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Apr 25

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The Ultimate ANS “Ethics” Collection


“Ethical Practice, Quality Care,” is the theme for this year’s National Nurses’ Week, which begins on May 6, 2015.  To celebrate this week, we have compiled from the Journal archives the most groundbreaking, read and cited ethics articles that address ethical issues in nursing and health care!  The collection features classic ANS articles from the first 20 years – articles that remain relevant, timely and essential guides for discussion and dialog related to the pressing ethical issues of our discipline.  The authors of the twenty articles in the collection are among the most cited nursing scholars whose writings continue to shape ethical thought in nursing.

This collection will be prominently displayed on the ANS Web site all week.  But it is available now so that you can have a head start in preparing for the many discussion that will focus on ethics during the week of celebration.  Click here to go to the collection.  ANA-NNW2015-Logo

Apr 15

Health Change Trajectory Model


The discipline of nursing now has a growing and rich body of theoretical models that provide useful perspectives from which we can build practices addressing some of the most pervasive health challenges we and our patients face.  These models also facilitate the design and implementation of research projects that add to the evidence required for effective outcomes of practice.  Our current featured article is an example!  The title is “The Health Change Trajectory Model: An Integrated Model of Health Change” by Deborah Christensen, BSN, RN.  Here is a message Ms. Christensen has prepared for the ANS blog:

Health change appraisal is unique to each individual with dynamic changes across the lifespan. To promote understanding of evolution and change in health care appraisal, I developed the Health Change Trajectory Model by

Deborah Christensen

Deborah Christensen

integrating concepts from uncertainty in illness and illness trajectory theories. The integrated model is applicable to any change in health, not just the occurrence of chronic illness.

Nurses are the key health care providers who assist others in understanding and coping with health changes. Placing the experience of health change in a trajectory framework offers a new and creative perspective for nurses as they assist patients and families with positive adaptation to changes in health throughout the life course. Conceptualizing the nurse as health change management partner emphasizes the nurse and patient/client partnership with patients clearly in charge of shaping their health management trajectory.

Studies from uncertainty in illness theory indicate that there are phases when uncertainty can be perceived as an opportunity rather than a threat. For example, in several types of cancer there are periods of remission (comeback phase) interrupted by disease progression (acute or downward phase). Through genomic research and the development of targeted and immunotherapies, patients may have several different treatment options that can be perceived as opportunities. Further, the experience of decreased energy in the absence of illness can be perceived as a threat or as an opportunity for positive changes in physical activity and nutrition. How is uncertainty perceived in these situations? How can uncertainty as opportunity be supported? I believe that in answering these questions, nursing interventions can be developed to help patients move toward adaptation and a balanced perceptual shift from threat to opportunity in uncertainty, thus, optimizing their health change trajectory. The Heath Change Trajectory Model provides the theoretical framework for exploration of all perceived health changes, not just those specific to chronic illness, as unique opportunities for a more optimistic view of health change.

This article will be featured on the ANS web site for the next couple of weeks and will be available at no charge while it is featured!  So please visit the web site to get your copy, and come back to this blog and share your feedback and ideas!  We would be delighted to hear from you!

Apr 1

Shifting the discourse around large bodies


Ingrid Ruud Knutsen, RN, PhD from Oslo and Akershus University College of Applied Sciences and University of Oslo, Norway is the author of our current featured article that explores the health consequences of contemporary society’s views about large bodies.  The article is titled “A Discursive Look at Large Bodies—Implications for Discursive Approaches in Nursing and Health Research.  Dr. Knutsen shared this message for ANS readers about her work:

How have we come to understand obesity as an illness that is treated by surgery and medication in contemporary healthKnutsen300 care? Through research projects, I have experienced that people in large bodies often feel stigmatized, especially by health professionals. There are reasons to question whether the general attitude towards people in large bodies represent a greater challenge than the large body itself for obese people. For what is health? – is it happy, self-confident people enjoying life and their opportunities or is it people striving towards a perfect exterior? For scientists it is important sometimes to stop and question premises for our knowledge, conditions and situations, to reflect about whether we could serve patients better by approaching them in other ways and understand their situations through alternative perspectives. A reflective and critical approach related to how to challenge understandings we take for granted represents an important angle in research. Discursive perspectives and discourse analysis are based on an epistemology welcoming other questions and new approaches to challenge traditional knowledge and understandings. Such perspectives give opportunity to enrich research in nursing and health.

We would be delighted to see your comments and responses appear here!  You can download your copy of Dr. Knutsen’s article while it is featured on the ANS web site, then come back here to leave your comments!

Mar 18

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Social Withdrawal and Migraine Headaches


Starting on March 18th, a new article will be featured for free download from the current issue of ANS!  The article, titled “Social Withdrawal as a Self-Management Behavior for Migraine: Implications for Depression Comorbidity Among Disadvantaged Women,”  is authored by Shawn M. Kneipp, PhD, RN, ANP-BC, APHN-BC and Linda Beeber, PhD, RN, CS, FAAN.  Recognizing social withdrawal as a distinct, highly nuanced coping strategy in
symptom self-management, they explore its relevance for understanding migraine-depression symptoms within the life context of socially and/or economically disadvantaged women.  They recommend further nursing research  that draws from complexity science theory and methods to better understand these dynamics and ultimately improve care.  Dr. Kneipp  shared this message about their work for ANS readers:

I would not have expected to be writing on this topic two years ago.  As is frequently the case with scientific inquiry, however, unexpected study findings, combined with ongoing clinical work and research with women who are socioeconomically disadvantaged, led me down this path.  The unexpected findings came from a

Shawn Kneipp

Shawn Kneipp

clinical trial with women in a Welfare Transition Program (WTP), which suggested headaches may be associated with job loss in the previous year.  Given the erosion of economic safety nets in the U.S. generally, and the current limits on economic assistance receipt through the Temporary Assistance for Needy Families (TANF, or ‘welfare’) program more specifically, obtaining and maintaining employment has become an even more critical social determinant of health for women who are socioeconomically disadvantaged.

Linda-Beeber-e1380548224649

Linda Beeber

From a number of prior studies, we have also known for a while that depression is highly prevalent in this group, that depression impedes women’s ability to function in the workplace, and that depression is most often present in the context of other chronic health conditions.  Despite this, there are large gaps in the literature on headache symptoms (predominantly migraines for women) in relation to socioeconomic status and self-management, in the context of other highly prevalent disorders (i.e., depression), and the associated morbidity in terms of work-related functioning.  This recognition, informed by clinical observation of how this population was often managing their migraine-related symptoms as they struggle to perform well at work, was the driving force in wanting to begin to pull the relevant disease-trajectory and self-management theoretical pieces surrounding this issue together.

The theoretical perspectives offered in this article underlie a current pilot study we are conducting to determine the feasibility of a novel data collection approach to further examine how disadvantaged women self-manage migraine symptoms. As with the majority of my research, women from the community of interest are playing a crucial advisory role in designing, conducting, and interpreting the findings from the pilot work. Given the preliminary feasibility findings, and looking to our future work in this area, nurse researchers have a great deal to contribute in the way of both theory and intervention development and testing to better manage comorbid health conditions, improve work-related functioning, and improve their odds of achieving economic self-sufficiency.

Go to the ANS web site now to download your copy of this article – it is important both in content and method.  then come back here and share your thoughts, questions and ideas – we would be delighted to hear from you!

Mar 10

Issue topic planned on “Toxic Stress”


We have just announced our projected issue topic on “Toxic Stress” for ANS Volume 39:4.  Manuscripts are due on April 15, 37-3 cover2016, but can be submitted at any time! Here is the description of this topic:

Toxic Stress
Vol 39:4 – December 2016
Manuscript Due Date: April 15, 2016
Toxic stress, unlike positive or tolerable stress, can result in life-long health challenges. For this issue of ANS we seek manuscripts that focus on the contributions that nurses are making to understanding the dynamics of toxic stress, and nursing approaches that demonstrate effective outcomes for children and adults suffering the effects of toxic stress. Articles that provide research outcomes, theoretic and philosophic constructions, practice models, or educational programs related to toxic stress are welcome. Implications for the development of nursing knowledge must be emphasized.

In addition, we always welcome submissions for the new “ANS General Topic” at any time!  Here is the information about this type of submission:

ANS General Topic
Manuscripts considered any time
Manuscripts submitted as “ANS General Topic” are expected to address the purposes of ANS, which are to contribute to the development of nursing science and to promote the application of emerging theories and research findings to practice.

You can see the full listing of our planned issue topics on the ANS Web site!  And our guidelines for authors can always be found here!

Mar 4

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Understanding Survivor Guilt


Our current featured article addresses the meaning of survivor guilt, and by understanding this experience, seek effective ways to alleviate the suffering that comes to those who experience it.  The article is titled “Survivor Guilt: Analyzing the Concept and its Contexts”  The authors, Sadie Pauline Hutson, PhD, RN, WHNP, BC, Joanne M Hall, PhD, RN, FAAN, and Frankie Lane Pack, BA have provided the following commentary about their work, including a digital story video for ANS readers!

Survivor guilt, as presented in our analysis, is not monolithic. It manifests in many diverse temporal and situational contexts. It may be anticipatory or emerge years after the loss was experienced. The manifestation of survivor guilt is complex, in part, because the response is highly individualized. The following digital story demonstrates anticipatory and

“loss-in-process” forms of survivor guilt. After the video, Sadie Hutson offers a reflection on the nature of her survivor guilt, and how it is, presently, to remember the events surrounding the death of her mother, Joy.

“On its surface, this digital story may not seem like a characterization of survivor guilt; yet it underscores the expansion of this concept to include varied contexts. As a child, I remember feeling isolated and alone. I polished my mom’s toes as she lay dying as if to say, “this is no longer a luxury my mom will be able to enjoy.” I anticipated

events that she would miss and sometimes even imagined what I might feel when that time came. As I approach and experience various life milestones, feelings of guilt reinforce that my mother was cheated. I was cheated. Yet, I survived to tell the story.

This concept analysis relates to our scholarship in varied ways. First, the authors of this paper are also study team members on a National Institute of Nursing Research funded R21 (5R21NR014055-02) aimed at exploring end-of-life care and service needs of persons living with HIV/AIDS in Appalachian Tennessee and Alabama. In conducting this mixed-methods study, we noted the importance of survivor guilt when individuals discussed the guilt they felt for

Sadie Hutson

Sadie Hutson

surviving decades longer than many of their close friends, relatives, and significant others who lost their lives at the height of the AIDS epidemic. In Hutson’s work as the director of a hereditary cancer risk assessment program in Pikeville, KY, survivor guilt continues to be pervasive (as it was when the concept first became a focus for Hutson in 2001) among individuals who test negative for the known hereditary cancer gene present in their family. Rather than feeling relief for being spared, these individuals experience guilt for being the “lucky one,” citing that the result often drives a wedge in the relationships between mutation-positive and mutation-negative family members. Survivor guilt is also relevant to Dr. Hall’s work with female survivors of childhood maltreatment (R01NR07789). In these data, often the thriving survivor of a chaotic and abusive situation expressed feelings of guilt for leaving behind siblings who did not become successful in life and were still “stuck” in the trauma, sometimes still living with the perpetrators or abusive partners.

Nurses encounter the trauma of survivor guilt in many situations, yet they may not always see it, if the lens through which it is viewed is too narrow. Nurses must first see survivor guilt. After we have seen it in a particular context,

Joanne Hall

Joanne Hall

situation-specific theory can be developed to better characterize the survivor guilt and guide interventions to mitigate the fallout in that context. Perhaps, digital storytelling is one such strategy. It is salient that the same strategies will not work for all. Survivor guilt can be highly damaging, or wilted to being merely a form of nostalgia. We need to understand the process by which individuals resolve their own survivor guilt, as well as therapeutic strategies that fend off traumatic guilt that can be paralyzing, isolating, and disempowering. This will mobilize sufferers to move forward into the fulfilling lives they deserve.

While their article is featured, you can download it at no cost.  So visit the ANS web site now to get your copy, read the article, and return here to share your thoughts and ideas about this very thought-provoking article!

Feb 18

Sources of Inner Strength for Elderly People


Our current featured article comes to ANS from Finland authors Erika Boman, MSc, RNT; Anette H¨aggblom, PhD, RNT; Berit Lundman, PhD, RN; Bj¨orn Nygren, PhD, RNT and Regina Santamaki Fischer, PhD, RN.  Their article is titled “Inner Strength as Identified in Narratives of Elderly Women: A Focus Group Interview Study.”  While it is featured on the ANS web site, you can download your free copy of this article here!  Erika Boman has shared this message for ANS readers:

Do you study inner strength? Is that possible? Those are questions often asked when presenting the research topic of our interest. And yes, I can see what they mean. If you google on inner strength today you get 14 200 000 hits where inner strength is interpreted in almost the same amount of ways. That is why I am so happy that I have been privileged to work with members in a research group that thoroughly have studied the concept, and through meta-analysis developed a theoretical model of inner strength. In the model inner strength is conceptualized by four interacting core dimensions: connectedness, creativity, firmness and flexibility. The core dimensions have explicit definition and are more in depth described in the article, with reference to the theoretical model. Further a questionnaire was developed to measure each dimension and thereby a person’s degree of inner strength. Studies, applying the scale, have for example shown that strong inner strength is associated with better self-rated health. And through literature review inner strength has been interpreted as a health resource for experiencing well-being despite illness. 

My field of interest is related to health and quality of life among elderly women and elderly women, in general, outlive men, have impaired socio-economic and functional status, as well as report more health problems. I thought to myself – research is implying that inner strength is of importance for experiencing well-being despite illness. Identifying sources of inner strength can give health care personnel valuable information about elderly people’s capacities despite their frailty erika_johansson_2and weakness. So now there was this theoretical model defining the concept, a questionnaire to estimate a person’s degree of inner strength, as well as literature suggesting that inner strength is a health resource of importance. But, is it always applicable in nursing to use a questionnaire to estimate a person’s inner strength? What about criticism to nursing science being to theoretical? Is there some way we can enlighten how inner strength can be expressed in everyday conversations implementing the theoretical model? The aim of this study was therefor to explore how inner strength and its dimensions, as described in a theoretical model, can be identified in the narratives of elderly women. Focus group interviews where made with 29 women between the age of 66 and 84. Inner strength was identified in there narratives of the elderly women as a strive to be in communion, to make the best out of the situation, having a mind-set that it is all up to you, and considering life as a balancing act. Further descriptions are found in the article, where also possible application of the theoretical model in relation to previous research is discussed. The study is considered to add nuance to the notion of inner strength and deepen empirical knowledge about the concept. Finally, we hope that this study can be a contribution to narrowing theory to practice.

Please join the conversation to explore the ideas presented here and in the article!  Share your comments here, and we will respond!

 

Feb 13

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Editorial messages: Contexts and Patterns of Health Behavior


The current issue of ANS has three important editorial messages that ANS readers will not want to miss.  My own editorial, titled “Editorial Standards of Quality: Examining Patterns of Health in Scholarly Publishing,” is part of the International Academy of Nursing Editor’s initiative focused on exposing the practices of predatory publishers, and affirming the high editorial standards that characterize credible and reliable journals.  If you have not yet examined this important issue, read this editorial and the resources that I reference in it.  You can also refer to my recent blog addressing the broad topic of open access publishing, a credible publishing model founded on the intent to make scientific research freely available to all. However digital open access publishing has also opened the door to editorial practices by some that compromise editorial standards, and it is incumbent on all scholars to be fully informed about these practices in order to distinguish which practices are sound and which are not.

Dr. Mickey Eliason, a leading scholar in the area of LGBT health, examines the influence of neoliberalism in shaping health behavior in her guest editorial titled “Neoliberalism and Health.”  Dr. Eliason focuses on the neoliberal ideal of individualism and examines how this ideal creates the tendency to overlook contextual, upstream factors that shape patterns of health behavior.  Essentially, Dr. Eliason takes a critical look at the upstream factors that shape patterns of scholarship, and how earthresearchers can resist the tendency to study individual factors without adequately integrating contextual factors.

Dr. Richard Cowling has also contributed a guest editorial to this issue titled “Contextualizing Patterns of Health Behavior: A Unitary-Emancipatory-Transformative Perspective.” Dr. Cowling also addresses the necessity of contextualizing health behavior in the quest to reach for wholeness. He explains that wholeness can only be fully appreciated from a perspective that fully integrates the contexts in which human behavior occurs.

All of these editorials are available at no cost on the ANS web site.  Visit the web site now to download your copy, and return here to share your own perspectives and ideas.

Feb 7

ANS Volume 38:1 Just Released! Patterns of Health Behavior


Patterns of health behavior, the topic of this issue of ANS, are at the heart of nursing’s concern. In this issue you will find 38-1 coverthought-provoking articles that address specific health behaviors that constitute human responses to health challenges. Several of these articles provide insights that expand understanding of human responses, and evidence that inform nursing practice. Watch the ANS web site and blog over the coming weeks as we feature each of these articles, with messages from the authors about their work.

Visit the ANS web site now!  Here is what you will find in this new issue!

Guest Editorial by Mickey Eliason – Neoliberalism and Health

Guest Editorial by Richard Cowling –Contextualizing Patterns of Health Behavior: A Unitary-Emancipatory-Transformative Perspective

Erika Boman, Anette H¨aggblom, Berit Lundman, Bj¨orn Nygren and Regina Santamaki Fischer – Inner strength as identified in narratives of elderly women: A focus group interview study

Sadie P. Hutson, Joanne M. Hall and Frankie L. Pack – Survivor Guilt: Analyzing the Concept and its Contexts

Shawn M. Kneipp and Linda Beeber – Social Withdrawal as a Self-Management Behavior for Migraine: Implications for Depression Comorbidity Among Disadvantaged Women

Ingrid Ruud Knutsen – A Discursive Look at Large Bodies—Implications for Discursive Approaches in Nursing and Health Research

Deborah Christensen – The Health Change Trajectory Model An Integrated Model of Health Change

Jan 15

Preventing Sudden Infant Death Syndrome (SIDS)


Our current featured article is by Sherri L. McMullen, PhD, RN, NNP-BC and Mary G. Carey, PhD, RN, CNS  title “Predicting Transition to the Supine Sleep Position in Preterm Infants.”  Their article demonstrates how good nursing care, focused on anticipating the needs of families after discharge from the hospital, can make a difference – even to the point of preventing a SIDS death.  Dr. McMullen shared this message about her article, which is based on her dissertation research:

Thank you for your interest in our article entitled “Predicting Transition to the Supine Sleep Position in Preterm Infants.” This article is work related to my PhD dissertation research and I am passionate about the topic. I had the privilege of meeting Peggy at the 2014 National League for Nursing Writing Retreat in Phoenix and I am so pleased to see my McCullen-300manuscript in press. I have been a Neonatal Nurse Practitioner for over 20 years and I decided to extend my expertise to include academia and research. I miss my submersion in clinical, but think it’s really important to research clinical practice to continually improve the care we provide patients. So much of the care we offer to our smallest patients impacts them after hospital discharge.

Positioning preterm infants supine while hospitalized and after discharge is an important aspect of infant care and its relatively new topic with little research completed to date. Preterm infants are positioned in a variety of positions while in the neonatal intensive care unit to promote optimal neurodevelopment. The preterm infant’s musculoskeletal system is pliable with risks of deformity with suboptimal positioning. The supine position is an important modifiable practice that reduces the risk of sudden infant death syndrome after hospital discharge. The retrospective research completed shows there is great variability in the clinical practice and there are three factors that predict a greater than one week transition to the supine position before hospital discharge. More research is needed to determine the optimal timing of transition and what developmental impact this transition has on the preterm infant. A balance must be found between allowing enough time for the infant to become acclimated to the supine position without impacting neurodevelopment.

You can obtain a free copy of this article while it is featured on the ANS web site!  Visit the web site today, then return here to share your comments and ideas!

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