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Posts from the ‘Featured Articles’ Category

Theory of Planned Behavior


The current ANS featured article is titled “Analysis and Evaluation of the Theory of Planned Behavior” by Sueyeon Lee, MSN, RN and Catherine Vincent, PhD, RN. Download your copy of this article while it is featured, and share your comments below – we welcome your discussion! Here is a message sent by Sueyeon Lee about this work:

To explain and predict various human health behaviors, many theories and frameworks have been applied in the nursing discipline. As one of the most influential behavioral theories, the Theory of Planned Behavior has been widely used to predict a number of health-related behaviors and has contributed to knowledge development in nursing. However, the theory has not been examined in depth based on a nursing framework for systematic theory analysis and evaluation. Moreover, there is a need to determine whether the theory can be effectively applied in the current nursing context, in which nursing care, human behavior, and related factors are continuously changing. In our article, we comprehensively and in detail analyzed and evaluated the Theory of Planned Behavior based on Fawcett and DeSanto-Madeya’s nursing framework.

Also, we reviewed previous studies about health behaviors such as physical activity, diet management, and smoking cessation among people with cardiac disease—the leading cause of death worldwide—and evaluated the theory’s application in this population. We think that our results will contribute to a better understanding and appropriate application of the theory within the nursing domain.

Complexities of Nursing


The current ANS featured article is titled “Complexities in Studying and Practicing Nursing—A Theoretical Elaboration Based on Reflections by Nurses and Nursing Students” authored by Joakim Öhlén, PhD, RN; Annette Bramstång, MScN, RN; Frida Lundin Gurné, MScN, RN; Anneli Pihlgren, BSc, RN; Marie Thonander, MScN, RN; and Marit Kirkevold, EdD, RN. You can download this article at no cost while it is featured, and we welcome your comments and discussion of this article in the comments below! This is a message that Dr. Öhlén provided about this work:

We’ve explored ideas about nursing as a subject from the perspectives of nurses and nursing students. The motive for the project was discussions about current nursing practice and the development of nursing as a subject, which in our Swedish healthcare as well as scholarly context has been characterized by a sometimes really intense debate about terminology (nursing vs caring), what it should encompass (generic caring knowledge vs professional nursing knowledge and skills), and where its boundaries with other subjects lie.

For this reason, we performed a participatory action project to explore nursing students’ and clinically active registered nurses’ experiential ideas about nursing – to provide a foundation for a critical reflection on the complexities involved in studying and practising nursing. We performed two empirical cycles and one final cycle with a theoretical interpretation. In total there were 238 participants. We who undertook the study are all nurses in metropolitan Sweden; professors, teachers, clinical nurse specialists and nursing students.

L-R: Marie Thonander, Annette Bramstång, Marit Kirkevold, Anneli Pihlgren, Joakim Öhlén (Frida Lundin Gurné is missing)

From focus group data we identified nine experiential ideas about nursing as a composite of subject, nursing practice and being a nurse. The ideas ranged from Nursing is holistic to Nursing is prioritising, and to Nursing is following check-lists and guidelines. Then, the ideas were presented to supervisors in clinical practice, teachers/researchers and students, and all of these perceived all nine ideas to be important foci for students’ learning in clinical practice. Finally, the ideas identified were related to clinical gazes and to two different epistemological structures.

We think our result will contribute to explain the confusion many nursing students and practising nurses express with regard to nursing as a composite of subject, nursing practice and being a nurse. We hope you’ve been interested in the article and here you can listen to us telling about the study, and that reading it will open up for critical reflections, commentaries and for the discussion to be continued. Thank you

Frailty in Older People Living With HIV


The current ANS featured article is titled “Frailty in the Context of Older People Living With HIV: A Concept Analysis” by Evelyn Iriarte, MSN, BSN, RN; Rosina Cianelli, PhD, MPH, RN, IBCLC, FAAN; and Joseph De Santis, PhD, APRN, ACRN, FAAN. While this article is featured you can access it on the ANS website at no charge here

Evelyn Iriarte

I am currently a PhD candidate at the School of Nursing and Health Studies at the University of Miami. My dissertation is entitled “Impact of HIV Self-Management on Multidimensional Frailty and Quality of Life among Hispanic/Latinx People Living with HIV Infection Aged 50 and above”.  In the context of developing my dissertation, I wrote this concept analysis aimed to analyze the concept of frailty in the context of older people living with HIV (PLWH). The reasons to start writing this article were that despite advances in knowledge about older PLWH, frailty remains a challenge to HIV care. Numerous studies have documented its impact; however, the concept remains unclear. This knowledge is needed to promote an increased understanding and recognition of frailty among PLWH due to its potential preventive role within health care services. However, there is still much debate about the concept and its’ measurement, as this concept has not been clearly explored and defined within the context of older PLWH.  

This concept analysis provides an initial framework for understanding frailty in the context of older PLWH that includes attributes such as older age, inflammatory, hormonal, and immunological dysregulation, HIV-specific factors, comorbidities, and social, structural, and behavioral factors. Furthermore, frailty is evidenced as a state of vulnerability to HIV infection stressors, unintentional weight loss, exhaustion/fatigue, slower gait speed, decreased physical activity level, and muscle weakness. This state is manifested through several adverse outcomes that can impact health and quality of life.

In light of the current potential impact on health care, frailty requires further empirical and conceptual work. It is critical to continue developing research to advance the knowledge about frailty among older PLWH, principally regarding its assessment and interventions to prevent or treat frailty centered in holistic care.

Authors L-R: Dr. Joseph De Santis, Mrs. Evelyn Iriarte, and Dr. Rosina Cianelli
ANAC Conference 2021

Integrated Chronic Care Model


The current ANS featured article is titled “Complex Adaptive Systems: A Framework for an Integrated
Chronic Care Model
” by Patricia R. Gilman, PhD, MSN, APRN, ACNS-BC. While this article is featured you can download it at no cost from the ANS website. Dr. Gilman shared with us this background about her work:

Patricia Gilman

As a board-certified advanced practice clinical nurse specialist in adult health, my work centers on improving healthcare quality and outcomes within patient, nursing, and systems spheres of influence. Starting my nursing career more than forty-five years ago as an LPN in a rural Minnesota community hospital, I went on to earn an associate degree at the Brainerd Community College in 1986, a bachelor’s degree at Augsburg College in Minneapolis, MN in 2007, and a master’s degree at Winona State University in Winona, MN in 2010. I am a Robert Wood Johnson Nursing and Health Policy Fellow and received my Ph.D. in nursing and health policy from the University of New Mexico Albuquerque in 2018. My research examined the relationships between states’ practice authority, professionalism, autonomy, and interprofessional team function among advanced practice nurses across the U.S. I am a strong advocate for nurses and advanced practice nurses’ ability to practice at their highest level of education and licensure. I have served as a member for the Legislative and Regulatory Committee of the National Association of Clinical Nurse Specialists (NACNS) and am a member of the College of Cardiology, Society of Critical Care Medicine, American Association of Critical Care Nurses, NACNS, American Association of Heart Failure Nurses, and Sigma Theta Tau and Phi Kappa Phi Honor Societies.  

I have a broad clinical background encompassing ambulatory clinics, small, medium, and large academic hospital settings. Currently, I work as a clinical nurse specialist at a hospital within a large healthcare system in California’s Central Valley region. Aside from facilitating improvements in patient care quality, standards of nursing care and nursing practice, and system processes, I support and conduct evidence-based practice and research projects. Research interests and projects include chronic care and heart failure populations, end-of-life care, advanced practice nursing practice, nursing theory, and healthcare policy.

The model presented in my article needs refining and testing to see how significant the effects of external agents are on treatment regimens for individuals with chronic conditions. Given the time and resources to do it, this model depiction is just the beginning of a highly complex system that would be intriguing to explore; the intent is to stimulate thought about future research using Complexity Science, specifically CAS,  to understand complex relationships among populations with chronic conditions.

My other accomplishments include songwriting, music performance, and medium to large-scale stained-glass artwork. With my husband, John, we enjoy motorcycle riding and spending virtual time with our two adult children and two teenage granddaughters who live in Minnesota.

Integrated Chronic Care Model

Synergy Model for Patient Care


The current featured ANS article is titled “Description and Evaluation of the AACN Synergy Model for Patient Care Employing the Critique Frameworks of Chinn and Kramer (2011) and Fawcett and DeSanto-Madeya (2013)” authored by Soyun Hong, MSN, RN and Eunkyung Kim, MSN, RN, nurse scholars at Yonsei University in Seoul, Republic of Korea. While this article is featured, you can download the full PDF at no cost. The authors shared this background about their work for ANS readers:

This study aims to describe and evaluate the AACN Synergy Model for Patient Care that aligns nurses’ competencies with the needs of patients and their families, developed by the American Association of Critical-Care Nurses. The description focuses on objectively explaining the theory, while the evaluation is based on established standards to determine its viability for application in nursing practice. This study applies Chinn and Kramer’s (2011) theoretical description method and Fawcett and DeSanto-Madeya’s (2013) theory analysis method to evaluate the AACN Synergy Model for Patient Care. The results show that the AACN Synergy Model for Patient Care makes it possible to confirm the concepts and characteristics of nursing by providing a theory that explains nursing practice within the health care system. Further, the AACN Synergy Model for Patient Care is a framework that properly matches patients’ characteristics with nurses’ competencies in achieving optimal outcomes and nurses’ satisfaction at its core. The current description and evaluation of the AACN Synergy Model for Patient Care suggests that it is a well-developed middle-range theory with social and theoretical significance. Moreover, it is an effective framework for nursing practice and research to visualize the impact of nursing.

AACN Synergy Model for Patient Care

Racial Discrimination and Pregnant African American Women


The current ANS featured article is titled “Perceived Racial Discrimination in the Pregnant African
American Population: A Concept Analysis
” authored by Megan R. Mileski, MSN, RN; Maria R. Shirey, PhD, MBA, MS, RN, NEA-BC, ANEF, FACHE, FNAP, FAAN; Patricia A. Patrician, PhD, RN, FAAN and Gwendolyn Childs, PhD, RN, FAAN. While the article is featured you can download and read it at no cost! Here is a message about this work from the primary author, Megan Mileski:


Megan Rutland Mileski

I am currently a PhD candidate at the University of Alabama at Birmingham School of Nursing conducting a dissertation entitled “Exploring the Relationship Between Chronic Stressors and Protective Factors and Preterm Birth Risk in an African American Pregnant Population”.  My primary research interest is to better understand the relationship between perceived racial discrimination and adverse birth outcomes such as preterm birth and maternal mortality/morbidity rates in the United States, particularly in the South.  I hope to build a program of research with this as my focus and found it critical to first define “Perceived Racial Discrimination in the Pregnant African American Population.”

Symptom Management for Adults with Cancer


The current ANS featured article is titled “Symptom management Theory: Analysis, Evaluation, and Implications for Caring for Adults with Cancer” by authors Asha Mathew, MBA, MSN, RN, RM; Ardith Z. Doorenbos, PhD, RN, FAAN; and Catherine Vincent, PhD, RN; College of Nursing, University of Illinois, Chicago. The PDF of the article is available for download at no cost while it is featured, and we encourage readers to share your responses here. Asha Mathew sent this summary of their work for ANS blog readers:

Asha Mathew Solomon

Theories of symptom management help nurse researchers organize the intricate relationships within the symptom experience. Our article presents a detailed analysis of the Symptom Management Theory (SMT) using Fawcett and De-Santo Madeya’s criteria for theory critique. To examine the application of SMT among adults with cancer, we performed a systematic review and identified 20 research studies that operationalized SMT concepts and propositions in adults with cancer. Further, using Silva’s evaluation criteria for empirical testing of a theory, we identified that only 35% of the studies had used the SMT to an adequate extent. We concluded that using SMT in longitudinal studies and comparing cancer-related outcomes with and without use of SMT are warranted.

Ethical Leadership and Moral Sensitivity


The current ANS featured article is titled “Effect of Ethical Leadership on Moral Sensitivity in Chinese Nurses: A Multilevel Structural Equation Model” by Na Zhang, PhD; Xing Bu, MBA; Zhen Xu, PhD; Zhenxing Gong, PhD and Faheem Gul Gilal, PhD. This article from researchers in China and Pakistan will be available for download while it is featured. We invite you to engage here with the authors and other ANS readers about this work! Here is a message from Dr. Zhang about this work:

This article aimed to explore the relationship between ethical leadership (a contextual factor at the higher organizational level) and nurses’ moral sensitivity (the individual outcome at a lower level), a cross-sectional quantitative study design was used. Participants were 525 nurses at 65 various departments in public tertiary hospitals. These results showed that ethical climate played a mediating role in the relationship between ethical leadership and nurses’ moral sensitivity. Moreover, nurses’ employment type moderated the mediating effect of ethical leadership on their moral sensitivity. Additionally, the link between ethical climate and moral sensitivity of contract nurses was stronger than that of nurses employed by the state.

Commonalities in Nursing Perspectives among Six Countries/Regions


Our current featured ANS article is titled “Commonalities in Nursing Perspectives Among 6 Countries/Regions” authored by Eun-Ok Im, PhD, MPH, RN, FAAN; Reiko Sakashita, PhD, RN; Chia Chin Lin, PhD, FAAN; Eui Geum Oh, PhD, RN, FAAN; Hsiu-Min Tsai, PhD, RN, FAAN; Wipada Kunaviktikul, PhD, RN, FAAN; Lian-Hua Huang, PhD, RN, FAAN; Hsiu-Hung Wang, PhD, RN, FAAN; and Linda McCauley, PhD, FAAN, FAAOHN. Dr. Im provided this description of the evolution of this work for ANS readers:

The idea of this manuscript started with a question from one of my PhD students who came from a different discipline (cannot remember exactly which discipline she came from). As I remember, the question was raised during a PhD class on how nursing is different from other health-related disciplines and what would be unique aspects of nursing research.  As a group, we had a discussion on many unique aspects of nursing research including our holistic approaches, our caring views, our unique contextual understanding, etc. At the end of the specific class, all of us agreed that nursing research would be different from other disciplines’ research because of these unique perspectives. Then, the specific student raised a question, “what is a nursing perspective?”  I remember that I talked about nursing scholars’ historical discussions on nursing perspectives (e.g., its foci on human beings as a whole, understanding human experience in different stages of health, a practice-oriented discipline, a health-oriented discipline, etc.). However, after the meeting, I felt a dire need for defining a nursing perspective in this interdisciplinary world and thought about what I could do about it.  I suggested the specific student to do an independent study with me so that we could define a nursing perspective together through a systematic literature review, and she agreed to work on it.  However, due to her busy life as a PhD student, she dropped off from the project. Then, I have tried to revive the idea of this paper with several different PhD students, but the efforts with PhD students did not work after all. Looking back on it, it would be a very difficult task for a PhD student to define a nursing perspective even through a systematic literature review.

After a few years passed, I became to get involved with leaders from several Asian countries. Through international workshops and conferences, we became to get engaged in discussions on many different issues/concerns related to nursing across the globe.  Then, I proposed this project on nursing perspectives to the leaders.  All of us naturally became interested in this topic because all actually experienced the same phenomenon with an increasing number of interdisciplinary collaborative projects and witnessed the struggles of nursing students from other disciplines. 

As soon as we began to work on this project on nursing perspectives, this article was written very quickly and smoothly with the inputs from the leaders. This topic was a timely topic for all of us across the globe. All of us have been thinking of this topic throughout our career. Eventually, the paper became a very interesting paper that could reflect nursing perspectives across six different countries/regions. This paper includes only the themes reflecting the commonalities in nursing perspectives across the countries/regions, but we had other themes reflecting differences in nursing perspectives across the countries/regions.  Yet, since the purpose of this paper was to find out the essence of nursing perspectives that could cross the countries/regions, we just focused on the commonalities in nursing perspectives.

As discussed in the paper, nursing perspectives are circumscribed by cultural and historical contexts of individual countries/regions; nursing perspectives are inclusive of philosophical pluralism; nursing perspectives are women-centered and care-oriented holistic views; nursing perspectives are ethical and humane perspectives; nursing perspectives respect human beings’(persons’), families’, and/or communities’ own views and experiences; and nursing perspectives assume diversity in nursing phenomena.  While some of these characteristics of nursing perspectives were expected and discussed from the beginning of the project, others were identified later at the end of the project.  Interestingly, all of us agreed that nursing perspectives had more similarities than differences across the countries/regions.

Based on the findings on commonalities in nursing perspectives across the countries/regions, we made several suggestions for future nursing researchers while acknowledging the limitations of this work.  With historical evolutions and revolutions of nursing, the characteristics of nursing perspectives could change, but some essential characteristics will not change. Actually, these essential characteristics need to be retained throughout different generations of nurses. This paper provides some of these essential characteristics of nursing perspectives that we should keep across different generations of nurse researchers throughout the world.

The characteristics of nursing perspectives that we found and reported in this paper, however, may not be applicable to nursing perspectives in different geographical areas.  Maybe, a nursing perspective in African or South American countries might have different characteristics that are not included in this article.  Maybe, after some time has passed from now, our future nurse researchers who will read our paper would say that they need to work on what a nursing perspective is because the characteristics of nursing perspectives that we wrote in this paper may not be applicable to future nursing.  As we did for this paper, they would feel like that a nursing perspective needs to be re-defined with all the changes that our next generation would meet.  Maybe, at that time, some nursing activities could be delegated to robots and nursing researchers may think some main tasks/responsibilities of nurses in our generation would be obsolete and not applicable to their nursing phenomena.  I think our efforts to define a nursing perspective is not only a difficult task, but also a continuous task that we should take across time points and across geographical areas.

I want to say thanks to Dr. Chinn for this great opportunity to open a dialogue with my respected colleagues across the globe. I hope this blog could continue our discussions on what a nursing perspective is, and it could initiate international dialogues on nursing as a discipline within current interdisciplinary environments.  To conclude this blog, I am attaching a picture of roses blooming on my front yard.  When we moved to our new home, we thought these would be weeds, so we planned to eliminate these. However, as the temperature got warmer, these turned out be roses.  Maybe, some characteristics of nursing perspectives that we are currently thinking as obsolete would turn out to be “roses” in our future generations, which is the reason that we should continue our dialogues on nursing perspectives. Indeed, we never expected this COVID19 pandemic. This pandemic has obviously brought nursing care for patients with infectious diseases back to the center of nursing care, and might be making some changes in nursing perspectives across the globe.  We never know.

Nursing With the People


The current featured ANS article is titled “Nursing With the People: Reimagining Futures for Nursing” authored by Jessica Dillard-Wright, PhD, MA, RN, CNM and Vanessa Shields-Haas, MSN, MA, RN, FNP-BC, SAFE-ME – available to download at no cost while it is featured! The authors describe what this article adds to the literature as being “. . . a robust discussion of nursing’s resistance to and complicity with structures of white supremacy and neoliberalism. This then serves as a platform to engage a radical imagination for the future of nursing.” The authors shared this message about their work:

L-R – Jess, Vanessa

Nursing is limited only by what we can imagine as possible. With “Nursing With the People: Reimagining Futures for Nursing,” we (Vanessa and Jess) are hoping to invite a broader dialogue in nursing around what is possible for our discipline, where we have been, where we are going, and what shapes the terrain we navigate. The circumstances of the ongoing COVID19 pandemic and the inequities laid bare in the wake of civil protests against police brutality demands our full attention. To this end, in our paper we recognize the deeply political nature of nursing work, attending to the ways our profession has, by turns, upheld oppression and fostered liberation. We sketch out a brief schema for thinking about change in nursing, outlining approaches including reform, whistleblowing, and radical resistance, recognizing the complexities and complicities of our disciplinary history. We use the tensions that arise when we complicate our history to invoke a radical imagination for nursing, a doorway to alternate possibilities for the future of health, wellbeing, nursing, and healthcare.

This paper is, in some ways, a culmination of sorts. We first “presented” what would eventually become this paper at Nursing Mutual Aid’s 2020 Twitter conference, a radical and unique event designed to connect nurses to one another in a time when sheltering in place led us to seek connection in new ways. We presented a more refined version of the topic at the 2021 Nursing Theory Conference, where ideas, engagement, and feedback from participants in that space propelled us forward. Our collaborative scholarship here was forged through our grassroots efforts with Radical Nurses Collective, a space for organizing and action. The kernel for Radical Nurses Collective was planted in another radical space, the 2018 NurseManifst Nurse Activism Think Tank organized by Peggy Chinn. “Nursing With the People” creates a tidy sort of symmetry that way.

In many other ways, it is a starting place – a foundation for dreaming up what is just, what is equitable, what is possible, if we choose to see it. We hope you read our paper. We hope you share your thoughts here. We want to know what you see for the future of nursing, for the care we provide. And we want to build that together. We invite you to contemplate nursing’s past to understand where we find ourselves now. We welcome you to activate your radical imagination. To paraphrase the inimitable Ursula Le Guin, we close with the reminder that, although the structures and systems that exist seem immutable, at points past “so did the divine right of kings. Any human power can be resisted and changed by human beings.” What it takes is imagination and collective will. We hope you will join us.


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