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Nov 2

Transition from student to professional: High-Stakes clinical simulation


Clinical simulation has become a standard teaching and learning approach in nursing education. Dr. Mary Ann Cordeau’s article titled “Linking the Transition: A Substantive Theory of High-Stakes Clinical Simulation”  reports the findings of a grounded theory study that reveals a 4-stage transition experienced by students as they learn caring as a professional nurse.  Dr. Cordeau describes her research:
I have been involved in developing clinical simulation as a teaching/learning/assessment strategy at Quinnipiac University for the past seven years. During that time, I have conducted one-on-one simulations, group simulations, and most recently have been involved in streaming scenarios from the laboratory to the classroom. When I began to examine the clinical simulation literature, I learned the majority of the research was quantitative.  There was very little information on the student’s perspective of the clinical simulation experience. My background in history and phenomenology led me to focus on the qualitative aspect of clinical simulation. My initial research examined the lived-experience of high-stakes clinical simulation. The results of that study greatly influenced my approach to using clinical simulation with junior and senior nursing students.  The next logical step in examining clinical simulation was to use grounded theory to reveal the social psychological problem and process used to cope with the problem. At the time I was conducting the grounded theory study, I was teaching Transitions theory to the junior nursing students.  I began to see a connection between Linking and Transitions. Discussing my thoughts with colleagues and expert nurse researchers prompted me to examine Linking as fostering the situational transition from student to professional nurse.
 I would like to thank all of the students who participated in the studies and everyone who advised and supported me on my journey of discovery.
Visit the ANS web site today to download your copy of this very interesting article!

Oct 31

Transitions to Independent Living for Developmentally Impaired Young Adults


Dr. Geraldine Pearson,PhD, PMH-CNS, FAAN, in her featured article titled “The Transition Experience of Developmentally Impaired Young Adults Living in a Structured Apartment Setting,” reports the findings of a study conducted with young adults with a history of pervasive developmental disorders.  The young adults were all no longer eligible for child services in their area, and were transitioning to independent living.  It is rare that researchers turn directly to people who experience such extensive physical and psychologic challenges as participants.  Dr. Pearson’s work with her participants yielded impotant insights into their experience, as well as very important  explanations of methodologic adjustments that needed to be taken into consideration in the conduct of this research. She shared this description of her work in this message for the ANS blog:

Peggy asked me to begin this blog about my my paper published on the July-September 2012 online issue of ANS. titled “The Transition Experience of Developmentally Impaired Young Adults Living in a Structured Apartment Setting”. It detailed my dissertation research with a population of chronically disturbed young adults. I learned so much from these young adults trying to grow up with chronic psychiatric and developmental impairments and very little family support. The research is fairly clear in defining the need for parental figures to guide and assist as these individuals pass into adulthood. I think of these young people as I read the recent statistics about so many college graduates moving back home with their parents. While economics are cited as the predominant reason for this, I also wonder how many of them feel the need for family support as they face an unfriendly economic environment where living is expensive. My research participants were attempting to grow up using limited public resources for housing and expenses. Most appeared to live at the poverty line and they clearly struggled.

There were also some unique moments as I conducted the interviews in participant living environments. One young man proudly spoke of the “crickets” that were darting up his kitchen wall. He seemed oblivious to the fact that he was actually infested with roaches!

Participants were polite, eager to talk about their lives, longing for someone to talk with them. At the conclusion of the research interviews I was left to ponder the plight of this population, their quality of life, and what we, as mental health professionals, might be doing to improve their living. I didn’t come away with clear answers. In the end, the research cemented my passion about caring for these individuals, whether children, adolescents, or young adults. It is such an honor to have this paper published in ANS!

I believe you will find this featured article to hold valuable insights for all nurse scholars, not just because of the substance of the article, but as an exemplar of approaches to nursing research with those who are most vulnerable, and whose experience remains essentially unknown.  Visit the ANS web site now to download your free copy!

Oct 26

Transition to adulthood for youth with special needs


The transition to adulthood is a daunting one for all teens and their parents, but when the teen is developmentally disabled, this is a mammoth challenge.  Today’s “Editor’s Pick” article addresses this challenge, and report the findings of a study in the San Francisco Bay Area that included 64 youth and their parents. The article, titled “Parent and Youth Priorities During the Transition to Adulthood for Youth With Special Health Care Needs and Developmental Disability,” provides evidence of the need to broaden the usual health care transition goals for special-needs youth and their families.  This study was funded by the National Institute of Child Health and Human Development.

Roberta Rehm, PhD, RN, FAAN  is the lead author of this article; her co-authors are  Elena Fuentes-Afflick, MD, MPH; Lucille T. Fisher, PhD, RN; and Catherine A. Chesla, DNSc, RN, FAAN.  Dr. Rehm shared this description of the background of the project and what they are planning for the future of the project:

The TAPS (Transition to Adulthood Plans Study) project came about because parents in my previous studies with younger children told me how concerned they were about transition to adulthood issues. Parents worried about what would happen to their children as they aged and the children got bigger and older, but still needed a lot of support. I wanted to explore what was happening around planning for the transition to adulthood and the impact of caring for teens and young adults on the families. I recognized that parents worked closely with schools and health care providers, so included teachers and primary care providers in the TAPS study.

I am particularly interested in that group of young people who will continue to need support and assistance throughout their lives, so we defined “youth with complex needs”, for this study, as teens and young adults who have both a chronic health conditions and a developmental disability. Obviously, there are many other ways this population can be defined, but for any particular study decisions must be made so that recruitment can be focused.

As we proceeded with data analysis, TAPS’ project director, Lucy Fisher, and I began partnering with a local affiliate of Family Voices (Support for Families of Children with Disabilities, a parent-run organization that provides support and education to families of children with disabilities. We designed and did some initial testing of an intervention based on what we learned in TAPS, and focused it around “Person Centered Planning” strategies. We will continue working on this intervention and hope to add other community partners and test its effectiveness in the future.

Please visit the ANS web site today!  This featured article is available for free download for a limited time – get your copy today!

Oct 17

Immigrant and refugee women experiencing postpartum depression


This featured “Editor’s Pick” article represents one of the most important aspects of nursing scholarship – our abiding concern for the health of communities that are all too frequently ignored.  Anyone who is in a situation outside of one’s zone of personal comfort faces immense challenges, but the challenge is amplified for women experiencing one of the most dramatic of life transitions – pregnancy and birth.  This article, titled “Barriers and Facilitators of Social Supports for IMmigrant and Regugee Women Coping with Postpartum Depression” was authored by a team of researchers: Joyce Maureen O’Mahony, PhD, RN; Tam Truong Donnelly, PhD, RN; Shelley Raffin Bouchal PhD, RN and David Estes, PhD.  Dr. O’Mahony and Dr. Donnelly (shown in the photo to the right), described their interests in this project:

Joyce O’Mahony’s experience as a community health nurse encouraged her to explore further the postpartum depression experiences of immigrant women in her doctoral research. This research study was motivated by the need to enhance opportunities for improved health through the perspectives of immigrant and refugee women in the postpartum period.

Tam Truong Donnelly’s research encompasses health and wellness of immigrants and refugees which include immigrants’ and refugees’ mental healthcare, immigrant women’s breast cancer and cervical cancer screening practices. Currently her research focuses on Arab women’s breast cancer screening, depression among cardiovascular patients, and lifestyle risk factors that contribute to chronic diseases.

A continuation of this study is necessary to design intervention strategies for postpartum depression support and health care access for immigrant women. Future research studies are planned for: a) knowledge synthesis of immigrant women’s experiences of postpartum depression in Canada; b) focused interventions of providing appropriate support and educational components for immigrant women in the perinatal period.

This research provides important implications for health care of immigrant and refugee people. Visit the ANS web site now to download a free copy of this very important 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!

Oct 3

Evidence supporting father-friendly care for families


One of our “Editor’s Picks” for the current ANS issue is the article titled “Transition to Fatherhood: Modeling the Experience of Fathers of Breastfed Infants.”  The authors, Francine deMontigny, Carl LaCharite and Annie DeVault, describe a research project in which they examined a model of the relationships among father involvement, perceived parental efficacy, events related to breastfeeding, support, stress, and income with a sample of 164 fathers of breastfed infants.  The lead author, Dr. deMontigny, whose photo is featured here, describes their work that led to this study:

For over 15 years, I have been meeting with fathers, their partner, health professionals, to hear their point of view of what influences this transition. Needless to say, their spouse is an important source of support. But it stands out that nurses too can make a difference in fathers’ experience. Every time a nurse remarks positively about fathers’ abilities with their newborn, she contributes to strengthening the relationship between the father and the child. Our team has developed the Father Friendly within the Family Initiative to support health professionals in their efforts to build stronger ties with fathers and their families. We strongly believe that engaged fathers contribute to the family’s development.

This article is available for free download now!  So visit the ANS web site, and discover this and many other recent articles that can shape the future of nursing practice!

Sep 28

Acculturation & negative health outcomes


In one of our featured articles from the current ANS issue focusing on “Transitions,” Dr. R. Jeanne Ruiz and her colleagues present their research investigating the effects of acculturation on the health of pregnant Hispanic Women in the United States.    This research provides very important evidence for nurses and other providers who care for pregnant Hispanic women in the United States, but there are also important implications related to culture and health.  An important contribution of this study is the inclusion of physiologic measures.  Ruiz and her colleagues concluded that:

” ….  repeated or chronic physiological adaptation to stressors is an explanation for the “unhealthy assimilation” effect seen in Mexican immigrants.”  (see page E9)

As the authors of this article confirm, more research is needed to understand the health effects of cultural stress, how the dynamics of acculturation relate to health and well-being, and most important, ways in which nurses and other health care providers can promote health and well-being for immigrant women and families.

Sep 19

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Choosing contentment in the midst of life transitions


Susan Bonis’ featured article, which describes a philosophic (hermeneutic) study,  is an example of scholarship that some assume is far removed from the practical realm of nursing practice.  But to the contrary, this thought-provoking article sheds light on one of the most vexing challenges of human practice – how do people come to a sense of enduring serenity (contentment) in the midst of the disharmony created by serious health challenges?  As Dr. Bonis states in her article: “Evidence-based practices begin with understanding the science that underpins the discipline. Nursing is a human science; therefore, it is essential to understand the basic human phenomena that underpin being human, such as contentment.” (see page 274 of her article, available for free download until 9/30/12).

Dr. Bonis examined the published memoir of Dawn Prince-Hughes, a researcher of primate identity and culture.  The memoir, titled “Songs of a Gorilla Nation: My Journey through Autism,” recounts Prince-Hughes’ experience of coming to understand her own journey living with autism.  Dr. Bonis’ hermenuetic interpretation of the memoir, cast in the perspective of the nursing human becoming philosophic framework, provides the basis for her analysis of the experience of contentment.  As a reader of this article, you may not share for yourself the human becoming philosophy, but you will find connections between this philosophy and the most fundamental of nursing concerns.  For me one of the fundamental nursing concerns that this article addresses is that of promoting high-level wellness.  Dr. Bonis describes the process of  contentment as a paradoxical living calm-turbulence in challenging situations – a process that seems to me as central to the basic nursing concept of high-level wellness.  In her conclusion, Dr. Bonis states that “As humans live rhythms of contentmentdisharmony, contentment is glimpsed in serene and pleasurable moments of feeling listened to, understood, cared for, loved, and respected, as well as in moments when they trust, unburden, and laugh while all-at-once acquiescing to arduous situations.” (See page 282). What an inspiring image for nursing practice, and for the outcomes that I believe we all seek!

Let us know your thoughts and responses to this featured article!  Leave your comments here – and we will respond!

Sep 12

Aging, language and health care


How we talk and think about aging is something that most often is taken for granted.  This is not the case for Connie Madden and Kristin Cloyes who have investigated the language of aging in history, theory and research.  They point out in their featured article titled “The Discourse of Aging,” the experience of aging is common to all humans, but it remains poorly understood.  Their analysis reveals how the language of aging has shaped not only our general ideas about the “common” aging experience, but the research and theories related to aging.  Their analysis shows how language has tended to dichotomize how we think about aging as an either-or — living longer or living better.  Nursing, they believe, can make a significant contribution to understanding aging by bringing a holistic view to this experience, and challenge notions that perpetuate limited and stereotyping assumptions about aging. Here are some reflections from the authors about their work on aging:

Connie Madden: My interest in the language of aging has been fueled through my experiences as a nurse educator talking with students about their experiences and perceptions.  Through PhD course work as a student in the University Of Utah Hartford Center Of Geriatric Nursing Excellence, I have been able to expand my interest through exploring the relationship between language, perception and the practice of providing nursing care for older adults.  In a particular course, The Philosophy of Inquiry ,  Dr. Kristin Cloyes helped put those  pieces together  through examination of anti-aging and healthy aging language as it intersects in the larger aging discourse.
Kristin Cloyes: It’s always inspiring when a scholar is able to take the typical structure of a required course and shape it into something they really want to say, growing a field she or he is passionate about in new directions. In this case, the structure involved a required course paper in which I ask students toexplore a central concept in their area of interest, to identify common epistemological assumptions that shape the field and to explore how these assumptions stand up when viewed from differing frameworks. Connie used the paper to embark on an incisive analysis of assumptions about aging, and how these may shape nursing education. After I suggested that her thesis should be developed for publication, I was lucky enough for Connie to invite me to help expand and refine her ideas about the discourse of gerontology as an emerging area of study.
The credit on the illustration “The Seven Ages of Man” shown above reads:  Bartolomaeus Anglicus, Le Proprietaire des Choses tres Utiles … Paris 1510

Sep 5

Nursing perspectives on culture and health


The article now featured in our “Editor’s Picks”by Martha Baird illustrates perfectly, to me, many of the features that characterize nursing perspectives.  The article, titled “Well-being in Refugee Women Experiencing Cultural Transition,” recounts two research studies that Dr. Baird conducted.  These studies provided evidence from which she developed a situation-specific theory of wellness among South Sudanese refugees in her community.  The concepts that stand out as specific concerns for nursing include culture, wellness, transition, family, relationships and health.  Here Dr. Baird describes the experience of this research, and the South Sudanese family who helped make her work possible:

The research that led to the Theory of Well-being in Refugee Women in Cultural Transition would not have been possible without the help and guidance of Rebecca Mabior and John Akuei, my friends, translators, and interpreters. They have not only served as culture brokers between the South Sudanese community and myself, but have become part of our extended family.

John and Rebecca came to the US in 2001 as refugees. John was one of the Lost Boys of Sudan from the Kakuma Refugee Camp in Kenya. Rebecca came from Khartoum, the capital of Sudan, where she was practicing as a registered nurse. She and John met in the US, married, and have three children Atem 8 years, and Akon and Akuei, 3 year-old twins (see family picture). Their families still live in South Sudan and have never met their three children. Since South Sudan became a separate nation on July 9, 2011, they are able to visit their homeland for the first time in over 10 years. Next year, their oldest son, Atem will meet his grandparents for the very first time.

Working with the Sudanese refugee community on these two research projects has taught me the importance of long-term and sustainable relationships with the communities we are serving and hoping to effect positive health change.

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