explore and interpret the lived experience of a Taiwanese nurse working in a U.S. hospital.METHOD. Hermeneutic phenomenology was applied to obtain information through in‐depth telephone interviews.FINDINGS. Four themes emerged from the analysis and interpretation: (a) frustration in language and communication; (b) cultural differences in patient care; (c) support from work environment; and (d) advantages of working in the U.S. nursing system. The main issue causing the participant's unhappiness was the language and communication barrier.CONCLUSIONS. These findings are relevant to nurses and administrators who work with international nurses who wish to understand international nurses' frustration, needs, and work values. Appropriate support can tremendously help international nurses adjust to a foreign work environment.
- Development of the Basic Knowledge Assessment Tool for Medical‐Surgical Nursing (MED‐SURG BKAT) © and Implications for In‐Service Educators and Managers
BACKGROUND OF THE PROBLEM. Medical‐surgical nursing is now the largest specialty in acute care, and needs an objective measure of basic knowledge necessary to provide safe care to patients. The Joint Commission on Accreditation of Healthcare Organizations noted that healthcare organizations have in the past relied on education and experience to support competence, but an increasing number are seeking objective measures of a nurse's knowledge that is required for safe practice. The American Nurses Association adds that safe practice is both a professional and a moral responsibility.PROBLEM. A review of the literature failed to locate a standardized test of basic knowledge in medical‐surgical nursing. In‐service educators and managers need such a test to facilitate orientation programs, and as a way to safely decrease the length of orientation for new employees with previous experience in medical‐surgical nursing.METHODS. The purpose of the study was to develop a valid and reliable test to measure basic knowledge in medical‐surgical nursing.FINDINGS. The Basic Knowledge Assessment Tool for Medical‐Surgical nursing was developed with support for its validity and reliability.
- Conceptual Parameters of Acculturation Within the Asian and Pacific Islander American Populations: Applications for Nursing Practice and Research
TOPIC. Asian and Pacific Islander Americans (A&PIAs) are experiencing health inequities. For example, A&PIA is the only racial/ethnic group in America to experience cancer as their leading cause of death. Several studies within the A&PIA population have pointed to acculturation as a significant variable to explain their health and health‐seeking behaviors. Acculturation is a key construct in understanding the health of the A&PIA population.OBJECTIVE. The purpose of this concept analysis is to provide a current conceptual understanding of the relationship between acculturation and health, especially within the A&PIA populations, which will serve as a pragmatic guideline for nursing practice and research. Understanding the contemporary issues surrounding the conceptual application of acculturation will aid in the development of appropriate programs to reduce health inequities.METHODS. Acculturation was explored using the Morse method of concept analysis. An iterative historical and contemporary literature review across the disciplines of anthropology, sociology, psychology, medicine, and nursing was completed. Analytical questions asked of the resultant data provided the theoretical definition, antecedents, key attributes, outcomes, and implications.RESULTS. The concept analysis resulted in a new theoretical definition that includes multidimensional concepts of acculturation. Dilemmas in the measurement of key attributes of acculturation include unidirectional and bidirectional analysis, psychometric issues, and the appropriateness of proxy measurements. Outcomes of acculturation on health can be positive or negative and depend on an individual's or group's ability to navigate freely with necessary supports. Results of the conceptual analysis resulted in recommendations for nursing practice and future acculturation research.CONCLUSION. While debate continues about the appropriate use and definition of acculturation, researchers agree that it is an important construct in understanding the health of migrating individuals and groups. Currently there is no testable framework that delineates the role of acculturation in health. Further research is indicated to clarify the relationship between acculturation and health.
- EDITORIAL: Communicating Through the Written Word
- An Ecological Model of Workplace Bullying: A Guide for Intervention and Research
The origins and outcomes of workplace bullying can be understood through the use of a conceptual model which is based on the ecological perspective. This model portrays the work environment as a series of nested, interconnected layers that exist within society as a whole. These layers are society (macrosystem), the corporation (exosystem), the co‐workers and managers of the bully and target (mesosystem), and the bully and target (microsystem). Workplace bullying does not occur in isolation. Elements at each of these levels serve as antecedents to bullying, and the outcomes of bullying are manifested at each of these levels. These antecedents and outcomes need to be considered when developing interventions that target workplace bullying. The model can be used as a theoretical framework to guide intervention planning and evaluation, and can also be used to guide the formulation of questions for empirical research.
- Doctoral Persistence and Doctoral Program Completion Among Nurses
PROBLEM. The United States is experiencing a critical shortage of registered nurses, which is due to multiple factors, including a deficit of full‐time doctorally prepared nursing faculty.METHODS AND FINDINGS. This review of the literature addresses doctoral persistence and the challenges faced by doctoral nursing students. Themes found in this review included periods of transition, parenthood and outside demands, delays and “marinating” in the data, and positive aspects. These issues need to be addressed in order to increase doctoral student retention and reverse the nursing shortage.
- Toward a Mid‐Range Theory of Nursing Presence
BACKGROUND. Presence is widely accepted as a core relational skill within the nursing profession. Nurse educators are challenged to ensure that the humanistic aspects of client care are included in the Bachelor of Science in Nursing (BSN) curriculum. Introducing and teaching presence skills early in the BSN curriculum will ensure the essential value of relational engagement with clients. Nursing literature, however, notes presence is a challenging concept for BSN students. Articulating a mid‐range theory of nursing presence will facilitate students' conceptual understanding of presence and guide nurse educators to teach presence skills.AIMS. To propose a mid‐range theory of nursing presence. Within the theoretical model, identify development opportunities to improve student nurse use of presence as a relational skill.METHODS. An extensive literature review was conducted. Materials were synthesized and the mid‐range theory was developed.DISCUSSION. Kim's nurse‐client domain provided the perspective that guided the parameters of the theory. Professional nursing presence is dependent upon the combination of five variables: individual nurse characteristics, individual client characteristics, shared characteristics within the nurse‐client dyad, an environment conducive to relational work, and the nurse's intentional decisions within the practice domain. The variables are described and the relationships among variables depicted in the model. Specific nurse‐sensitive points during a nurse‐client interaction determine or influence the nurse presence intervention and dose. Areas designed to teach or improve relational skills are identified for the BSN educator.CONCLUSION. A mid‐range theory of presence contributes to our understanding of the relational aspects of nursing practice within the contemporary healthcare environment. Identifying strategies to teach BSN students presence skills will facilitate the incorporation of the humanistic aspects of client care in the undergraduate curriculum.
- Nursing Sabbatical in the Acute Care Setting: What Is the Evidence'
PURPOSE: To review and examine the literature supporting a professional sabbatical, a potentially viable and innovative change strategy that could renew, revitalize, and retain nursing staff practicing in the acute care setting.METHOD: A literature search was completed using multiple search engines to procure articles that could answer the question: What is the evidence related to professional sabbaticals in nursing?FINDINGS: The search yielded 19 articles: one historical document, eight scholarly business articles, and 10 nursing publications. The literature review revealed most sources described sabbaticals using anecdotal data and 14 of the 19 articles were labeled as expert opinion or consensus.CONCLUSION: Borrowing from the successes in academia and other non‐nursing professions, a human capital investment opportunity exists to design and test nursing sabbaticals. The authors identified a nursing sabbatical as a viable option, which can enhance nursing retention and revitalization.
- Integrative Review Utilizing Dexmedetomidine as an Anesthetic for Monitored Anesthesia Care and Regional Anesthesia
BACKGROUND. Dexmedetomidine is increasingly being used as a sedative for monitored anesthesia care (MAC) with regional anesthesia. This literature review critiques 12 studies that used dexmedetomidine as the primary anesthetic. Study designs include prospective, retrospective case studies and randomized double‐blind and randomized single‐blind studies.METHODS. Twelve studies utilizing dexmedetomidine as the primary anesthetic that were found via electronic databases including CINAHL, Ovid, and MEDLINE. All studies were completed within the past 10 years and met inclusion and exclusion criteria.RESULTS. The results of dexmedetomidine efficacy as a primary anesthetic agent for MAC procedures varied. There is significant evidence showing that dexmedetomidine is not an appropriate anesthetic for colonoscopies, though there were mixed results showing its efficacy in ENT and dental procedures. Despite that, dexmedetomidine has been shown to be successful in orthopedic, vascular, plastic, lithotripsy, and diagnostic procedures, though patients are at increased risk of recall.CONCLUSION. Dexmedetomidine is an effective MAC anesthetic for specific procedures. Further research is needed to determine which specific procedures are appropriate for dexmedetomidine. Lastly, dexmedetomidine is more costly than current MAC anesthetics, making it difficult to justify its use.
- Healthcare Utilization Among Patients With Vocal Cord Dysfunction
BACKGROUND. Acute asthma‐like symptoms are anxiety producing for patients, and improper diagnosis leads to inappropriate use of asthma medications, unnecessary office and emergency room visits and referral to specialists to determine the cause. Vocal cord dysfunction (VCD) is responsible for 15% of referrals for dyspnea on exertion and frequently leads to multiple emergency room visits.PURPOSE. The purpose of this study was to explore healthcare utilization among patients with VCD compared to patients with asthma and report the demographic characteristics of patients with these diagnoses receiving outpatient specialty care.METHODS. In this retrospective study, the de‐identified electronic medical records of 285 participants receiving outpatient specialty care with a documented diagnosis of VCD, asthma, and VCD and asthma during the years 2007–2009 were explored with descriptive statistics, chi square, and Poisson regression.RESULTS. Despite the perception of overuse of medical resources among patients with VCD, participants in this study were seen in the outpatient clinic less frequently than participants with asthma, they used less inhaled controller medication, and there were no reported emergency room visits or hospitalizations. Females were more likely to experience this disorder. Patients with VCD were twice as likely to receive medication for anxiety and/or depression, which suggests that mood is a contributor to this disorder. Past or current allergy immunotherapy was utilized by nearly half the sample, which greatly reduces the triggers associated with VCD symptoms and asthma exacerbations. It is surmised that appropriate management including allergy immunotherapy and patient education impacted the use of hospital and outpatient services. Estimated controller inhaler costs for the entire sample were surprisingly high. Use of a controller inhaler, however, was significantly lower among patients with VCD as compared to patients with asthma which is appropriate.CONCLUSION. Nurse practitioners and other healthcare providers are challenged to reduce unnecessary inhaler prescribing among patients with VCD without asthma and to seek specialty consultation to confirm or refute the diagnosis of asthma when needed.
- Overcoming: A Concept Analysis
BACKGROUND. Nurses often work with individuals and populations striving to improve or maintain the quality of their lives. Many, struggling from complex health and social problems, are challenged to surmount barriers to achieve this goal. The growing number of homeless families in the United States represent one such cohort.AIMS. To develop an operational definition of overcoming and explicate its meaning, attributes, and characteristics as it relates to homeless families.METHODS. Using the concept analysis method described by Walker and Avant, along with an extensive literature review, and sample cases pertaining to family homelessness, we delineated the defining attributes, antecedents, consequences, and empirical referents of the concept, overcoming.CONCLUSION. The results of this concept analysis, particularly the relationship of overcoming to family homelessness, provide guidance for further conceptualization and empirical testing, as well as for clinical practice.
- Oppression: A Concept Analysis and Implications for Nurses and Nursing
PURPOSE. To synthesize the literature's discussions on oppression and to explore its implications for nurses and nursing.SOURCE. Published literature.CONCLUSION. Oppression requires a set of norms that are determined by a dominant group and a belief of the inferiority of those outside the dominant group. The attributes of oppression are unjust treatment, the denial of rights, and the dehumanizing of individuals. Nurses and the nursing profession both work with oppressed groups and are themselves an oppressed group. By helping their oppressed and vulnerable patients resist the status quo, nurses will begin resisting their own oppressed environment, which will eventually lead to freedom for their patients and themselves.
- Florence's Candle: Educating the Millennial Nursing Student
Florence Nightingale's Candle serves as a symbol of the nursing profession. It is utilized in different venues, including nursing education. The Millenial students in today's higher education setting, particularly in nursing, would benefit from applying its symbolism in the classroom and in their nursing careers. The concepts of technology, discovery, and coming together as a nation are discussed as they relate to nursing education and to Florence's candle of caring.
- A Social Purpose Model for Nursing
The very current international debate regarding the construction of professional role‐identity in nursing involves analysis of context, competency, reflection, and theory.PROBLEM. What most of the literature shows is that nursing continues to struggle with inherited moral and behaviorist constructs in which essential is in opposition to essentialist caring values and remains part of a convoluted argument. Each of these two types of caring either figure or pre‐figure in the “future of nursing,” which, in the 21st century is contained within the market economy of healthcare reforms and international change. Therefore, how nursing's past is mapped is germane to any current or future understanding of nursing in a multidisciplinary workforce.METHODS. The paper takes a theoretical position employing a nursing model, newly constructed by the author, to examine 21st century nursing. The model seeks to gain an informed knowledge of practice to develop a means of evaluating nursing within its social context. The model is called a social purpose model. This article provides a historical mapping of the concept of new nursing from when it was utilized in another context nearly 18 years ago to now in the United Kingdom. This article includes a critical discussion of nursing's purposeful future to make the discussion more meaningful from an international perspective. Cartographically linking the past to the present is important, but if there is opportunity to define and identify the profession for a purposeful future, appropriate tools are needed to do so.FINDINGS. This article offers a social purpose model in which a subjective, objective, and contextual ideal of what nursing is today can be explored critically and applied both to the student and mentor's practice arena.CONCLUSION. To extend a definition of nursing for pragmatic purposes, nursing needs to be defined in relation to the social context within which it is practiced. Theory and experiential evaluation must inform action as a working adjunct to governmental documentation, taking 21st century nursing from the desktop to the bedside.
- Making Healthy Connections: Introducing Nursing as a Career Choice to Middle School Students
The current economic climate has resulted in many experienced nurses returning to the workforce. Despite this, the nursing shortage is looming in our future and the recruitment of a diverse nursing workforce reflective of the population remains a high priority. The Merrimack Valley in northeastern Massachusetts has two large cities, Lawrence and Lowell, in which the Hispanic and the Southeast Asian populations are disproportionately higher than state and national levels. Through the University of Massachusetts Lowell's Bring Diversity to Nursing Project, partnerships with both city school systems were developed and after‐school programs aimed at highlighting nursing as a career choice were initiated. Mr. Thompson's Heart is the focus of a middle school, pre‐entry program developed by faculty. Introducing career choices in middle school gives students fundamental information about careers and how to begin investigating them. Mr. Thompson's Heart introduces nursing as a career choice combining career information with a focus on developing healthy lifestyle habits. Multiple hands on activities create excitement and interest in the nursing profession.
- Nurses' Caring Attitude: Fall Prevention Program Implementation as an Example of Its Importance
BACKGROUND OF THE PROBLEM. Fall prevention programs are universally multidisciplinary, but nursing care plays the central role. Since October 2008, Medicare has no longer reimbursed acute care hospitals for the costs of additional care required due to hospital‐acquired injuries (e.g., injurious falls).PROBLEM. However, fall prevention programs for hospitalized patients have had limited success, and multifaceted strategies for implementing fall prevention programs cannot guarantee success. It is possible that cultivating and sustaining a caring attitude among clinicians is often overlooked as an intervention strategy.METHOD. This article discusses the barriers to implementing fall prevention programs in acute care hospitals. The attributional theory of success and failure is used to analyze these barriers. In addition, the author discusses whether a lack of knowledge and/or a lack of caring attitude play a role as the underlying barriers to implementing a successful fall prevention program. A patient's story illustrates patients' expectations for the care environment to center on their needs. Possible educational strategies as interventions for fall prevention programs are discussed.FINDINGS. It is suggested that education goals for nurses need to not only promote their professional knowledge and skills in implementing a fall prevention program but also cultivate their caring attitudes.
- EDITORIAL: Converting Manuscripts to Hot Issues
- Managing Multiple Generations: Scenarios From the Workplace
PROBLEM. The current nursing workforce is composed of multigenerational staff members creating challenges and at times conflict for managers.METHODS. Generational cohorts are defined and two multigenerational scenarios are presented and discussed using the ACORN imperatives and Hahn's Five Managerial Strategies for effectively managing a multigenerational staff.FINDINGS. Communication and respect are the underlying key strategies to understanding and bridging the generational gap in the workplace.CONCLUSION. Embracing and respecting generational differences can bring strength and cohesiveness to nursing teams on the managerial or unit level.
- Concept Analysis of Acculturation in Filipino Immigrants Within Health Context
Although acculturation has been widely used as a health research variable among other immigrant populations, it is nonexistent to the Filipino immigrant population. Accurate assessment, measurement, and exploration of acculturation of Filipinos in the United States can help improve the overall health care of this population. The work of Walker and Avant is used as a guide to analyze and clarify the operational definition of acculturation of this group within the context of health.
- The Place for Innovation in Nursing
- Converse in Creative Controversy
- Creative Controversy Reply to Editor: “Rapid Change”
- Introducing . . .
- Competency Education and Validation in the United States: What Should Nurses Know'
This article provides an overview of the progress in the past decade toward effectively documenting the initial and continuing competence of registered nurses.
- The Gift of Listening: JUST Listening Strategies
The purpose of this paper is to examine how the simple act of listening deeply to patients serves as a potentially powerful tool in determining treatment plans, improving patient compliance, decreasing costs, increasing efficacy, and improving patient‐practitioner relationships. Nonegoic listening is a transformative practice that can be integrated into clinical training and practice. A growing body of experiential and anecdotal evidence indicates that this is an area ripe for further investigation to enhance nursing interventions and cultural competencies. Given the significant role that advance practice nurses have in directing patient care, integrative listening can be valuable in shaping patient care.
- Mock Webpage: An Innovative Assignment for Second‐Degree Nursing Students
Generating challenging and meaningful academic assignments for nursing students in which the student manages the technology used to deliver information is needed for accelerated second‐degree nursing students. Developing those assignments is critical for keeping accelerated second‐degree students engaged in the learning process. They are highly motivated, self‐directed learners who have been found to have a preference for teaching‐learning experiences that incorporate the use of technology. This paper describes the development of a mock webpage assignment to meet the learning needs of accelerated second‐degree nursing students.
- Concept Analysis: Nurse‐to‐Nurse Lateral Violence
PURPOSE. The purpose of this paper is to examine the concept of nurse‐to‐nurse lateral violence (LV).SOURCE. Published literature—LV among nurses is significant and results in social, psychological, and physical consequences, negative patient and nursing outcomes, and damaged relationships. An extensive review of literature through Health Source, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ProQuest health, and Medical Complete was used to determine agreement and disagreement across disciplines and emerging trends.CONCLUSION. This concept analysis demonstrates that nurse‐to‐nurse LV is nurse‐to‐nurse aggression with overtly or covertly directing dissatisfaction toward another. Origins include role issues, oppression, strict hierarchy, disenfranchising work practices, low self‐esteem, powerlessness perception, anger, and circuits of power. The result of this analysis provides guidance for further conceptual and empirical research as well as for clinical practice. Organizations must learn how to eliminate antecedents and provide nurses with skills and techniques to eradicate LV to improve the nursing work environment, patient care outcomes, and nurse retention.
- An Appraisal of the Factors Influencing Human Sexuality Research in Nursing
BACKGROUND. Conducting human sexuality research continues to be a challenge for nurse researchers and may seem daunting to nursing students interested in conducting human sexuality research.PURPOSE. The purpose of this paper was to conduct a comprehensive review of the literature to appraise the factors that have influenced human sexuality research for nurse researchers.FINDINGS. Various factors, both intrinsically and extrinsically to the nursing profession, have had an influence on human sexuality studies conducted by nurse researchers.CONCLUSION. A critical appraisal of the findings from the review of the literature provide implications for nurse researchers as well as students of nursing interested in conducting human sexuality research.
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- Military Resilience: A Concept Analysis
Background Since the events surrounding September 11, 2011, and natural disasters, research on resilience has shifted from children to adult resilience. The military began to embrace the concept in 2008 in an effort to decrease the number of military service member (SM) suicides. Purpose The purpose of this article is to explain resilience as it relates to military SMs using the process for concept analysis outlined by Walker and Avant (). Findings Adaptive coping, personal control, hardiness, and social support are the attributes that characterize psychological resilience in SMs. Antecedents for resilience are life events such as serious accidents, prior deployments where death is witnessed, and combat involvement. Consequences of high resilience include decreased mental health symptoms and career and personal success, while consequences of low resilience include increased mental health symptoms and participating in high‐risk behaviors. Practice Implications Understanding resilience as it relates to SMs is critical. Nurses must be able to assess SMs and be equipped to refer them or their family members to the most appropriate care. As more is learned about resilience in the military community, there may be broader implications to the civilian community. Improved understanding of psychological resilience may lead to improved interventions appropriate for both civilians and military SMs.
- Concept Analysis of Professional Socialization in Nursing
Purpose The aim of this study is to clarify the process of professional socialization, and to identify its attributes, antecedents, and consequences in nursing. Rodgers' evolutionary method of concept analysis was used to clarify the concept of professional socialization in the field of nursing. Source A literature review was conducted by performing a search on scientific databases using the key terms “socialization,” “professional socialization,” and “nursing.” Four hundred forty‐six papers for the period 1995–2009 were found, out of which 47 articles and 4 books were selected for the analysis. The process was audited by two independent experts in order to ensure neutrality and credibility. Conclusion Professional socialization is a complex process with four critical attributes: learning, interaction, development, and adaptation. Comprehensive educational programs, competent role models, and the provision of adequate field experiences were found to be the antecedents of these attributes. They have either positive or negative consequences for the professional development of nurses. These findings not only add to the body of knowledge, but also serve as an important impetus for further theory development and research in nursing.
- Isolation: A Concept Analysis
Topic Concept analysis of isolation. Purpose This article uses Walker and Avant's methodological approach in distinguishing the concept of isolation between the normal, ordinary language usage and the scientific usage of the concept. Background The importance of social contact has long been recognized as a fundamental need for humans. The concept of isolation is used throughout the lay and scientific literature and has a primarily negative connotation for humans. The experience is sometimes severe enough to result in serious reductions in adaptation and performance. Data Sources The Medline, CINAHL, and Google Scholar databases were searched using the key terms of concept analysis, human, and isolation with no restriction on the year of publication. English language reports were used exclusively. Conclusion Three attributes were identified: sensory deprivation, social isolation, and confinement. Antecedents included individual perception and situational dimensions. Consequences included anxiety, depression, mood disturbances, anger, loneliness, and adverse health events. Through this concept analysis, isolation has been theoretically defined as a state in which an individual experiences a reduction in the level of normal sensory and social input with possible involuntary limitations on physical space or movement. Systematic studies of isolation using this concept can ultimately enhance nurses' knowledge base and contribute to the quality of life for isolated persons.
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- Abusive Supervision and Nursing Performance
Purpose This is a report on a 2008 investigation of the influence of abusive supervision on nursing performance among registered nurses in an urban South Florida county. The findings suggest implications for patient satisfaction. Background Research suggests that a myriad of negative personal and workplace consequences result when a supervisor is abusive. Researchers have reported frustration, anxiety, stress, psychological distress, problem drinking, family problems, less organizational commitment, fewer organizational citizenship behaviors, and greater intention to resign. Abusive supervision affects an estimated 13.5% of U.S. workers and costs U.S. corporations an estimated $23.8 billion annually. However, there was little understanding of abusive supervision's impact on performance, including within health care. Methods This study utilized an anonymous mail questionnaire of a random sample of 6,500 registered nurses in an urban South Florida county. Descriptive statistics were used to examine the responses. The survey instrument was self‐reporting. Results The study found that targeted subordinates reacted with noncompliance with significant organizational performance norms. The incidence of abusive supervision was 46.6%, with 36.6% of the nurses reporting negative influence on performance and compliance. Conclusions Supervisory abuse is a problem to the healthcare organizations because of the counterproductive behaviors that resulted. Concern is specifically suggested regarding possible negative influences to patient satisfaction. This article offers a change model and recommendations to curtail abusive supervision.
- Chief Nursing Officers' Perceptions of the Doctorate of Nursing Practice Degree
Problem Nurse executives practice in a business environment, which requires a skill set that has traditionally not been included in advanced nursing curriculum. The Doctorate of Nursing Practice (DNP) essentials are designed to address this gap in education while maintaining the focus on advanced nursing practice and executive management competency. Current literature supports the appropriateness of the DNP with practice focus areas of advanced practice specialties and nursing leadership. Although certification and educational bodies, and some professional nursing organizations, have embraced the DNP as the terminal degree for non‐research‐focused nurses, there remains a gap in the literature in regards to the perceptions of validity of the DNP for nurse executives. Method The purpose of this capstone project was to investigate the perceptions of practicing chief nursing officers (CNOs) in the acute care setting regarding the application of the DNP degree for nurse leaders. Utilizing an online survey, specific perceptions investigated included application and appropriateness of the DNP in a business‐based practice model and managing daily nursing operations. Findings CNOs practicing in the acute care setting differed on their responses regarding whether the DNP should be the recommended or the required degree in CNO development programs. CNOs with tenure responded more positively to the perception that the DNP curricula contains advanced nursing knowledge content appropriate to nurse executive practice. Conclusions Practicing CNOs in the acute care setting do perceive the DNP as an appropriate degree option for nurse executive roles at aggregate, system, and organizational levels.
- Sleep Disturbance in Nursing Personnel Working Shifts
Objective The aim of the present study was to explore the factors that are associated with sleep disturbance in nursing personnel working irregular shifts. Methods A cross‐sectional survey was carried out. The Standard Shiftwork Index was used for data collection, which was completed by 365 nurses and nurse assistants working shifts including nights. Results Female nurses and nurses with elevated levels of chronic fatigue were found with greater sleep disturbance between all shifts. Sleep disturbance between most shifts was greater in participants with more than 18 years of working experience and those having family members to look after. No differences were observed in family status, professional training, or circadian characteristics. Conclusion Our results suggest that demographics, working characteristics, and family structure are associated with sleep disturbance between shifts in nursing personnel. The modification of shift schedules according to individual needs and preferences is necessary for the reduction of sleeping problems.
- Nursing Students' Clinical Judgment Regarding Rapid Response: The Influence of a Clinical Simulation Education Intervention
Aim The aim of this study was to examine the impact of a novel educational intervention on student nurses' clinical judgment regarding the management of patients experiencing rapid clinical deterioration. Method A randomized sample of baccalaureate nursing students enrolled in the final semester of their program at a midwestern public university participated. All students (N = 79) were pretested; the control group (n = 39) was posttested after receiving traditional code blue and rapid response education. The intervention group (n = 40) was posttested after receiving a novel education intervention. Results An independent t‐test revealed that nursing students who received the innovative education intervention had significantly higher posttest scores (M = 90.91, standard deviation [SD] = 8.73) than did the nursing students who had not received the intervention (M = 64.80, SD = 19.69), t(77) = 7.65, p <.001). Conclusions The findings demonstrate that clinical simulation is effective in improving students' knowledge and clinical judgment, specifically concerning rapid response systems.
- If They Do Call You a Nurse, It Is Always a “Male Nurse”: Experiences of Men in the Nursing Profession
Background and Purpose. Men are underrepresented in nursing, accounting for less than 6% of Canadian nurses. This research explores issues surrounding recruitment, retention, and work life satisfaction for men who are nurses working in acute care settings Method and Findings. Purposive and snowball sampling was used in this descriptive, qualitative study. Sixteen men participated in four focus groups conducted in three communities in southwestern Ontario. The participants revealed that work stress, lack of full‐time opportunities, and gender‐based stereotypes contributed to job dissatisfaction. Providing care to patients and making a difference were personal rewards that influenced their desire to stay in the profession. To promote nursing as a viable profession, unrestricted by gender, the participants recommended that recruitment strategies begin at an earlier age. Discussion and Conclusion. Findings are discussed in relation to recruitment and retention issues with implications for education, practice, and management.