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Posts from the ‘Featured Articles’ Category

Jun 13

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Caring as Emancipatory Nursing Praxis


The new featured article in the current ANS issue challenges readers to examine values and believes that form a foundation for nursing as caring within complex technical and economically driven systems. The article, titled “Caring as Emancipatory Nursing Praxis: The Theory of Relational Caring Complexity,” is authored by Marilyn A. Ray, PhD, RN, CTN-A, FAAN and Marian C. Turkel, PhD, RN, NEA-BC, FAAN.  They have each provided interesting background about their work, and insight in to how their ideas have emerged:

From Dr. Ray:

My journey focusing on the study of human caring in complex hospital cultures began in 1969 as an MSN student in nursing and anthropology where I conducted an ethnography of a hospital. My interest in the study of nursing as a “small” culture and health care/hospital organizations as “small” cultures led to seeking a Master of Arts in Cultural Anthropology, and a PhD in

Dr. Marilyn Ray

Dr. Marilyn Ray

Transcultural Nursing where, within my dissertation, grounded theories of nursing as transcultural caring were discovered. The substantive theory of Differential Caring unfolded showing how the dominant environmental context of different hospital units influenced the meaning of caring, such as, the interrelationship between technology and caring in an Intensive Care Unit, economics and caring in Administration, and spiritual-ethical caring in the Oncology Unit. Analysis and insight led to the discovery of the formal theory of Bureaucratic Caring (rendering the paradox of human caring in complex organizations which continues today). Subsequent research on the technology and economics of caring, exposure to Rogerian unitary science and the emerging field of complexity science/s through teaching philosophical inquiry, caring science, qualitative research methods, and conducting research with the late Dr. Alice Davidson continued to open my mind to the significance of human-environment integrality. Over the past 20 years accomplishing funded research with Dr. Marian Turkel on economic caring within many public, military, and private complex healthcare systems exposed more of how the contextual dimensions of economics, political, legal and technological phenomena enlightened our understanding of contemporary practice, and how the research illuminated the discovery of the Theory of Relational Caring Complexity. This theory deepened our commitment to seeking understanding of human rights, social justice and social caring ethics as emancipatory praxis in complex systems and prompted us to share this content.

As a doctoral student of Dr. Madeleine Leininger, my classmates and I received the gift of exploring “caring as the essence of nursing.” As a former faculty member of the University of Colorado College of Nursing (and now as a Professor Emeritus at Florida Atlantic University), I have had the opportunity of sharing ideas of and learning about, and researching caring science, ethics, unitary science, complexity sciences, and the feminist ideal of peace power with Drs. Jean Watson, Sally Gadow, Marlaine Smith, Peggy Chinn, the late Alice Davidson, and many other professionals. This knowledge has directed and continues to direct the discipline of nursing. At the same time, as an officer in the United States Air Force Reserve, Nurse Corps, I was aware of how these ideals needed to be embedded in local and global cultures, including not only the military, but also, the Transcultural Nursing Society, World Health Organization and United Nations. I am a charter member of the International Association for Human Caring and have been committed to co-creating awareness of caring science and art, respect for human dignity, cooperation, and reasoned dialogue to lay the foundation for a sustained commitment to human rights and social justice. These actions hopefully will lead to peaceful coexistence among all people and a world without war. Nurses have the obligation to be examples of human caring–to seek ethical caring knowledge, promote moral mindfulness, give voice to the voiceless, cultivate humanity, understand transcultural nursing and social/cultural contexts, and exercise ethical judgment and evaluation to facilitate the creation of peaceful communities of caring worldwide.

From Dr. Turkel:

Like my co-author and colleague, I am committed to the advancement of the scholarship of caring science and complexity science. My professional career trajectory is grounded in the philosophical tenets of caring being essential to the disciplinary foundation of nursing and the theoretical concepts of caring and complexity serving as a framework for professional nursing

Dr. Marian Turkel

Dr. Marian Turkel

practice. My journey into caring as a substantive area of study within the discipline unfolded when I entered graduate school at Florida Atlantic University (FAU) in 1989. It was a wonderful time to be at the university as our Dean, Dr. Anne Boykin was integrating caring into the curriculum and Dr. Leininger and Dr. Watson came to university sponsored conferences. I became very involved with the International Association for Human Caring (IAHC) and met Dr. Ray who was our eminent scholar. My favorite story is that I knew she was important, not sure what an eminent scholar was, and did not know if I was allowed to talk with her. She taught nursing leadership and we formed an instant personal and professional relationship as we had shared values related to caring in complex systems. As a nurse leader, I was always challenged by the paradox between caring and economics within complex systems and the social injustice that registered nurses often face in the real world of hospital nursing practice. My master’s thesis was A Journey into Caring as Experienced by Nurse Managers. Managers shared their frustration of trying to care when economics ruled decision making. My doctoral dissertation, Struggling to Find a Balance examined the paradox between caring and economics from the perspective of patients, nurses, and administrators.I was on faculty at Florida Atlantic University and the sentinel qualitative and quantitative research that Dr. Ray and I completed validated that caring was explicitly linked to improved patient and nurse outcomes and hospital system economic outcomes.

My life journey took a turn and my husband and I relocated to Chicago and then Philadelphia. I made an intentional decision to return to practice and began my journey into “praxis” (informed practice). I went back into the hospital setting but with a new lens, using research, evidence-based practice and caring theory to inform and transform practice. I continued my involvement with the IAHC, re-connected with Dr. Watson and became involved with the Watson Caring Science Institute (WCSI). As faculty within WCSI, I work with hospitals to create caring healing environments for employees, patients, and families by integrating caring theory into the practice setting. My scholarship is now focusing on leadership framed in caring science where intention setting, caring , love, peace, and values ground the practice of leadership. I just ended my IAHC Presidency May 2014 with a conference in Kyoto, Japan sponsored by IAHC and Kobe University. The conference theme was the Universality of Caring with over 781 Registered nurses from 20 countries and regions in attendance. On a personal note, I am moving back to Florida in July and returning to Holy Cross Hospital where I used to work and met my husband. My vision is to co- create a very innovative Service-Academic Partnership with Florida Atlantic University College of Nursing. In caring and peace, Marian

Visit the ANS web site to see this wonderful article – you can download it at no cost while it is featured!  Then return here to share your comments and ideas!

May 31

Double-duty care-giving: Nurses’ Unpaid Family Work


The authors of the current ANS featured article examine the phenomenon of nurses’ unpaid family work – a growing trend in the face of inadequate health care resources.  In other professions, unpaid professional services are considered “pro bono”  professional service to the community.  But for nurses, their unpaid work in families is invisible and unrecognized, and as the authors indicate, this unpaid work has implications for nurses’ paid work as well.   The article, titled “Professionalizing Familial Care: Examining Nurses’ Unpaid Family Care Work” by Oona St-Amant, MScN, RN; Catherine Ward-Griffin, PhD, RN; Judith Belle Brown, PhD; Anne Martin-Matthews, PhD; Nisha Sutherland, MScN, RN; Janice Keefe, PhD; and Michael S. Kerr, PhD is a report of a grounded theory study based on interviews with 32 nurses over a 6 to 12 month period.  The lead author, Oona St-Amant shared this background about their work:

As co-authors, we are delighted that our work has been selected to be featured in this current issue of ANS. Our article entitled “Professionalizing Familial Care: Examining Nurses’ Unpaid Family Care Work” builds on a body of work which st-amant250investigates the experience of double duty caregiving (DDC), that is, the provision of care to an older relative by a health care professional. At the helm of this work is Dr. Catherine Ward-Griffin who has built a program of research on the negotiation of care boundaries between and among health care providers, older adults and family caregivers. Several of the co-authors such as Drs. Brown, Keefe, Martin-Matthews and Kerr have been actively involved in several studies in developing this work.

As lead author, I have been extremely fortunate to complete my doctoral studies under the supervision of Dr. Ward-Griffin and commence a program of research centered on various forms of unpaid care work, including family caregiving, double duty caregiving and international volunteer health work in a variety of contexts. In this article, we shed light on nurses’ unpaid family care work. Unlike when other professionals employ their paid skills and employment resources in an unpaid fashion, nursing unpaid care work is not characteristically valued as “pro bono” (for public good), even when the transfer of skills is similar. Instead, akin to other forms of unpaid family care work, double duty caregiving tends to be invisible work. And yet, approximately 35-40% of nurses over 35 years of age engage in this work, and this figure is expected to increase with an aging population.

In this article, we examine the specific strategies that contribute to the professionalization of care work in familial domain. Additionally, we explore some of the implications of professionalizing family care. In response to this evolving body of work, the research team in collaboration with multiple project collaborators developed a policy brief with explicit recommendations for action. Specifically, the policy brief sets out five recommendations at various levels of policy including 1) employers/health care agencies; 2) health care administrators, human resource managers, researchers, policy makers; 3) employers/health care administrators; 4) national, provincial and territorial professional health associations; and 5) governmental officials, employers, and union representatives.  You can download the DDC Policy Brief here.

We welcome your responses and comments on this article!  Visit the ANS web site to download a copy of this article at no charge, then return here to share your ideas!

May 24

The Other Mother


The article that is featured now on the ANS web site is titled  “The Other Mother: A Narrative Analysis of the Postpartum Experiences of Nonbirth Lesbian Mothers” by Michele M. McKelvey, PhD, RN.  As LGBTQ rights have emerged as a social movement, research related to the experience of LGBTQ people and families has begun to appear in scholarly literature across all disciplines.  Dr. McKelvey’s study addresses a human experience that is shared by many women world-wide, but in the context of a lesbian family, the experience of motherhood involves unique challenges.  Dr. McKelvey shared this background about her study :

My interest in lesbian mothers grew out of my personal and professional experiences. As an obstetrical nurse for more than 20 years, I noticed an increase in the number of gay and lesbian couples becoming parents. Although these parents have a great deal in common with most new parents, they also have unique needs and experiences. For these women, becoming mothers was an intentional, thoughtful journey. Many became pregnant after years of infertility treatment, miscarriages, and other physical and emotional losses. All mothers certainly love their children but I believe that there is something special

Michelle McKelvey

Michelle McKelvey

about these mothers. My nurse colleagues and I wanted to provide sensitive, culturally appropriate care to lesbian mothers. As I searched the literature, I realized that studies about any aspect of lesbian motherhood were rare. Lesbian mothers were virtually absent in the literature.

I was extremely inspired by the work of Eliason, Dibble and DeJoseph (2010) publicizing nursing’s silence on LGBT Issues in ANS. While physicians and our interdisciplinary colleagues have endorsed LGBT issues, we, as nurse, have remained silent. It is my hope that publications like mine will help to break that silence, embrace LGBT health and end disparities in this community.

I was so fortunate to be a doctoral student of Dr. Cheryl Beck at the University of Connecticut. Dr. Beck, my beloved mentor and major advisor, ignited my passion for qualitative research. As a beginning doctoral student, I conducted my first pilot study, a descriptive phenomenological study of the childbearing experiences of lesbian mothers. I followed up this study with a metasynthesis on the same topic. My doctoral student colleagues and faculty mentors encouraged and celebrated my research.  With their support and nurturing, I was able to find my voice and ultimately recognize nonbirth lesbian mothers. During my doctoral studies, I also became a mother. My wife Jill and I welcomed our precious daughter, Molly, into our family on January 5, 2010. She continues to be our greatest blessing.

My ANS article is based upon my doctoral dissertation: The Other Mother: A Narrative Analysis of the Postpartum

Molly's family

Molly’s family

Experiences of Nonbirth Lesbian Mothers. As I listened to the stories of nonbirth lesbian mothers’ first year of motherhood, I realized that marriage equality is a significant health issue. Marriage equality provided these mothers with validation as legal parents as well as the legal protection that their children could not be taken away from them. Without this legal parentage, these mothers were essentially legal strangers to their own children. The results of my study validated my steadfast belief that indeed, the personal is political (Hanisch, 1969).

I have always believed that “timing is everything”. Although I probably could have completed my PhD years ago I “trust the process” that it was completed at exactly the right time. Marriage equality for same sex couples continues to evolve throughout our country. Social acceptance of LGBT people has grown exponentially.  The Institute of Medicine (2011) and The Joint Commission (2011) published significant documents calling for health care professionals to provide family-centered, respectful care to LGBT individuals and their families. These monumental documents validated the crucial need for my research.

I look forward to continuing my program of research on lesbian mothers. The results of my study suggest several possible research opportunities. It is my honor to share my research with the readers of ANS. I am sincerely grateful to the editors and reviewers. ANS has always been a leader in nursing scholarship and innovation. I am grateful for the journal’s willingness to embrace cultural diversity and particularly issues related to LGBT health.

While this article is featured on the web site, it available for free download – so visit the web site today!  Then share your comments with us here – we are eager to hear from you!

 

May 4

Teen mothers – twenty years later!


We are delighted to include in the current issue of ANS a long-term follow-up study of teen mothers.  The article, titled “Teen Mothers at Midlife: The Long Shadow of Adversarial Family Caregiving” by Lee SmithBattle, PhD, RN and Victoria Leonard, PhD, RN, APRN, is a rare examination of evolving multi-generational relationships in the lives of teen mothers who participated in a study 21 years ago, when their infants were in the first year of life.

Teenage girls have been having babies for a very long time. My own mother had me when she was 19 years of age. Because she

Lee SmithBattle

Lee Smithbattle

was married to my 18 year old dad, and because marriage provided a passage to adulthood for many young couples of my parents’ generation, teenage pregnancies were not an issue, even though many marriages were hastily arranged to conceal a premarital conception. As “shotgun marriages” declined, other practices emerged to conceal or punish pregnant, unwed teens. White girls were spirited away to maternity homes to give birth and to be “rehabilitated” for their sexual transgressions. They were also forced to relinquish their babies for adoption. A teenage girl in my own neighborhood shared this fate; she unexpectedly disappeared and returned home months later with no word of what had happened (and certainly no baby in tow).

Maternity homes, however, excluded black teens, so as shotgun marriages declined, black teens gave birth and raised their children with family help. A decade later, in the late 70s, as white and black teens, like older low-income women, began to keep their babies as single mothers, they faced a lot of public ostracism and scientific scrutiny. It was in this context that I began visiting pregnant and parenting low-income women as a new public health nurse. My parents’ working class background could not have differed more from the disadvantaged families I visited, but public health nursing practice, in the grand tradition of Lillian Wald, Myra Breckinridge, and Margaret Sanger, taught me important lessons about social inequalities and perverse policies, and being humble, curious, and open to experiences that differed from my own. (As an aside, these lessons are beautifully brought to life in Call the Midwife, a television series produced in the U.K. which is currently airing on public television in the US). In the late 70s, scientific discourse on teen mothers was just beginning, and the media reports and scientific literature on teen mothers were difficult to reconcile with what I was learning from the families I visited as a PHN. Yes, the teens on my caseload were not going to graduate from high school, but this was not for lack of interest or motivation but because high schools excluded them. 04_small250Perinatal and social outcomes could be worse for teen mothers than older mothers, but were often comparable when teens had access to resources and good health care. And teens who had the help and support of family members seemed to have advantages that older mothers sometimes lacked when they were bereft of partner and family support. Making sense of these issues was a strong motivating factor for me to return to graduate school.

I began this study two decades ago. When I left the homes of the teen mothers after conducting the final interviews in 1989, I never expected to see the families again, so the final good-byes brought a sense of loss. After all, I had spent close to 25 hours in each home over a 3 month period, interviewing teen mothers and family members, and hanging out in their kitchens, living rooms, and bedrooms, observing daily life with babies to tend to. I attended birthday parties, picnics, and other family events, and also participated in mundane activities like folding laundry. Vivid memories of some of the initial visits are still etched in my memory. I suppose it was these memories, as well as my curiosity about how their lives might unfold, that led me to the second study, and then the third, fourth, fifth, and sixth. Other researchers apparently have also found it difficult to end relationships with study participants; for example, Rochelle Dalla has followed a group of teen mothers on a Navajo reservation for more than 12 years. Frank Furstenberg finally ended his remarkable study of teen mothers after 30 years. I wonder how he managed to do it. George Elliot’s (1964) words capture why I will embark on the seventh study in a couple more years:

“Every limit is a beginning as well as an ending. Who can quit young lives after being in long company with them, and not desire to know what befell them in their after-years? For the fragment of a life, however typical, is not the sample of an even web: promises may not be kept, and an ardent outset may be followed by declension; latent powers may find their long-waited opportunity; a past error may urge a grand retrieval.” (Eliot, G, 1964. Middlemarch. New York: Signet.

An impressive number of qualitative studies on teen mothers (and a growing number on teen fathers) are published every year, and this work continues to challenge our assumptions and stereotypes of teen mothers and the perverse ways that social 01_small300inequities and childhood adversities shape the lives of U.S. children. Equally important, quantitative studies that control for teen mothers’ background factors confirm the long arm of social disadvantage, showing that teen mothers do about the same on a range of outcomes as older women from similar backgrounds. Stereotypes and assumptions die hard, however, especially when sex, poverty, and race are part of the mix.

In addition to the families who welcomed me into their homes, other relationships have nurtured this research. I have had the best and most generous mentors. Edna Dell Weinel always demonstrated public health nursing at its finest and Patricia Benner modeled how to listen closely and with deep respect for various voices in the text. Vickie Leonard, the co-author of this paper, has

Vicki Leonard

Vicki Leonard

been a fellow traveler on this study from the time we began our first semester as doctoral students together. Because Vickie’s dissertation focused on older mothers with career commitments, pouring over our interviews and sharing stories from our respective families provided a rich comparison for how social worlds set up different and similar meanings, practices, and ways of being a mother. With each follow-up study, Vickie has read several cases to help clarify and refine my interpretations. Every researcher should be so lucky. The artwork accompanying this blog was created by Hilda Robinson, a dear friend and artist in Oakland, California, who turned the family stories of my dissertation into these and other paintings.

Finally, I would like to applaud Advances in Nursing Science for its commitment to publishing the lengthy papers that qualitative research requires. Amid the general press in nursing journals to publish short, empirically-based studies, ANS has courageously provided a home for scholarly qualitative work. ANS published my very first paper from Time 1, and then others along the way. Longitudinal studies are rare in nursing, and I’ve been fortunate that ANS has always welcomed a diversity of philosophical approaches and study designs. Nursing has been enriched by the courage of ANS’s editor and reviewers.

 Visit the ANS web site while this article is featured to download and read this article at no cost.  We welcome your comments here – we will respond!

Apr 16

Developing a Frailty Framework for Vulnerable Populations


The featured article from the current issue of ANS is titled “Development of a Frailty Framework Among Vulnerable Populations,” authored by Benissa E. Salem, PhD, MSN, RN; Adeline Nyamathi, PhD, ANP, FAAN; Linda R. Phillips, PhD, RN, FAAN, FGSA; Janet C. Mentes, PhD, APRN, BC, FGSA; and Catherine Sarkisian, MD, MSPH; Mary-Lynn Brecht, PhD.  Recognizing that nursing is at the forefront of care for most vulnerable populations, they collaborated in developing a wholistic framework that can be used to guide research with these very difficult-to-reach groups of people.  Dr. Salem shared this message about their work:

 

Salem-Benissa-Committee-Picture

Mary-Lynn Brecht, Janet C. Mentes, Adey Nyamathi, Benissa E. Salem, Catherine Sarkisian and Linda Phillips.

We are so pleased that our article has been selected to be featured in this current issue of ANS.  I have been so blessed to work with my dissertation chair, Dr. Nyamathi, along with my committee members, Drs. Phillips, Mentes, Brecht and Sarkisian in the development of this manuscript.  Further, I have been privileged to consult with Drs. Gobbens and Morley regarding the model. The framework has been inspired by several disciplines (nursing, gerontology/geriatrics and vulnerable populations), along with those who are homeless. Frailty itself is a construct which is challenging to disentangle. When working with vulnerable populations, specifically, homeless populations, it is imperative to understand unique antecedents which may influence frailty and outcomes. Drawing upon the literature focused upon homelessness, discussion with experts, and based upon experience and discussion among coauthors, the model guides possible antecedents, along with frailty, and the outcomes.  Future models related to this construct should assess nursing intervention components and the potential for frailty to be a dynamic, rather than a static state. Further, application of the model and refinement related to other vulnerable populations are all areas of future work.

While this article is featured, you can download it at no cost.  We hope you will do so, and return here to offer your ideas and responses to this very important work.

Apr 5

Developing Praxis in Nursing Education


Our featured article from the current issue of ANS is titled “Work-Integrated Learning: A Didactic Tool to Develop Praxis in Nurse Education” by Elisabeth Dahlborg Lyckhage, PhD, RNT, RN and Sandra Pennbrant, PhD, RNT, RN.  In

Elisabeth Dahlborg Lyckhage

Elisabeth Dahlborg Lyckhage

this thought-provoking article, the authors examine the concept of “praxis,” clarifying various meanings and proposing a view of this concept that challenges nurse educators to examine, with students, their nursing actions from a philosophical, theoretical, and practical point of view.  They provided this message about their work as nurse educators in Sweden:

Our interest in the concept of praxis was aroused some ten years ago when we noted that the concept was used in completely different ways in nursing. Sometimes one was referring to routines, sometimes to the tangible reality (as practice), sometimes to the connection between theory and practice. To deepen and clarify the meaning of the concept of praxis, in order to use praxis as the knowledge created in the

Sandra Pennbrant

Sandra Pennbrant

meeting between theory and practice, we have used work integrated learning. University West is responsible on the national level in Sweden for developing work integrated learning. It is therefore important for teachers in the nursing program to use work integrated learning as a tool for developing praxis.

 

 

 

 

 

While their article is featured on the ANS web site, you can download it free of charge!  We welcome your comments and responses; read the article and return here to share your ideas!

 

Mar 20

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Exploring the meaning of cultural competence


The current ANS featured article is titled “Cultural Competence in Health Care: An Emerging Theory” by Isabelle Soulé, PhD, RN.  In this article, Dr. Soulé presents the outcomes of her qualitative descriptive study to examine the current state of cultural competence in health care.  In her conclusion, she states: “This exploration of cultural competence in health care and health care education is a small step toward achieving a more complex understanding of cultural competence that moves away from superficial approaches toward recognition of the interplay of the many economic, political, geographic, and social conditions that provide a context for health disparities and health care disparities in our world today.”  Dr. Soulé provided this additional reflection on the complex relational challenges of health care in a world that is culturally diverse:

         Like so many others, I am uncomfortable with the term cultural competence.  Despite it being my primary area of research, over time, I find myself using the term less and less. I am not dissuaded by the ideals it represents such as receptivity, flexibility, curiosity, inclusivity, understanding context, and humility, but rather that the term inadvertently implies an endpoint despite what is stated to the contrary. In part, perceptions concerning cultural competence are derived from the concept being nested within US healthcare systems and healthcare education which are based on competence. Competence is indeed a worthy goal, but I argue it is not globe300enough.

Cultural competence is centrally relational in nature, and high-quality relationships require awareness, flexibility, and humility. This includes being open to learn, conceive of alternate sets of values, appreciate how mind-sets develop, and understand that all behaviors make sense in context. Inevitably, individuals and communities brought up in widely varying contexts and backgrounds live in widely different realities or “truths”. This understanding has been deeply embedded in me after 15 years of working abroad with indigenous peoples and with refugee communities from all over the world. In short, these communities have been some of my most important teachers.

In a typical US healthcare encounter, power and privilege often lie firmly on the side of the healthcare provider as a result of specialized education, professional and economic status, and even national citizenship. It can be challenging to recognize this privilege and realize the distance it can place between provider and client / family / community. This makes it difficult if not impossible to negotiate a collaborative plan of care. In order to redress power imbalances between provider and client, system and community, genuine humility is required. Humility includes respecting difference and recognizing that all perspectives have value. Difference is legitimate and people who have different ways of expressing themselves and enacting health and illness are just as valued as our own. Respecting different viewpoints as equally valid can serve healthcare providers in revealing where their viewpoints may be incomplete or limited. In addition, interacting in a non-judgmental way with people who have different ways of looking at things requires asking more questions than simply giving answers – a key skill in the development of trust and empathy.

Humility, not often addressed in professional circles, can be thought of as an accurate assessment of oneself, an ability to recognize and acknowledge limitations, and a willingness to be influenced by alternate values and worldviews. Humility may not be simply overlooked in US healthcare, but may actually be perceived as antithetical to competence, professionalism, and professional practice. Because many health professionals are educated to think in these terms, they may be quick to misunderstand or reject teachings that offer an unrecognized worldview or alternate set of truths. Moreover, building partnerships where health professionals respect the expertise of the client and family in their own healthcare decisions runs contrary to how professionalism is taught and role modeled in our schools and professions today.

Interacting from a starting point of humility rather than professional expertise (competence) can generate a very different type of healthcare encounter that, in the end, can be more satisfying to both client / family as well as healthcare providers. However, to elevate the position of humility in healthcare education and systems, radical transformation will be required. A beginning point can include creating safe places for students and faculty to discuss and learn from their less than elegant cultural moments (incompetence) without judgment, and with emphasis on openness (humility) and deep learning. In this spirit, the following questions can be used to begin this conversation:

  1. What assumptions am I making?
  2. How else can I think about this?
  3. How might the other person (family, community) be thinking about this?
  4. What am I pretending to not know?

Developing cultural competence and cultural humility – may the discussion continue.

Please do engage in this conversation by sharing your comments and ideas here!  You can download this featured article on the ANS web site at no charge while it is featured.  Then return here, and let us hear from you!

Mar 7

Research practices to address health equity


The authors of our current featured article provide exemplars from a study exploring African American participation in research to demonstrate the use of a combined framework for analysis that examines the interactions of environment, culture, biology and history to understand the complex problems of health inequity.  The article, titled “Uniting Postcolonial, Discourse, and Linguistic Theory to Explore Participation of African Americans in Cancer Research as an Effect of Social and Historical Race Relationships” is authored by Darryl Somayaji, PhD, RN, CNS, CCRC and Kristin Gates Cloyes, PhD, RN.  They present a compelling discussion of the need to better understand the experience of African Americans as research participants, and to use this understanding to change the social and political realities of the research environment, research practices, and the teaching of research methods. Dr Somayaji shared the following account of how this work evolved:

Kristin and I are honored that our article was selected to be featured for the current issue of ANS. I was fortunate to be a doctoral student of Dr. Kristin Gates Cloyes at the University of Utah, School of Nursing. Although our clinical backgrounds and expertise are different (Kristin’s in mental health; mine in cancer and cancer research), we share a

Dr. Somayaji (left) and Dr. Cloyes

Dr. Somayaji (left) and Dr. Cloyes

common history of interest in social justice and health equity. Kristin’s knowledge and expertise in critical research was instrumental in opening my eyes to new ways of thinking about research theory and how different approaches to research can translate to practice. The article “Uniting Postcolonial, Discourse, and Linguistic Theory to Explore Participation of African Americans in Cancer Research as an Effect of Social and Historical Race Relations” is from my dissertation work on exploring African American participation in research. Our hope is that this article will illuminate the complexity of participation in cancer research, and the importance of understanding how history, relationships, and language are closely tied to research subject identity.

The article will be available at no charge while it is featured on the ANS web site!  I invite you to read this important and thought-provoking article while it is featured, and contribute your responses and thoughts on this topic by commenting here.  This is a topic that calls for ongoing and lively discussion, and we welcome the opportunity to engage using this blog!

Feb 14

Focus on transitions from a nursing perspective


Eun-Ok Im, PhD, MPH, RN, CNS, FAAN is the author of our latest featured article titled “Situation-Specific Theories From the Middle-Range Transitions Theory.”  She begins her article is a concise overview of nursing’s theoretical evolution, placing the emergence of situation-specific theory in an historical context.  Dr. Im and Dr. Afaf Meleis first introduced the concept of situation-specific theory in their 1999 ANS article titled “Situation-specific theories: philosophical roots, properties, and approach” (ANS 22:2, p 11-24).  This current article provides, in addition to the historical overview, an analysis of 6 situation-specific theories and themes reflecting commonalities and variances in the theory development process.  Dr. Im shared this message about her work:

As you can see in the picture, we had lots of snow here in Philly, and hope all of you would stay warm and safe!  🙂snow

First of all, thanks a million for this opportunity to discuss my article with my respectable colleagues and students.  This article was originally initiated because of doctoral students in my theory class in Spring, 2013.  The students wanted to know about how a situation specific theory could be developed from a middle-range theory.  Although I previously wrote about the integrative approach to development of situation specific theories, the paper might not be adequate to address the students’ questions. The students were eager to learn about the exact theory development process that had been taken in previous development of situation specific theories. Also, since our original paper on situation specific theories was written in 1999, I thought this might be the right time to evaluate how situation specific theories have been developed.  Especially, I was wondering how situation specific theories were derived from middle range theories and further developed as “ready-to-wear” theories.

As the article illustrates, the development of situation specific theories from the middle-range Transitions theory were on the same directions that were originally proposed, and I could extract several themes reflecting the commonalities and differences in the theory development process.  The reviewed situation specific theories derived from Transitions theory focused on specific phenomenon of interests with narrow foci and provided clear implications for nursing practice. They were developed using multiple sources of theorizing, but mainly based on research-evidence. They

Dr. Eun-Ok Im

Dr. Eun-Ok Im

specified, added and combined major concepts and/or sub-concepts, and they had been developed to advance nursing theory toward forms of theory applicable to specific practice situations.

In the article, based on these findings, I proposed two implications for future development of situation specific theories: (a) to continue our efforts to further develop, specify, and modify the concepts and sub-concepts of situation specific theories through “integrative approaches”; and (b) to support the situation specific theories with strong collective evidence from nursing practice and apply and evaluate the situation specific theories in practice settings. From this stance, I would like to work on further recommendations for future development of situation specific theories.

Through this blog, I hope to open a conversation on the directions for future development of situation specific theories, which would be essential for future nursing knowledge development. Any thoughts would be greatly appreciated.

I join Dr. Im in encouraging you to respond to her article, and participate in a conversation here about these ideas!  This kind of conversation is vital for the future development of our discipline!  You can download your copy of her article while it is featured at no cost, so read it today, and come back here to join the conversation!

 

Jan 23

Knowing the patient in an age of electronic records


In our current featured article, authors Tiffany Kelley, PhD, MBA, RN; Sharron Docherty, PhD, PNP-BC, FAAN and Debra Brandon, PhD, RN, CCNS, FAAN report on their qualitative study designed to explore the meaning of the concept of “knowing the patient.”  This work provides important evidence on which to develop and design systems in patient care settings for recording and tracking information that serve the nurses’ needs for knowing their patients on a level that supports the best possible individualized nursing care.  Dr. Kelley describes how this work came about:

This article, “Information Needed to Support Knowing the Patient” was the first research study I conducted as part of my Ph.D. program at Duke University School of Nursing. I came to the program with the experience of working with an academic medical center during their transition from a paper-based record to an electronic health record system. I recall supporting many nurses providing direct inpatient care during and after the transition. After weeks on the kelley300system, I remember hearing nurses tell me a variation of “I feel like I don’t know my patient.” I wondered, “What does this phrase mean?” and “What had changed in the transition from a paper to electronic health record to stimulate this response?”

The questions travelled with me as I transitioned to a doctoral student at Duke. I recall being in my Philosophy of Science class during my first semester and describing this experience. My professors, Dr. Debra Brandon and Dr. Sharron Docherty (co-authors of this paper) were also intrigued. They listened attentively during class and encouraged me to explore this phenomenon further in the empirical literature. In doing so, I came across several papers where ‘knowing the patient’ was a key finding in qualitative studies of caring, the nurse-patient relationship, and decision-making. However, few scholars had directly asked nurses what it means to know their patients. Additionally, the literature was limited in describing the relationship of the information found in the patient’s medical record to support nurses’ knowledge of the patient. In the era of electronic health records, the role of the patient’s record must be understood so that we can ensure the design supports nurses to know their patient for optimal health outcomes.

This paper, “Information Needed to Support Knowing the Patient” is a qualitative descriptive study that aimed to understand the meaning of ‘knowing the patient’ from the perspective of nurses caring for hospitalized pediatric patients in an intensive care setting. We selected this population and setting as they represent a vulnerable patient population who are often unable to communicate their care needs due to their developmental status (e.g., infant or toddler) and/or medical condition (e.g., intubated or sedated). Additionally, we aimed to understand how nurses use available information sources to know their patients. The findings from this study have strong implications for how we begin to approach integrating EHRs and other clinical information systems into hospitals in order to support nurses in knowing the patient. Many opportunities exist to create new electronic solutions that address nurses’ existing information needs and gaps from the existing solutions. Future studies must aim to conduct process-oriented research studies to understand how and why nurses use specific information to know their patient and subsequently where the information is stored within the EHR.

I hope that you enjoy reading this paper.

To read the article, go to the ANS web site and download your copy while it is featured at no cost!  And then, please share your comments and feedback here!  We would be delighted to hear from you!

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