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Catching the Narrative Wave in Research and Practice

The current ANS featured article is titled “Claiming the Narrative Wave With Story Theory” authored by Patricia Liehr, PhD, RN and Mary Jane Smith, PhD, RN, FAAN. The article is available for download at no cost while it is featured. In this article, the authors clarify the nature, the importance, and the benefits of narrative in both research and practice.  Download the article now, and share your comments for discussion here!  This is a message provided by Dr. Liehr for ANS blog readers:

Mary Jane Smith (right) and Patricia Liehr (left_

Near the end of our STORY-WAVE paper, we say: “In order to attend to unique health challenges for those in our care, nurses must embrace the idea that listening to another’s story is as essential as any other vital sign.” Hardly any nursing action occurs without some understanding of the context that has supported an individual’s presenting health challenge. In fact, another’s story can tie together other pieces of clinical data in a way that makes sense; that enables human-centered precision care. Story is a vital sign; story theory proposes a way for nurses to think about, collect and analyze practice and research stories.

Just recently, while talking with a nurse who has spent the last 30 years working in the emergency room, the conversation turned to what energizes her and keeps her passion for nursing alive. In a move to South Florida about a decade ago, she was introduced to the population of Jewish patients who bear the history of the Holocaust, branded onto their wrists. She has invited these older adults to talk about the marking, thereby offering an opportunity to “make visible” what can easily be overlooked in an emergency room visit. “…sometimes they pause and I can see that they are considering what I have asked but almost all of them speak to me about the Holocaust. I LOVE caring for these older adults.”  We believe that stories like these create a context for caring; in this case, infusing advanced ER knowledge and sophisticated skills with recognition of person that makes a difference in well-being.

In 2020, the Year of the Nurse and Midwife and the 200-year anniversary of the birth of Florence Nightingale, it is definitely time to claim the narrative wave. Why????….because story is central to our practice and our research. In the last line of our STORY-WAVE paper we say: “Story theory can help nurses raise recognition of stories from practice and research as valuable guiding evidence, thereby claiming the narrative wave as an integral facet of disciplinary knowledge development.”….that’s why.

Theory-guided Practice: Application of Transitions Theory

Our first featured article from the latest ANS issue (coming soon!) is titled “Reducing 30-Day Readmissions Through Nursing Science: An Application of Transitions Theory With Best Practice Guidelines” by Bridget Stixrood, MSN, RN, CNL.  In this article, Ms. Stixrood provides an exemplar of theory-guided practice!  While the article is featured, you can download it at no cost.  We welcome your feedback and comments!  Here is a message from the author about her work and her perspective:

Bridget Stixrood

I am honored to present my article outlining the Transition Management Model to this issue of ANS.

 The Transition Management Model was completed as a part of my MSN program. The goal of the project was to improve care transitions for patients and reduce 30-day readmission rates for an Independent Health Network. At this unique healthcare setting nurse care coordination was utilized to manage care for complex Medicare and Medicaid covered individuals. Upon initial design of the project I quickly became inspired and energized by the application of nursing science to frame best practice guidelines. I found that nursing theory provides enough flexibility to adapt to the unpredictable nature of healthcare politics, policies and emerging best practice guidelines.

This project underscores the overwhelming importance of nursing practice to improved health outcomes and reduced 30-day readmission rates. I believe some project success could be attributed to the holistic nature of nursing practice. As nurses we look at an individual’s whole health story including spiritual, mental, physical and environmental.

Behavioral health was particularly difficult to address in the Transition Management Model. Those with mental illness have an added barrier to care when they are symptomatic and need a higher level of management. Applying the Transition Care Model to mental health transitions could be a next step for this project. Improving community partnerships and using nursing science to address the complexities of healthcare in the US is desperately needed. I am curious about what types of breaks in healthcare delivery are you seeing in your community? How can we build a practice that maintains integrity despite what political constructs we work within?

This article is meant to be read as a catalyst and an example of how nursing theory, in this case Transitions Theory by Meleis, can be a useful tool in navigating the complex health stories of our patients and the healthcare environment we function within.

I obtained my MSN from Pacific Lutheran University in 2018. I obtained my Clinical Nurse Leader certification soon after graduation. After working as a labor and delivery nurse for a year while also working at the Pierce County Jail, I fell in love with nursing in the jail setting. I am currently working as a nurse at the King County Correctional Facility. I am passionate about nursing science, mental health care and public health.

I look forward to reading your comments and strengthening our practice together.

A Concept Analysis of Prodromal Myocardial Infarction Fatigue

Currently our featured ANS article is titled “Prodromal Myocardial Infarction Fatigue: A Concept Analysis” by John R. Blakeman, MSN, RN, PCCN-K.  Please download the article at no cost while it is featured, and return here to share your comments and feedback!  Here is John’s message about his work, including a presentation that he prepared featuring this work:

Symptom research is complicated. Because symptoms are, at their core, a human experience, each individual may perceive, attribute, and react to them in different ways. Because of the unique context in which they occur, symptoms cannot reliably be reduced to single, simple, objective pieces of data. Prodromal myocardial infarction (MI) fatigue is no different.

About six years ago, I began my adventure into the world of MI symptoms, especially MI symptoms experienced by women. I had heard about symptom differences between men and women, but, up to that point, I had not closely examined these symptoms in any comprehensive, systematic way. As I dove into the literature, one of the major themes that I identified was that fatigue was a particularly prevalent symptom experienced by women before an MI. However, fatigue was conceptualized in a variety of ways.

Symptom research is a messy business, partly because this research necessarily involves a considerable amount of self-report data. It is not uncommon to see multiple different descriptions of a given symptom. In the case of prodromal MI fatigue, I read a number of descriptions. Some research participants across studies had described this fatigue as “tiredness,” while others might have opted for the term “weakness.” Still others simply used the term “fatigue.” Study participants also provided an array of descriptions regarding the severity and intensity of this symptom. I recognized that this central, latent construct of prodromal MI fatigue was really made up of a number of other constructs, and I wanted to comprehensively review the literature to identify what exactly this latent construct of prodromal MI fatigue “looked like.” Out of this desire came the present concept analysis.

I learned that there was not a simple, neat definition that could be created, though I was able to identify several general commonalities across the many documents that I reviewed. I also recognized the need to further investigate prodromal MI fatigue, and I am now completing a qualitative study focused on women’s experiences of prodromal MI fatigue. This concept analysis helped frame my understanding of the symptom and guided me as I designed my study. Is there more work to do? Absolutely. I expect, and would hope, that this concept will be further refined and that researchers will be able to use this increased knowledge to improve care and patient outcomes. Indeed, if prodromal MI fatigue can be recognized early, morbidity and mortality can likely be reduced due to early intervention, prior to MI.


Women with Coronary Heart Disease and Depression

The current ANS featured article, free to download while it is featured, is title “Clarifying the Concept of Depression in Women With Coronary Heart Disease” authored by Sydney Buckland, MSN, APRN-FNP; Bunny Pozehl, PhD, APRN-NP, FHSFA, FAHA, FAAN; and Bernice Yates, PhD, RN, FAHA.  Sydney Buckland shared the following message with ANS readers about her work; I join her in inviting your comments and ideas related to this work!

Sydney Buckland, Ph.D., APRN, FNP-C
Staff portrait taken in the Michael F. Sorrell Center for Health Science Education on the UNMC campus in Omaha on Thursday, August 15, 2019.

My PhD dissertation work (which I completed in May, 2019) brought together three topics I’ve been passionate about for decades: cardiology, mental health (particularly depression), and the health of women. The intersection of mental health and coronary heart disease (CHD) finally began to be explored in earnest in the late 1990s, with lots of attention being paid to depression in particular. But as I immersed myself in this literature, it became clear to me that there was a rather glaring problem: the way depression was being defined. Or perhaps more accurately, the way it was not being defined. Even though authors would define other variables such as a myocardial infarction with very clear and specific criteria, nobody was defining depression. The official (DSM) diagnostic criteria for depression were never cited, and the vast majority of studies relied on screening instruments rather than clinical diagnostic interviews to determine depression status. What this did, in effect, was to turn the items included on the depression screening instrument into the de facto definition of depression. Given the huge variety of screening instruments, including those that do not follow DSM criteria and/or do not contain somatic symptoms, I wondered how many women with depression were being missed because of the choice of screening instrument.

I decided to write a concept analysis, really diving into what depression in women with CHD “looked like”. Since most of us are not trained to do a diagnostic interview, and diagnostic interviews are lengthy, the reality is that screening instruments will continue to play a central role in identifying (at least initially) those who have depressive symptoms. I wanted researchers and clinicians to be able to make an informed choice regarding a screening instrument to use with this population – one that matched women’s experienced symptoms and followed DSM criteria.

I am delighted to share my concept analysis with the ANS readership and truly hope that by clarifying this concept, women with CHD who are experiencing depressive symptoms will be identified, treated, and ultimately experience better health outcomes.

Movement and Mobility

Our current featured article is titled “Movement and Mobility: A Concept Analysis” authored by Elizabeth Moulton, MSc; Rosemary Wilson, PhD; and Kevin Deluzio, PhD. These concepts seem simple on the surface, even though both are integral to a large proportion of nursing care, they are often taken for granted. But as this article shows, they are far from simple, and are vital to a person’s health and well-being.  We welcome your comments and responses to this article – you can download it at no cost while it is featured, and then return here to share your comments!

Here is a message Elizabeth Moulton shared about this work:

When I began my PhD studies I knew that I was interested in how people moved and how this affected their overall mobility. I had worked for several years in a lab where we measured human movement with sub-millimetre accuracy. Yet, as I sat down to write my thesis proposal, I found that I was unsatisfied with how the terms movement and mobility were used in the literature. They were often used interchangeably and their relationship with one another was unclear.

This concept analysis was written as the first part of my PhD thesis. While writing it, I had the chance to go back to the fundamental definitions and explanations of movement that were introduced in high school Physics. Mrs. Jones’s clear explanation of how we know something is moving was the first thing to come to mind when establishing the defining attributes of movement. I expanded as the project progressed to encompass definitions found in the literature and my clinical experience as a nurse. These concepts were linked to the International Classification of Functioning, Disability, and Health to align them with an already well-established framework.

This concept analysis is the basis of all future works for my thesis. It has been used to assess tools that claim to measure movement and/or mobility in a scoping review and has been used in a paper that explores the operationalization of the concepts from theoretical definitions to definitions that can be used to establish measures for clinical and research purposes.

I’m delighted to share this concept analysis that has been fundamental to the progression of my research and hope that others will be able to benefit from it.

Ethics of Prison Palliative Care

The current ANS featured article is titled “Towards a Guiding Framework for Prison Palliative Care Nursing Ethics” by Helen Hudson, MSc(A); David Kenneth Wright, PhD.  In this article the authors interweave four strands of analysis—contextual, relational, social, and political—to produce a framework to guide ethical action in prison palliative care nursing.  This article is available to download at no cost while it is featured, and we welcome your comments here!  Here is a message about this work from the author Helen Hudson:

Helen Hudson

Most nurses have little cause to think about prisons or prisoners on a day-to-day basis, yet prisoners’ health needs are extensive. Markers of social disadvantage, including racialization, poverty, mental health issues and illiteracy, are overrepresented among prisoners throughout the Western world, reflecting a lack of access to the determinants of health prior to incarceration. As the global prison population ages, more and more people are dying behind bars of illness or age-related causes.

This paper came about as I examined the literature on palliative care for prisoners in anticipation of starting a doctorate on the topic, only to find that most scholarship engaged with the how questions, without considering the why. That is, end-of-life conditions and palliative care practices – where they exist – are described without much interrogation of why so many people are ending their lives in prison, or what that means, ethically, for the nursing discipline. Though the ethical challenges in this field of nursing are well described, to our knowledge no overarching framework has been put forward for understanding and addressing them. Together with my doctoral supervisor David K Wright, RN, PhD, CHPCN(C), I wrote this paper to address that gap. In it, we articulate an ethical analysis of palliative care nursing for prisoners throughout the illness and grieving trajectory (that is, not solely at end of life), both within and outside of prison facilities. Drawing on literature from various health disciplines – nursing, bioethics, medicine, social work, and public health – as well as prison studies and critical criminology, we synthesize perspectives that illuminate moral questions for practice, research, policy, education, and political action.

I’m excited to share this paper with the ANS readership and look forward to engaging with your comments.

Exploring the Meaning of Quality of Life

The current ANS featured article is titled “Analysis and Evaluation of Conceptual Model for Health-Related Quality of Life Employing Fawcett and DeSanto-Madeya’s Critique Framework” by Min Kyeong Jang, PhD, KOAPN, RN and Catherine Vincent, PhD, RN.  In this article, the authors examine the meanings of this construct in research and in practice, and point to the importance of adequate definitions and meanings for both research and practice.  You can download this article at no cost while it is featured; we hope you will and will also share your responses to the authors’ work here!  Dr. Jang shared this information about this work for ANS readers:

We are delighted that Advances in Nursing Science (ANS) invited us to contribute to the ANS blog. In the field of nursing, health-related quality of life (HRQOL) has been a significant issue that is essential to holistic assessment of patients’ health. In 1994, Wilson and Cleary developed a HRQOL model, and in

Dr. Carol Ferrans with Dr. Min Kyeong Jang

2005, this model was revised by Ferrans and colleagues to clarify the relationships among the theory concepts, expanding it into an ecological model. The revised HRQOL model was recognized for its promise for future use in HRQOL research and practice, but no previous authors had formally critiqued the model. In our article, we provide a comprehensive analysis and evaluation of the HRQOL model, which we hope will be useful for advanced nursing care and research.

In this article, we identified how the relevant concepts and propositions of the HRQOL model align with the nursing metaparadigm and maintain consistency. In addition, we found that this HRQOL model can easily and comprehensively be applied to improve nursing research and practice. One example is that this HRQOL model can be applicable as a guide for synthesizing an integrated literature review. Guided by HRQOL model, Min Kyeong and colleagues identified and synthesized essential key factors influencing mammography screening among breast cancer survivors from 2000 to 2017, published in the Oncology Nursing Forum. (Figure 1 – An example of applying the HRQOL model). Guided by the HRQOL model, the conceptual model of factors influencing surveillance mammography adherence was able to integrate all relevant key factors. Also, we believe that the most important advantage of using the HRQOL model is to ensure comprehensively covering important factors, some of which can be easily overlooked.

Briefly, Min Kyeong Jang, PhD, RN, KOAPN has been involved in cancer treatment and research for more than 10 years, while simultaneously developing expertise in methodological studies. To be specific, HRQOL is one of her research interests, and Dr. Carol Ferrans, PhD, RN, FAAN (Harriet H. Werley Endowed Chair in Nursing Research) was her PhD mentor (See photo above – Drs. Jang and Ferrans). To develop accurate QOL instruments for use in Korean health care research, Dr. Jang guided the translation of all 15 versions of the Ferrans and Powers QOL instrument, and she also studied the methodologies of theory analysis and theory development with Dr. Catherine Vincent as her guide (co-author).

In collaboration with various research teams, Min Kyeong Jang has been pursuing investigations involving QOL, cancer-related symptoms, chronic pain relief interventions, exercise program development, and sarcopenia, with the ultimate goal of enhancing survivorship care for cancer patients. She is currently working as a postdoctoral fellow at both the University of Illinois Cancer Center and University of Illinois at Chicago College of Nursing with Dr. Ardith Z. Doorenbos and colleagues. She believes that the HRQOL model merits examination to further assess its applicability and usefulness within nursing science; thus, she is applying this model to provision of supportive care for patients.

Jang, M. K., Hershberger, P. E., Kim, S., Collins, E., Quinn, L. T., Park, C. G., & Ferrans, C. E. (2019, November). Factors Influencing Surveillance Mammography Adherence Among Breast Cancer Survivors. In Oncology nursing forum (Vol. 46, No. 6, p. 701). Used by permission






Figure 1.  An example of applying the HRQOL model

Jang, M. K., Hershberger, P. E., Kim, S., Collins, E., Quinn, L. T., Park, C. G., & Ferrans, C. E. (2019, November). Factors Influencing Surveillance Mammography Adherence Among Breast Cancer Survivors. In Oncology nursing forum (Vol. 46, No. 6, p. 701).


Figure 2.  Drs. Jang and Ferrans


Planned ANS featured topics!

As we approach the year 2020, we invite ANS readers and nursing scholars everywhere to take a look at the topics we are featuring in the next couple of years. Even though we no longer dedicate entire issues to a topic, we continue to call for articles related to topics that we believe have particular significance for nursing and healthcare.  Here is the lineup:

Methods for Nursing Knowledge Development
Vol 43:3 –  September 2020
Manuscript due date: January 15, 2020
Vol 43:3
We seek innovative approaches to knowledge development in relation to all patterns of knowing in nursing. We also welcome manuscripts that critique any methodologic approach, manuscripts that explore the philosophic, including ethical underpinnings related to the development of nursing knowledge, and manuscripts that address the critical connections between practice and knowledge development approaches.
Humanizing Precision Science
Vol 43:4 –  December 2020
Manuscript due date: April 15, 2020
Vol 43:3
One of the trends of our time is the development of “precision science” – a trend that deserves careful consideration going forward. We seek manuscripts for this issue that provides assessment, explanation, evaluation and critique of this trend in light of the underlying foundations of nursology. This featured topic intentionally calls for both rigor and creativity that provides avenues for discussion and possible new directions in the development of our discipline.
Social Influences on Health
Vol 44:1 –  March 2021
Manuscript due date: July 15, 2020
Awareness of social influences on health (often called social determinants of health) has grown in recent decades as social, political and environmental challenges have increasingly threatened the health and all it inhabitants.  For this issue we invite articles addressing specific nursing approaches related to these issues, and advances in nursing knowledge that forms a foundation for nursing’s contributions to this important area of focus.
Historical Trauma & Health
Vol 44:2 –  June 2021
Manuscript due date: October 15, 2020
Nursing has a long history of practice and scholarship related to the care of people who experience trauma of all types. However, the health effects of historical trauma only recently have begun to be conceptualized and understood as a significant determinant of health.  For this issue of ANS, we invite scholarship that addresses this important connection and provides a clear perspective founded on nursing’s fundamental values. We welcome research reports, philosophic, including ethics analysis, and exploration of theory and evidence guided practice.
Social Justice, Big Data & Health Disparities
Vol 44:3 –  September 2021
Manuscript due date: January 15, 2021
We are seeking articles that provide a social jusice lens to the emerging ways in which big data are being used , and how these approaches can inform nursing approaches to addressing health disparities. We seek in particular articles that report research, practice, education and policy informed by nursing theoretical and philosophic perspectives.
Values and Vicissitudes of Nursing Scholarship
Vol 44:4 – December 2021
Manuscript due date – April 15, 2021
The evolution of scholarship as online publishing emerged in the past 15 years now points to an urgency to be crystal clear about the standards that shape the scholarship of our discipline, affirm these standards as collective values, and that serve as guideposts for the evolution of scholarship in the future.  For this issue of ANS we welcome manuscripts that explore the values and vicissitudes on which our standards are built.  Articles can address specific areas of focus, or more broadly on underlying philosophic concerns.

General Manuscripts are welcome any time ​

Manuscripts generally relevant to the purposes of the journal are welcome at any time. The purposes of ANS are to advance the development of nursing knowledge and to promote the integration of nursing philosophies, theories and research with practice. We expect high scholarly merit and encourage innovative, cutting edge ideas that challenge prior assumptions and that present new, intellectually challenging perspectives. We seek works that speak to global sustainability and that take an intersectional approach, recognizing class, color, sexual and gender identity, and other dimensions of human experience related to health.​​

Translating practice guidelines into practice

The current ANS featured article is titled Implementation of Clinical Practice Guidelines in the Health Care Setting A Concept Analysis by Melissa Beauchemin, MPhil, RN, CPNP; Elizabeth Cohn, PhD, RN; and Rachel C. Shelton, ScD, MPH.  The article is available for download while it is features and we welcome your ideas and responses in the comments here!  These authors were concerned with the challenges of implementing clinical guidelines, and their concept analysis, and their analysis reveals 7 attributes necessary for effective implementation.  Here is a message from Melissa Beauchemin about this work:

As a research nurse practitioner in pediatric oncology, I became interested in how evidence is translated into clinical practice. I noted hesitations in integrating new evidence into clinical care, and I realized that challenges at multiple levels may present as a barrier. These observations were one of the main drivers for to pursue a PhD. I chose to focus my dissertation on guideline implementation and tools, specifically informatics-based approaches such as clinical decision support, that may be effective in translating evidence into practice. During a course in conceptual and theoretical frameworks, my professor, Dr. Elizabeth Cohn, encouraged my interest in guideline implementation, and I began writing this concept analysis. Using Walker and Avant’s methodology and in consultation with an expert in implementation science, Dr. Rachel Shelton, we searched the existing literature to inform a clear definition of a challenging concept in healthcare. I just started as a postdoctoral research fellow and continue working with our implementation science core at Columbia University, and my research interests continue to focus on an interdisciplinary approach to improve the integration and implementation of evidence-based clinical practice supportive care guidelines for pediatric, adolescent, and young adult cancer into cancer care delivery. The multi-level approaches that we outline in this concept analysis are each distinct and integral components to a successful implementation.

The Ethic of Belonging in Nursing

The first featured article in the new issue of ANS (volume 42:4) is titled “Analyzing Patients’ Complaints: Awakening of the Ethic of Belonging” authored by Yan Ming, BSN, RN; Holly Wei, PhD, RN; Hong Cheng, BSN, RN; Jie Ming, BSN, RN and Mark Beck, DNP, RN. This article is one of our ANS Continuing Education offerings and is available for download at no cost while it is featured!   In this article, the authors analyzed patients’ complaints through the lens of human relations and nursing ethics. Here is a message from Dr. Wei regarding their work:

Ms. Yan Ming and Dr. Holly Wei at a quality of care improvement meeting

The ethic of belonging, according to Emmanuel Levinas, is the first principle of science and is a priori of the ontology of separateness of being. We all belong to the universal field of love before we are separate beings, in which wholeness and connection come before separation and division. The universal love and transpersonal caring relationship are the essences of how one treats “the other.” “The other,” according to Levinas, is someone else other than oneself. The ethic of belonging is the interconnectedness with the infinite universe and the consciousness of the spirit and energy source. Based on this worldview, the ontology of caring relations and awareness of belonging become part of the ethical foundation of the discipline of nursing.

Healthcare is undergoing transformation globally. As in the United States, healthcare in China also faces healthcare reform. China embraces two significant challenges in healthcare: one is the volume-based payment system, and another one is the medical model of the nursing education curriculum. The payment system in China is still primarily a fee-for-service payment system, a system that is based on quantity, not quality, and a system that has been phased out in the United States. The nursing education program in China, from its beginning, has adopted a bio-medical model, a direct reproduction of the medical education curriculum.

The field of medicine, including nursing, has traditionally been considered as “hard science,” where the training of nurses focuses more on the tangible medical knowledge and skills and less on the “soft” and intangible humanistic caring. However, as economies grow, people’s expectations for a high quality of care increase. Patients expect a high quality of care in both clinical skills and humanity, which has created discrepancies between the quality of care expected and the quantity-based and illness-centered services offered. The gaps are directly associated with increased patients’ complaints, legal disputes, and violence.

This article has investigated patients’ complaints from a nursing ethics perspective. The notions introduced in this paper, such as “the other,” human-centered holistic caring, and nurse-patient relationships, are important concepts in nursing ethics and practice.

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