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Posts from the ‘Editor’s Picks’ Category

Power & Resistance in Mental Health Practice


The current featured ANS article is titled “Power and Resistance: Nursing Students’ Experiences in Mental Health Practicums” by Allie Slemon, MSN, RN; Vicky Bungay, PhD, RN; Emily Jenkins, PhD, RN and Helen Brown, PhD, RN. As the authors state, this article adds to the need for interventions that respond to everyday power imbalances in mental health care settings, and I believe, in all health care settings. The article can be downloaded at no cost while it is featured, so we invite you to read this article and return here to share your comments.  Allie Siemon shared this background about her work:

Allie Siemon

This article presents findings from my Master’s thesis work on nursing students experiences of their mental health practicums.

My clinical background is in mental health nursing, and I previously worked as a Clinical Instructor supporting students through their mandatory mental health practicum in a general nursing program. Through this experience, I observed how many students struggled with many of the particular challenges this practicum: fear of violence, worrying about being unable to make a difference, and navigating new systems such as locked doors and seclusion rooms. Yet as much as students expressed difficulty in navigating these challenges, they also demonstrated a deep commitment to their patients’ safety and well-being.

Vicky Bungay

In my Master’s degree, I began to examine the evidence on mental health practicums in nursing programs and found a small yet powerful body of literature illustrating that students in mental health practicums across many countries experience the types of challenges I had observed in my educator role. I also found that these experiences that students were having in their practicums negatively impacted students’ overall preparedness to work with individuals experiencing mental health challenges. Supporting students in navigating difficult mental health placements is a gap in our nursing education programs, and extends to gaps in mental health care delivery. To date, there have been relatively few qualitative studies that have contributed nuance and depth to our understandings of how students experience these practicums and navigate these challenges that have been illuminated largely through quantitative and survey-based research.

Emily Jenkins

I hope that this article can support nursing educators like myself in supporting students through the challenges of the mental health practicum, and can inspire nurses and nursing managers to shift practices in the mental health inpatient setting that are difficult for students and, importantly, patients. I also hope that thinking about mental health practicums as a space where resistance to power is possible can give students a new language and perspective on navigating complex environments and challenging experiences in the mental health practicum. I believe when students feel empowered and supported, they can demonstrate compassion, engagement, and commitment, and make an incredible difference in the experiences of their patients.

Helen Brown

Throughout the process of my Master’s research, I was supported by my committee: Vicky Bungay, Emily Jenkins, and Helen Brown. Each of them has contributed immeasurably to the research and to this article.

Reflective Action for Social Change


The latest featured article in ANS is titled “Cultivating Praxis Through Chinn and Kramer’s Emancipatory Knowing” authored by Jessica Peart, BSN, BA, RN and Karen MacKinnon, PhD, RN. In this article the authors explain how emancipatory knowing provides nurses a formal structure to recognize the sociopolitical factors affecting wellness, while making evident the ethical imperative and central role of taking reflective action toward social change—the praxis of nursing. The article is available for download at no cost while it is featured, and we welcome your comments and ideas!  Here is a message from Jessica Peart about this work:

What do we value as nurses?  What is important to know in order to practise safely, competently, and ethically? These questions took on a new meaning when I started my Masters of Nursing program last year as I study to become a Nurse Practitioner.

Jessica Peart

  My background—prior to my nursing career—as a community organizer laid the groundwork for seeing nursing through the lens of social justice.  The perspective, skills, and knowledge I garnered through my community work is threaded throughout my daily nursing practice.  In fact, they are integral to my “nursing toolbox” as a client and community advocate, in the critical empathy that I display supporting clients “on the margins”, and in my comfortability in the “grey” areas of our practice where nursing isn’t well represented by tick boxes or flow sheets.

But how do nurses, especially those pursuing advanced practice roles, develop competencies that forward the social justice lens that foregrounds our ethical practice when they came into their nursing role without a background in social justice work?  Following this path of inquiry in my MN coursework led me to Peggy Chinn and Maeona Kraemer’s exploration of emancipatory knowing as a means through which nurses can better understand the socio-political forces affecting our clients and take action towards more equitable social relations.  The mandate for nursing as social justice is clear, but the path we take to get there might not always be.  I found that Chinn and Kramer’s emancipatory knowing can help nurses to shed a light in the directions we might take towards cultivating the reflective practice that we have come to know as nursing praxis.

 

 

Emancipatory nursing, the environment, and anti-oppressive practice


Our featured article for the coming two weeks is titled “A Theoretical Framework for

Elisabeth Dahlborg- Lyckhage

Emancipatory Nursing With a Focus on Environment and Persons’ Own and Shared Lifeworld” by Elisabeth Dahlborg Lyckhage, PhD; Eva Brink, PhD and Berit Lindahl, PhD. In this article, the authors conceptualize “rooms” that re-focus understanding of the central phenomenon of the person’s experience of health, along with the central influence of the environment in shaping that experience (see model below). The theoretical framework leads to understanding and action in the form of anti-oppressive practice (AOP). They state: “Knowing

Eva Brink

the complexity involved in defining health is basic to understanding a person’s experiences of health. But, in contemporary nursing, definitions of health need to be complemented by more explicit critical and environmental aspects, the aim being increased equality and social justice.” (page 344).  Dr. Dahlborg-Lyckhage shared this message about their work:

Due to a growing inequity, regarding both health and received care among different groups we propose an emancipatory theoretical framework for nursing care practice. The focus on environment is a way of connecting to Nightingale’s work, although in the

Berit Lindahl

Western world of today there are other problems in the environment that affect nursing care. By using the metaphor room, we scrutinize our environment, from the philosophical level to the interactions between care seeking persons and the professionals. We hope that the paper will contribute to the existing literature on equality in nursing.

 

Promoting Mental Health of Female Veterans


Our current featured article, which also provides 1.5 Continuing Education contact hours, is titled “Clearing Away Past Wreckage: A Constructivist Grounded Theory of Identity and Mental Health Access by Female Veterans,” authored by Lindsay Williams, PhD, MS, RN, PHN, PMP; Carol Pavlish, PhD, RN, FAAN;Sally Maliski, PhD, RN, FAAN; Donna Washington, MD, MPH. This article provides important insight to understand how women Veterans make health care–related choices and process traumatic events (such as military sexual trauma). This article is available at no cost while it is featured, and I hope you will share your thoughts about this work!  Here is a message that Dr. Williams has provided giving some background to this article:

This is a culmination of work from my dissertation that recognizes the service of women Veterans and their experiences before, during, and after their military service that ultimately lead to the use of mental health outpatient services.

Lindsay Williams

My interest in this work stemmed from my professional and personal passion to advocate for vulnerable women and amplify their voices. Women Veterans face tremendous obstacles from the pressures of military service, but I wanted to delve deeper into their lives before and after service and explore what led them to the military, and what happened to them once they left. Not being a Veteran personally, I was concerned about my placement as a researcher, and that participants would perceive as someone seeking to exploit their stories. Fortunately, I had the support of my advisors: Drs. Carol Pavlish, Sally Maliski, and Donna Washington in exploring this topic by preparing me with the tools to respectfully approach, and interview this group of women. I used Constructivist Grounded Theory methodology, as articulated by Charmaz (2014), to inform the development of the interview questionnaire with a focus on decision-making for outpatient mental health services. Using that as a starting point enabled me to maneuver backward and forward in how I approached the interview and the questions I asked.

In the course of completing this study, I was honored to interview these women and hear their powerful stories, which were undoubtedly marked by trauma throughout their lives, which became one of the major categories of my model. Another incredible part of their stories were the ways they renegotiated the place, and inherently the value, that trauma had in their lives. They were able to see the positive aspects of their service and see themselves as survivors.

I believe this study has policy and practice implications within and outside of nursing practice. As more women serve and leave the armed forces we have a responsibility to anticipate their needs, advocate for their care, and have timely, trauma-informed, gender-informed care at the ready at all points along this trajectory.

Reference:

Charmaz K. Constructing Grounded Theory. 2nd ed. Thousand Oaks, CA: Sage Publications; 2014.

 

Emancipatory Cultural Competency in Nursing


We are delighted to introduce the current ANS featured article, titled “An Emancipatory Approach to Cultural Competency: The Application of Critical Race, Postcolonial, and Intersectionality Theories” authored by Linda M. Wesp, MSN, RN, FNP-BC; Victoria Scheer, BSN, RN; Ashley Ruiz, BSN, RN; Kimberly Walker, MSN, RN, CHPN; Jennifer Weitzel, MS, RN; Leslie Shaw, MSN, RN, ACNP-BC; Peninnah M. Kako, PhD, RN, FNP-BC; and Lucy Mkandawire-Valhmu, PhD, RN. In this article the authors address the critical need for approaches in nursing education, research and practice that uphold the core nursing value of commitment to social justice.  Download a copy of this article at no cost while it is featured, and share you comments and ideas about these ideas on this blog!  Here is more information about this work from the authors:

Linda M. Wesp

Emancipatory \ i-​ˈman(t)-​sə-​pə-​ˌtȯr-​ē\ (adjective): freeing from any controlling influence1

As peers pursuing a PhD in nursing at University of Wisconsin-Milwaukee, we have found common ground with our professors Dr. Lucy Mkandawire-Valhmu and Dr. Peninnah Kako in a passion for learning about and using critical and feminist theory to shape our thinking and our work, especially intersectionality, critical race theory, and postcolonial feminisms.  The idea of this paper was originally born from several brainstorming sessions between Linda Wesp and Victoria Scheer. As we sat and talked and thought, we kept coming back to our common frustration that the theories we were finding so helpful

Victoria Scheer

and informative in our research were not being talked about in nursing or health care at all, outside of a few PhD level classes.

Early in 2018, Dr. Mkandawire-Valhmu encouraged the group of us using critical theories in our research to join forces with one another and challenged us to think about how we could take these theories and apply them.  The special ANS issue on emancipatory nursing seemed like the perfect fit for the ideas we were already tossing around about various areas of the nursing profession that would benefit from a more critical approach.  Each of us brought a specific working knowledge about the various

Ashley Ruiz

theories we used for this paper, whether intersectionality theory, critical race theory, or postcolonial feminist theory.  One of the main goals of our project was to intentionally and carefully distill the main ideas of these theories and make them understandable and applicable for nurses who may be unfamiliar with them (see Figure).

As we considered our experiences as clinicians, educators, and scholars, we decided that the way nursing approaches “cultural competency” could benefit greatly from the tenets outlined in the various critical theories.  As it is currently conceptualized, “cultural competency” in nursing (and across all health care settings) does not

Kimberly Walker

provide nurses with the tools to identify and disrupt the major structural processes and oppressive ideologies that create marginalization and inequity.  These ideologies are a controlling influence on our profession and health care as a whole. And so, we thought, what if we could outline specific ways to bring an emancipatory approach to our current understanding of cultural competency?  We began in our knowledge of the theories that seek to disrupt oppression and hegemonic thinking that create health inequities, and used this to come up with tools to equip nurses with new ways of thinking about and caring for populations that are different from them (even, and especially, for nurses who are well intentioned and think they are being “culturally competent”).

Jennifer Weitzel

Diving deeply into the theories as we prepared this paper meant we had to do our own personal work about how power and privilege works in our own lives, and think about our own approach to caring for people who are different than us. We also thought a lot about the ways that power and privilege play out in the academy and in our health care institutions, and what that means for us as nurses occupying positions that are generally considered “less powerful.”  These are not always easy realizations,

Leslie Shaw

especially for people who benefit from having more power and privilege because of the color of our skin, or our gender identity, or the country where we were born, or the letters behind our name.

We do not take lightly the magnitude of the emancipatory approach we are proposing here, and yet we feel deeply that we must continue to push for change.  We as nurses must continue to understand how power and privilege work to create and maintain difference and inequality in our

Peninnah M. Kako

world.  Continuing to approach difference in the ways we always have will mean that we completely misunderstand and erase certain populations (e.g. people of transgender experience) and/or that we continue to create unintentional and implicit bias for other populations (e.g. people who experience racialization and are therefore considered “racial or ethnic minorities” in the U.S.).

We hope that this paper is just the beginning of a larger conversation within our profession that can create much needed dialogue and change.  Also, we have so many more ideas to talk about!  We hope to spark ongoing

Lucy Mkandawire-Valhmu

ideas, that might begin with questions like: Where else have nurses already been applying an emancipatory approach to cultural competency, as we suggested here, in our educational and clinical programs?  What does it look like for nurses to remain self-reflexive about our own biases?  How does implicit bias contribute to inequitable patient outcomes?  What would it look like for the nursing profession to shift from the phrase “cultural competency” to the concept of cultural safety2, which more accurately represents the emancipatory approach we suggest here?

What have you already been doing or thinking about in this area? We would love to hear from you. As the largest health profession in the U.S., we can create a slow and steady shift that leads to lasting change and health equity for all people.  Please share your thoughts, publish your experiences, and let’s keep the conversation going!

References

  1. Merriam-Webster Dictionary. Available at: https://www.merriam-webster.com/dictionary/emancipate. Accessed October 31, 2018.
  2. Mkandawire-Valhmu L. Cultural Safety, Healthcare and Vulnerable Populations: A Critical Theoretical Perspective: Routledge; 2018.

 

 

Transforming Health Interviews


The first featured article in ANS Volume 41:4 discusses ways to move interviews to approaches that more clearly reflect the context and experience of health challenges.  The article is titled “Creating Emancipatory Dialogues About Identity and Health by Modernizing Interviews,” authored by Doris M. Boutain, PhD, RN, PHNA-BC; Robin Evans-Agnew, PhD, RN; Fuqin Liu, PhD, RN; and Marie-Anne S. Rosemberg, PhD, RN. The article will be available to download at no cost while it is featured, and we invite you to read it and join a discussion in this blog!  The authors sent this message about this work for ANS blog readers:

Imagine the following scenario: it is the afternoon of a school day and a health

Doris M. Boutain

researcher, the recruited youth, and parents meet for the first time. The place is a quiet corner of a public café selected by the parents who will give their consent for research participation. The researcher explains the study using consent forms previously distributed to the family to read. The parents ask a few questions and then sign the consent form. The youth also signs the assent form. Then the researcher conducts a short interview asking the youth some pre-selected, close-ended questions about demographics and establishes a follow-up meeting time. What is the value of the information collected in this encounter, and who owns this value? How does this

Robin Evans-Agnew

encounter set up the power-relations for the development of knowledge for the remainder of the research study? What did the researcher miss that might have been important concerning the identity and health of the youth.

We developed this article to share another way to design an interview. Dr. Boutain was first introduced to the need to transform the interview in her dissertation research on hypertension management with African Americans in rural South Louisiana in 1999. In her dissertation, she describes a story of how she developed her interview questions using the advice from two neighborhood groups who both instructed her to modify the interview question “How much money do you earn in a year?”, by phrasing it differently and having a different target

Fuqin Liu

of inquiry. Namely, they suggested the two questions, “Are you doing okay making your ends meet?” together with “How does making ends meet affect your blood pressure?” The neighborhood groups’ suggestions led Dr. Boutain to consider a genesis of power in the interviewer-interviewee relationship. Namely, two questions became apropos: Who decides which questions to ask in the interview?, and Which interview questions are most meaningful for research participants?. The neighborhood groups taught Dr. Boutain to ask about the relationship between identity and health, and to care about the research participants’ way of relating their identity to their health in the process of the interview. The neighborhood groups provided a public service to Dr. Boutain and created the emergence of the Identity-Research-and Health

Marie-Anne S. Rosemberg

Dialogic-Open-ended interview (I-REH-DO).

As former graduate students and current colleagues working with Dr. Boutain we identified ourselves in a participatory scholarship group called “Scholars Ready”. Drs. Evans-Agnew, Liu, and Rosemberg, applied the I-ReH-DO interview in their own research beginning in 2010. Our article is an opportunity to provide new insights into the application of the I-ReH-DO interview across diverse, and critically situated, research interests. Our work involves community-based inquiry and health interview environments similar to the scenario above. Dr. Rosemberg’s interests lie in transnationalism and immigrant worker health, including people working in hotels and nail salons. Dr. Liu conducts inquiry about global maternal child health, especially in preconception and interconception care policy in China. Dr. Evans-Agnew focuses on childhood asthma inequities, citizen science, and environmental justice with Latina and African American groups. Dr. Boutain, as the John and Marguerite Walker Corbally Professor in Public Service at the University of Washington, has deepened her interests in systems research to promote knowledge about how to sustain health equity policies and practices with community-based organizations, faith-based organizations, and public health programs and services.

As scholars ready to advance emancipatory research methodologies, we are excited to publish the use of the I-ReH-DO interview. We regard the I-ReH-DO interview as an important visioning tool for new and experienced researchers to elicit novel ways of knowing about identity and health. The I-ReH-DO interview will facilitate research encounters which advance the power of participants to define their identity and health in a way that is significant and relevant for them. Thus, we as researchers will support the emergence of emancipatory research generation. We envision that the use of the I-ReH-DO will: (1) facilitate knowledge generation from participants who define themselves for themselves; (2) extend the close-ended facet of demographic surveys to result in rich contextual data; (3) inform sustainable programs/interventions that are applicable to individuals’ identity; and (4) foster changes in structural/systemic forces that participants identify as drivers of their health.

Doris M. Boutain
Robin Evans-Agnew
Fuqin Liu
Marie-Anne S. Rosemberg

 

Structuring Nursing Knowledge


The current ANS featured article presents a new way of structuring nursing knowledge.  It is title “The Nursing Knowledge Pyramid: A Theory of the Structure of Nursing Knowledge” by Veronica B. Decker, DNP, PMHCNS-BC, MBA and Roger M. Hamilton, PhD.  This article is available to download at no cost while it is featured, and I join the authors in inviting you to post your comments here, and to join in a discussion of their work!  Dr. Decker shared this message about the evolution of this work:

Veronica Decker

The idea for the Nursing Knowledge Pyramid started in the fall of 2012 when I was in my first semester of a Doctor of Nursing Practice (DNP) program at Wayne State University. I was going to school full time and working full time. I was (and still am) living in Orlando Florida and I attended my courses synchronously on-line. The internal visual I maintain from this time includes seeing my cohort in their classroom seats in downtown Detroit, while I was in front of my lap top video cam in the den of my home, in sunny Florida. Most of the time, my fellow classmates would instant message me that they were a little jealous of the weather.

I was taking a course on foundations in nursing from doctors Nancy George and Rosalyn Peters when my work on knowledge development started. I was trying to get my head around integrating philosophical and theoretical perspectives of nursing to create a solid foundation for nursing practice and meet the requirements of an assignment for the course, which included a very detailed rubric. The paper I submitted to my professors was titled Toward a Theory of Cancer Coping. I titled it after Imogene King’s 1971 – Toward a Theory for Nursing: General Concepts of Human Behavior in mind. It made sense to me because I realized my ideas weren’t fully established yet, but I had made a solid start. This first document included a concept map that aligned King’s conceptual system with my own nursing system model, which included the Nursing Knowledge Pyramid. Over the next two years, nearly every assignment even remotely asking for use of theory, I would continue to enhance and better define this work.

As many of you know, DNPs are required to complete projects rather than the traditional PhD dissertation. To meet the requirements of my program, I completed two projects. A clinical performance improvement project (Decker, Howard, G.S., Holdread, H., Decker, B.D., Hamilton, R.M. 2016). and a theoretical application by developing a practice theory called Substructing a Cancer Coping Rule-base, which included the Nursing Knowledge Pyramid.

The Nursing Knowledge Pyramid (NKP) is a practical approach to support nursing practice. In my DNP program I was able to use the pyramid as a means of bridging the gap between theory and practice. As an experienced psychiatric mental health advanced practice nurse (APRN), I could operationalize the research project by methodically going from abstract knowledge (bottom of the NKP) to the concrete knowledge (top). The abstract level of the project was my knowledge as an APRN developed over my 30 years of experience. The middle tiers indicate the theoretical underpinnings and evidence-based practice. The most concrete knowledge at the top of the pyramid was the rule-base used to offer my patients coping strategies to handle their distress. Most recently we utilized the NKP to help develop the key conceptual relationships and theoretical foundation for a case study where the patient had an unrealistic fall risk appraisal. The patient was treated with a feedback strategy to reframe her perception of risk of falling. I’m interested in feedback from others who are considering using the NKP in their research.

References

Decker, V.B., Howard, G.S., Holdread, H., Decker, B.D., Hamilton, R.M. (2016). Effects of an Automated Distress Management Program in an Oncology Practice. Clinical Journal of Oncology Nursing, 20(1), e9-15.

King, I.M. (1971). Toward a Theory for Nursing: General Concepts of Human Behavior. New York, NY: Wiley.

Theory Development Strategies for Middle Range Theories


The current featured article in ANS provides an analysis of methods used for development of middle-range theories over the past decade, titled “Theory Development Strategies for Middle-Range Theories” by Eun-Ok Im, PhD, MPH, RN, CNS, FAAN. Download the article at no cost while it is featured!  Here Dr. Im describes the background of this work:

First of all, I want to say that it is my great honor to have another paper published in Advances in Nursing Science.  Advances in Nursing Science has

Eun-Ok Im

been my number one journal in learning, developing, and disseminating my theoretical works throughout my career. I really appreciate all the works in Advances in Nursing Science that have been the insights for all my theoretical works.

This summer, I was in Australia, “the land down under.” They were having a winter while it was an obvious hot summer in North Carolina where my home was (please enjoy the below pictures from Australia; Koala was sleeping while showing only their back, and the winter beach had lots of rain and winds). Their cars were driven on the opposite direction; drivers were sitting on the right side and cars were going on the opposite lanes. So, I needed to think from the opposite side even when crossing the streets. Likewise, this paper started from the opposite side of a meta-theorist (that I personally identify myself); what students would want to know about middle range theories.

This paper was initiated because of my PhD students who asked me about theory development strategies that had been used in development of middle range theories.  I had a class on middle range theories versus situation specific theories. Unlike situation specific theories whose development methods were clearly proposed in the literature, the theory development methods used for middle range theories were not clear in the literature, and the students were asking what had been recently used in development of middle range theories and how they could develop their own middle range theories. Unfortunately, I could not articulate a clear answer for their questions although I knew about several strategies that had been proposed and used to develop middle range theories in the literature. I didn’t have any idea on how middle range theories have been developed in recent years. That was the start point of this paper. From a student’s perspective, I myself wanted to know how middle range theories had been developed during the past 10 years.

Although the task of conducting a systematic integrated literature review was extensive, I need to admit that this literature review did not include the middle range theories that had been developed before 10 years ago. Thus, many of the famous and widely used middle ranges theories are missing in this review. I just wanted to see the currently used theory development strategies in the past 10 years so that I could see the current trends and provide directions for future development. Another point that I need to admit was: there was no in-depth investigations on the philosophical and methodological aspects of the middle range theories in this paper because many of the articles on middle range theories that were reviewed did not specify their philosophical and methodological bases of theory development; many of them were confused even on the types of theories that they developed.

Despite these limitations, it was obvious that middle range theories became an essential part of theoretical bases in nursing, and I can see their steady and continuous development during the past decade. At the same time, I can see the necessity of further development of middle range theories in their philosophical and methodological bases. Hope this article could give an understanding on what is happening in development of middle range theories and hope this could give some insights to future theorists as I got my insights from the theoretical works that have been published in Advances in Nursing Science.

Best luck to all of us during this hot summer~  Or, cold winter (for many of us)~

From Eun-Ok Im, in Summer, 2018 in the U.S.

 

 

 

Nursing Health Assessment Using Storytelling


The current ANS featured article reports a project that demonstrates how storytellng as a means of assessment has the potential to expose the complexities of health experiences that are not readily uncovered using standard assessment approaches.  The article is titled “Narrative Inquiry Into Shelter-Seeking by Women With a History of Repeated Incarceration: Research and Nursing Practice Implications,” authored by by Amanda Marie Emerson, PhD (English), PhD (Nursing), RN.  Dr. Emerson shared this information about her work:

I had the enormous good fortune during my PhD program in nursing (2017,

“The Sexual Health Empowerment (SHE) for Cervical Health Literacy and Cancer Prevention study team, December 2017: (Back row) Katherine Gwynn, Amanda Emerson, Molly Allison, Brynne Musser. (Front row) Joi Wickliffe, Megha Ramaswamy (PI), Shelby Webb. Used by permission.

University of Missouri-Kansas City) to become part of an interprofessional team (RNs, public health professionals, health educators, medical residents, social workers, a sociologist, and even a historian!) doing cervical cancer prevention research led by Dr. Megha Ramaswamy (PI) at the University of Kansas Medical Center, and my mentor Dr. Patricia Kelly (Co-I) (UMKC). The Sexual Health Empowerment (SHE) study, funded by the National Cancer Institute, sought to learn whether a interactive, trauma-informed, small-group intervention centered on cervical health literacy and feminist principles would increase up-to-date Pap screenings among women detained in county jails. We implemented the program with successive cohorts of women over 2 years beginning in 2014 and have been following up for 3 years. In addition to my role in the intervention itself, I took part in an ethnographic sub-team that conducted interviews and participant observation with a group of volunteers in the community after their release.

The Advances in Nursing Science article reports on a series of particular interviews I conducted with those women. We were initially impressed by the variety of strategies women used in highly challenging circumstances (i.e., poverty, physical and emotional abuse, child separation, even during incarceration) to get and give social support to one another. In my analysis of the interviews—a course of coding, reiterative reading for themes, memoing, discussion with team members—a particular set of stories coalesced. Almost to a woman, the participants in our follow-up research struggled to find secure housing when they returned to the community. This basic need drove many of the stories they told, organizing how they perceived and interacted with others and impacted how they understood choices related to their health and safety. It bears noting that I have a background in literature as well (PhD, 2004) where I learned to recognize the power of stories to give form to versions of self and other, to shape feeling and motivate behavior. The stories about shelter-seeking told by women with histories of repeated incarcerations in this study were not long, but they were rich in implications for the women’s health. The analysis I present in this narrative inquiry maps a couple key trajectories the stories about shelter seeking take and serves as a call to nurses who work with women in the community who may have backgrounds involving incarceration. I urge nurses to listen up, to make stories part of the assessment. As my analysis illustrates, those narratives can carry otherwise unavailable information about threats to health and safety and open up valuable opportunities for nurse-led education and advocacy.

 

Testing a nurse developed, patient-centered health tracking app


The current featured article in ANS is titled “The Usability and Acceptability of a Patient-Centered Mobile Health Tracking App Among a Sample of Adult Radiation Oncology Patients,” authored by Susan D. Birkhoff, PhD, RN; Mary Ann Cantrell, PhD, RN, CNE, FAAN; Helene Moriarty, PhD, RN, FAAN; and Robert Lustig, MD, FACR. The article is available at no cost while it is featured on the website!

In speaking about this work, Dr. Birkhoff emphasized how important it is for nurses to be involved in designing, creating, and evaluating digital tools. Nurses, she believes, have a rich perspective on what patients need, arising from their close relationship with patients.  Her work reported in this article arises from her realization that existing digital tools lack the perspectives that nurses bring to healthcare. In this video, she speaks to her experience conducting this study, and why it is important.

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