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Sexual Disparities for Black Females


The current ANS featured article (available at no cost while features) is entitled “Black Female Sexuality: Intersectional Identities and Historical Contexts” authored by Natasha Crooks, PhD, RN; Randi Singer, PhD, MSN, MEd, CNM, RN, and Audrey Tluczek, PhD, RN, FAAN. Dr. Crooks provided this information about this work:

As a Black female researcher, my passion lies within addressing sexual health disparities and social inequities Black girls and women face throughout the life course. The motivation for my research stems from my clinical experiences in women’s sexual and reproductive health. I began investigating the experiences of Black female sexual development for my dissertation and have built upon this work by including adolescent girls. Many women from the study described how their intersectional identities and historical context influence their sexual development, aligning intersectionality to the findings of my grounded theory study.

Intersectionality is an important framework to use in nursing as it emphasizes the historical context, which is often absent in nursing theory. Intersectionality is a concept many of us may be familiar with; however, there is a lack of understanding particularly in nursing regarding its use. There is a complexity and discomfort in discussions of intersectionality as it describes social hierarchies (i.e., power and privilege) as well as consequences of those concepts (i.e., internalized oppression and historical trauma), especially as nurses and the field of nursing are predominately white. However, nurses are at the forefront of social justice and have a responsibility to provide culturally safe care. We thought it was important to discuss how research on Black female sexuality led to the development of an expanded intersectionality model and how it could inform research, theory, practice, and education.

We believe this work is timely considering the social awakening the Black Lives Matter movement has shed light on and the injustices Black communities face. In this article, we highlight many of the social inequities, which have led to historical trauma among Black women. We wanted to demonstrate the importance of intersectionality in relation to health, as well as the importance of historical context in health care. Historical context is critical in examining social inequities and health disparities among underrepresented populations. This framework may be useful in understanding how systemic issues have impacted health disparities, such as the disproportionate death rate of COVID-19 cases within Black communities.

Satisfaction Outcomes for Women “Choosing to Go Flat” after Mastectomy


The current ANS featured article, available at no cost while it is featured, is titled “Satisfaction Outcomes in Women Who “Choose to Go Flat” After Mastectomy: An Integrative Review,” authored by Tracy E. Tyner, MSN, APRN, ACNP-BC; Mikyoung A. Lee, PhD, RN. We invite you to download the article while it is featured, and share your comments related to their integrative review. Here is a message provided by lead author Tracy Tyner about this work.

Tracy Tyner

Tracy Tyner

Imagine, if you can, being diagnosed with breast cancer or you are at high-risk based on genetic or familial factors. After thoughtful and careful consideration and conversations with your healthcare team, you have decided to undergo a mastectomy and forego breast reconstruction, an option recently defined by the National Cancer Institute (2020) as Aesthetic Flat Closure, or in lay terms, “going flat.” Aesthetic flat closure is defined as a surgical procedure to remove excess fat and skin, followed by tightening of the skin to create a smooth, flat, nicely contoured chest wall, and can occur at the time of mastectomy or after reconstructive breast implant or autologous breast flap removal. After the mastectomy, you awaken to discover that you did not receive a flat closure but instead found excess amounts of skin along your chest wall with unexpected tissue deformities. Imagine looking at your chest wall with these deformities every day for the rest of your life. The potential short and long-term physical and psychological sequela these women experience is infinite.

Mikyoung Lee

Healthcare journalists are reporting similar events from women all across the country. In speaking with women who have undergone aesthetic flat closure, I have heard both amazing and disturbing stories surrounding their flat closure experiences. As a nurse practitioner with a family history of breast cancer, I felt a duty to answer the call from these women by enrolling in a Doctoral Nursing Program with a research focus on patient-reported outcomes in women choosing mastectomy with aesthetic flat closure.

To better understand this population, the authors, Tracy E. Tyner and Dr. Mikyoung A. Lee, set out to identify satisfaction outcomes in women choosing to go flat after mastectomy through an integrative review. Satisfaction outcomes addressed in this literature review included: chest wall appearance/aesthetic satisfaction, decision satisfaction, healthcare clinician interaction/care satisfaction, and factors affecting satisfaction. Most studies compared outcomes among different surgical options: breast-conserving surgery, mastectomy without reconstruction, and mastectomy with implant or autologous flap reconstruction. Only two qualitative studies specifically addressed women who “chose” to go flat. Overall, decision satisfaction was good, but there were mixed results on aesthetic satisfaction. Studies looking at satisfaction with healthcare clinician interactions were quite illuminating, revealing issues of paternalism, implicit and explicit biases regarding societal femininity and breasts, and a lack of educational resources available for these women. The strongest factors impacting satisfaction were body image, body mass index, radiation therapy, and access to information and resources.

This literature review found a significant paucity in the literature on satisfaction outcomes in women choosing mastectomy with aesthetic flat closure. We have only scratched the surface on understanding patient-reported satisfaction outcomes in this population. Future research needs are limitless. As nurses, we can play a pivotal role in improving patient satisfaction and health outcomes for women “choosing to go flat.”

National Cancer Institute (2020). Aesthetic flat closure. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/aesthetic-flat-closure

 

Guidance on Concept Analysis


Beth Rodgers

For the current issue of ANS, I invited Beth Rodgers, PhD, RN, FAAN, to share her thoughts and guidance for nurse scholars embarking on this important work! Dr Rodgers is Professor Emeritus, University of Wisconsin Milwaukee, Nursing Alumni Endowed Professor, Department of Adult Health and Nursing Systems. Her work defining quality in concept analysis work as enabling conceptually sound research to improve clinical care was recently explicated in the Journal of Nursing Scholarship.1 In this Guest Editorial, Dr Rodgers further explains the importance of this necessary intellectual challenge for the discipline. Access her Guest Editorial “Confronting Conceptual Challenges in Nursing Scholarship” and share your comments and responses here!

  1. Rodgers BL, Jacelon CS, Knafl KA. Concept analysis and the advance of nursing knowledge: state of the science. J Nurs Scholarsh. 2018;50(4):451–459. doi:10.1111/jnu.12386.

Information Security in Nursing


The current featured ANS article is titled “Information Security in Nursing: A Concept Analysis” authored by Jiwon Kang, PhD, RN and GyeongAe Seomun, PhD, RN — free to download while it is featured. This work resulted in a model that the authors project can guide the identification of physical, technical, and administrative attributes and definitions of information security in nursing. Dr. Seomun provided this description of their work:

Information security in nursing requires technical, physical, and administrative security, which comprise an essential information security aspect. Physical security includes disaster prevention measures to protect information processing facilities, where information systems are located, from natural disasters and insider threats, as well as methods for protecting information systems from invasion and destruction. Technical security includes information data protection. The most basic countermeasures are to control access to the information system or to use software with enhanced security is a macro-based security measure that establishes the law, the safety and reliability of information systems.

We performed the task of compiling and analyzing the essential attributes of the information security in nursing derived from the review of the literature in the theoretical phase and the attributes of the concepts identified in the fieldwork phase. In the theoretical phase, 7 attributes (facility stability, external access and intrusion control, technical access control, use of functions, establishing a system, management of human resources, and responsibility for information security) were derived. Seven attributes (facility stability, environmental control, access to information, practical use of security systems, stability, persistence, and professional responsibility) were analyzed in the fieldwork phase. In summary, the attributes of information security in nursing were derived from 7 attributes (facility stability, environmental control, information accessibility, take advantage of features, systematicity of of education, and professional responsibility) in 3 domains [See Figure].

Nurses can review the environmental controls of the workplace and the stability of the facility. They can understand and use the accessibility of health information and the functions of the security program. They can follow the system of the work, recognize the patient information security-related matters through education, and evaluate and maintain medical information security with professional responsibility.

The security of patient information in the nursing field is a sensitive situation, and understanding the information security of the nurse is necessary. Nurses’ information security is an important concept, it is necessary to develop scale suitable for the current situation. Nurses’ Information Security Scale assesses aspects of physical, technical, and administrative security based on conceptual analysis. Nurses can develop a systematic method of performance to enhance the security of medical information with this scale. This study is useful for educators interested in strengthening nurses’ information security

Updated ANS Author’s Guide: Anti-racist Guidelines


The recent spotlight on police brutality and killing of Black Americans prompted widespread reflection and change toward social justice and racial inequities in almost all sectors of society – including the realm of scholarly publishing. The “Scholarly Kitchen,” blog of the Society for Scholarly Publishing, posted a notice of an “Antiracist Framework for Scholarly Publishing” on August 6, 2020 that serves as a guide to re-shape policies and practices in the production of scholarly literature.

I am delighted to share the outcome our initiative to examine and revise guidelines and practices for Advances in Nursing Science. As Editor, I established a workgroup of scholars of color who serve on the ANS Panel of Reviewers to take a deep dive into the journal’s “Information for Authors”. Together we created major anti-racist changes that have now gone into effect.

The changes that we made begin with a fundamental acknowledgement of the power of the published word to shape thought and power structures, and the responsibility of authors in situating their work within existing power structures:

Published scholarly works play a major role in shaping thought and power structures. We encourage authors to include a standpoint statement that describes your position relative to power relations of race, gender, and class. This is particularly important if your work involves disadvantaged populations or issues of social determinants of health and health equity. Examples include: 

  • “The authors Identify as white middle-class nurses. We have drawn on literature authored by scholars of color to inform the design, interpretations and conclusions reported in this article.”
  • “Our work arises from our experiences as able-bodied nurses, as well as our identities as mixed-race descendants of immigrants from Central and South American countries.”

The following is a new section that specifically addresses guidelines related to racism:

The ANS leadership – Editor, advisory board members, peer reviewers and Publisher recognize that published scholarly works are vehicles that can challenge systemic racism and intersecting forms of power inequities.  ANS expects an explicit antiracist stance as a means to provide scholarly resources to support antiracism in research, practice, education, administration, and policymaking. To this end, we offer the following guidelines:

  • Remain mindful of the many ways in which white privilege is embedded in scholarly writing, and engage in careful rereading of your work to shift away from these explicit and implied messages.  As an example, general “norms” are typically taken to reflect white experience only; this is revealed when the experience of people of color are taken to be “other” or “unusual” or worse yet “unhealthy” 
  • When race is included as a research variable or a theoretical concept, racism  must be named and integrated with other intersecting forms of oppression such as gender, sexuality, income, and religion.
  • If your work does include race,
    • Provide a rationale that clearly supports an antiracist stance.
    • Be careful not to explicitly or implicitly suggest a genetic interpretation.
    • Explicitly state the benefit that your work contributes on behalf of people of color.
  • Refrain from any content that explicitly or implicitly blames the victim or that stereotypes groups of people; situate health inequities clearly in the context of systemic processes that disadvantage people of color. 
  • Focus on unveiling dynamics that sustain harmful and discriminatory systems and beliefs, and on actions that can interrupt these structural dynamics.

Please visit the complete ANS Information for Authors to review these changes. We welcome your feedback, comments and questions! Please respond below!

Deep appreciation to the following team of ANS peer reviewers who developed these guidelines:

Helene Berman, RN, Ph.D, University of Western Ontario

Mary K. Canales, Ph.D., RN, University of Wisconsin, Eau Claire

Lucy Mkandawire-Valhmu, PhD, RN (also member of Nursology.net management team)

Margaret Dexheimer Pharris, RN, PhD, FAAN, St. Catherine University (Emerita)

Bukola Oladunni Salami, RN, MN, PhD, University of Alberta

Holly Wei, PhD, RN, CPN, NEA-BC, East Caroline University

Jennifer Woo, Ph.D., CNM, WHNP, FACNM, Texas Woman’s University (also member of Nursology.net management team)

Advancing Nursing Policy Advocacy


The first featured article for ANS 44:1 is titled “Advancing Nursing Policy Advocacy Knowledge: A Theoretical Exploration” authored by Patrick Chiu, RN, MPH. This article is available to download at no cost while it is featured, and we invite you to add your comments below to advance this discussion! Here is the background that Mr. Chiu provided for ANS readers:

Patrick Chiu

Advocacy is a concept that all nurses are familiar with. It’s introduced to students right at the beginning of nursing education and is constantly promoted by nursing organizations as a key nursing role. Similarly, nurses are increasingly called on to engage in political discourse and to influence policy at all levels. While this enthusiasm has been generated by nursing leaders, organizations, and global campaigns, much of the discussion has focused on the idea of ‘getting a seat at the table’, with little emphasis on the knowledge and skills required to effectively influence policy.

Throughout my years in clinical practice, government, professional associations, and nursing regulation, I have had many discussions with novice and seasoned nurses at the local, national, and global level. Conversations related to patient, health system, or policy issues have always generated similar responses – that there is a need to galvanize more nurses to influence policy. Despite this eagerness, I’ve always wondered why in many jurisdictions across the globe, this remained an aspirational statement rather than a reality. A close look at the literature suggests that perhaps the discipline has not fully explored the areas that require further knowledge and skill development to fully realize this engagement.

Although I had worked in policy advocacy for a few years, it wasn’t until my experience participating in the International Council of Nurse’s (ICN) Global Nursing Policy Leadership Institute in 2017, where I began to understand the gap. While nurses are phenomenal at bringing forward content expertise on a range of health and public policy issues, little attention is placed on developing the knowledge and skills required to navigate political contexts, actors, and policy processes – all of which are integral to policy change.

I began writing this article for a theory development class in my PhD program in hopes of advancing the theoretical basis of policy advocacy knowledge within the discipline. By combining ideas from the extant literature and my professional experiences, my goal was to explore how current conc

epts within nursing could be extended from a micro to macro level; and to integrate concepts from the field of policy studies to provide a framework for nurses seeking to engage in policy advocacy to advance social justice.  Recent events have once again exposed the high levels of racial injustice and health inequities that continue to exist within our society. While the ideas presented in this article are open to critique, I hope it serves as a useful reference for nurses across all domains wishing to strategically influence health systems and policy.

 

School Nurses Building Healthy Environments


Our current featured article is titled “School Discipline Experiences Among Youth With Disabilities From the Perspective of School Nurses” authored by Hannah E. Fraley, PhD, RN, CNE, CPH; Gordon Capp, PhD, LCSW; and Teri Aronowitz, PhD, APRN, FNP-BC, FAAN. Download this article at no cost while it is featured — we welcome you comments below. Here is a message from Dr. Fraley about this work:

As an early career scientist and scholar, I have been building the science surrounding prevention of

Hannah Fraley

youth violence, particularly trafficking, among youth attending schools in the U.S. A large focus of my work has been on evaluating and building awareness among school nurses   regarding how youth experiencing violence and trafficking present in schools so that school nurses can identify and prevent trafficking, given survivors of trafficking consistently report that they are often misperceived in care interactions as “trouble” and “behavioral”. In these foundational studies, we have identified another common theme brought forward by school nurses- youth with disabilities are particularly misunderstood in schools and it is known in literature that they are a population of youth most at risk for violence. This led my colleagues and I to further explore our qualitative data through secondary analysis exploring the perspectives school nurses have regarding discipline practices in school among youth with disabilities using the Peace and Power Conceptual Model.

Our findings highlight youth with disabilities can experience unjust, harsh disciplinary practices because they are misunderstood and mislabeled, fueled by lack of awareness, and understanding among school faculty. These attitudes shape the power-over dynamics in schools, perpetuating the unjust experiences of youth with disabilities, our most vulnerable youth. Particularly, school nurses in our study have shed light on minority youth with disabilities disproportionately experiencing harsh discipline, including unjust, unwarranted restraints and seclusion, kicked out of classrooms and schools, and sent to residential placements, placing them at higher risk for exposure to violence and the juvenile justice system. School nurses’ perspectives of these youth also often conflicted with other colleagues, creating power-over dynamics, such as being left out of planning teams for youth with disabilities and their input disregarded. Bringing to light the disparate discipline experiences of youth with disabilities in our schools is critical to work towards rebuilding emancipatory school systems that promote social-emotional school-wide programs and restorative justice practices, consistent with peace-power dynamics. Findings from this secondary qualitative data analysis have set the stage for my future study with adults with disabilities exploring their past school discipline experiences. Because people with disabilities are often understudied, hearing directly from people with disabilities themselves about their school discipline experiences will not only serve to inform my future work with school faculty, but will serve to bring their voices and experiences forward.

Social Cohesion in Health


Our current featured ANS article is titled “Social Cohesion in Health: A Concept Analysis” authored by Hailey N. Miller, PhD, RN; Clifton P. Thornton, MSN, CPNP; Tamar Rodney, PhD, PMHNP-BC; Roland J. Thorpe Jr, PhD and Jerilyn Allen, ScD, RN. We invite you to download this article at no cost while it is featured, and share your thoughts here! Dr. Miller shared this background about this work:

Hailey Miller

Early on in my PhD program, I grew an interest in understanding the social determinants of health, specifically as they relate to cardiometabolic diseases. While conducting a literature review to narrow my dissertation research question, I identified a gap in the literature surrounding the relationship between social cohesion and obesity. At the same time, I noticed the heterogeneity in how dimensions of the social environment, specifically social cohesion, were conceptualized and operationalized in literature. This made using the findings to draw conclusions and inform my dissertation work difficult. As a result, my colleagues and I decided to conduct a concept analysis on social cohesion. The findings from this concept analysis were integral to the development of my dissertation and the interpretation of my findings. It is my hope that readers find this article useful in informing their future work, as well.  

Collaboration – DNP and PhD


Our current featured article is titled “Constructing Doctoral Leadership Scholarly Role Boundaries Through Intraprofessional Nursing Education,” available for download while it is featured. The authors are Peggy Jenkins, PhD, RN; Jacqueline Jones, PhD, RN, FAAN; Alexis Koutlas, MSN, RN, NE-BC; Suzanne Courtwright, MSN, RN, PNP; Jessica Davis, FNP, AOCNP, ACHPN and Lisa Liggett, RN, MSN, CCRN. In this video, Dr. Jenkins is joined by three of her co-authors who recently completed their DNP programs, to discuss the value of DNP and PhD collaboration.

Peggy Jenkins
Jessica Davis
Alexis Koutlas
Lisa Liggett

NICU to Home Transitions for Adolescent Mothers


The latest featured article is titled “The Complexity of the NICU-to-Home Experience for Adolescent Mothers: Meleis’ Transitions Theory Applied” by
Elizabeth Orr, MSc; Marilyn Ballantyne, PhD; Andrea Gonzalez, PhD and
Susan M. Jack, PhD. This article presents an exemplar of the application of nursing theory in nursing practice, and is available to download at no cost while it is featured. The primary author, Elizabeth Orr, provided this message about this work:

Elizabeth Orr

As a nurse in a busy Neonatal Intensive Care Unit (NICU) you quickly become accustomed to the ‘revolving door’ nature of admissions, transfers and discharges – as one infant leaves the unit, they are swiftly replaced by another. During my 13 years as an RN in the NICU, I found admissions very fulfilling; the whole team would spring into action, working together to stabilize a critically ill infant or prepare newborns and their families for urgent surgery. Discharges and transfers were somewhat less satisfying. Being well enough to be discharged from intensive care was always something to be celebrated, however I often found myself wondering how infants and families fared post discharge; hoping someone in the community would notice, and tie up any loose ends that may have gone overlooked on account of the complexity and acuity of the NICU patient population and environment. These feelings of uneasiness at discharge – in particular with the more vulnerable adolescent mother/baby dyads in the NICU – served as the impetus to explore the NICU-to-home experience further.

The importance of successful care transitions and the need for novel patient- and family-centered care approaches to ensure safety in the hospital-to-home process is becoming a recognized priority within healthcare. However, while exploring the existing literature on NICU-to-home transitions, what I found striking was the primary and often exclusive focus on the discharge event. Very little attention was given to the fact that, according to Meleis’ Transitions Theory, at the time of discharge from NICU adolescent mothers are experiencing at least 4 transitions: (i) a health-illness transition—NICU admission; caring for an infant with increased risk of developmental-delay/complex health needs; (ii) a developmental transition—becoming a mother; (iii) a situational transition—discharge home from the NICU and notably, these 3 transitions occur within the context of a fourth transition; (iv) the developmental transition of the adolescent mother to adulthood.

This paper applies Meleis’ Transitions Theory to the example of hospital-to-home transitions for adolescent mothers and their infants and argues for and increased recognition of the importance of overlapping and intersecting transitions and an overall more holistic, theory-informed approach to understanding hospital to home care transitions.

 

           

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