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Jun 18

Developing Compentency Assessment Tools


The featured article by Shoa-Jen Perng, PhD and Roger Watson, PhD titled “Psychometric Testing of an Instrument Measuring Core Competencies of Nursing Students: An Application of Mokken Scaling” provides a report of a study  developing a tool to measure 8 core competencies of nursing students in Taiwan.  The authors propose that one way to bridge the gap between nursing education and practice is to competency-based approaches that prepare nursing students for practice.  Dr. Perng describes their work here:

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Drs. Perng and Watson

It is an honor to have our manuscript published in Advances in Nursing Science. As a nurse educator I have strived to find an instrument that is useful to measure students’ learning outcomes. Previous literature has offered a lot of significant works, but some of the content or items in the existing instruments were not suitable for my needs. I needed an instrument that is not only valid for varied types of students, but also one that shows the strength and weakness of the students. The use of Mokken scaling analysis seemed suitable to expand the possibilities of assessment outcomes. In my role as a Director, Department of Nursing I hope that the results of assessing nursing students using this approach can provide information for further educational improvement. My co-author, Dr. Watson is a respected scholar and also a wonderful mentor for my research career. We are grateful for this opportunity to share our work in ANS and in this blog post. I hope you find our work is helpful to develop a new measure, and I look forward to your comments.

To examine their work further, visit the ANS web site now, and you can download a copy at no cost while the article is featured!

Jun 11

Practical Guidelines for Feminist Research


The current “Editor’s Pick” article is by Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, who has published a number of articles that focus on feminism and nursing.  As a feminist scholar in nursing, she is well qualified to offer to the discipline her article titled “Practical Guidelines for Feminist Research in Nursing.”  Dr. Im provided this message, and an invitation for readers to engage in discussion of this article with her on this blog!

First of all, thanks a million to you, Dr. Chinn, editor of  ANS!!!  Thanks for choosing my article as the “Editor’s Picks” so that I could have scholarly discussion with all my respectable colleagues throughout the world.

To explain the background of the article…  The article was motivated by questions from my own doctoral students.  In my doctoral classes, I have frequently been asked about “how to conduct” a feminist study.  As all of us would agree, there is no one way to conduct a feminist study, but the students were eager to hearN753-April-2013 about my previous experience in feminist studies and some advice for their future feminist studies. That was the start point when I re-collected all my previous research notes from three feminist studies that I had conducted and re-analyzed to identify what would be essential components in feminist research.

Through the process, I have extracted a total of 10 idea categories, and I have proposed guidelines for these idea categories. Yet, these guidelines would not be new to feminist scholars/researchers who have been conducting feminist research. Rather, these are the ones that feminist scholars/researchers have taken for granted. However, for our novice feminist scholars/researchers, these kinds of explicit guidelines would be helpful (my hope!!!).

As noted in the article, there are several major limitations of the article.  I simply took a pragmatic approach to provide tangible guidance for feminist research. Also, the guidelines are from only three Internet-based studies with limitations in generalizability.

Anyway, I think we could further develop the guidelines for our future generation through our future collective efforts.  So, please feel free to add absent components that you found in your studies.  Thanks for all your attention to this article and thanks again to Dr. Chinn for this opportunity to dialogue with other scholars!

I invite you to download your copy of this article now at no cost, and engage in this dialogue!

Jun 5

Storytelling, narrative inquiry, health inequities and health outcomes


These four “topics” do not often appear in the same context together, but that is exactly what authors Nicole Y. Pitre, PhD, RN; Kaysi E. Kushner, PhD, RN; Kim D. Raine, PhD and Kathy M. Hegadoren, PhD, RN have accomplished in their featured article titled “Critical Feminist Narrative Inquiry: Advancing Knowledge Through Double-Hermeneutic Narrative Analysis.”  This article describes an innovative approach to research that holds great potential for creating sustainable social change that supports positive health outcomes, especially for those whose “voice” is rarely heard.  Dr. Pitre shared this message about her work:

Critical feminist narrative inquiry is a research methodology that evolved from Dr. Kaysi Kushner’s work on theoretically triangulated critical feminist grounded theory (also published in ANS in 2003). I developed this approach to narrative inquiry through my doctoral work under the supervision of Dr. Kushner and Dr. Hegadoren, and with the support of Dr. Raine, all members of my supervisory committee and co-authors of this article. I am particularly grateful to them for their guidance as I developed this method of narrative analysis. We are delighted that this article is published in ANS.

My work was inspired from my reflections on the following assertion: “Know that no one is silent though many are not heard. Work to change this” (Anonymous). Narrative inquiry is known to be a method designed to give voice to participants through the stories that they wish to share. While I found that during the interview process narrative inquiry approaches were consistent with a feminist agenda, I soon realized that existing methods of narrative analysis did not provide a foundation or strategies to examine stories from a theoretically triangulated critical feminist perspective. I concluded that current approaches did not allow for participant’s voices to be fully heard, nor did these permit an explication of the constraining and silencing social, structural, and ideological conditions and practices that shaped their experiences. This integration is the aim of critical feminist narrative inquiry.

Critical feminist narrative inquiry constitutes a means for participants’ voices to be heard and to influence social action toward change. Through critical feminist narrative inquiry, it also is possible to uncover women’s or men’s strengths, challenges, and reflexive choices and decisions as they strive to manage adverse conditions. The use of critical feminist narrative inquiry ultimately allows the researcher to reveal the conditions that create and perpetuate marginalization, vulnerability, and stigmatization and that limit agency and identity in a person’s life.

We believe that this evolving methodological innovation has the potential to support the work of nurse researchers who are dedicated to expose and to act upon health inequities and social injustice. We greatly appreciate this opportunity for dialogue and we welcome your comments and thoughts.

While this article is featured, it is available for free download!  So visit the ANS web site now!

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.

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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!

May 21

Intellectual Curiosity


This week we introduce a new “Editor’s Pick” article titled  “Intellectual Curiosity: A Principle-Based Concept Analysis” by Bedelia Russell,  MSN, RN, CPNP-PC, CNE.  She has shared the background about her work with us, providing insight into the influences on her thinking including her daughter’s drawing!

If someone had told me when I began doctoral work I would not only contribute to ANS but also participate in the ANS blog, I would have questioned their sanity. I am so honored to be among all these other respected contributors. I began my doctoral work in 2010 following nine years of work as a fulltime faculty… I was the last Master’s prepared nurse to be tenured in our system so tenure was not a variable in my return to graduate school. Why then consider the daunting task of PhD work? When I reflect back, I guess I am guilty of the very subject of my article… intellectual curiosity. Around me… everyone was going back to school… newer faculty with eyes on tenure had made the commitment and I was continuing on in my role as a well-respected educator. But the pressure was there… internally, some external… to join in, and admittedly, I was curious. Could I do the work? Bedelia RussellHow would I balance family? Would I finish? How would I continue to do my job… my job … it was then it hit me… my pull towards PhD work, my motivation, was my job… I had hit a plateau in course redesign and I was asking questions and approaching nursing education with questions that no one around me could answer. It occurred to me that maybe doctoral study would help with those questions and provide new insights into my practice of nursing education.

Intellectual curiosity is something I have for many years evaluated baccalaureate students on… they either demonstrated it or they did not… and I knew what that looked like. So when my first concepts class in my doctoral program required a concept analysis, my cohort talked me into analysis of intellectual curiosity. I remember us all trying to decide on our concept and throwing out ideas to each other. When intellectual curiosity was suggested, it was followed by my peers adding, that should “be easy” and there should be “plenty of information out there.” I have both thanked them and cursed them since those days of convincing me but would not for one day regret the path that seemingly simple decision has led me down.

My work so far has revealed two things. The first is concept analysis that can provide context and understanding of the existing state of the concept is important to advance the science of our discipline. It is in part why I utilized a principle-based concept analysis method. I do not believe it is enough to simply breakdown a concept into its elements… we need to take that concept and look at it from multiple perspectives… multiple disciplines… and then see how our discipline can utilize it. The second revelation is that while I knew what intellectual curiosity looked like… albeit, merely from my perspective… I was unaware of the possible influencing variables and potential consequences for intellectual curiosity.

I am now intrigued with the role it seems motivation has in relation to curiosity. I am left to wonder what our role should be as nurse educators in influencing and modeling the concept of intellectual curiosity and can we perpetuate curiosity once is has occurred.

An important lesson from our first semester philosophy class was to determine our philosophy of science. It was an arduous discovery of finding out I aligned with interpretive inquiry, specifically with Heidegger’s assertions on phenomenology. This view was cemented in a drawing my youngest daughter made at that time, included here.

drawingWhen I asked my four year old daughter where her eyes, nose, and mouth were, her response was “Mommy, I am looking at the clouds…. You are looking at the back of my head.”  This picture is now a bit faded but still hangs on my wall beside my desk. It serves as a reminder on the importance of context, history, and multiple perspectives… something important in examination of the concept of intellectual curiosity in my work ahead. Going forward, my dissertation will look at intellectual curiosity from the perspectives of educators who teach in online learning environments. I welcome your comments on my current work and am both humbled and appreciative of this opportunity for dialogue.

You can download a copy of this article now, while it is featured on the ANS web site!  Then, leave your comments here to discuss your thoughts with the author!

May 14

2 Comments

Why concept analysis?


Concept analysis continues to be a cornerstone of many doctoral programs, but as important as this activity is, very few reach a level of development that is suitable for publication. The current featured article, titled “Concept Analysis: Method to Enhance Interdisciplinary Conceptual Understanding” explains an approach to concept analysis that can enhance the quality and worth of this very important activity.  The author of this article,  Susan Bonis, has one of the best explanations about “why” this is so important, and has provided this interesting background about her work:

It is an honor to have this article published in ANS. This method of concept analysis is a critical component of work related to understanding, defining and describing the foundation of nursing knowledge: What is nursing? What is the unique contribution of nursing to the health care arena? What is nursing research? What is nursing knowledge? Although these are not new questions, they are questions that arise almost daily. How do we respond?

This method of concept analysis is one means to provide clarification to these questions. A previous article, Knowing in Nursing: A Concept Analysis (Bonis, 2009, JAN, 65(6)) provided interesting insight to nursing knowledge, as well as to the knowledge base of other disciplines. According to the Sue-Bonis-300findings of that concept analysis, the essence of nursing is personal knowing, or the individual experience of health and illness, of medicine is technical/procedural knowing, and of behavioral health is knowing as a cognitive process. As you can see from the findings of this study, the knowledge base of each discipline is unique; therefore, the contribution of each discipline to the health care arena is unique.

Understanding how concepts are used within disciplines is critically important for nurse researchers, who tend to ‘borrow’ research instruments from other disciplines. How a concept is understood and used in nursing is not necessarily the same as how that concept is understood and used in other disciplines.  For example, the Empathy Quotient was developed by Simon Baron-Cohen (psychologist) as a diagnostic tool to differentiate between the cognitive processes related to empathy in normal-functioning adults and those with Asperger’s syndrome. Although it is a beautiful tool and very useful for diagnostic purposes, it would not be appropriate for a nurse researcher interested in understanding more about empathy as a personal experience for nursing student to use the Empathy Quotient. To do so would be a contribution to the foundation of knowledge for behavioral science, not to the foundation of nursing knowledge.

I experienced a similar situation in seeking to understand more about contentment as a quality of life for parents of children on the autism spectrum. Four research instruments focused on contentment have been developed in the behavioral sciences; each one is a diagnostic tool to measure the cognitive processes that describe depression. It would be inappropriate for me to use any one of those instruments, even though they clearly are used to measure contentment. The conceptual understanding of contentment varies greatly between nursing and behavioral science. Behavioral science uses contentment as a short term cognitive response to events in the moment. In nursing, contentment is used to describe a way of being that evolves over time; a phenomenon at a much higher level of abstraction (but then again, that brings us to another discussion related to phenomenological issues in nursing research. We’ll save that for future discussion!).

What are your thoughts on concept analysis prior to instrument selection? Are we contributing to the knowledge base of another discipline when we borrow research instruments? What about interdisciplinary collaboration? What are the challenges?

Thank you for reading the article! I hope to dialogue on this critical matter in nursing research.

May 8

Philosophic inquiry for nursing: a crucial connection


Because nursing is a very “practical” endeavor, the crucial underpinnings of philosophy are sometimes difficult to recognize.  But in this article the authors, Pamela J. Grace, PhD, RN, FAAN and Donna J. Perry, PhD, RN, explain why this is such a critical connection.  Their article titled “Philosophical Inquiry and the Goals of Nursing: A Critical Approach for Disciplinary Knowledge Development and Action” is currently featured on the ANS  web site.  Dr. Grace and Dr. Perry provided this interesting background to their work:

From Pamela Grace: The idea for this paper had been germinating a long time and went through several iterations. It benefited from the critique and suggestions of many colleagues, doctoral students and the ANS reviewers but we are sure that there is much more that can be said and we look forward to an ongoing dialogue.

A very early version of the paper was presented as part of a 4-paper symposium sponsored by International Philosophy of Nursing Society (IPONS) members and accepted for presentation at the Royal College of Nursing (RCN) 2010 Research Conference. IPONS is a forum for philosophical dialog and has among its aims: “to promote and establish philosophy of nursing, and health care in general, as a credible and important field of philosophical and critical inquiry” and that was the intent of the symposium to highlight the role and importance of philosophical thought for disciplinary purposes.

The shape of this version emerged as a result of co-teaching a doctoral seminar at Boston College with Donna Perry in the Spring of 2012. The course was focused on understanding philosophical and socio-political influences on health policy and ways in which nursing research can be use to inform and shape health policies. I used a much rougher draft of the paper as one of the assigned readings. Donna’s insightful and helpful suggestions on the manuscript, ideas about the hierarchical structure, and addition of Lonergan’s thoughts really helped refine the paper in a way that we believe makes it broadly useful to the profession.

The original and more personal reason for the paper is that, over my many years as a practicing nurse both in critical care settings and later in primary care as an ANP, I struggled with the healthcare environment – how it often and sometimes in subtle ways undermines good practice or fails to meet the needs of individuals and their communities. This struggle led me to doctoral studies in philosophy. I was hoping to learn ways of addressing practice problems. In this environment I was free and indeed encouraged to question everything. The skills and perspective gained I took with me into nursing academia only to discover that this sort of probing inquiry, that is not afraid to question how various projects and different levels of curricula meet nursing goals, seems to be losing ground as a valued a mode of knowledge development.

FYI the International Philosophy of Nursing Society  (IPONS) annual conference is in the US this year (Atlanta) Sept 7-9th.

From Donna Perry: My interest in philosophy stemmed from my undergraduate education at Saint Anselm College. The curriculum there was centered in an innovative and engaging humanities foundation which integrated scholars and scholarship from multiple disciplines. I took several extra courses in philosophy and found that it provided a helpful lens for all my future studies. When I started doctoral work at Boston College I purposefully sought out the philosophy department where I was introduced to the work of Bernard Lonergan, S.J. who had taught at BC. His cognitional philosophy provides a rich account of interior human consciousness. My own research focuses on transformative decision making around social issues that impact health. I found that Lonergan’s philosophy provided a deep and encompassing viewpoint from which to address issues of concern to humanity and to nursing.

When Pam extended an invitation to work with her on this manuscript I eagerly accepted. Not only was the topic of interest but I felt that it was critically important to address the importance of philosophical inquiry in nursing. It is important to note that this manuscript continued to evolve after submission. Reviewers who generously shared their time and thoughtful comments were instrumental to this process. The reviewers’ comments on the initial manuscript raised questions about the broad scope we had ascribed to philosophical inquiry. As all good questions do, these caused me to think critically about our paper. The different activities we had described were all important elements of philosophical inquiry. But clearly we needed to develop a way to differentiate and organize these different components. The process of bringing some clarification to this range of philosophical activities gave me the insight into developing a taxonomy for philosophical inquiry. Our hope is that this taxonomy might be helpful for scholarly development in the profession as we seek to address the many contemporary challenges to health and further the human good.

If you have not already, visit the ANS web site and download your copy of this very interesting article at no charge!

Apr 28

Evidence for creating distance delivery systems


We are now featuring the article titled “Barriers to Mental Health Care: Perceived Delivery System Differences” by Patricia Lingley-Pottie,  PhD, BNRN, CCRC; Patrick J. McGrath, PhD, OC, FRSC; and Pantelis Andreou, PhD.  This article reports the results of a study designed to explore differences between distance and face-to-face delivery of care for families with children who have mental health problems.  They used tools to measure perceived treatment barriers, therapeutic processes, and outcomes.  Their results provide evidence that distance delivery is a viable mode of health care delivery and has potential to bridge gaps in delivery that exist for marginalized populations. In Dr. Lingley-Pottie’s description of her work, she explains how her program of research has evolved; we include here links to the two articles that precede this one so that you can explore more background leading to this article.

It is an honor to have our manuscript published in Advances in Nursing Science (ANS). This is the final paper of my PhD dissertation and the last in a series of three that have been published in ANS. My research focuses on exploring the distance treatment experience from the participants’ perspective. The participants received Strongest Families intervention, evidence-based, psychologically informed mental health services that are delivered from a distance using highly-trained, non-professional coaches. Strongest Families was designed to ensure that neither time nor distance are barriers to care; coaching calls are scheduled at times convenient to families.

With the emergence of new distance service delivery systems and a scarcity of research in the field of pediatric mental health via telehealth using non-professionals, we decided to plan a series of research studies involving Strongest Families intervention programs.

Our initial research showed that therapeutic alliance existed in the absence of face-to-face contact between a coach and adult or child participant. The qualitative data collected to examine the participants’ opinions about advantages and disadvantages of distance treatment versus a face-to-face treatment experience (Lingley-Pottie & McGrath, 2007) suggested enhanced therapeutic alliance, uninhibited self-disclosure and the virtual elimination of stigma, which were attributed to visual anonymity and privacy offered by the distance setting. Results suggested that the barriers that exist with traditional mental health services were absent with Strongest Families. Moreover, results indicated possible differences in therapeutic processes between systems, informing the next projects.

An extensive literature search revealed that existing theoretical frameworks are based on face to face intervention and may not sufficiently apply to distance treatment, especially if a new phenomenon such as visual anonymity has an impact on therapeutic processes. Moreover, existing scales were primarily derived from professional opinion and may not adequately capture important participant or end service user information. To further examine differences between delivery systems (Distance versus face-to-face), we developed and validated a scale (Treatment Barrier Index-TBI) that was grounded in the participants’ distance experience to ensure inclusion of concepts relevant to the distance treatment and the end users’ perspective (Lingley-Pottie & McGrath, 2011).

The TBI was then used in this current study, the featured publication, to explore differences in perceived barriers to care and therapeutic process between two delivery systems (distance versus face-to-face). The results showed significantly Dal.Psych.2013-300fewer barriers associated with distance treatment and suggests significant differences in therapeutic processes between systems. Therapeutic alliance and self-disclosure significantly influenced the TBI score, favoring distance treatment and supporting the assumption that distance systems offering visual anonymity may eliminate the negative effects of stigma that some individuals experience with face-to-face treatment.

Innovative, cost-effective delivery systems are an important key to health care reform. These interesting findings will hopefully inform and generate more research in distance system design as well as stimulate the rethinking of existing theories and their relevance or applicability to distance treatment. Continued research will be important to ensure that programs are designed to meet the users’ needs and yield strong health outcomes. Nurses are often at the forefront of innovation in service delivery. We have the potential to make a significant contribution in this exciting, developing field of research.

Visit the ANS web site today!  You can download this current article at no cost while it is featured, and also connect to the other articles published by these authors!

Apr 16

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Manuscript due date extended for “Innovations in Health Care”


Spread the word!  we have extended the manuscript due date for “innovations in Health Care” to April 25, 2013!  Given the challenges of the current system changes, and nursing’s unique role in creating these changes, this issue topic is extremely important.  We want a strong nursing “voice” to come through in this ANS issue!  Here is a description of the topic:

Innovations in Health Care Delivery
Vol 36:4 –  December 2013anspic2004.jpgManuscript Due Date: Extended to April 25, 2013
Health care systems worldwide have undergone dramatic changes since the beginning of the 21st century, and for this issue of ANS we are calling for manuscripts that provide evidence of approaches to health care that address pressing issues that gave rise to the changes. In particular, we seek manuscripts that describe nursing models that have influenced health care delivery, and evidence related to outcomes based on these models. We also welcome manuscripts that present theoretical and philosophical perspectives that contribute to understanding and shaping health care delivery policy and decisions.

 

Apr 9

Shifting the focus to public policy


The current Editor’s Pick article is an excellent example of scholarly dialogue that offers a new perspective on a problem, shifting the focus from an individual approach to a broad public policy approach.  The article is titled “Redefining Gender-Based Power to Move Beyond Interpersonal Approaches to HIV Prevention”.  The authors, Kate Louise Horton and Shari L Dworkin, recognize the value and importance of interpersonal approaches to problems of gender inequity, but examine the need to also shift to the realm of public policy in addressing a widespread problem.  Kate Horton shared this reflection on how their work evolved:

Redefining gender based power evolved from a paper originally written for Ruth Malone’s “Theories of the Policy Process” teensclass at the University of California San Francisco School of Nursing. An inspirational and empowering class for a neophyte Health Policy doctoral student, it provided the inspiration to look beyond the traditional scope of nursing practice, to examine the broader context of gender-related health inequalities and the lack of policy engagement with the issue.

The article is intended to move the conversation forward, so that much needed policy attention can be garnered, to address some of the massive social and structural inequalities faced by women (and particularly women of color) that affect their health. As interdisciplinary scholars (a Nursing and Health Policy doctoral student, and a Sociology professor) the authors hope that the article challenges both policy discourses surrounding gender, power, and inequality, as well as the scope of nursing practice.

We would like to thank Ruth Malone for her inspirational teaching, and Anne Teitelman and colleagues for providing an empirical platform upon which to develop these theoretical ideas.

In the current environment of nursing and health care the prevailing focus is on individuals, and individual responsibility for health and well-being.  This article provides an excellent analysis that documents the value of shifting the focus to the public realm, the realm of public policy.  Visit the ANS web site now to download this article at no charge while it is featured!

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