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Oct 14

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Learner-Centered Clinical Growth


In the current ANS featured article, author Jessica Barkimer, MSN, RN, CNE illustrates the value of evolutionary concept analysis to understand a dynamic, changing phenomena – clinical growth.  The article, titled “Clinical Growth: An Evolutionary Concept Analysis” is available at no charge while it is featured on the ANS website!  Here is Ms. Barkimer’s description of her work that led to this article:

As an educator who teaches nursing students in various clinical learning environments, I embrace the student-centered approach.  Each student brings forth unique previous experiences that contribute to his or her own construction of knowledge.  Years ago, while working on my degree, Masters of Science in Nursing Education, I encountered students who were functioning at various levels in the same cohort of students.  Learning objectives

Jessica Barkimer

Jessica Barkimer

often guide educators, however, in an attempt to facilitate the learning of each student, I often wondered, “how can an educator determine if a student demonstrates an appropriate amount of growth to progress to the next level?”  This multifaceted topic requires examination to benefit nurse educators, students, and patients.  Currently, I am working towards my PhD in nursing and have had the opportunity to work with faculty at Marquette University who have helped guide me in this process of knowledge discovery.

This article presents the findings of the conceptual analysis of clinical growth, using Rodger’s evolutionary method.  These findings represent a holistic approach, focusing on cognitive, affective, and psychomotor domains of each learner, requiring growth in all three areas.  This concept analysis and model lay the foundational groundwork for examining relationships among the antecedents, attributes, and consequences, which are essential for a nurse educator to understand and implement in practice, moving nursing education forward.  This examination of the literature also allowed me to consider various instruments designed to capture the aspects of clinical growth.  I look forward to continuing my research in this area.

Oct 7

Internet Recruitment of Racial/Ethnic Minority Research Participants


The currently featured article in ANS presents an examination of six practical issues the authors encountered in recruiting Asian-American breast cancer survivors as participants in an intervention study conducted on the internet.  The article is titled “Internet Recruitment of Asian American Breast Cancer Survivors,” authored by Eun-Ok Im, PhD, MPH, RN, CNS, FAAN; Yaelim Lee, PhD, RN; Xiaopeng Ji, MSN, RN; Jingwen Zhang, PhD; Sangmi Kim, MSN, RN; Eunice Chee, BSE; Wonshik Chee, PhD; Hsiu-Min Tsai, PhD, FAAN; Masakazu Nishigaki, PhD, RN, PHN, CGC; Seon Ae Yeo, PhD, FAAN; Marilyn M. Shapira, MD, MPH; Jun James Mao, MD, MSCE.  This informative article is availabe at no charge while it is featured; we invite you to read the article and contribute your responses to the article here!

Sep 28

Published Ahead-of-Print!


The following 2 items were added to PAP on 9/26/2016.
David, Laura
Letter to the Editor: PDF Only
Rahemi, Zahra; Williams, Christine Lisa
Original Article: PDF Only

Sep 23

Nurse Fatigue in the Hospital


The latest featured article from the current issue of ANS  is titled “Interpretation of Hospital Nurse Fatigue Using Latent Profile Analysis” by Diane Ash Drake, PhD, RN and Linsey M. Barker Steege, PhD. You can access this article here at no charge now while it is featured. Dr. Drake and Dr. Steege have each provided a message about their background and the work that has led to this article!  Leave your comments here to join a conversation about their work.

From Diane Drake –

diane-drake

Diane Ash Drake

I have had the privilege to consult as the Nurse Research Scientist at Mission Hospital, Mission Viejo, CA since 2003. Nurse fatigue quickly became a focused research interest supported by a small team of hospital nurse leaders who understood the potential adverse effects of long work shifts, and wanted to better understand hospital nurse fatigue and investigate fatigue risk management strategies. During the initial literature search we reviewed several nurse fatigue dissertations and contacted one investigator, a human factors engineer, who fortunately joined our study team. I want to thank Dr. Linsey Steege who shares the authorship of this paper with me for her perseverant collaboration and brilliant research intellect. Ultimately, my investigation of hospital nurse fatigue is about supporting the important work of hospital nurses with the purpose of making fatigue risk management a reality.

From Linsey Steege –

barker_linsey

Linsey M. Barker Steege

As an industrial and systems engineer, my overall research goal is to design work systems to improve health, safety and performance of health professionals, and by doing so, to benefit society by improving healthcare quality and patient outcomes. Human factors engineering is a focus area within industrial and systems engineering, which examines the interactions between humans, tools and technologies, the physical environment, and the organization of work in an effort to optimize human performance and well-being. In recent years, multiple agencies including the Institute of Medicine, the President’s Council of Advisors on Science and Technology, the National Academy of Engineering, and the Agency for Healthcare Research and Quality have pointed to the importance of partnership and collaboration between systems engineering, including human factors engineering, and healthcare. I feel privileged to be able to collaborate with Dr. Drake and the Mission Hospital nurse fatigue study team to better understand nurse fatigue in the context of the hospital nurse work system and work toward improved fatigue monitoring and risk management systems.  The findings from this paper offer a new approach for measuring nurse fatigue and may be useful in developing more efficient fatigue monitoring systems and for evaluating the effect of fatigue risk management strategies.

 

 

 

Sep 16

Trauma Informed Nursing Practice with Teen Mothers


The current ANS featured article is authored by Sarah Bekaert, MSc and Lee SmithBattle, PhD, and is titled “Teen Mothers’ Experience of Intimate Partner Violence: A Metasynthesis.”  We invite you to download this article from the ANS website and return here to add you comments to a discussion of this very important issue.  Sarah Bekaert shared this background about this article:

This paper arose from the two authors’ mutual interest in the lived experience of teen mothers.  Sarah Bekaert is currently lecturing at City University, London, UK, and practicing clinically in Sexual Health and Contraception with Oxford University Hospitals Trust.  A Children’s nurse by background, she has a special interest in teen health,

Sarah Bekaert

Sarah Bekaert

pregnancy and parenthood.  Her current PhD study explores the tension between public expectations for avoiding teen mothering and the private desire of some teens who have had a previous abortion to become a mother whilst still a teen.

Professor Lee SmithBattle of St Louis University, U.S., is a nurse who is currently on the seventh round of interviews with former teen mothers and their families.  Spanning 30 years, this qualitative longitudinal study challenges the pejorative assumptions of teen mothers by contextualizing their experiences and long-term outcomes.

With the explosion of qualitative research on teen mothering, Professor SmithBattle drew together a team to organize, summarize and review this research.  This first metasynthesis project focuses on intimate partner violence (IPV) in teen mother’s relationships.

Lee SmithBattle

Lee SmithBattle

We have organized our findings by the metaphor of a spider’s web to illustrate the trajectory of IPV in the young mother’s lives and attempts to extricate themselves from violent relationships.  The metaphor was inspired by a verse from the poem ‘Integrity’ by Adrienne Rich1, American poet, essayist and radical feminist of the 20th and early 21st century.*

Bekaert Fig1

Findings highlight pervasive violence in teen mothers’ childhoods and impoverished circumstances that make it difficult to leave an abusive relationship. We observe a constriction of the web as domestic violence emerges or worsens with pregnancy. As a consequence, young mothers become isolated, and live with the physical and psychological consequences of IPV. Research suggests that trauma informed nursing practice is needed to support teen mothers in violent intimate relationships to spin a new web.a

  • Rich, A. A Wild Patience Has Taken Me This Far, poems 1978-1981. WW. Norton and Company; 1981.

 

 

 

Sep 12

New Articles Published Ahead-of-Print


Published Ahead-of-Print on September 7:
Adkins, Cherie S.; Doheny, Kim K.
Original Article: PDF Only
Wool, Charlotte; Black, Beth Perry; Woods, Anne B. (Nancy)
Original Article: PDF Only
Reimer-Kirkham, Sheryl; Stajduhar, Kelli; Pauly, Bernie; Giesbrecht, Melissa; Mollison, Ashley; McNeil, Ryan; Wallace, Bruce
Original Article: PDF Only
Perry, Donna J.; Willis, Danny G.; Peterson, Kenneth S.; Grace, Pamela J.
Original Article: PDF Only
Cook, Laura Beth; Peden, Ann

Sep 9

Transgender Patient Care


Our current featured article is by Rebecca M. Carabez, PhD, RN ;Michele J. Eliason, PhD and Marty Martinson, DrPH title “Nurses’ Knowledge About Transgender Patient Care: A Qualitative Study.” This article is available for download at no cost while it is featured on the ANS website!  Dr. Eliason sent this message about her personal experiences embarking on a career focused on LGBTQ health:

In 1988, I started my first study of LGBTQ issues in nursing, and I was NERVOUS! I had escaped a homophobic healthcare clinic setting for the supposedly academic freedom environment of the university the year before, but they had hired me as a developmental psych person. Nothing on my vita indicated an interest in LGBTQ issues at that

Mickey Eliason

Mickey Eliason

point, nor had these issues every been discussed in my formal education, except for an off-handed comment about homosexuality being a mental disorder in one psychiatric nursing course I took.

I talked to my research mentor at the time, who told me, “It’s all well and good that you do this type of research, but just make sure that you get 2 or 3 publications in legitimate areas for every one you do on this topic.” I did that, but even then, had some challenges when I came up for tenure.  I am glad to report that things have shifted in nursing since then, and articles on LGBTQ issues are becoming much more widespread. Now people are able to say LGBTQ and now what it means.  Even Donald Trump, halting and awkward as it was, uttered the initials at the Republican National Convention and called for equal rights (it might be the only sensible thing he has ever said on the campaign trail). We have made progress on LGB issues, but the growing edge of our movement in the past few years has been related to transgender issues.

In regards to this particular study, on nurses’ knowledge of transgender health care needs, our findings demonstrated that nurses’ willingness to work with diverse patients is laudable, but their lack of knowledge and fund of misinformation is quite alarming. This study was conducted in the San Francisco Bay Area, where presumably, nurses have much more exposure to LGBTQ issues than in many other places, but even here, we encountered negative attitudes and nurses saying that they never learned anything about this population in their educational programs or in continuing education.

This study was part of a much larger project on LGBTQ issues more broadly initiated by Rebecca Carabez, and a team

Rebecca Carabez

Rebecca Carabez

of nursing students worked on the project.  One identified as transgender, and we watched as they struggled with finding employment when the student’s appearance did not match their gender on legal documents, and who became more depressed as time wore on without meaningful employment. Transphobia has material consequences on individual’s daily lives—without adequate employment, transgender people are likely to live in poverty and suffer all the negative consequences of that poverty, from lack of any regular source of healthcare (leading to getting needed hormones and other treatments on the street), to “illegitimate” employment in the drug or sex trades, homelessness, and other serious issues.  We found in our study that many nurses laughed when talking about transgender issues—that nervous kind of laugh that means, “I’m really uncomfortable with this question.” They often gave long, rambling, circuitous answers to the questions that indicated that they really had no idea how to answer. Few were overtly negative about transgender patients, but imagine what it would be like for a transgender patient to try to communicate with a nurse who was that uncomfortable.

Marty Martinson

Marty Martinson

My co-authors and I had long discussions about gender.  We all identify as sexual minority women, but none of us as transgender or genderqueer. We tried to imagine ways to break down the gender binary that has been in operation in our own lives but like most others, we are somewhat entrenched in that system and it is hard to imagine life without the breaking down of people into two genders. It requires a radical transformation in thinking and in language itself. We firmly believe that this transformation is necessary, not just to improve services for transgender patients, but for all patient care, because the gender binary and gender stereotypes have hurt us all.

We hoped that our article might start some conversations among nurses about how to treat their transgender clients/patients more respectfully, but even more, about how to have hard conversations about the nature of gender and sexuality and ultimately, how we treat each other.  I am gratified that today, unlike the late 1980s when I started writing about LGBTQ issues in nursing, that there is now a willingness to publish articles on these topics and to discuss how to integrate them into  nursing education. Talking and writing about LGBTQ issues is a first step, but I challenge you to read the article and ask yourself, “What can I do personally to effect change for transgender patients in my nursing setting?”

 

Sep 5

New Issue Topic Scheduled! “Crime, Justice & Health”


ANS Volume 40 Issue 2 will feature articles that address “Crime, Justice & Health.” Manuscripts for this issue are duelady-justice October 15, 2017.  Here is the issue call for submissions:

In the past several years, there is widespread recognition that cultural and political responses to crime, and standards of justice, are powerful factors that shape the health and wellbeing of individuals, communities, societies, and  governments. For this issue of ANS we are seeking nursing scholarship that addresses the complex factors related to crime and justice.  We welcome scholarly manuscripts that report research, theory, or philosophic analysis from nursing perspectives.  Manuscripts can explore these issue from the standpoint of perpetrators, victims, or those who govern systems of justice in societies worldwide.  Due date for manuscripts: October 15, 2017

Sep 2

3 Comments

Parents as Partners in the NICU


The latest featured article in the current issue of ANS is by Amy L. D’Agata, PhD, MS, RN and Jacqueline M. McGrath, PhD, RN, FNAP, FAAN, titled “A Framework of Complex Adaptive Systems Parents As Partners in the Neonatal Intensive Care Unit.”  The article is available for download at no cost while it is featured.  Dr. D’Agata sent this message for ANS readers, portraying the important interplay of her clinical experience and academic science to create new insights and new practices to improve care:

Amy pic

Amy D’Agata

I am honored to have my paper A Framework of Complex Adaptive Systems: Parents as Partners in the Neonatal Intensive Care Unit featured as an editor pick in Advances in Nursing Science.  This paper highlights complexities within the NICU, particularly around relationships and environments of care that may contribute to infant neurodevelopmental outcomes.  It is hoped that by acknowledging challenging factors of interpersonal communication, individual differences in practice and acute care environments, we may begin to redesign the current NICU model of care into a model that better promotes neurodevelopment.  Importantly, reframing how we think about parents and their participation in the care of their infant.

As a novice neonatal intensive care nurse, I loved the excitement the NICU provided, both from a technical and interpersonal perspective.  Through advances in technology and medicine, precious newborn lives were saved and family dreams were realized.  Supporting families as they went through a sea of emotions, learned who their baby was as a person and became a strong advocate for their baby.  I always loved working with families and helping them through this process, all while I was caring for their baby.  This is how we practice in the NICU, right?  By and large, nurses and physicians care for patients while families stand by and watch, right?  This is what has to happen in order to save lives, right?  We know best, right?  This is basically how we have always been trained, but now I wonder if there isn’t a different and better way.

McGrath pic

Jacqueline McGrath

After 14 years of professional nursing practice, I entered doctoral studies.  Early in the program I felt as though I was floundering because my research interests were all over the map.  I knew my population of interest would be NICU infants, but I wanted to fix lots of different issues.  Most of which were medical issues.  When potential ideas around developmental care were suggested by my advisor (and co-author) I quickly pooh-poohed them.  Developmental care was a fundamental component of NICU care, but not in my wheelhouse to study.

One day my doctoral advisor shared an article she had co-authored, Epigenetics and Family-Centered Developmental Care for the Preterm Infant.1   At the time I knew nothing about epigenetics so I was immediately curious.  After reading this paper I literally experienced a professional paradigm shift.  Swiftly brought into focus was the idea that all of our daily experiences impact us.  While this may not seem like a game-changing statement, the fact that seemingly insignificant experiences may trigger molecular changes was something I never considered.  This certainly wasn’t something I considered for our patients.

I have always passionately believed that the work we do in the NICU is important to an infant’s future, but as a nurse, I had practiced with the thought of meeting the necessary medical needs so that infants may one day leave the NICU with their family.  I didn’t intentionally practice with the idea that everything I did in the NICU, every single day, may leave a permanent molecular mark or imprint that may shape who that person becomes.  If I had understood the potential magnitude of my influence, I would have most certainly practiced differently early in my career.

Back to doctoral studies, following lots and lots of reading, my research program began to take shape.  I read volumes about early life experience, epigenetics, genetics, molecular experiences that ‘get under our skin’ and neurodevelopment.  During my academic studies I also continued practicing as a staff nurse in the NICU.  This was a time in which I felt a lot of turmoil as a caregiver, because of what I was learning academically and what I was observing and taking part in clinically, sometimes I felt such internal conflict.  To get through I need to reconcile that what I was learning from basic science was ahead of where we were clinically.

As a conceptual model and framework of the NICU infant experience, Infant Medical Trauma in the NICU, broadly reflects the adverse exposures that occur within the NICU doors and how they may contribute to long-term outcomes (see figure below).  Designing this model was the foundational to my dissertation work for exploring the relationships between NICU stress, genotype of stress associated gene FKBP5 and neurodevelopmental outcomes.  The goal of my dissertation study was to understand if some infants may be genetically more vulnerable to stress experiences in the NICU.

Understanding that some infants may be predisposed to stress sensitivity, and the dynamics of the NICU, parents may be ideally positioned for the role of co-caregiver.  Given the typical parent’s desire to learn anything that helps their infant, their sensitivity to their infant’s needs and awareness of the role they must fulfill once they leave the NICU, why do we place parents on the sideline while we care for their infant?   Are parents incapable of learning how to assess their infant or perform caregiving tasks beyond diaper changes, temperature measurement and feeding?  We expect them to be fully capable once we indicate discharge is eminent, why not earlier in the process?

If we are to improve neurodevelopmental outcomes in the NICU, we may need to critically assess how we practice and consider alternative models.  As care providers, our goal is to save lives and promote health.  While not intentionally inflicted, there are adverse experiences that result from that goal.  Parents are the constants in their infant’s life and the people who will care for their infant beyond the NICU.  In light of this we must begin to see parents as partners in every step of the NICU, including in the provision of care.

Infant Medical Trauma_final rev2 copy

 

  1. Samra, H., McGrath, J. M., Wehbe, M., & Clapper, J. (2012). Epigenetics and family centered developmental care of the preterm infant. Advances in Neonatal Care, 12(5s), s2-s9

Aug 26

2 Comments

Theory Integration to Explore Complexity


Our new featured article is titled “Using Theory Integration to Explore Complex Health Problems” by Brenna L. Quinn, PhD, RN, NCSN. We invite you to download the article while it is featured and return here to join discussion of these ideas.  In this message about her article, she describes the evolution of this article as a result of a rejection of another manuscript!

Brenna Quinn

Brenna Quinn

The idea for this article was actually born out of another article’s rejection. I met with my colleague Dr. Barbara Mawn to seek commiseration over the outright rejection and ask for help in writing an article about the importance of theory use and interdisciplinary integration, given that reviewer suggestions included removing the entire section on the study’s conceptual framework. Barbara’s mentorship was invaluable to the development of this article.  Said  conceptual framework is described in the ANS article as an example of interdisciplinary theory integration.

Use of theory to guide nursing research and clinical practice is underreported at best, but more likely is extremely underutilized. This is due to several factors, such as nurses receiving little education on theory use or confusion about how to interpret and apply theories to clinical practice.  Additionally, clinical nurses and nurse researchers may view nursing theories as too narrow to address the multi-faceted needs of patients or study populations.

Nurses know that they need to view patients and populations holistically, and cannot silo specific health problems.

Barbara Mawn

Barbara Mawn

For example: school nurses experience difficulty when assessing pain in children with intellectual and developmental disabilities. What kind of pain assessment tools has the nurse learned about? Has the school offered any continuing education opportunities regarding pain assessment for special populations? Do classroom teachers know which behaviors may be indicative of student pain? What is the ability of the student to report painful experiences?  Or, perhaps a nurse is working with a patient who has not been taking a medication prescribed for diabetes. The nurse must consider more than a presenting high blood glucose reading. Did the patient understand the nurse practitioner’s instructions for taking the medication? Can she access the pharmacy? Read the bottle? Administer the medication correctly? What is her level of cognition?

Many variables factor in to complex health problems faced by people today. However, this may not always appear clear to nurses and researchers when looking at nursing models. Using a non-nursing model, such as a model from psychology as described in the ANS article, can help frame the use of nursing theory components to the health problem at hand.

After reading this article, I hope nurses take the opportunity to explore both nursing and non-nursing theories that can guide and enlighten new approaches to clinical and research activities. Thank you for featuring this article on the ANS blog!

Quinn Picture1

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