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Posts from the ‘Editor’s Picks’ Category

Dec 10

9 Comments

What’s the Point of the Evidence Debate?


We have just published ahead of print an article that will be published in the first issue of 2014!  The article is titled “Particularizing the General: Sustaining Theoretical Integrity in the Context of an Evidence-Based Practice Agenda” by Sally Thorne, PhD, RN, FAAN, FCAHS and Richard Sawatzky, PhD, RN.  Dr. Thorne and Dr. Sawatzky have extended their discussion of the “evidence” debate with this message for ANS blog readers:

Although we realize that “the evidence debate” may seem like a tired topic for some readers, we think it remains one of the most important avenues through which nurses can find their grounding in why the philosophy of science really matters to our discipline. Health and public policy get made on the basis of a complex and highly

Dr. Sally Thorne

Sally Thorne, PhD, RN, FAAN, FCAHS

politicized combination of ideology and science. We tend to think about ideology as if it exists in the world of “the other” and not in our own disciplinary knowledge. And yet, we must recognize that nursing has always been driven by so much more than just empirical science or philosophy, even if we sometimes struggle with how to name, conceptualize and justify those other forms of knowledge that influence our practice.

For us, the history of theoretical and philosophical knowledge-building in nursing is quite fascinating. Although it has taken a lot of twists and turns along the way (some of them sufficiently awkward as to be downright embarrassing), once you clear away the “noise” and reflect on what many of the founding nurse theorists and scholars were struggling with, you realize that they were grappling with incredible complexities. The language they used was sometimes a bit convoluted or misleading, and the competitiveness among the individual theorists and their disciples was at times unseemly. Nevertheless they were trying to work out ways of conceptualizing the rather marvelous constellation of intellectual and behavioral competencies that characterize the practice of nursing when it is done at its best, in order that we could improve our capacity to help nurses achieve that.

Of course if nursing were derived from a simple skillset, then that theorizing and philosophizing would have been

Dr. Sawatzky

Richard Sawatzky, PhD, RN

easy.  But it is not. And that’s what makes the story so fascinating. Patients are complex and adaptive, and so are we. The social and ideational worlds within which people experience health and illness are dynamic, multilayered, and fraught with uncertainties and complexities.  The thinking nurse – that nurse we refer to as “expert” within his or her population group or setting – is always skillfully navigating that great chasm between science (which represents the general past) and context (which represents the particular moment), not to mention looking forward to considerations of possible implications for the future.

In re-entering the “evidence debate” in this manner, we wanted to juxtapose ideas about how we make sense of knowledge that comes from certain kinds of formally derived scientific processes with those that have to do with nursing’s inherent interest in the individual case. We believe that the trend towards standardized practice in health care during recent decades (e.g., reliance on general clinical practice guidelines) is increasingly at odds with notions of heterogeneity and individual differences (or “anti-standardization”), such as those prompted by field of personalized medicine. Just as many forms of medical management are moving away from population-based science (i.e., reliance on population averages) toward novel targeted and individualized therapies arising from genomics, proteomics and pharmacogenomics, we believe that nurses will need systems and structures through which to focus and strengthen individualized care and patient-centered approaches. These are not simply vague abstractions, but complex and challenging dimensions of the intellectual approach that nurses must always bring to their practice.

So for us, it seems useful to really push nurses toward clarity in what does and does not constitute evidence in the conventional sense. Slippage with how we frame the basis of what we think we know will only serve to discredit our profession as a credible contributor to the larger world that is wrestling with these evolving ideas. We are concerned that the tendency to reconceptualize certain forms of knowledge as “evidence,” in an attempt to obtain credibility, will not serve the nursing well. Nursing practice and theories are unavoidably influenced by many valuable forms of nursing knowledge that do not necessarily conform to conventional notions of “evidence.” Rather than “branding” all nursing knowledge as “evidence,” nurses are challenged to articulate what these “non-evidential” forms of knowledge are and what the basis is of their justification. We want to remobilize an enthusiasm for why nurses ought to care about the nursing theory world by bringing into focus the relevance that disciplinary thought has in the larger world of contested practices and influence upon futures.

We keep returning to this idea that the dialectic between the general and the particular is really the essential element in the uniqueness of nursing knowledge, our defining characteristic, the idea best captures what we are.  As we continue to develop our collective expertise and wisdom with regard to evidence generation and interpretation – figuring out how we learn about the patients of the future through systematic and rigorous exploration of the past – it will be imperative that we not forget the “artform” of individualized holistic care, enacting relational practice, and taking an intersectional lens on the social determinants that may be shaping the health and illness experience of the patient who is before us in the moment.

Thanks for taking this journey with us, and we look forward to a lively debate!

You can download this article at no charge now on the ANS web site!  Get it, read it, and come back here to engage in this very important, and interesting debate!

Dec 5

More on eSchoolCare


Our recent post from Dr. Lori Anderson’s featured article titled “The Development and Implementation of eSchoolCare: A Novel Health Care Support System for School Nurses” has drawn the attention of school nurses worldwide, affirming the great need for a support program like the one described in this article.  So I asked Dr. Anderson to provide a response to some of these comments here:

Thank you for the comments regarding the eSchoolCare blog posting. We take very seriously the feedback that we receive from school nurses. We built the eSchoolCare program from the ground up with strong nursing input, so it is gratifying to hear it resonates with nurses. On the other hand, your comments speak to the continued unmet needs of school nurses not only across our country, but worldwide.

One of the most popular features of eSchoolCare is the Community Forum. Nurses tell us that this is often the first place they check when visiting the site. A sample of  the topics from some recent postings: Management of diarrhea in the school, photo-screening, Definition of “medically fragile,” Vision screening for farsightedness, MA Billing, Policy for Service dogs/pets, Communicable disease-prevention, and Chronically absent students. This is a real potpourri of topics but captures the diversity of school nurse practice.  I think the Community Forum is helping to address the isolation that we have seen with school nurses and that the blog replies verify.

These are tight budgetary times and we realize that nurses may not have the funds to subscribe. We have had some very good success with local foundations and businesses sponsoring a subscription for their school nurse/s. If you would like more information on eSchoolCare, on the cost of a subscription, or ideas and sample letters for sponsorship, please emailsupport@eschoolcare.org or visit eschoolcare.org.

Thank you to everyone for commenting!  It is great to hear from you, and hope you will continue to share your ideas along the way!  If you have not already seen Dr. Anderson’s article, it is still available as a free download on the ANS web site!

Nov 30

9 Comments

Innovative support for primary care school nurses


School nurse Lori S. Anderson, PhD is the author of our current “Editor’s Pick” article titled “The Development and Implementation of eSchoolCare: A Novel Health Care Support System for School Nurses.”  In this article Dr. Anderson describes the eSchoolCare program that provides support for 97 school nurses in 67 rural school districts in South-Central Wisconsin.  The article provides background, theoretical framework, implementation and evaluation of this innovative project. Dr. Anderson shared for ANS readers her own background in school nursing, and why this project is so important for nurses who are primary care providers in schools, and for the children and families they serve:

My introduction to school nursing came early. My mother was a long-time school nurse and during my high school years I helped her out during vision and hearing screenings. I loved the independence of her work and the focus on improving the health and well being of school-age children. So following suit, my first job fresh out of nursing school was in a rural school system in southern Wisconsin.  I was responsible for 4,500 students in

Dr. Lori Anderson

Dr. Lori Anderson

six separate school buildings. I quickly learned two things, that the downside of the independent practice was a sense of isolation and that while I had hoped to make an impact on the health and wellness of students through teaching and other prevention activities, my time was largely spent caring for children with chronic health issues, some serious. The seeds for the eSchoolCare project were sown during this time. While I could pick up a phone and call my school-nurse-mother for support and expert guidance, many school nurses were and still are left looking for evidence-based resources to guide their practice and for support to decrease the sense of isolation.

Julia Lear, director of the Center for Health and Health Care in Schools at George Washington University, has used the phrase “hidden health care system” to describe the large number of professionals who provide care to children and youth in schools across the United States. Most of these professionals are nurses and the health care needs they attend to are becoming increasingly numerous and complex. The Affordable Care Act encourages community-based services, yet policy makers and those in the traditional health care arena have little knowledge about this “hidden” system of care.

Nurses are also providing care in homes, workplaces, and long-term care facilities, among others. These community settings provide challenges to nurses similar to those encountered in schools, problematic communication with traditional health services, isolation, and difficulty accessing evidence-based resources to guide care. The solution to these complex challenges will be multi-dimensional. But technology now allows us to bring resources and support to nurses in these settings in a way that we had not done before. Our eSchoolCare project uses mobile technology to bring the expertise and resources of an academic healthcare setting to the nurse in the community, decreasing their sense of isolation and providing them with evidence-based approaches to care delivery. Think of it as the online version of having a “mom” nurse expert on the other end of the phone line.

We are eager to hear your comments and ideas about this important project!  Visit the ANS web site now to download your copy of this article at no charge, and share your comments here!

Nov 18

Human Flourishing: A Nursing Ethic


Our current featured article in ANS is titled “An Innovative Professional Practice Model: Adaptation of Carper’s Patterns of Knowing, Patterns of Research, and Aristotle’s Intellectual Virtues.”  The author, nurse ethicist Barbara Bennett Jacobs, MPH, PhD, RN, translates an adaptation of Carper’s patterns of knowing into a nursing metalanguage of science, ethics, art, and advocacy.  Dr. Jacobs shared this commentary on her work that gave rise to this article:

Barbara-Jacobs300

Dr. Barbara Jacobs

The phrase “change is constant” is being used now by hospital administrators to partially explain the restructuring of departments and services that is often accompanied by acquisitions of smaller and/or regional hospitals into large corporations.  These changes in health care delivery systems are not limited to hospitals, as these corporations include, for example, agencies and services that provide home-care, out-patient services, emergency medical services and other community health care enterprises.  As the template changes, so does the status quo.  This ought to empower nurses to evaluate the status quo and suggest changes within the nursing profession for a number of reasons.  The one most obvious reason is, as Dr. Kagan opines in her guest editorial, – “to make things better.”  Better patient outcomes, better patient health, better prevention strategies, better human flourishing.

Without an underpinning in nursing knowledge, nurses will be ill-equipped to ask critical questions, to analyze the status quo, or through a process of praxis change those practices and structures that are unjust or inequitable in their practice environments.  The ethos of nursing is a strong one and ought to be visible, evident, and valued and unique from the institution’s ethos.  In order to accomplish this in the rapidly changing health care environments, imagination and innovation have the potential to make a difference.  Unfortunately, “change is not constant” in nursing education and practice to the degree it is in other realms of health care.   Take for example electronic charting – a wave of tsunami proportions.  As nurses now are more tethered to the i patient (a phrase coined by Dr. Abraham Verghese to describe the patient as data points) they are less available to move in the patient’s landscape with hopes of performing acts of aesthetic quality or to engage in such a way that is personal, intersubjective and meaningful to the patient.  Yet the technology prevails with support from some nurses, but others lament their loss of time to “be with” patients.  The question to ask is whether some innovation like electronic charting is in harmony with the voice of nursing, the ethos of nursing, and the philosophy of nursing or is it another institutional innovation that requires acquiescence and submission by the nursing population with minor input.

Thirty years ago Carper gave us an understanding of what nurses need to know to do what they need to do that is recognizable, valued, and defined as knowing that can be expressed as knowledge.  The professional practice model concept is fertile territory for planting these patterns of knowing along with other important concepts such as values, virtues, and research in such a way that the model enhances its applicability, adaptability, and usefulness to achieve the telos of nursing.  Professional practice models benefit the institution for sure but the real benefit, the real truth, the real reason to have them is to join in solidarity with those persons, families, and communities who call on nurses to answer the moral call to enhance their threatened human flourishing.

The model presented in this paper has been revised, revised, and revised again so as to reflect the thousands of patient narratives I have been blessed to experience.  The two patients in the paper are real, both having a profound impact on my current role as a nurse ethicist.  Both patients were not only medically complex requiring empiric knowing, both where vulnerable to threats to their self-determination requiring ethical knowing, both ached for meaningful personal encounters with their nurses requiring aesthetic knowing, and both changed (as did the nurses who cared for them) requiring personal knowing as a result of the covenantal relationship.  This model may not appeal to every nurse but the hope is that it will generate dialogue, reflection, and controversy.

Please consider entering in to dialogue here!  Download your copy of this article now while it is featured, and come back here to share your thoughts, challenges and questions!

Oct 25

Overcoming that which divides


The current “Editor’s Pick” article presents what the authors, Geraldine Gorman, PhD, RN and Corinne Westing, MS, RN,  call a “union narrative as a nursing parable.”  Their article is titled “Nursing, Unionization, and Caste: The Lessons of Local 6456” which provides an account of one local unionization effort, as well as an analysis of the far-reaching implications for reaching across that which divides us to create peace in our own communities.  Corinne shared this story of the work she and Gerry have pursued together over the past 5 years:

This article started in some ways in the winter of 2009. President Obama’s first term in the White House. This was during my first semester of nursing school, in Obama’s home town. I was lucky to have as one of my first classes a course intended to help new nursing students navigate the cultural and social transition into the nursing world. Gerry and I found we were completely simpatico. When I entered the Master of Science program in my pursuit of a career in nurse-midwifery, Gerry asked me to share my knowledge and experience or labor organizing as it impacted nursing, by giving a lecture for her class to supplement the presentation

Corinne Westing

Corinne Westing

traditionally given by the Illinois Nurses Association. I had been around the National Nurses United, which represents the nurses at Cook County, University of Chicago, and a few other hospitals in the Chicago area. I had read a few things about nursing strikes over the years and was generally very sympathetic toward organized labor and nurses’ grievances.

During that time, faculty at the University of Illinois began organizing of their own accord. In the wake of the economic crisis that was deeply impacting public education, faculty had every reason to begin to explore organizing. Amidst the hostility surrounding this union drive at the College of Nursing (CON), Gerry and I—and of course other union sympathizers—began a conversation about what was going on. We struggled with the divide between unionization in some of the clinical sites the CON sends its students to and the negative reception nursing colleagues gave the union organizers at the CON. How could unionizing be accepted for rank and file nurses but not for academic nurse workers, especially those in an increasingly stratified workplace like the public university?

Over the semesters, my research into the history of nurse unionism proved challenging. I could not find one single source that could knit together this story—especially not in nursing literature. There would be hints of the back story in labor texts and historical archives. The narrative was unfolding, and it was my pleasure to try

Gerry Gorman

Gerry Gorman

to construct a coherent version that could also shed light on current conditions in academic labor, including in the nursing world.

As frustrating this journey to unearth radical nursing past proved, it also was profoundly rewarding to discover how well nurses belie the myth of the “handmaiden” or subservient comforter. Though women may be socialized to nurture, when put in collective working conditions like the hospital unit, women care workers, like all workers, will eventually struggle. And it turns out that even a tenure-driven, female-dominated academic workplace can contain the seeds of struggle.

We worked on this article through the ups and downs of the card drive at the University, and in the context of a successful strike by Chicago public school teachers. We chewed on the meaning of the mass protests against austerity and union rights just north in Madison while we watched as little organized resistance developed to take on rising tuition costs at our University. We solidarized with the movement of the 99% in Chicago and hoped that Occupy would inspire increased support for campus labor, including professors. We submitted this article in the shadow of President Obama’s second inauguration, as hope of change from above seemed to dissipate, and we struggled with where to go from here. Within UIC United Faculty, negotiations continue; still no contract, still a pressing need to build links between students, faculty, and other campus labor groups to help win this much-needed agreement.

It was an honor to work with Gerry through the process of shaping this piece to contribute to the discussion about how working conditions shape clinical and teaching practice. We are extremely grateful for the opportunity to share this work with you, through Advances in Nursing Science. We hope that this article has inspired critical thought about the roles we play in our workplaces and how, collectively, we can make nursing stronger, on the nursing unit and in the classroom.

Visit the ANS web site today to download your copy of this article while it is featured at no charge and read their account  – one which deeply honors the intent and hope to seek peace in our communities.

Oct 22

Strength Amid Struggle


The current “editor’s pick” article is a notable example of a nursing perspective that is based on people’s strengths as they face health challenges, not solely on the challenges themselves.  The article, titled “Intimate Partner Violence in Mexican-American Women With Disabilities: A Secondary Data Analysis of Cross-Language Research” is authored by Chris Divin, MSN, RN, FNP; Deborah L. Volker, PhD, RN, AOCN, FAAN; and Tracie Harrison, PhD, RN.  Ms. Divin shared this background on the work that she completed for this article with her advisors, Drs. Volker and Harrison:

I have had the privilege of being a nurse for over thirty years. Almost half of those years were spent working in Latin America. It was in Venezuela when I worked with a group of health promoters that I first learned of the complexities of intimate partner violence (IPV). Our health group started a support group for women who were living in situations of IPV. We strengthened one another as we sat on hand made cushions in a safe and hidden open air patio behind the clinic. For the “Dia Internacional de la Mujer, International Day of Women,” men, women, and children joined together to paint murals throughout the barrio addressing the reality of IPV.

Until I worked in geriatrics as a nurse practitioner, I, like many people, held the mistaken assumption that IPV is only a phenomenon affecting younger women. I was both surprised and saddened that some of the women I

Chris Divin, MSN, RN, FNP

Chris Divin, MSN, RN, FNP

cared for in their 80s continued to struggle with IPV in their relationships. I presently work as an FNP providing primary care at a domestic violence shelter one day a week where I see the acute effects of abuse. I am passionate about the work I do, not only to raise awareness about IPV but to hope, dream, and continuously wonder what more can be done about this serious but preventable public health issue.

I was reminded at the Nurses Network for Violence against Women Conference in Vancouver earlier this year that nurses are called to be natural advocates for women affected by the multi-faceted health issues of IPV, and belonging to a predominantly female profession, there is tremendous power in numbers. I am delighted to be among nurse researchers who are actively engaged in pursuing a deeper understanding of this phenomenon, especially in the area of long term effects of abuse in an aging population. Not only is it important to recognize the scars of abuse but the amazing strength, perseverance, and peace that women manifest in the midst of their adversities.

Lastly, I, a novice researcher, had the opportunity to work on this study for over a year guided by two most amazing qualitative researchers. I have expressed gratitude to Dr. Harrison repeatedly for the “goldmine” that was handed to me when I was given the opportunity to analyze some of the data that had been collected for an entirely different study; an ethnographic investigation of health disparities and disablement among Mexican-American and non-Hispanic white women aged 55-75 years. I gained deep appreciation for the complex and intricate details that go into a secondary data analysis. I also could not help but wonder how many different research questions could be answered with data obtained for an entirely different objective and study. What richness in the human story and how serendipitous that ANS was soliciting articles for their “Peace and Health” issue as we were actively analyzing these stories for glimpses of peace and health amidst multiple adversities including IPV. We are very grateful for the timing and opportunity to publish in ANS and we appreciate any questions or comments in regards to our article.

Visit the ANS web site to day to download your copy of this article at no charge!  And do make comments here … the authors of ANS articles are eager to hear from you!

Sep 27

Promises of Peace and Development


In this current “Editor’s Pick” article titled “Promises of Peace and Development: Mining and Violence in Guatemala” the authors, C. Susana Caxaj, PhD, BScN; Helene Berman, PhD;, Jean-Paul Restoule, PhD; Colleen Varcoe, PhD and Susan L. Ray, PhD, tell a compelling story of the lives of people struggling for peace against great odds.  And, they connect this story to the lives of you and me – to all nurses who live and work in relatively privileged contexts who can, and must, be guided by a sense of responsibility to ensure human and environmental health in our quest for global peace and health.  Dr. Caxaj, who is a native Guatemalan, has shared this message about here work, with additional background about the challenges before us as nurses:

ANS_marlin-mine300

The Marlin mine involves deforestation, open-pit cyanide leaching and underground mining in extracting gold and silver. The mine has been linked to changes in water quality and quantity in the region. Photo: Allan Lissner

In “Promises of Peace and Development,” I wanted to contemplate peace in its elusive, aspirational and distant sense. For countries and regions throughout the world, scarred with a history of militarized violence and genocide, peace is only known in its absence, received as an empty gesture, and known as a broken promise. Indeed for many Guatemalans, myself included, the Peace Accords of 1996, which marked the formal end of a 36 year civil war, more aptly known as a genocide that targeted the diverse Mayan Indigenous peoples of Guatemala, has simply marked a transition towards a new type of violence and impunity. In May of last year, Rios Montt, a military dictator during the worst years of violence, was convicted of genocide. Yet less than 2 weeks after the verdict, the case was overturned. For many, this has been a source of further disillusionment. In writing this paper however, I did not wish to simply surrender to cynicism, instead, I wanted to document the conditions amenable to peace, and in contrast, activities or practices, sometimes called “development,” that must be signaled, as mechanisms of conflict, war and insecurity.

When I think of the word peace, I often think of the expression “no justice, no peace.” My work with the community of San Miguel Ixtahuacán certainly reflects this reality.  Over years of getting to know community members and the months at a time that I have spent living among them, I have seen first-hand the profound inequities and injustices that shape local

In July 2011, the Peoples International Health Tribunal was carried out in San Miguel Ixtahuacán. The tribunal included testimonies from mining-affected communities in Mexico, Guatemala and Honduras affected by Goldcorp's marlin mine.

In July 2011, the Peoples International Health Tribunal was carried out in San Miguel Ixtahuacán. The tribunal included testimonies from mining-affected communities in Mexico, Guatemala and Honduras affected by Goldcorp’s marlin mine.

residents’ experiences. The presence of Goldcorp’s Marlin Mine, by exacerbating inequities, has brought new challenges and conflicts to the region. By failing to represent or recognize the community’s wishes and vision for development, this large-scale project has continued a legacy of social exclusion and colonialism.

As nurses we know that these political contexts ultimately impact the health of communities. As I write this, I have another manuscript open where I have started to write about the many mental health challenges that community members have reported. It is heartbreaking to know the degree of suffering that so many residents in this community have endured. My hope is that in reading this paper, more nurse scholars and health researchers generally will incorporate a critique of mainstream notions of development as central to a global health equity mandate. And further, that they will champion Indigenous rights and self-determination as key components of an upstream health promotion approach.

Nurse researchers have a lot to learn from Indigenous communities who are often the first to be negatively impacted by these large-scale projects. We must recognize their knowledge and experience if we are to work towards healthier societies. We must also develop creative ways to marry this knowledge with our scholarship if we are to build solutions that are equitable, sustainable and culturally relevant. Arising from this research, community members were able to partner with regional, national and international organizations as well as other mining-affected communities to develop the first ever Peoples International Health Tribunal. This tribunal, a social forum or ‘popular trial,’ was held in the municipality on July 14th and 15th of 2011. There, in front of a panel of International judges – including internationally renown journalists, environmentalists, lawyers, and others, including the former advisor to the World Bank, community members gave testimonios or testimonies, denouncing the mining company and detailing the harms that they had suffered. The international panel of judges found Goldcorp guilty of violations to the communities’ environment, health and human rights. Certainly this is but a humble step towards justice, but all in all, we must continue to work with communities negatively impacted by large-scale projects to pursue justice, and ultimately, towards a healthier and more peaceful society.

To download your free copy of this article, visit the ANS Web Site now!  It is available at no charge while the article is being featured.

Sep 15

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Critical Cultural Competence


In the current, very timely “Editor’s Pick” article titled “Critical Cultural Competence for Culturally Diverse Workforces: Toward Equitable and Peaceful Health Care, Dr. Adel F. Almutairi and Dr. Patricia Rodney describe the concept of “critical cultural competence” as essential to peace and health.  In their analysis, they view peace as not only a political responsibility of the state, but also a sociocultural concept that is relevant to all human encounters, animated by the ideal of human dignity.  The basis for this perspective is described in the article as follows:

The theoretical underpinnings of the approach to critical  cultural competence that we articulate in this article is an extension of the findings from Almutairi’s doctoral research project, which was a qualitative exploration of the cultural competence of a multicultural nursing workforce in a tertiary hospital in Saudi Arabia.  The nursing workforce in that Saudi tertiary hospital includes nurses from more than 25 nationalities from different parts of the world who provide care to the indigenous people of Saudi Arabia. The findings in Almutairi’s doctoral research project explicated the complex nature of cultural and linguistic diversity during clinical encounters. He found that this diversity poses threats to the physical, psychological, emotional, spiritual, and cultural safety of nurses, patients, families, and their communities. Such threats are caused by the increased potential for cultural clashes, negative attitude, and misunderstandings related to both communication and behavior. (p. 203)

Using evidence from Dr. Almutairi’s research, they present an analysis of the challenges of working in a multicultural environment, as well globe300as insights that can lead to peace in health care delivery.  They conclude:

 In this article, we have argued that because of its foundations in postcolonial theory and cultural safety—as well as its operationalization through critical awareness, critical knowledge, critical skills, and empowerment—critical cultural competence offers an action orientation from which to enact our shared responsibility and address structural injustices. It is our conviction that as a nursing profession we are well positioned to look toward the future and share responsibility locally, nationally, and globally to foster equitable and peaceful heath care. (p. 209)

I hope that ANS readers will find this message relevant, will share this work broadly, and will join the challenge to foster equitable and peaceful health care.  To download your copy of the article at no cost, visit the ANS web site now!

 

Sep 5

3 Comments

Coming home from war


LisaMarie Wands, RN, PhD is the author of the current “Editor’s Pick” article titled “No One Gets Through It OK”: The Health Challenge of Coming Home from War.  In her mixed-methods study, Dr. Wands explored not only the experience of student veterans coming home from war, but ways they have used to overcome the challenges they face.  Dr. Wands shared this background about her work:

After serving military duty, coming home is a much-anticipated and usually joyous occasion; however, the process of reintegrating into previously-known, civilian-world relationships and environments is often fraught with struggle for veterans. Training, deployment experiences, and time inevitably change the brave persons who voluntarily serve our country through military service, while their family, friends, and communities also change with the passage of time. Reconciliation between these old-but-new entities requires effort in often unanticipated ways, and seeking assistance with encountered difficulties may not be intuitive for the individuals navigating the difficult journey of reintegration. Likely influenced by the learned military mindset that individuals should be strong and self-sufficient, veterans often rely on intrinsic processes to overcome the challenges they face during their experience of coming home. Necessity, so the saying goes, is the mother of invention; couple this with resourcefulness and determination developed during military duty, and it reasonably follows that veterans will strive to independently rise up to meet the challenges before them. Paying attention to these inherent responses is a logical place to gather information that could potentially guide the formation of interventions delivered by healthcare providers, including nurses who as a collective discipline have not strongly articulated our relationship with this group of vulnerable persons.

Wands-Photo

Dr. LisaMarie Wands

I was extremely fortunate to have engaged with a group of student veterans who were willing to share their stories of coming home with me. Recruitment efforts for this study were challenging, which I believe suggests veterans’ reluctance and/or inability to articulate their experiences of either deployment or reintegration. As a unique population, I think student veterans can teach us a great deal about caring for veterans in a variety of settings, and I am tremendously grateful for the experience of listening to their stories and now sharing them with the nursing community.

We invite you to read her article, and share it with others — providers who work with returning veterans, and returning veterans and their families.  You can access the article at no charge on the ANS Web site while it is featured!  Add your comments and responses here!

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