The current ANS featured article is titled “Advances in Conceptual and Methodological Issues in Symptom Cluster Research: A 20-Year Perspective” authored by Carolyn S. Harris, BSN, RN; Marylin Dodd, PhD, RN; Kord M. Kober, PhD; Anand A. Dhruva, MD; Marilyn J. Hammer, PhD, RN; Yvette P. Conley, PhD; and Christine A. Miaskowski, PhD, RN. The article is available for free download here while it is featured, and we welcome you to read the article and share your comments here. Carolyn Harris shared this message about her work for ANS readers:
My program of research is centered on the identification of phenotypic characteristics and molecular markers that place patients with cancer at increased risk for a higher symptom burden. This research is informed by several years of experience as an oncology nurse where I witnessed firsthand the complexity of effective symptom management. For example, while patients with cancer often report multiple, co-occurring symptoms, these symptoms are often assessed and treated one-by-one. In addition, the symptom experience of these patients is highly variable: with some patients reporting several severe and distressing symptoms and others reporting a lower number of symptoms with lower severity. As described in this paper, symptom cluster research has the potential to address these important clinical issues and improve the symptom experience of patients with a variety of chronic conditions. This paper provides conceptual clarity for the application of two analytical approaches to symptom cluster research and describes novel methods that have recently emerged to facilitate our understanding of symptom clusters.
My program of research centers on health and healthcare inequities in the cancer care sector. The research findings reported in “Access Denied…” represents one component of a multiple methods study that investigated issues of access to cancer care among Indigenous Peoples in Canada, and was the final component of my doctoral dissertation. My interest in issues of inequitable access to cancer care and Indigenous Peoples was born out of my experiences as a clinical oncology nurse, and repeatedly seeing Indigenous patients be diagnosed with advanced cancers, often cancers that we have the ability to detect early and treat. As I started to ask questions of clinicians around me as to why we were seeing these patterns, the responses I received often attributed these late diagnoses to “lifestyle” choices or increased cancer risk. Yet there seemed to be more to the picture that I wasn’t hearing, and I wondered about issues of accessibility, which formed the basis of my dissertation research. The findings reported in this article focus specifically on interviews with oncology nurses to understand their perspectives on the barriers to and facilitators of access to oncology care, which has not yet been explored in existing literature. We were particularly interested in nurses’ perspectives as they provide the bulk of clinical care, daily navigate the tensions between individual patient experiences of illness and suffering and the health system in which they work, and also have experiences of caring for Indigenous patients over time and various practice settings. Nurses provided important insights into many of the challenges surrounding access to oncology care and drew attention to the actual and potential work of oncology nurses in addressing these inequities. It seems the role of nurses is not often considered in relation to healthcare access, however these findings open space to not only see the valuable work being done by nurses, but to consider where and how we, as a profession, could better to confront inequities in access to oncology care for Indigenous Peoples by addressing healthcare access at all levels.
Nurse educators have a responsibility to prepare students for ethical and safe client care, which is why significant efforts are put into preserving the academic integrity in assessments. We believe that authentic open-book take-home exams are a tool that can be structured and delivered in a way that minimizes cheating possibilities. This article explores how to enact Critical Caring Pedagogy by role modeling integrity during value-based dialogue. In addition we discuss why students may cheat and how educators can design their exams in a way that prevents cheating possibilities (see Figure). We hope that this discussion stimulates discussion and debate around how to create (nearly) cheat-proof authentic exams.
A Student-Centered Approach to Authentic Written Exams
I learned a tremendous amount of information during my PhD coursework. I can still remember sitting in my Theoretical Basis of Nursing Research course, discussing the importance of defining variables precisely and transparently. My classmates and I agreed that if variables were imprecisely defined, operationalized, or reported, trusting the findings of a particular study is more difficult and muddies the science. It was during this time that I began to think more carefully about the common variables used in research reports. Certain fundamental demographic variables, such as sex and gender, are among the most used variables in all research reports.
At the time, many questions circled my mind, including (but not limited to):
Do researchers carefully decide whether they will use sex, gender, or both as variables in their studies?
How precisely are sex and gender defined and operationalized in nursing research?
How much ambiguity exists in the way that sex and gender are described in research reports?
Do researchers understand the difference between sex and gender?
Simultaneously, I was beginning to think about my dissertation study – what variables I would include and how I would define and operationalize these variables. Notably, my dissertation work focused on women’s experience of prodromal myocardial infarction symptoms – those symptoms that occur in the days, weeks, and months before myocardial infarction. Thus, it was especially important for me to think about what I truly meant by women’s experiences… Did I mean biologically female (at least as assigned at birth, based on genitalia)? Did I mean woman, as in a person who identified as a woman, even if their sex assigned at birth was not female? Or did I mean something else?
As a first step in answering the many questions that I had about sex and gender, I undertook a comprehensive literature review, ultimately penning an article titled “Words Matter: Sex and Gender as Unique Variables in Research,” also published in Advances in Nursing Science. This initial paper helped me focus my thinking regarding these two variables, and upon completion of my PhD, I decided to more fully explore how sex and gender were used in the research published in nursing journals.
I collaborated with Dr. Valentina Fillman to conduct the present study. She and I had long discussions about what research questions to include and how best to capture what was “happening” in the nursing literature. Ultimately, we decided that we needed to start at a basic level, given that limited information has been published about how sex and gender are specifically used/reported in research published in nursing journals. We felt that this initial work could point us in new directions moving forward – highlighting areas requiring additional focus or attention.
While I will let the article speak for itself, so to speak, the bottom line is that we found a large amount of ambiguity in the way that sex and gender were defined, used, and reported across the articles included in our study. It is important to note that in some cases it was difficult to know how authors defined or used sex and/or gender, given that reporting was limited. However, even when sex and/or gender were more clearly reported, issues of ambiguity or imprecision were common. In some cases, sex and gender were used interchangeably, and it was difficult to know which of these variables the authors truly measured.
Ultimately, the findings of this study led me to the conclusion that all researchers need to decide with more care a) whether they will use sex, gender, or both as variables in their research, b) how they will define and operationalize these variables, and c) how they will clearly report these variables. As researchers, I think that we sometimes become so focused on defining and measuring outcome variables that we take the demographic or independent variables in a study for granted. Perhaps these demographic variables have become so familiar that we do not give them additional thought. However, I hope that this paper serves to remind us all of the importance of carefully measuring and reporting sex and gender in research.
Our area of interest is obesity, especially the problem of obesity recidivism. Intensive efforts to promote healthy eating and higher physical activity, alone or in conjunction with pharmacologic agents or surgical interventions, have failed to quell obesity prevalence. Furthermore, decades of research have shown weight loss produced by a negative energy balance, or caloric intake below energy expenditure, is attended by a reduction in the basal metabolic rate that suppresses further weight loss and promotes fat recovery. This annoying but consistent outcome suggests to us that obesity may serve a functional, protective function. Furthermore, if excess fat serves a functional purpose, losing weight in obesity that does not resolve the underlying environmental stimulus may exacerbate the biological drive to gain more fat. Based on this framework, we surveyed the literature in search of antecedents or precursors of weight gain, adipogenesis, or increased fat mass that could explain intractable obesity.
Our research revealed that a major function of adipose tissue is maintenance of core body temperature, and the body’s temperature regulation is highly integrated with body mass and energy expenditure. White adipose tissue reduces heat loss through the skin, while brown adipose tissue dissipates or disperses heat. Increasing body temperature activates temperature-sensitive hypothalamic receptors to reduce food intake and simultaneously stimulates brown adipose tissue energy dispersal. Hypothalamic detection of cooler body temperature stimulates food consumption and lowers energy expenditure.
Other research shows normal body temperature in Americans has declined in men and women over the past century, which could explain the concomitant rise in the population’s adiposity. Increased exposure to air-conditioning also corresponds to the acceleration of obesity rates during the same time frame. We also found research that demonstrates exposure to whole-body warm ambient temperature is associated with fat loss in human subjects.
We conclude declining core body temperature and lower ambient temperature may be an important contributor to intractable obesity. Revisioning clinical obesity as a problem of adaptation to pervasive low ambient temperature offers a new perspective for obesity research and management.
My research interests focus primarily on pregnant women in vulnerable contexts and prenatal nursing care. Soon, I will be submitting my doctoral dissertation, a descriptive and interpretative qualitative study aimed at better understanding the prenatal nursing care experience of pregnant women in vulnerable contexts. The experience of prenatal nursing follow-up has a significant influence on women’s use of health services. The nurse’s pregnancy follow-up can contribute to preventing health complications for both the mother and the fetus. In my doctoral project, I identified the factors influencing the experience of prenatal nursing care for these women, the way in which the relationship between the pregnant women and the nurse influences the experience of prenatal nursing care, as well as avenues for improving the prenatal nursing care experience of pregnant women in vulnerable contexts.
The current ANS featured article is titled “Self-management of the Dual Diagnosis of HIV/AIDS and Diabetes During COVID-19: A Qualitative Study” by Julie A. Zuñiga, PhD; Heather E. Cuevas, PhD; Kristian Jones, PhD; Kristine Adiele; Lauren Cebulske; Livia Frost; Siddhaparna Sannigrahi, BS; Alexandra A. García, PhD, RN, FAAN; and Elizabeth M. Heitkemper, PhD, RN. The article is free to download while it is featured and we welcome your comments and responses here! Dr. Zuñiga sent this message about her work for ANS readers:
My area of research is HIV self-management and HIV prevention in under-represented communities. I recently completed an NIH-funded mixed methods study of people with the dual diagnosis of HIV and diabetes to explore self-management barriers and facilitators for both conditions. From the findings, we extrapolated that social determinants of health were more influential in this population than in people living with HIV only. In the context of Covid, it became easier for some people to engage in some diabetes management behaviors during the lock down period. With the stigma of blood and HIV, it can be uncomfortable for people with the dual diagnosis of HIV and diabetes to test blood sugar outside of their homes or around others. My current study continues the stigma and discrimination research umbrella with a focus on barriers, facilitators, and preferences for HIV prevention in the transgender and gender expansive community.
The current ANS featured article is titled “Coaching for Childbearing Health: A Theory Synthesis” authored by Jennifer M. Ohlendorf, PhD, RN and Lisa Anders, PhD, RN, IBCLC. This article is available at no cost from the ANS website while it is featured! Here is a message from Dr. Ohlendorf about the importance of this work:
One of the highest priorities of nursing and advanced nursing practice is health promotion, specifically health behavior change. Over the past 20 years, the science of health behavior change has developed into the science of self-management—because most of the actual “doing” of health promotion is comprised of daily choices made by people in the midst of their complicated lives. What this means is that providers must find effective ways to use the limited time they have with patients to influence health behaviors people may engage in in their daily lives.
In my work, I am interested in patient-centric approaches to making physical activity and nourishing eating behaviors part of the perinatal transition. Transitions are periods of disorganization, followed by a process of engagement in the life change, and then a period of reorganization. The way the transition unfolds results in a person having achieved a new identity. Nursing interventions aimed at key timepoints–taking into account the context of the person’s life–to promote positive self-management can result in the person having incorporated health behaviors as part of this new identity.
This article presents a model that can be used during perinatal care visits to engage in goal setting and planning with pregnant people to promote physical activity and nourishing eating behaviors. The Coaching for Childbearing Health (CoaCH) Model incorporates salient concepts from Ryan and Sawin’s Individual and Family Self Management Theory (2009) and from Meleis’s Transitions Theory (2000), along with qualitative data women shared as part of a goal-setting intervention during pregnancy. The qualitative data was keyThe resulting model can be used to design context-appropriate interventions nurses could use in prenatal practice to promote healthy behaviors across the perinatal transition.
This model has already been used to design a coaching intervention and feasibility testing is complete for the intervention. Next steps are to work with our clinical partners to begin a full-scale trial so that, in the future, this coaching can be implemented by nurses in perinatal practice to partner with people who are pregnant or postpartum to develop sustainable, healthy behaviors.
Communication is a core competency in oncology care and a heavily discussed topic for healthcare professionals. Additionally, much of this information and research is applied broadly and in many different contexts. During my PhD program, I started taking classes and learning more about Critical Race Theory and Feminist theories. It made me start to question whether important voices were being left out of oncology care conversations, particularly those related to interpersonal communication. When I started this critical concept analysis, I intended to focus solely on looking at interpersonal communication through a critical lens specific to oncology care. However, the lack of literature analyzing the intersections of race, class and gender in health communication is vast. I hope that this article not only highlights that gap but also emphasizes the many areas and opportunities that exist for enhancing our communication to promote more equity in oncology care and considering a wider frame in our traditional conceptualizations related to health communication.
I heard Karin Kirchhoff speak at a conference almost 40 years ago on the topic of accuracy of reference in nursing journals. This topic has been on my mind ever since and I have always used her original research as a benchmark for accuracy. Our study shows that accuracy has improved dramatically over the past four decades. We found low error rates overall and only 1.3% of references (8 out of 666) could not be retrieved at all. I attribute much of this change to electronic resources for searching, retrieval, and reference management, at both the local and global level. This is a very positive finding.
One thing that struck me, as I sorted through and carefully looked at actual citations, is how little the format has changed, even though the type and location of sources has changed dramatically. APA style was first introduced in 1929 and at that time they asked for the author name(s), article title, journal title, year, volume, and page numbers. At that time, those guidelines probably sufficed for the vast majority of citations, except for maybe the occasional dissertation or reference to a legal citation. Now, almost 100 years later we are basically using the same format, with the addition of the DOI. However, how and where we retrieve information is vastly different. Print journals are no longer the norm; in fact, it is probably safe to say that journal articles are no longer the primary source for information. They share the stage with reports, white papers, policy briefs, legislative documents, blogs, dissertations, fugitive literature and more. Does this 100 year old APA format really work to provide accurate and concise information to retrieve a citation anymore? Maybe it is time to rethink what exactly needs to be included in a citation and make it as streamlined and versatile as possible. Scholars, authors, and students need to be able to move beyond styling references as part of their authorial activity. It’s tedious and time consuming and at this point, provides very little added value. Time to call for a reference citation revolution!
The essential 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.
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE) www.publicationethics.org
The ANS Blog provides a forum for discussion of issues raised in the articles published in Advances in Nursing Science. We welcome all authors and readers to post your comments and ideas on the blog! If you would like to be an author on this blog, let us know!
The journal Editor is Peggy L. Chinn, RN, PhD, FAAN. Dr Chinn founded the journal in 1978.
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A wonderful serenity has taken possession of my entire soul, like these sweet mornings of spring which I enjoy with my whole heart. I am alone, and feel the charm of existence in this spot, which was created for the bliss of souls like mine. I am so happy, my dear friend, so absorbed in the exquisite sense of mere tranquil existence, that I neglect my talents. I should be incapable of drawing a single stroke at the present moment; and yet I feel that I never was a greater artist than now.