The current featured ANS article is titled “Evaluation of an Ecological Model for Work-Related Musculoskeletal Disorders” authored by Minjung Kyung, RN, MPH; Laura Wagner, PhD, RN, FAAN; Soo-Jeong Lee, PhD, RN, FAAOHN; and OiSaeng Hong, PhD, RN, FAAN. Visit the ANS website to download this article at no cost while it is featured. Minjung Kyung has shared this message about this work:
Minjung Kyung
Musculoskeletal disorder is the largest category of occupational health problem that not only affects nurses but also many other occupations, causing a temporary or permanent disability. Work-related musculoskeletal disorders are the results of the interaction between external physical demands, psychosocial work factors, and the internal biomechanical, physiological, and psychological responses of individuals. Many interventions focusing on correction of individual’s biomechanics and lifting techniques have been implemented, but they were not very effective for reducing musculoskeletal injuries. Considering various risk factors and their interactions, a comprehensive understanding of the physiology of work-related musculoskeletal disorders is required for developing an effective intervention to prevent WRMSDs.
Sauter and Swanson’s ecological model for work-related musculoskeletal disorders consist of three parts: biomechanical, psychosocial, and cognitive structures. This model is also distinguished by its focus on cognitive processes and expanded musculoskeletal outcomes such as symptom reporting, health care utilization, disability, and performance problems. Employing Chinn and Kramer’s framework, we evaluated the ecological model to determine its appropriateness and usefulness in nursing paradigm.
I am very excited to share this paper and hope this would be helpful.
Our current featured article is titled “Guided Participation for Clinical Practice: A Middle-Range Theory of Teaching and Learning” authored by Karen Pridham, PhD, RN, FAAN and Rana Limbo, PhD, RN, CPLC, FAAN. While it is featured you can download the article at no cost! We welcome your comments and discussion of this article in the comments below. Dr. Pridhame shared this background about their work for ANS readers –
Karen Pridham
The article, “Guided Participation for Clinical Practice,” written with Rana Limbo, is the culmination to date of years of experiences working with families. These experiences include observing, reflecting, and wondering with parents of children and with our research team about how parents and later, the nurses we were working with, were thinking through and coming up with new solutions to the health-related issues they were dealing with. Our observations led us to reflect and wonder how my students, and later my colleagues, made their own assessments about parents and their children working on health-related tasks and responsibilities. In the process, were parents themselves learning to more confidently and competently manage these issues–specifically problems or goals–and achieve the outcomes they wanted to accomplish?
Rana Limbo
Together, research assistants, graduate students, colleagues (e.g., co-investigators and research teams), and I, kept on thinking, learning about, and developing Guided Participation over the decades, a process that remains ongoing due to the assumption that Guided Participation is dynamic. Our many miles of automobile travel together, most often in pairs, to observe and discuss feedings with many families and the in-depth reflection and analysis that followed on the ride home were invigorating and productive of new insights and concepts for describing parents’ goals and competencies and Guided Participation processes. These concepts had origins in Rogoff’s work, were studied together in seminar courses, and in our own meaning making and concept naming from discussion of research experiences. Ours was a process of theory development through deep and challenging experiences with families—parents and their infants—in need of description and explanation–cast against study of the literature. The rich description in the literature included Dewey’s Education as Experience; Vygotsky’s concepts of socially-based learning, among them the zone of proximal development; and Rogoff’s ideas of learning as a collaborative process, contextually and culturally attuned to the other.
We went beyond noticing that something was missing or incomplete in traditional teaching/learning patterns based in information sharing, important in its own right but not sufficient for theory development of participatory learning in clinical practice. We had experienced, over decades of our lives and in many settings, learning within a relationship, another Guided Participation assumption, when we were engaged in activity vital to projects that mattered deeply to us. Among the guides who shaped my orientation towards learning through experience was my mother. When I was 12 years old and teaching summer Vacation Bible School in the small community in which my family lived, I was challenged by the behavior of an 8-year-old boy who disengaged from participation with the group, seemingly self-absorbed and fidgety—clearly not having a good time, consequently making a nuisance of himself. When I asked my mother, who was an experienced Sunday School teacher, how to handle the situation that was joyless for both the child and me, she suggested I find out from him what he wanted to work on at Vacation Bible School. He surprised me with a clear and doable activity, and with my asking the question (later to be learned as joining attention), we formed a relationship, and had a time that I remember as good for the rest of the week. It was a pivotal, amazing teaching/learning experience for me. Later, as a graduate student in nursing, I had the good fortune to be one of the four students in the first class the renowned scholar and practitioner of pediatric nursing, Florence Blake, had at the University of Wisconsin-Madison. She taught me the meaning of “being with” when she and I were with a toddler having a tantrum, so angry that it was enough to drive anyone in the vicinity away. But Florence Blake stayed put, sitting close to the child and telling him that she knew he was angry and upset. She would not leave him, she assured him, talking gently through his shrieks and thrashing about, a powerful lesson to me regarding how trust with a young child was maintained and strengthened—and what it took to be with someone and why.
With students and research assistants, we did not dwell on what was lacking in traditional teaching in clinical practice. Our new, evolving frames of mind oriented us to finding a language for recording our work with families and communicating what we were observing in learning through participation. We were also creating a “dictionary” of sorts of issues families were working on or needed to work on, the processes we were using to work on the issues with them, and the competencies they were developing in Guided Participation sessions, often focused on the infant’s feeding, sleeping, growth, and development.
Dr. Rana Limbo, co-author of this article and first author of a companion article¸ collaborated with me in many home visits, reflected with me in depth about what we had experienced with a family, and co-taught classes of public health and neonatal intensive care nurses and led many reflective practice sessions with these nurses and nurses providing Guided Participation to parents of fragile infants. These experiences with Dr. Limbo greatly enlarged my thinking about Guided Participation concepts, including joining attention, sharing understanding, making connections, and transferring responsibilities, as well Guided Participation as a clinical practice. The collaboration with Dr. Limbo in many contexts and venues, including automobile trips generally 90 minutes one way, has kept Guided Participation a dynamic and developing—exciting and intriguing–practice.
The first featured article in the latest issue of ANS is titled “Exploring the Usefulness of Theory-Guided Reflection During the COVID-19 Pandemic” authored by Kathleen Sitzman, PhD, RN, CNE, ANEF, FAAN; Tristin Carpenter, MSN, RN; Kim Cherry, MSN, RN; and Ileen Craven, DNP, MSN, CNS, RN-BC. We invite you to download this article at no cost while it is featured, and share your comments and reflections for discussion here. Dr. Sitzman shared this message about this work for ANS readers:
I and my study team have been teaching theory-based content in the Caring Science, Mindful Practice Massive Open Online Course since 2015 and have been struck by fact that learners consistently express genuine gratitude for the opportunity to share and reflect upon care-giving experiences with each other in this online caring community of learners. We decided to carefully study this phenomenon in the hope of better-understanding how learners use Watson’s Human Caring Theory to better-understand and describe their feelings and experiences. We found that theoretical structure helped spark memories and careful analysis,and also provided opportunities for meaningful reflection related to the power and importance of caring work. We are hoping this paper will inspire nurse educators to consider adding additional opportunities for learners at all levels of nursing education to learn through theory-guided reflection.
The current issue of ANS includes the new ANS section featuring works focused on the scholarship of Rogerian Nursing Science. This section is called “Visions,” the title of the Rogerian Nursing Society journal. Visions was founded in 1993, and became a part of ANS in 2023, with the Visions article appearing as the last article is every print issue of ANS. The current Visions article is titled “A Unitary Theory of Healing Through Touch,” authored by Marlaine C. Smith, PhD, RN, AHN-BC, HWNC-BC, HS-GAHN, FAAN and Sean M. Reed, PhD, APRN, ACNS-BC, ACHPN, FCNS, SGAHN. Here is a message from Dr. Smith about this work:
Marlaine Smith
The publication of this article has been a long time coming! It was one of those manuscripts sitting in the “To Do” pile waiting for the two of us to find enough time together to update, refine, and polish it before we felt it was ready for submission. The practice theory that we developed was born from the findings of a qualitative study of the experiences of persons with advanced cancer receiving massage and simple touch. The qualitative study was “nested” in a RCT (Kutner, Smith, Corbin et.al., 2008) focused on studying the outcomes of both massage and simple touch (a “control condition” that the research team developed consisting of laying hands on 10 locations of the body for 3 minutes at each location). Dr. Jean Kutner and I were co-PIs on this study, and during data collection we received comments from the data collectors and those providing the touch that the participants in both groups were sharing rich, detailed accounts of their experiences. We realized we needed to capture these experiences in a qualitative study. Toward that end a subgroup of the team conducted interviews of 17 participants. Smith and Reed analyzed the data from the interviews. Both of us shared a unitary worldview, and it was clear that our theoretical perspectives were shaping how we conceptualized and languaged the findings. One’s philosophical/theoretical perspective informs all theory development but is often not made explicit. We used a constructivist, retroductive theory development process where both inductive and deductive processes informed the development of the theoretical concepts. The assumption is that theories, especially at the practice level, are developed within a larger conceptual/philosophical system of ideas, ours being Rogers’ Science of Unitary Human Beings. I still remember our collaborative theory development process…how much fun it was….the creativity…the A-Has of discovery as our analysis led to articulation and elaboration of the concepts.
Sean Reed
As we state in the article (Smith & Reed, 2023), healing, from the definitions of unitary scholars, is a transformative process characterized by remembering one’s integral nature, awareness of wholeness, appreciating wholeness, and/or coming into right relationship. So the concepts of sensing, reflecting, and connecting specify how touch facilitates this process of healing. From a Rogerian perspective healing through touch is perceiving the whole, one’s bodily feelings, integrating information toward transformative perspectives, and experiencing self as integral with others and the universe. The metaphor of “Sanctuary” was used to capture the essence of the experience of healing through touch. The theory was linked to Rogerian science through the concepts of wholeness (sensing), awareness (reflecting) and presence (connecting) (p. 8).
There are some important “take aways” in this article. We’ve already mentioned the first…the joy of theory development. It is important to demystify the process of developing and linking concepts to create the meaning of phenomena important to nursology, and to do so in a way in which the ideas are: 1) aligned with a larger conceptual/theoretical system (correspondence); 2) fit together at the same level of abstraction in a clear and simple way (coherence); and 3) offer usefulness for the professional practice and advancement of the discipline (pragmatics) (Kaplan, 1964). Another important “take away” is that touch is literally at our fingertips, and we need to use it as an expression of our intentions to promote health, healing and wellbecoming. While there are more data supporting the effects of massage for healing, the findings from both quantitative and qualitative studies suggest that even simple touch has perceived benefits. In my experiences as a patient and family member of patients in acute and long-term care, it seems that the use of touch as a caring-healing modality is rare or absent. If we value theory-guided, evidence-based practice, then this can no longer stand! We have clear evidence of the benefits and a practice-level theory explaining its linkages to healing. It’s time to intentionally integrate touch into nursing practice as a standard of care. During our research we heard from family members who were hesitant to touch their seriously-ill loved ones. Engaging family members and their loved ones in discussions about the kinds of touch that might be comforting is a good way to have family members express their care through touch and for the patient to receive the healing from this love and caring. Based on the theory and evidence it is time for forms of touch such as backrubs, foot and hand massage and expressing caring and comfort through simple touch to be included in foundational courses in nursing. These competencies easily align with the AACN Essentials’ Domains of Knowledge for Nursing Practice and Person-Centered Care and the Concepts of Communication, Compassionate Care, Evidence-Based Practice and Clinical Judgement.
Practice theories in the discipline of nursing can offer descriptions of how health patterning modalities like touch can make a difference in health/healing/wellbecoming and guide nursing practice. It is our hope that this article contributes to that end.
Kaplan, A. (1964). The Conduct of Inquiry. San Francisco: Chandler Publishing.
Kutner, J.S., Smith, M.C., Corbin, L., et al. (2008). Massage therapy vs. simple touch to improve
pain and mood in patients with advanced cancer: A randomized trial. Annals of Internal
Medicine. 149(6), 369-379.
Smith, M.C. and Reed, S. (2023). A unitary theory of healing through touch. Visions:
Scholarship of Rogerian Science in Advances in Nursing Science, 46(2),219-232. doi: 10.1097/ANS.0000000000000487.
Our current featured article in ANS is titled “A Concept Analysis of Structural Competency” authored by Katerina Melino, MS, PMHNP-BC; Joanne Olson, PhD, RN, FAAN; and Carla Hilario, PhD, RN. We welcome you to download this article at no cost while it is featured on the web! This message from Katerina Melino gives background about her work:
My interest in structural competency was born out of my professional experience as a registered nurse and psychiatric mental health nurse practitioner, and the tensions and gaps I grew increasingly aware of in my practice and the health care system over the course of my career. For the last 13 years, I have worked as a nurse in acute and emergent mental health care, substance use treatment, and HIV mental health care. My clinical work in each of these settings has been with people with mental health challenges who are disproportionately Indigenous, Black, and people of colour; LGBTQ+ identified; and living in poverty. Many of my clients struggled to access appropriate treatment, experienced challenges in maintaining engagement with care, and were hampered in their mental health recovery by factors that could not be addressed by the biomedical model of care in which I was working. Structural competency offered a way to conceptualize what I was seeing in practice, as well as possibility in how to move forward in addressing these gaps.
Structural competency is a nascent concept in the health professions literature and has only been published on in the discipline of nursing since 2018. It represents an evolution of cultural competency and incorporates understandings of the social determinants of health, structural violence, and critical race theory in conceptualizing how factors far outside the individual locus of control influence individual health. This concept analysis uses Rodgers’ evolutionary method to examine how disparate meanings and uses of this concept across medicine and nursing can be synthesized to broaden our multidisciplinary conceptual approach to addressing health inequity. I am excited by the promise of structural competency to transform our approach to clinical mental health care.
Many thanks to my mentors, Dr. Joanne Olson and Dr. Carla Hilario, who guided me in doing this research.
We began our initial Future of Nursing (FON) research efforts with a 2016 presentation at the American Public Health Association (APHA) annual meeting, using critical discourse analysis to examine public health nursing’s (PHN) representation within the FON and five-year evaluation reports, Robert Wood Johnson Foundation (RWJF) nursing campaigns, and previous Institute of Medicine Reports that informed the FON. As a research methodology, discourse analysis was selected because of its usefulness in examining dominant discourses that influence nursing practice. The analysis indicated that public health was often constructed within the context of individualized care. The public/community health workforce was narrowly defined with PHN presented primarily through case studies of individualized care while population health focused on clinical population categories. This first investigation raised more questions than answers, especially regarding processes surrounding the FON’s development and the RWJF’s unique role in the effort. We were therefore well positioned to continue this work when we learned a second report was being planned.
Mary Canales
As public health nurses, our initial reactions to the planning of a second FON report that would focus on nursing’s role in addressing the social determinants of health (SDoH) was met with both a sense of validation and apprehension. On the one hand, it was validating to have nurses practicing in specialties within the profession beyond those in PHN recognize the critical role that SDoH play in perpetuating health inequities. On the other hand, we were also apprehensive about the potential for SDoH being narrowly conceptualized – and what that might mean for the scope of interventions in which nurses would be asked to engage. Specifically, nursing’s history of directing practice, education, and research endeavors at the individual level has produced a profession that overwhelmingly, and willfully, dons blinders to understanding the socially-constructed systems that differentially drive the health of the individual patients for whom care is provided, and the communities to which they belong.
At the time the second FON process was launched, I had just stepped into the role of Chair of the APHA’s Public Health Nursing (PHN) Section. Given that populations with the worst health outcomes due to SDoH have been a long-standing focus of PHN, it seemed reasonable to expect that public health nurses as a collective, through their member organizations, would figure prominently as presenters or panel participants both within the National Academies of Science, Engineering, and Medicine (NASEM) FON committee, and at the public forums held by the FON committee. I anecdotally observed the opposite, whereby several leaders of the APHA PHN Section in collaboration with other PHN-focused organizations (the Council of Public Health Nursing Organizations, among others) regularly attempted to engage in the process, but to little avail. Ultimately, APHA PHN leaders were able to provide two minutes of testimony at the public forums. However, nurses from acute care systems were routinely given much more ‘discursive space.’ The irony of this was not lost on us, and these observations led to the systematic, critical examination of the entirety of the process and the juxtaposition of nursing as a self-regulating profession through professional organizations, the discursive space afforded nursing representation during FON processes, and what this might mean for nursing’s collective agency.
The current featured ANS article is titled “Considering the ‘Bitter Rivalry’ Within the Context of European and Colonial History of Women Healers” by Adeline Falk-Rafael, PhD, RN, FAAN. This article will be available for download at no cost while it is featured – an apt resource for the week we celebrate “Nurses’ Week”! Here is a message that Dr. Falk-Rafael provided giving some background related to this work:
I first learned about Mary Seacole from a group of Caribbean nursing students who were in my leadership course in a BScN program at York University in Ontario, Canada. They presented Seacole to the class as a nursing leader whom they admired. A number of years later, I heard Mary Seacole spoken of in disparaging terms at a nursing meeting so turned to her autobiographical account of her life and work. Her book, I believe, reveals her to have been a woman healer, providing both caring and curing services to the people she served, like women had for centuries before her.
I have also long been an admirer of Florence Nightingale. I wrote this article to honour both these 19th century nurses in the hopes of lessening what has been called a “bitter rivalry” among today’s nurses. As I reflected on the current polarized views among nurses and others, I was reminded of the historical treatment of women healers, particularly by medicine, and wondered whether a similar dynamic might be at play within nursing with regard to Mary Seacole. I draw no generalized conclusions in that regard, believing the answer is likely complex and different for each, but hope the article leads readers to consider the bitter rivalry and draw their own individual conclusions.
Featured currently in ANS is the article titled “The State of the Science of Nurses’ Implicit Bias: A Call to Go Beyond the Face of the Other and Revisit the Ethics of Belonging and Power” by Holly Wei, PhD, RN, CPN, NEA-BC, FAAN; Zula Price, PhD, FNP-BC, RN, CNE®cl, CD(DONA); Kara Evans, MSN, RN, NPD-BC, NEA-BC; Amanda Haberstroh, PhD, MLIS, AHIP; Vicki Hines-Martin, PhD, PMHCNS, RN, FAAN; Candace C. Harrington, PhD, DNP, MSN, APRN, AGPCNP-BC, CNE, FAAN. Note that Nursing Professional Development Credits are available for this article!.The article is available to download at no cost while it is featured!
Dr. Holly Wei, Professor, Associate Dean at East Tennessee State University College of Nursing, provided this background information about the work reported here:
The current focus on health equity and racial health disparities has brought implicit bias to the forefront of healthcare delivery. As the interests in health inequity and disparity grow, we want to examine the current research on nurses’ attitudes and behaviors. The broad and pervasive impacts of implicit bias have been examined across social and cultural institutions and systems, including healthcare, education, and housing. Because nurses spend the most time with patients, they play a significant role in patients’ and families’ healthcare experiences and outcomes.
This paper presents the current state of the science of nurses’ implicit bias and the primary sources of nurses’ implicit bias – race/ethnicity, sexuality, health conditions, age, mental health status, and substance use disorders. Nurses’ implicit bias is analyzed and described using Levinas’ face of the Other and ethics of belonging, Watson’s human caring and unitary caring science, and Chinn’s peace and power theory. This paper invites nurses to go beyond ‘the face of the Other’ and revisit the ethics of belonging and power. We hope these theories can provide a guideline and call for nurses to work together with organizational leadership and other healthcare disciplines and stakeholders to mitigate implicit bias and optimize healthcare outcomes.1,2
References
Wei H. The development of an evidence-informed Convergent Care Theory: Working together to achieve optimal health outcomes. International journal of nursing sciences. 2022;9:11-25. https://doi.org/10.1016/j.ijnss.2021.12.009
Wei H, Price Z, Evans K, Haberstroh A, Hines-Martin V, Harrington CC. The State of the Science of Nurses’ Implicit Bias: A Call to Go Beyond the Face of the Other and Revisit the Ethics of Belonging and Power. Advances in nursing science. 2023. 10.1097/ANS.0000000000000470
The current featured article is titled “Factors Involved in Nurses’ Health-Seeking Behaviors: A Qualitative Study” authored by Tahereh Najafi, PhD, MSc, BScN, RN; Forough Rafii, PhD, MSc, BScN, RN; and Sara Rahimi, BScN, MSN, RN. The article is available for free download while it is featured.. Sara Rahimi has provided this background information about the work reported here:
The motivation to do this research was created in my mind when I lost one of my experienced nurse friends due to metastatic pancreatic cancer shortly after a late diagnosis. He had been experiencing some clinical symptoms for a long time, but he often ignored them or sought treatment with the help of his knowledge. After this painful incident, as a nurse educator, I realized in my interactions with nurses that most of them spend all their time working at the patient’s bedside and taking care of them, and they do not care about their health as much as they should. So this question was formed in my mind, why do nurses delay seeking health even though they know the importance of early referral and timely treatment? What factors affect nurses’ health-seeking behavior (HSB)? Therefore, as a Ph.D. candidate in nursing, I decided to devote my dissertation to this topic. My review of the existing literature did not reveal much information on this topic, and I decided to explore these factors as a qualitative study by conducting unstructured interviews with nurses. Interviews with nurses allow a deep understanding of their experiences when facing health problems. By content analysis of the conducted interviews, five major concepts were developed: fear, trust/distrust, excuse, access, and support. This article sheds light on the barriers and facilitators of nurses’ HSB in a country like Iran that faces a shortage of nursing workforce and a high population of communicable and non-communicable diseases. Recognizing nurses’ HSB is important in ensuring the health of the nursing workforce and providing quality care to patients by a healthy workforce. This study helps health policymakers and managers to be aware of the barriers to nurses’ HSB and use this information to plan to improve health or change the poor health behaviors of nurses. Future research is needed on how nurses’ HSB can affect their behavior with patients and their care.
I would like to thank my dear mentors, Professor Forough Rafiei and Professor Tahereh Najafi who guided me in doing this research.
The essential purposes of ANS are to advance the development of nursing knowledge and to promote the integration of nursing philosophies, theories and research with practice. We expect high scholarly merit and encourage innovative, cutting edge ideas that challenge prior assumptions and that present new, intellectually challenging perspectives. We seek works that speak to global sustainability and that take an intersectional approach, recognizing class, color, sexual and gender identity, and other dimensions of human experience related to health.
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE) www.publicationethics.org
The ANS Blog provides a forum for discussion of issues raised in the articles published in Advances in Nursing Science. We welcome all authors and readers to post your comments and ideas on the blog! If you would like to be an author on this blog, let us know!
The journal Editor is Peggy L. Chinn, RN, PhD, FAAN. Dr Chinn founded the journal in 1978.
