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Posts from the ‘Nursing Practice’ Category

May 12

Nursing Practice and the Criminal Justice System


The current issue of ANS features two articles focused on Crime, Justice and Health.  The first of these two articles is titled “In a Spirit of Restoration: A Phenomenology of NursingPractice and the Criminal Justice System” by Geraldine Gorman, PhD; Rebecca M. Singer, ND; Erin Christmas, MS; Catherine Herbstritt, MS; Layne Miller, MS; Mary Murphy, MS; Cailan Shannon, MS; and Katrina Wyss, MS.  We invite ANS readers to download this article while it is featured (no cost), and share your reflections in the comments section below.  Dr. Gorman shared this summary of her work, and how she became dedicated to addressing this timely and important social justice issue, followed by a message from co-author and faculty colleague Rebecca Singer:

From Geraldine Gorman:

Tragedy and crisis divert our attention from other tragedy and crisis. I became interested in prison reform back in the 90’s when I attended a forum focused on the impact of Buddhism on healthcare.  A Religious Studies professor from DePaul University in Chicago talked about  the

Geraldine Gorman

sangha he initiated for the men imprisoned in the maximum security facility in Michigan City, IN. I was intrigued and Ron invited me to attend one of their Zen Buddhist sittings. For the next 15 years I went into the prison as a volunteer with the Buddhist group, sitting and chanting in Korean– not a word of which I understood– and getting to know the men, some of whom had spent time on death row. During those years  3 executions took place, one which took the life of one of the members of the sangha. A peaceful protest accompanied each state-sanctioned murder with black robed Buddhists  sitting silently in the parking lot, from dusk till dawn. The reverberations from each death ran deeply.

But then 9/11 shook the world and my nursing conscience turned from the injustices of the prison industrial complex to the horrors of war. I continued going into the prison but war dominated my thoughts and words and  outrage.  This is what happens when the dike starts springing too many leaks. We have only so many hands, so much time.  It goes without saying that our current political dike has become a sieve.

Ten years ago as part of our public health nursing class, I began bringing students to the Indiana prison. They were able to walk through the cell blocks, observe what passes for healthcare, listen to men describe their journey to and through incarceration. Chicago’s own Cook County Jail had remained an impenetrable fortress until very recently when our reform-minded Sheriff reached out to the College of Nursing and we began providing health education to the men and women detained in the cavernous jail. Our article describes the initiation of this project, along with the gratifications and challenges faculty and students encountered.

We appreciate the opportunity to share this with the ANS audience. While we must pay close attention to the ever present rumors of war and more war, we cannot allow our attention to be diverted from the injustices in our own communities.  And we need to expose our students to what is done in our names without paralyzing them. Such is the challenge for nursing practice, education and scholarship: to witness and confront insurmountable suffering and to move forward.

From Rebecca Singer:

My primary area of practice is within humanitarian response work which takes me to conflict or post-conflict zones where I try to provide services with few resources to displaced peoples who have lost nearly everything but their lives. In my work with students, they express interest in this work and often ask what they should do to prepare for a job in humanitarian response. After

Rebecca Singer

several weeks in the jail, I realized that Cook County Jail was the closest I had ever come to a refugee camp in Tanzania or a displaced persons’ settlement in South Sudan while never traveling beyond my own city’s limits. The students and I needed to travel no further than 26th and California, just over 2.5 miles from our own College of Nursing, to be surrounded by displaced peoples who have lost nearly everything but their lives and to provide health education with few resources but our wits, several pieces of paper and a poster board.

As the weeks passed and we struggled to understand the rules, to navigate the bleak halls, and to be heard over the din, I came to see how much like a foreign country the jail was. Each time we enter the jail, we repeatedly are asked to show our ID and permission letter, which serve as our passport to this foreign land. We pass through metal detectors and check-points which remind me of the international borders and military check-points I cross to get to my other work. They check our bags and confiscate anything that might pass as contraband; this week a permanent marker and next week a roll of tape. We must pack our bags with care.

The people who get caught up in our criminal justice system live in the same city that we do, yet their lived reality is essentially foreign to me and to most of the students.  They often speak a different language, using slang that I have never heard.  Coming from parts of the city with higher rates of unemployment and lower rates levels of education, they function in an economy far removed from the Loop that I can see from our campus. The exchange of illegal items, including illicit drugs and the firearms that drive up the rates of violence in their communities, render the currency they use different from ours. And while our city is diverse, the range of brown and black people I meet in the jail do not look like the faculty I call my colleagues at our university.

Yet, it is only like a foreign country, because, in fact, this jail is in our city. It houses fellow citizens of our Midwestern city–polite, friendly sports’ fans who love to complain about the weather. They are fellow citizens whose current conditions serve as a stark and vivid reminder that the social determinants of health are at play right here. Now when students ask me about my humanitarian response work and express interest in doing it, I can encourage them to come with us to do that very work without traveling more than 2.5 miles—no passport necessary—just pack with care.

Sep 4

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Embedding a Palliative Approach in Nursing Care Delivery


We are delighted to feature the open access article titled “Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis” authored by Richard Sawatzky, PhD; Pat Porterfield, MSN; Della Roberts, MSN; Joyce Lee, PhD; Leah Liang, MSN; Sheryl Reimer-Kirkham, PhD; Barb Pesut, PhD; Tilly Schalkwyk, MSN; Kelli Stajduhar, PhD; Carolyn Tayler, MSA; Jennifer Baumbusch, PhD; and Sally Thorne, PhD. This article not only addresses the significant challenges of palliative care, but also serves as an example of the translation of knowledge into practice. We welcome you to download and read the article at any time – it is permanently available at no cost to readers.  Then return here and share your comments and ideas!  This is a message from Dr. Sawatzky about the work of this team of authors:

“A palliative approach is not a service” (quote from Carolyn Tayler)

Richard Sawatzky

Although we realize that end of life care may require care from professionals who have been formally trained in palliative care, mostpeople who have life limiting illnesses receive care in settings where access to palliative care professionals is limited. To address this, our team has been studying how the notion of “a palliative approach” can help to embed general principles and practices of palliative care broadly into the healthcare system. The Initiative for a Palliative Approach in Nursing: Evidence and Leadership (www.iPANEL.ca, led by Kelli Stajduhar and Carolyn Tayler) engages nurse researchers, practitioners, and administrators in British Columbia, Canada, who share a common goal to integrate a palliative approach throughout the healthcare system. Building on our prior publication on “Conceptual Foundations of a Palliative Approach” (Sawatzky, Porterfield et al. 2016), the current article is one of the iPANEL studies that specifically seeks to synthesize across insights derived from different sources of knowledge relevant to a palliative approach as the basis for supporting nursing care teams to embed a palliative approach into their practice. In doing so, we have broadened the scope of what is

Pat Porterfield

typically considered “knowledge synthesis”, by translating general knowledge from previous studies into particular contexts of nursing practice. This knowledge synthesis process reflects the fundamental form of nursing knowledge application we articulated in a prior publication in ANS on “Particularizing the General” (Thorne and Sawatzky, 2014). We hope that, in addition to contributing to an understanding of a palliative approach, the article will spark further discourse about effective methodologies for particularizing general knowledge within local contexts of everyday nursing practice.

Jul 22

Measurement of Holistic Nursing Values


In the current ANS featured article, author Elizabeth Kinchen, PhD, RN, AHN-BC, addresses the challenges facing nursing to address the primary care needs of populations now served because of access to the U.S. Patient Protection and Affordable Care Act.  The article, titled “Development and Testing of an Instrument to Measure Holistic Nursing Values in Nurse Practitioner Care” provides evidence of the effectiveness of nurse practitioner care.  Dr. Kinchen provided this description of her work:

Elizabeth-Kinchen

Dr. Elizabeth Kinchen

With the expansion of health care accessibility in the United States, nurse practitioners (NPs) are projected to assume increased responsibility for a large portion of primary care delivery. This article derives from my dissertation research, in which I explored the patient’s perception of the nature of the nurse practitioner’s care, specifically the preservation of holistic nursing values. I think this topic has special importance in describing the unique contribution which NPs make to primary care delivery.

The impetus for this research came from my experiences in working with and being cared for by nurse practitioners in acute care, academic, and clinic settings. Many of the patients I came in contact with confided that they preferred the nurse practitioner’s care because NPs take time to listen to them and consider all aspects of their circumstances when providing care. These qualities are hallmarks of nursing care, which, I contend, is by tradition and definition holistic in nature. Furthermore, the incorporation of holistic nursing values in NP care exemplifies the value of the NP role for patients.

The majority of research into NP care has hitherto focused on satisfaction and practice style, and has been mainly qualitative in design, so this study, using a newly-developed instrument, represents a contribution to quantitative research on NPs that does not address provider-driven indices such as satisfaction, but rather patients’ perceptions of the preservation of nursing values in NP care.

My dissertation research, guided and supported by Dr. Bernadette Lange and Dr. Ruth McCaffrey, was undertaken to develop and test the Nurse Practitioner Holistic Caring Instrument (NPHCI), a new instrument designed to gauge the extent to which nurse practitioners preserve holistic nursing values in their care. Results from this study support previous research findings regarding the holistic qualities of NP care, wherein NPs report incorporating holistic nursing values in practice; namely, patient advocacy, listening, non-judgmental acceptance of patient choices, and viewing patient conditions from a comprehensive, whole-person perspective. These are attributes which define holistic nursing care, and which the IOM1 cites as defining primary care delivery.

Nurse practitioner care is posited to differ in essential ways from purely medical practice, most importantly in its attention to a relationship-centered, coordinated and comprehensive mode of care delivery. Exploring a care model which highlights the incorporation of nursing values in NP practice therefore has great significance for patients, practitioners, and educators in guiding care, improving practice, and planning academic curricula. In addition, it is hoped that studies documenting the nature and value of NP care will also inform policy creation and reform, especially in matters such as reimbursement, scope of practice, and collaborative regulation.

Therefore, as next steps in this research, I hope to explore how holistic nursing values are incorporated in nurse practitioner care in larger, more diverse patient samples, and in NP program curricula, by revising the NPHCI for use in nursing faculty populations.

1. Institute of Medicine. The future of nursing: Leading change, advancing health. http://www.iom.edu/~/media/Files/Report%20Files/2010/The-Future-of-Nursing/Future%20of%20Nursing%202010%20Report%20Brief.pdf. Published October 2010. Accessed October 18, 2014.

Download this important article now at now cost, while it is featured!  Then return here to participate in discussion of your ideas based on Dr. Kinchen’s article!

Dec 30

An exemplar of theory-guided practice


sullivan-bolai300

Susan Sullivan-Bolyai

All too often nurses wonder what theory has to do with their practice, sometimes even denying the relevance that theory might have to practice!  Our current featured article addresses this issue, providing a wonderful example of the relevance and usefulness of theory-guided practice.  The article, titled “Tried and True Self-Regulation Theory as a Guiding Framework for Teaching Parents Diabetes Education Using Human Patient Simulation,” is by Susan Sullivan-Bolyai, DNSc, CNS, RN, FAAN; Kimberly Johnson, BSN, CDE, RN; Karen Cullen, BSN, CDE, RN; Terry Hamm, BSN, CDE, RN; Jean Bisordi, BSN, CDE, RN; Kathleen Blaney, MPH, RN; Laura Maguire, MS, RN; and Gail Melkus, EdD, RN, FAAN.  In addition, it provides a wonderful example of a creative use of simulation to enhance patient teaching and learning.  Speaking about their article, Dr. Sullivan-Bolyal says:

in the spirit of family nursing research using Jean Johnson’s interpretation of Self-Regulation theory to guide our parent education intervention speaks to the unique core values of nursing and our contribution to searching for better ways to improve family and patient clinical outcomes. We hope this article underscores the importance of using theory to drive our nursing interventions.

Visit the ANS web site to download your copy of this article while it is featured!  Then return here, and add your comments, questions and ideas – we would be delighted to hear from you!

Jun 26

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Nursing as Body Work


The current “Editor’s Pick ” article from the current ANS issue is titled “Critical Perspectives on Nursing as Bodywork,” authored by Karen Anne Wolf, PhD, APRN-BC, DFNAP. In this thought-provoking article, Dr. Wolf  calls for nurses to reject the objectification of the body and instead reclaim body work as integral to a holistic perspective.

Dr. Wolf shared this message about her work for ANS readers:

Nursing as work is the focus of my scholarship. In past work, I have explored the larger structural issues in the collective history of nursing. In this paper I explore the paradoxical nature of nursing as bodywork. Scratching beneath the surface of the issues of status and power opens a window on the variety of factors that shape the work of nurses in relation to their patients. The nurse-body relationship is so fundamental to nursing work that we are blind to its social impact. This results in contradictory images and experiences. For example, nurses are revered as “most trusted” and angelic in many countries yet Wolf300exposed to persistent degradation within the media and in public discourse.

Nursing work continues to be viewed as low status despite professionalization efforts. The social discomfort with the human body contributes to the paradoxes in nursing as bodywork. The relational boundaries between nurses and patients blur ordinarily taboo spaces. The intimacy of providing physical care carries the stigma of nursing as dirty work. Yet this same intimacy throughout the sacred rituals of birth, death, and vulnerability contributes to the entrusted relationship. De-stigmatizing nursing as bodywork begins with accepting our bodywork relationship. Without such an acceptance, there is a tendency to distance nursing from the body through the increasing use of ancillary nursing workers or technology. Recognizing the paradox of nursing as bodywork is a critical to the future of the profession. I would suggest that we consciously claim and embrace the relational care for the body rather than reject it. Nurses must be mindful and respect the power inherent in their privileged and intimate relationship with patients.

Download your copy of Dr. Wolf’s article at no cost while it is featured on the ANS web site! We welcome your thoughts and comments in response!

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!

 

May 28

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The cognitive work of nurses


In the current Editor’s Pick article titled “Use of the Critical Decision Method in Nursing Research: An Integrative Review,”  author Priscilla K. Gazarian, PhD, RN reports on her synthesis of  7 studies that explored nurses’ cognitive processes in today’s work environment.  She describes her work as follows:

I have been curious about how nurses make decisions for some time. How  do nurses “know” what the right action is in any given situation? Intuition has not been a complete enough explanation for me.

Nursing is unique in many ways, but especially in its decision making. Nurses make decisions under extreme conditions. Often, the nurse has only an instant to decide. The stakes may be very high, maybe even life or death. The decision occurs in an environment that is marked by complexity. In addition, nursing’s commitment to holism requires that the nurse consider each situation within an individual context.

In my role as a Clinical Nurse Specialist and Nurse Educator I have observed nurses act with precision and accuracy in complex situations. I have also seen beginning nurses struggle to learn to “Think like a nurse.” When I watch an experienced nurse, the actions seem well coordinated and fluid, but I am only seeing the tip of the iceberg. Beneath the surface, nurses are continuously perceiving, organizing, interpreting, and deliberating. All the time. In fact, researchers have documented an ICU nurse makes a decision every 30 seconds (Bucknall 2000). How do they do it, and do it so well?

I was first introduced to the critical decision method as published in 1993 here in ANS. The method seemed a good fit for understanding the uniqueness of nurse decision-making. I read more about the method and digested other studies that had used the method. When I looked at the body of studies that had used CDM in nursing, I became aware that when taken together,  these studies corroborated much of what I had observed in practice about nurse decision making.

iceberg550

The Critical Decision Method is certainly useful in describing the cognitive processes of nurses. In addition, the resulting descriptions of situated decision making can provide a framework for instructional materials, to inform the design new information technologies, and to improve and advance nursing practice.

I am grateful for this opportunity to share my work in ANS and in this blog post.  I hope you find my synthesis rings true to what you know about the complexity and uniqueness of nurse decision-making, and I look forward to your comments and dialogue on how this method can be used to influence the development of nursing practice.

Go to the ANS web site now to download your copy of this informative article!

Jan 9

Critical Caring model
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Critical Caring Model update!


One of the best things about having a blog for ANS is the ability to update content along the way!  Adeline Falk-Rafael has provided an update on the model that she and Claire Betker used as the basis for their research reported in the article titled “The Primacy of Relationships: A Study of Public Health Nursing Practice from a Critical Caring Perspective.”  (See the recent blog post about this article).  Dr. Falk-Rafael explains this new depiction as follows:

This model of Critical Caring theory represents more of an evolution in the graphic depiction of the model than in the theory itself.  The color and artwork better depict the metaphor of the tree and are more suitable for the web than the previous black-and-white diagram and results, hopefully, in more legible text.  As in the previous model (published in ANS 35:4), the trunk of the tree, which supports the praxis branches, is comprised of the tenet of Critical Caring as a way of being, knowing, and choosing, along with 2 carative health promoting processes.  The shading  and positioning of each is helpful both in differentiating the carative processes from the tenet and in emphasizing the centrality of the latter.

I believe this model brings the elements of critical caring into focus, and helps to comprehend the whole of the process that the model represents.  Many thanks to Dr. Falk-Rafael for providing this update!

critical caring-DRAFT3

Nov 13

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Rural Nursing and Palliative Care


This “Editor’s Pick” article describes an analysis of two studies that examine nursing palliative care in rural settings.  The authors (Barbara Pesut, PhD, RN; Barbara McLeod, MSN, BSN, RN; Rachelle Hole, PhD, MSW; Miranda Dalhuisen, BSN, RN) explain how the findings of these studies inform nursing practice in palliative care, and the ways in which the rural context shapes nursing practice. Their analysis provides insight into the ways in which nursing palliative care improves quality of life.  Dr. Pesut described their project as follows:

This article was birthed out of the Initiative for a Palliative Approach in Nursing: Education and Leadership, more commonly known as iPANEL.

“Research for nurses by nurses” is the motto for iPANEL.  A population aging with multiple chronic health conditions provides some important challenges for nurses, challenges that require both evidence and leadership. Research conducted by members of this team have indicated that a failure to identify and support those who are dying may have adverse consequences including poor symptom management, lack of advance

Barbara McLeod (L) and Barbara Pesut (R)

care planning and failure to attend to important psychosocial and spiritual issues. These issues are particularly relevant for nurses working in non specialized palliative settings such as acute medical units, residential care and home health.

iPANEL is a unique team, funded by the Michael Smith Foundation for Health Research, of researchers, clinicians, administrators and policy makers whose goal it is to integrate a palliative approach into the care of those living with life limiting chronic illness.  A palliative approach takes the supportive principles of palliative care and applies them in an upstream approach, recognizing that although there is a role for specialized palliative care, a palliative approach can be used by all nurses in all contexts to improve the care of the dying. A palliative approach begins by recognizing that a person with an advancing chronic illness may indeed be on a dying trajectory and then having sensitive and ongoing conversations around the goals of care.

This particular project arose out of my (Barb Pesut’s) interest in rural palliative care. Having done extensive ethnographic work examining palliative care in rural areas I was struck by how the rural context influenced

Rachelle Hole (L), Miranda Dalhuisen (R)

nursing work at end of life. I observed how policies and programs generated in urban areas had unintended consequences for nurses. For example, nurses in rural areas work outside of hours and scopes of practice to ensure that their neighbours and friends are well cared for. And yet, this may put them in difficult situations if they are not supported by administrators, if they feel less than competent in the care they are being asked to provide, or if the burden of care becomes too great. In the context of my research I heard many nurses talk about wanting more of the benefits of specialized palliative teams. And yet, I also observed a high degree of expertise and commitment in these nurses as they cared for palliative individuals. It made me wonder about the concept of specialty practice, and where it served nursing well…and not so well. Thus, rural nursing work became an important context in which to look at a palliative approach which seeks to apply the principles of palliative care within generalist contexts – the rural context became an important “living laboratory”. It also became an opportunity to deepen understandings of what rural family caregivers need most from nurses.

Barb Pesut and Barbara McLeod are academic/practice partners leading iPANEL on how to better understand how to educate nurses for a palliative approach. Rachelle Hole is a colleague from social work who brought her expertise in qualitative analysis and social systems to help us think outside of our ‘nursing lens’ as we analyzed the data. Miranda Dalhuisen is a palliative nurse and research coordinator – those invaluable partners who make our programs of research doable.

Visit the ANS web site today to download a free copy of this very informative and interesting article!

Oct 14

Supporting Parenting Transitions


This “Editor’s Pick” article by Dr. Karen Pridham and her colleaguesprovides interesting insights into the challenges of parenting prematurely born infants during their first year of life. The article is titled “Caregiving Motivations and Developmentally Prompted Transition for Mothers of Prematurely Born Infants,” and is authored by Karen Pridham, PhD, RN, FAAN; Tondi Harrison, PhD, RN; Roger Brown, PhD; Mary Krolikowski, MSN, RN; Rana Limbo, PhD, RN, PMHCNS-BC, FAAN and Michele Schroeder, PhD, RN, CPNP

Dr. Pridham shared this account of the team’s ongoing research in this area:

Early in 40 years of observing parents—mostly mothers—feeding their babies and listening to their accounts of what was happening for them and their babies as they grew older in the first year, it became clear that parents’ motives for feeding changed in ways that reflected infant anticipated or realized developmental changes. Parents’ stories of their babies’ feedings and the feedings they shared with us by allowing us to be present during the feeding and to discuss with them as we watched a video tape together after the feeding were powerful in shaping our view of transitions in parenting made evident in the context of infant feedings. These experiences also helped us view the infant as an important agent of the parent’s transition to new motivations, along with the new goals, expectations, and intentions they entailed. These transitions were at the micro level of developing parenthood, but we saw the transitions make a substantial difference in the parent-child relationship as well as in the parent’s confidence and self esteem.  Sometimes a nurse was in a position to help a parent make a transition to a new way of being with her child.

The mother of the 12-month old child in this picture* wanted him to progress to new foods and methods of feeding, a motivation constrained by feeding practice learned with older children and desire for efficiency and neatness in feeding. When she was encouraged by the nurse to give her son opportunities to feed himself in response to his signals of interest, she was amazed when he used the spoon to put food into his mouth. He was soon self feeding with pride, and mother and child were getting new pleasure out of their feeding interaction. Parents, at a problem solving session, discussed how they could feed consistently, advancing their transition in feeding practice to accommodate their son’s developing capacities .

Much work remains to be done to explore the features and health implications of parenting transitions as they are elicited and facilitated by the child’s advances in development.  The research team is currently modeling guided participation interventions to support parents, both mothers and fathers, in making adaptive transitions when anticipating or experiencing developmental advances of an infant with a complex congenital heart defect.

* All photographs used by permission of the parents

Visit the ANS Web Site to see more details of this article!

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