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Posts from the ‘Featured Articles’ Category

May 20

Mothering Experiences of Women With Substance Use Disorders


The current ANS featured article addresses the mothering experiences of women who use substances while pregnant, and the insights that can lead to providing compassionate nursing care for the women and their infants. The article is titled “The Mothering Experiences of Women With Substance Use Disorders” by Lisa M. Cleveland, PhD, APRN, PNP-BC, IBCLC; Rebecca J. Bonugli, PhD, RN, APRN, PMHCNS and Kelly S. McGlothen, BSN, RN, IBCLC, CIMI, and is available here for download at no cost while it is featured.

Dr. Cleveland sent this message about her work:

We are so pleased to share this paper with ANS readers. This is our 3rd publication from our research with mothers who have substance use disorders (SUDs) and as a result, they have taught us so much. I will forever be

Lisa Cleveland

Lisa Cleveland

grateful to these women for opening their homes and their hearts to us and for trusting us to tell their stories. It has truly been an honor and an enormous responsibility.

My interest in mothers with SUDs first began when I was conducting my dissertation study which was focused on the mothering experiences of women whose infants had been admitted to a neonatal intensive care unit (NICU). This was a grounded theory study to gain a better understanding of the process mothers experience during their infants’ NICU stay. While I was recruiting and data collecting for this study, I began receiving numerous phone calls from interested women wanting to participate whose infants had been admitted to the NICU for Neonatal Abstinence Syndrome (NAS). NAS is a constellation of withdrawal symptoms experienced by infants who are prenatally exposed to addicting substances such as opioids. Most of the women who called were in recovery programs and receiving medication assisted treatment using methadone but infants exposed to methadone may still develop NAS. These women met the inclusion criteria for

Rebecca Bonugli

Rebecca Bonugli

the study so they were enrolled and I interviewed them. I was not at all prepared for what I would discover. While all mothers who participated in the study perceived the NICU experience to be stressful, the mothers of infants with NAS described a uniquely different experience. Their experiences were filled with stories of social stigma, shame, guilt and overwhelmingly negative interactions with healthcare providers. Further, they had a strong desire to tell their stories and to be heard. I was so moved by the women that I pledged to continue my work with them upon completion of my dissertation.

As a result, when I’m asked how I came to be working with mothers who have SUDs and their infants, I often respond by saying, “I didn’t find them. They found me.” I had no idea at the time that they would become the focus of my program of research. When I completed my dissertation study, I conducted another qualitative study focused specifically on the experiences of mothers of infants with NAS. This article being featured in ANS is a report of our findings from that research. Further, due to all that my research team has learned from our qualitative work, we are now

Kelly McGlothen

Kelly McGlothen

truly beginning to understand the complexities of SUDs in women and the impact this has on the mothering experience. This knowledge has informed the study we are currently conducting entitled, “The impact of Kangaroo Mother Care (KMC, a method of skin-to-skin mother infant holding) on Stress Reactivity and Attachment in Mother-Infant Dyads Affected by NAS.” This is a mixed-methods study using a variety of measures to include: mother-infant salivary cortisol levels and within dyad synchronization, attachment and environmental stressor scores, length and cost of hospital stay and follow-up interviews to better understand the meaning of KMC for these mothers. We have recently received additional research funding and plan to expand our study to include assessment of prenatal salivary biomarkers of stress and post-discharge mother/infant follow-up including assessment of infants’ neurobehavioral organization and development over time.

Writing this manuscript with my treasured co-authors and continuing this research with the esteemed researchers who have now become my research team has truly been a dream and a passion of the heart. Thank you to the women who have so graciously shared their stories and families with us and for letting us become a part of their lives. They inspire me every day.

Cleveland LM. Newborn Abstinence Syndrome (accepted/in press). The North American Nursing Diagnosis Association-International

Cleveland LM, Bonugli RJ. Neonatal Intensive Care Unit Experiences of Mothers of Infants with Neonatal Abstinence Syndrome. Journal of Obstetrics Gynecology and Neonatal Nurses, 2014 May; 43:318-329.

Cleveland LM, Gill SL. Try not to judge: Mothers of substance exposed infants. MCN; American Journal of Maternal Child Nursing, 2013 Jul;38(4):200-205.

Cleveland LM, Horner SD. Taking Care of My Baby: Mexican-American Mothers in the Neonatal Intensive Care Unit. Issues in Comprehensive Pediatric Nursing, 2012 Jul;35(3-4):163-175.

Cleveland LM, Horner SD. Normative Cultural Values and the Experiences of Mexican-American Mothers in the Neonatal Intensive Care Unit. Advances in Neonatal Care, 2012 Apr;12(2):120-125.

Cleveland, LM. Symbolic Interactionism and Nurse-Mother Communication in the Neonatal Intensive Care Unit. Research & Theory for Nursing Practice, 2009 Jul;23(3):216-229.

Cleveland, LM. A Mexican-American Mother‘s Experience in the Neonatal Intensive Care Unit. The Journal of Perinatal & Neonatal Nursing, 2009 Jun;23(2):174-181.

Cleveland, LM. Parenting in the Neonatal Intensive Care Unit. Journal of Obstetrics, Gynecology, and Neonatal Nurses, 2008 Dec;37(6):666-691.

May 12

Global Policy and Women’s Health


Our first feature from the latest issue of ANS is titled “Raising Questions About Capitalist Globalization and Universalizing Views on Women: A Transnational Feminist Critique of theWorld Development Report: Gender Equality and Development” by Victoria L. Scheer, BSN, RN; Patricia E. Stevens, PhD, RN, FAAN and Lucy Mkandawire-Valhmu, PhD, RN. The article is available to download at no cost while it is featured!

The authors offer a critique of an important global policy document focussed on women’s health, and the way in which this policy document problematically represents women living in low-income countries.  The authors offer an alternative policy approach, emphasizing the important role that nurses can play in creating better global policy. Victoria Scheer sent this message about her work in this area, and invites readers to engage in discussion of their ideas:

It is a great honor to have this article chosen to be highlighted in the Advances in Nursing Science blog. This article was originally conceived from a project taken on as part of my doctoral course work. While taking a

Victoria Sheer

Victoria Scheer

feminist theory course offered in the Women’s and Gender Studies department, I found there to be a disconnect between the critical feminist standpoints I was reading, and what I often read within nursing literature. Specifically, I found there to be a dearth of critical analyses of international policies drawing on transnational and postcolonial feminist perspectives.

Given the recent release of the Sustainable Development Goals, an agenda undertaken across the globe, it seems both timely and imperative to integrate a perspective that centers women and focuses on the social, economic, and political determinants of health within the context of transnationalism and globalization.

With guidance and collaboration from co-authors Dr. Stevens and Dr. Mkandawire-

Lucy Mkandawire-Valhmu

Lucy Mkandawire-Valhmu

Valhmu, we are pleased to offer this critique of the World Bank’s 2012 World Development Report: Gender Equality and Development. Framed through a transnational feminist lens, we challenge the capitalist framework underpinning the agenda outlined in the Report, as well as the language used that we argue problematically represents women living in low-income countries. Through this analysis, we sought to demonstrate how economic globalization, unabated development, and misrepresentation may have negative implications in the lives of the world’s most marginalized women.

Nurses have a significant role to play in the international policy arena, and I hope this

Pat Stevens

Pat Stevens in Malawi

article provides a persuasive example of how a transnational feminist viewpoint may prove useful to advancing gender equality and social justice for women located in resource poor-countries, as well as those located in high income countries yet excluded from the benefits of modern capitalist states. We would also like to thank Dr. Chinn for the opportunity to share this article and look forward to hearing any feedback!

May 9

Health Needs of Young Women


“The Health Needs of Young Women: Applying a Feminist Philosophical Lens to Nursing Science and Practice” by Candace W. Burton, PhD, RN, AFN-BC, AGN-BC, FNAP is now featured on the ANS website. In this article, Dr. Burton calls for philoophic underpinnings that strenghthen nursing’s unique identity and contributions to the care of adolescent and young women.  The article will be available at not cost while it is featured, and we encourage you to contribute your responses and participate in discussion of these ideas!

Dr. Burton shared these reflections about her work for ANS readers:

It is a great pleasure to have the ANS blog feature this work on the philosophical underpinnings of research in young women’s health. The analysis reported here represents the very foundation of my own program of research into the dating abuse

BurtonPhoto3

Candace Burton

experiences of adolescent and young adult women. It is also a companion piece to my work on the theoretical foundations of this work “Relationships and betrayal among young women: theoretical perspectives on adolescent dating abuse” (Burton, Halpern-Felsher, Rankin, Rehm, & Humphreys, 2011).

I am especially pleased to have this article featured, because it helps to address some of the issues I have encountered as an instructor at the doctoral level in nursing. There is a great deal to learn in the process of becoming a nurse scientist and scholar in the 21st century, and the plethora of methodological and foundational information can be overwhelming to doctoral students. As a result, there is often little time or attention given to developing the self-concept of the scientist. Placing one’s area of interest and scholarly focus in the context of the philosophy of science and the theoretical lexicon is critical to both understanding the state of the science and to developing a scientific identity. For those scholars who aspire to a career in nursing science, this is fundamental to recognizing oneself as a part of the scientific community and to developing standing as a independent researcher.

The application of philosophical analysis within nursing science represents one of the most important functions nurses perform: the act of translation. At the bedside, it is often nurses who are called to translate care orders, lab results, and prescriptions into the best possible restoration of health and function to a patient. In our science, we also translate what we do clinically into the generation of evidence. Integrating philosophical contextualization of that science into our work as scholars creates a translational bridge between what we do and why we do it. I believe that this is often what we miss in educating ourselves as researchers; we may be inclined to gloss over the historical roots of research and focus instead on its application because that is what we gravitate toward as clinicians.

Nursing science is unique and therefore deserving of a unique place in the scientific repository. Our science, perhaps more than any other, combines multiple means of data gathering with direct experience and measurement.

Identifying the philosophical roots of our endeavors helps to cement the distinctive contributions of nursing science into the continuum of discovery. In developing this paper, I intended to both demonstrate the act of performing such an analysis and to illustrate the value of recognizing the many ways in which nursing science is a part of the larger scientific world. My area of interest is sparsely peopled, and I understand the challenges of feeling as though one is wandering without guidance through the literature! I hope that the publication of this work will make it a bit easier for those who are also interested in the health of young women and in the philosophy of science to discover where we have been and where we are headed.

References

Burton, C. W., Halpern-Felsher, B., Rankin, S. H., Rehm, R. S., & Humphreys, J. C. (2011). Relationships and betrayal among young women: theoretical perspectives on adolescent dating abuse. Journal of Advanced Nursing, 67(6), 1393-1405. doi: 10.1111/j.1365-2648.2010.05565.x

Apr 27

Constructivist Grounded Theory Method


Our current featured article provides a useful and interesting explanation of grounded theory methods directed to the needs of novice investigators, but can also be a useful resource for further discussion and development of these methods!  The artilce is authored by Tracey M. Giles, PhD, MNg, MACN, GradCertHDN, RN; Sheryl de Lacey, PhD, MA, BAppSc, RN; and Eimear Muir-Cochrane, PhD, FACMHN, MNS, BSc (Hons) RN, Grad Dip Adult Ed, and is titled Coding, Constant Comparisons, and Core Categories: A Worked Example for Novice Constructivist Grounded Theorists.  I encourage ANS readers to download the article while it is available at no charge, and return here to add your comments and perspectives on this very important topic!  Here is a message from the authors about their work:

It is a pleasure to have our article featured as the editor’s featured article on the Advances in Nursing Science blog. This is the second of two methodological articles I have written under the guidance of my PhD supervisors.

Dr. Tracey Giles

Dr. Tracey Giles

The first article, also published in ANS, examined the timing of the literature review in grounded theory research (Giles, King & De Lacey 2013). This second article “Coding, Constant Comparisons, and Core Categories, A Worked Example for Novice Constructivist Grounded Theorists” further contributes to the literature around grounded theory methods.

Grounded Theory Method is one of the most widely used qualitative research methodologies across a variety of disciplines, particularly nursing. Yet many researchers who claim to be using Grounded Theory Method fail to apply the core tenets of this methodology/methods package, possibly due to an inadequate understanding of the approach.

When I began my PhD research, I had not used grounded theory previously and as such I was eager to find practical

Professor Sheryl de Lacey

Professor Sheryl de Lacey

examples of its key methods and processes to guide me. However, I soon noted that while Grounded Theory Method has been described extensively in the literature, there are very few worked examples that track the development of initial and focused codes, through to the construction of tentative and major categories, and emergence of the core category.

Many experts believe grounded theory methods are difficult to explain in writing because of the multitude of different methods used and because the analytical activity required is a primarily cerebral process. Much of the advice I gained from the multitude of texts and articles I accessed was that the best way to learn grounded theory is to do it. And from personal experience this is certainly true. However, learning can be enhanced through the use of practical, worked examples.

I wrote this paper to help elucidate analysis, category development and to offer novice grounded theory researchers a

Professor Eimear Muir-Cochrane

Professor Eimear Muir-Cochrane

step-by-step example of how a grounded theory develops and is systematically constructed. Novice grounded theorist who are interested in a more detailed example of grounded theory can access my PhD thesis from Flinders University here.

Thank you for the opportunity to share our ideas about GTM research. We look forward to your thoughts about this worked example.

Apr 19

Transnational Perspectives to Improve Immigrant Health


We are delighted to feature a very timely article that focuses on nursing perspectives in promoting the health of immigrant populations through nursing research. It is available for download at no cost while it is featured!   The article is titled “Transnationalism: A Framework for Advancing Nursing Research with Contemporary Immigrants,”  authored by Marie-Anne S. Rosemberg, PhD, RN; Doris M. Boutain, PhD, RN; and Selina A. Mohammed, PhD, MPH, RN.  Here is a message from Dr. Rosemberg about her work:

In this article we initiate an in-depth conversation about Transnationalism and how this framework can benefit nursing science in exploring and understanding immigrant health. This framework provides an innovative approach for nursing research, encompassing all aspects of the research process: research design, method, ANS_Blog___ANS1048R1_doc__Compatibility_Mode_analysis, and dissemination strategies. Nursing research about immigrant health continues to be dominated by concepts such as assimilation and acculturation despite a shift in how approaches to everyday life communications have changed with the advent of social media and smart-phones. Given rapid technological advancements and globalization, nursing research among contemporary immigrants needs to reflect the current trends of trans-border communication and resource sharing and how these trends affect health outcomes among contemporary immigrants.

As stated in the article “Nurse researchers can use transnationalism as an approach to explore and interpret the complex health and social experiences of contemporary immigrant among study participants. Such level of exploration will reflect health equity research design and will promote change at the core of health disparities specific to contemporary immigrant populations. As we continue this conversation the goal is to move beyond the application of transnationalism in nursing research and explore how it translates to nursing praxis in promoting immigrant health.

I became interested in this framework while investigating how Haitian immigrants defined and managed their hypertension. While searching, reading and writing about the historical and political aspects of this immigrant group, I started to see something that was very interesting and that I had not seen in other nursing research projects about immigrants. I realized that in order to fully have a holistic view of this particular population and their health I needed to consider their country of birth in addition to their current place of residence (US). I found that Transnationalism was the ideal framework to explicate this phenomenon.

Co-authors Dr. Boutain and Dr. Mohammed were instrumental in helping me hone in on this phenomenon throughout the research process. During my interviews with participants, I found they had indeed created transnational identities. Participants reported using resources from their home country (country of birth) and host country (country of residence) to manage their disease. Their transnational identity influenced every aspects of their lives not only from a health promotion and disease management (e.g. receiving cultural medicines from home country) standpoint but also from economic (e.g. using their meager wage in the host country to send remittance to their home country) and political (e.g. supporting a presidential candidate in home country) standpoints. Participants were neither interested in assimilating, nor acculturating into the “melting pot” of contemporary US culture. They took pride in who they were, their culture and their heritage and had no intentions of forgoing their culture while making a life here in the US. Instead, they found a way to live within the geographic borders of the two countries.

I found that the delineation of the concepts of assimilation and acculturation may not ring true for all immigrant groups; especially for contemporary immigrants who maintain strong ties with their home country. Persisting in using the terms assimilation or acculturation among contemporary immigrants may prevent nursing researchers from fully grasping the immigrants’ experiences that increasingly transcend geographical and political borders and thus may result in inaccurate or incomplete data. Transnationalism shows promise for advancing nursing science as it allows for holistic approach in nursing research and praxis among contemporary immigrants.

Apr 11

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Advancing Nursing Informatics


Our current featured article, available at no cost while it is featured, addresses a theoretical model that advances the independent development of nursing informatics.  The article is titled “The Evolution of Data-Information-Knowledge-Wisdom in Nursing Informatics.” by Charlene Ronquillo, MSN, RN; Leanne M. Currie, PhD, RN; and Paddy Rodney, PhD, RN. Here is their message about this important work  for ANS readers:

Setting out to question one of the foundational theories in nursing informatics was a task we approached with much caution, care and respect, in the paper we have contributed to this journal. The theoretical framework we are

Charlene Ronquillo

Charlene Ronquillo

referring to is the data-information-knowledge-wisdom framework, often referred to as DIKW. Exploration of DIKW brought us on a very interesting journey: We delved into the literature from the early years when nursing informatics was first beginning to be established as a field of inquiry and we ended up exploring fields that included management information science, library sciences, and geographical sciences. DIKW is arguably one of the first concepts described as a unique feature of nursing informatics by Graves and Corcoran in their seminal paper, The Study of Nursing Informatics, published in 1989. DIKW might have faded into the past had it not been for the work that Nelson, and then Nelson and Staggers

Leanne M. Currie

Leanne M. Currie

added to the exploration and articulation of the framework. We feel privileged to be able to be able to build on the insights put forth by Graves and Corcoran almost thirty years ago, and advanced by Nelson and Staggers.

What began as a curiosity-driven exploration of the DIKW as part of a doctoral philosophy course in 2013 turned into a full investigation of this theoretical framework. Our investigation was spurred by the finding that beyond nursing informatics, many other fields of study mentioned, used, and critiqued DIKW. In the figure below, for instance, we provide a visual depiction of DIKW in the fields of nursing informatics (as a series of overlapping circles) and DIKW in computer science, management information systems, and library

Paddy Rodney

Paddy Rodney

sciences (as a pyramid). We found the opportunity to contribute to the ongoing evolution of DIKW by incorporating these ‘non-nursing’ perspectives to be a possible way forward.

Picture1

This drawing presents a side-by-side comparison of the DIKW models as depicted in nursing informatics (left) and computer science, management information systems, and library sciences (right) illustrate the common attributes of DIKW visualizations: consolidation of power, linear and positive growth, and an implicit assignment of value to concepts (i.e., “building” toward to the pinnacle of wisdom, which is the most important).

An important first step in our inquiry was gaining an understanding around what purpose DIKW served and the intention(s) around its introduction as a central aspect of nursing informatics. As is reflected in our paper, we continue to emphasize the crucial role and contributions of DIKW towards one of the key goals of nursing informatics–namely, to continue nursing’s historical efforts to make nursing work visible and “counted” in health systems by leveraging the opportunities presented by information technologies and the increasingly digitised world. The challenge, of course, as it has always been, is to develop methods that capture aspects of the complexity of nursing that cannot be easily measured or quantified.

We consider, in this paper, the various iterations and evolutionary developments of DIKW in nursing informatics as attempts at better understanding and operationalizing ways in which nursing work might be made more visible in health systems. In the process of developing this paper and attempting to gain clarity around how DIKW has been conceptualised, understood, and used, we stepped back and asked two key guiding questions: (1) Does DIKW serve clinical information systems, nurses, or both? And (2) What level of theory does DIKW occupy? It is by asking these questions that we offer a discussion about the assumptions implicit in the DIKW model and the subsequent implications of these assumptions. Finally, we explored the approaches taken by various authors in operationalizing DIKW in nursing, providing what we hope are fruitful insights into potential ways forward for this theoretical framework.

As Norma Lang claims, “If we cannot name it, we cannot control it, practice it, teach it, finance it, or put it into public policy” (Clark & Lang, 1992, p. 109). Indeed, Professor Lang has continued to be a pioneer in advocating for standard terminologies to advance nursing knowledge.  Here is a video in which Dr. Lang provides the context of this very famous quote.

It is with this guiding principle that we approached the critical examination of the evolution of DIKW. That is, we argue that each iteration, application, and attempt at further refining the DIKW model over the decades should be viewed as an important step forward towards the goal of making nursing work visible. It is our hope that our paper makes a contribution toward this end and supports other colleagues undertaking similar explorations.

Apr 1

Nursing Partnership with Parents of Technology-Dependent Children


It is our pleasure to feature an article by Michele A. Mendes, PhD, RN, CPN, titled “Partnership With Parents of Technology-Dependent Children: Clarification of the Concept.” As with many of the articles in this issue of ANS, Dr. Mendes focuses on ways in which technology influences the caring relationship that is central to nursing. You can download this article at no charge while it featured by visiting the ANS website! Here is a message in which Dr. Mendes describes more about her work in this area of practice:

mendesm

Michele A. Mendes, PhD, RN, CPN

It is a pleasure to be able to share my work and my passion for children dependent on technology, their parents and their nurses.  This manuscript is the third describing my program of research that aims to explore nursing practice with children dependent on technology and the broader group of children with special health care needs. The first focused on understanding the delivery of home nursing care to these children from the perspective of the people responsible for their care, their parents and home care nurses.  Initially, I examined home nursing care practice from the perspective of the parents.  Next, in a follow-up study, I examined home nursing care practice from the perspective of home care nurses.  These two studies told two separate parts of the story of home care nursing, but did little to explain how parents and nurses work together in partnership to provide the care the children need to survive and thrive.

As I discovered when reviewing the literature on partnerships between nurses and parents of child patients, the term partnership is used loosely and is poorly defined.  A concept analysis of partnership would certainly have provided increased understanding of the concept, but would lack the richness of data from the perspective of the partners involved.  A secondary analysis of the data from the previous two studies would have provided rich data describing how parents and nurses work together to provide home care, but would have lacked the depth of understanding that came with an analysis of the concept.  An adaptation of the Hybrid Model of Concept Development1 Allowed me to combine strategies of concept analysis and a secondary analysis of the data from the two previous studies to bring the richness of first-person accounts and the depth of concept analysis to the clarification of the concept of partnerships between parents of children dependent on technology and home care nurses.

  1. Schwartz-Barcott D, Kim HS. An expansion and elaboration of the hybrid model of concept development. In: Rodgers BL, Knafl KA, eds. Concept development in nursing: Foundations, techniques, and applications. 2nd ed. Philadelphia, PA: Saunders; 2000:129-159.

 

 

Mar 25

Reflections on Digital Technology and Empathy


In our current featured ANS article, author Pamela Bjorklund, PhD, APRN, CNS-BC, PMHNP-BC draws on personal experience and scientific literature to develop a commentary on nursing’s relational core in the context of growing digital technologies.  The article, titled “Gossamer Threads: Commentary on the Impact of Digital Technology on the Developing Brain and the Capacity for Empathy” will be available for free download on the ANS web site while it is featured!  We encourage you to take advantage of the opportunity to read this interesting article, and then return here to share you comments!

 

This article attempts to find points of nexus between seemingly disparate bodies of knowledge from diverse areas including technology, metaethics, moral responsibility, the art and science of empathy, relational theory, technology, and nursing. While the scope is intentionally broad and the essence of the paper is intentionally interdisciplinary, it has important implications for nursing—with its relational core, its unique as well as shared bodies of moral and scientific knowledge, and its interprofessional health care goals to maximize human growth and well-being across the lifespan in both health and illness.

In reviewing the research for this paper, the threads that connected these disparate bodies of knowledge initially seemed tenuous, fragile, gossamer-like. I envisioned the spider webs on grass and shrubbery that are only seen when certain conditions—the morning light and the dew—render them visible.

Although the scope is broad, the focal point of the paper is more narrow: namely, that science shows mixed effects of technology on brain development and on the development of empathy and other meaning-making human skills—and that a more intentional use of technology may better serve human development in the long-run. This does not impugn the undeniable value of technology to human endeavor. My position is already a both/and, not an either/or position. Technology is indispensable; it isn’t going to go away, and who would want it to, given its overwhelming benefits? However, human beings have some capacity to be intentional about the use of technology and to regulate its impact on their lives, which is what I suggest in this paper.

Part of what makes this article unusual in its integrations is that it intentionally blends research evidence with personal experience in ways that are unusual for some academic journals. The work has a relational as well as scientific context. The relationship with my daughter, shown in the picture on her 4th birthday and again as a teenager, informs my understanding of the roots of empathy and its role in moral response. The reality is that all research, even the “hardest,” cannot escape point of view. This paper clearly has a point of view, but I have tried to be completely transparent with it. Happy reading, and best wishes to all.

HannahPam

 

Mar 15

Cyberbullying in Adolescence


Currently we are featuring an article that addresses the very timely and significant issue of bulling in the context of online communications among teenagers.  The article is titled “Cyberbullying in Adolescence: A Concept Analysis” by Elizabeth Hutson, MS, RN, PMHNP-BC.  Featured article are available for free download while they are featured, so please visit the ANS web site to download and read this important article, and return here to share your comments!

Ms. Hutson shared this background about her work for ANS readers:

As a Child and Adolescent Psychiatric Nursing Practitioner I work in a mood and anxiety program where we see adolescents with primary diagnosis of depression, anxiety, and concurrent suicidal ideation. From my experience I noted that a major risk factor for these mental health concerns was bullying behaviors. Bullying in schools, unfortunately, occurs frequently and causes school avoidance, depression, and at its worst suicidal ideation and suicide attempts. There is an exorbitant amount of research into childhood bullying and one of the most commonly used definitions for bullying is given to us by Dr. Dan Olweus, who has over 40 years of expertise on childhood bullying.

Bullying Definition:

“A person is bullied when he or she is exposed, repeatedly and over time, to negative actions on the part of one or more other persons, and he or she has difficulty defending himself or herself”.

As though bullying was not bad enough a new phenomenon that has begun to cause problems in adolescence is cyberbullying. As adolescents, schools and parents began to see the devastating effects of cyberbullying researchers quickly leap into action trying to describe and explain this new phenomenon. Initially, they took the definition of bullying and added “electronic forms of contact” and went about with their research. Unfortunately, this new definition did not seem to convey what cyberbullying truly was. For this reason I chose to address the topic of cyberbullying in a concept analysis. I looked through the research and found 25 articles and one dictionary definition of cyberbullying and from these came up with a new defintition.

Definitions of Bullying

Mar 7

1 Comment

Ontology of Virtual Nursing Presence


The article currently featured on the ANS website is titled “On Virtual Presence ,” authored by Valarie S. Grumme, MSN, RN, CCRN; Charlotte D. Barry, PhD, RN, NCSN, FAAN; Shirley C. Gordon, PhD, RN, NCSN; and Marilyn A. Ray, PhD, RN, CTN-A, FAAN.  In this article the authors address the realities of maintaining a nurse-patient relationship in the context of online distant environments.  While this article is featured, it is available for download at no cost, so we invite you to read the article and return here to share your comments and ideas on this timely topic!

Ms. Grumme shared this information about this work, based on her dissertation research:

Grumme

Valarie Grumme

My interest in virtual nursing presence evolved as an outcome of my dissertation research on the use of social media groups by persons in the transplant community.  As a caring modality, nursing presence has been linked to traditional concepts of person with place, space, and time. However, advances in health care and communication technology have expanded nursing practice to nontraditional environments that preclude the physical presence of the nurse for a caring encounter. An increasing number of nurses are creating and maintaining nurse-patient relationships and practicing in a diverse range of specialties in virtual/distance environments.  The question arose; can nursing presence be “real” in virtual/distance environments? To answer the question, I explored theoretical and philosophical constructs of presence from multiple disciplines, including nursing, engineering, cognitive and behavioral science, and communications.

To understand the phenomenon, I found that I first had to delve into the deep existential roots of what it means to be truly present with another. Marcel’s mystery of presence, “even if I cannot see you, if I cannot touch you, I feel that you are with me . . . ” resonated with me.  In the existential writings of Buber, Marcel, Heidegger, and Levinas, the ontology of presence is interpersonal and relational; it includes interconnectivity, mutuality, intentionality, and love.  Existential thought is reflected in the writings of many nurse theorists, including many attributes of presence: “being with”, “being there”, bearing witness, commitment, and love.

The next reflective question was, how can the shared intimate and interpersonal relationship of presence be manifested in a virtual environment? Virtual environments of care are supported by a technological medium, a form of interface that enables the relationship between the nurse and nursed.  This concept is known as mediation.  Multidisciplinary studies of virtual presence consistently describe successful perceptions of virtual presence as a sense of being immersed in the experience as if the technological medium was not there (non-mediation).  Sandelowski alluded to this concept as well, describing a successful telepresence intervention where the shared experience of the caring conversation seeming dissolved the technological barrier between nurse and client.

The pandimensional nature of the internet extends the healing power of nurse caring to virtual environments, allowing persons to give and gain support for their unique expressions of health patterning without the constraints of place, space, and time.  The nurse artfully and intentionally utilizes the ability to recognize pattern, problem-solve, and employ both moral and emotional intelligence to provide a therapeutic and caring encounter through the technological medium supporting the nurse-patient relationship. I offer a new ontology of virtual nursing presence:

Virtual nursing presence is the unbounded and loving gift of self, manifested in the intimate, mutual, and intentional relationship of the nurse and the nursed. It is a presence that transcends place, space, and time, cocreated within the technological medium that supports the caring encounter, and can have lasting and lingering effect.

Writing this article with my esteemed colleagues was a personal journey of exploration, discovery, and appreciation of the human capacity for caring, wherever that need might be.  I thank you Dr. Chinn for the opportunity to share this knowledge with others.  I see advances in technology that support nurse caring as an opportunity, not a burden.  Care environments continue to evolve and challenge our ability to practice effectively. Extending our capacity to care into virtual environments adds another dimension to caring practice that will only continue to grow as we explore new frontiers and futures for humanity.

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