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Posts tagged ‘Ruth E. Malone’

Video Games and Adolescent Health

The latest featured article in the current issue of ANS is titled “’It Feels More Real’ – An Interpretive Phenomenological Study of the Meaning of Video Games in Adolescent Lives” authored by Susan R. Forsyth, PhD, RN; Catherine A. Chesla, PhD, RN, FAAN; Roberta S. Rehm, PhD, RN, FAAN and Ruth E. Malone, PhD, RN, FAAN.  I join the authors in encouraging you to download and read this article (available at no cost while it is featured!), and share your ideas and comments here!  Dr. Forsyth shared this background about her work, and the emergence of this particular report:

Youth today are growing up with electronic media embedded in their lives, different from all previous generations.  In my master’s work (and as a mother of a preteen) I became interested in this phenomenon and how exposure to and engagement with various imagery types might mediate adolescent perceptions of health and risk-taking. I was also interested in why adolescents still use

Susan Forsyth

tobacco products, despite knowing the associated risks. Looking at the research, I found that one reason is the continued normalization of smoking as a choice, especially within communities that are heavily marketed to by the tobacco industry. Thinking about this led me to focus my dissertation work on how adolescents and young adults perceived tobacco imagery in video games.  In a systematic review, I found that little had been done in this area, and that there was a perception that tobacco content was minimal in video games. Guided by my dissertation committee, I designed a qualitative study that allowed me to interview gamers online and in-person to ask them about the games they played, the role gaming had in their lives and their experiences with tobacco content in games.  I also examined each of the mentioned games for tobacco content.  One of the initial findings was that tobacco content was indeed present in more than 40% of the games mentioned by adolescents and young adults, and they ascribed meaning and value to that content.

This paper grew out of that work, and is one of five papers from my dissertation. It is the only paper that does not explicitly deal with tobacco content in video games.  After interviewing twenty young people about their experiences game playing and the meaning that playing had for them, it was clear that the experience of electronic gaming was qualitatively different than playing, for example, board games.  We found that the adolescents were telling stories of identity development, of relationships and how they were “in” the game world.  We realized that for participants, gaming served as another space they could go to practice and develop possible versions of themselves, with the addition of being able to use a disembodied electronic proxy as a way of presenting to others in the gaming community.  As a nurse interested in how corporate, societal and cultural forces influence identity development and health choices in adolescents, this was a provocative finding, pointing to a need for our profession to consider how adolescents use their electronic media when designing both individual patient plans and larger policy positions to maximize health for all of people for which we care.



The “As-if” World of Nursing Practice: Nurses, Marketing and Decision-Making

We are currently featuring the article titled “The “As-If” World of Nursing Practice: Nurses, Marketing, and Decision-Making” by Quinn Grundy, PhD, RN and Ruth E. Malone, PhD, RN, FAAN. Based on an ethnographic study, the authors conclude that “nursing must deconstruct the “as-if” nondecisional myth by confronting conflicts of interest and owning fully its rightful clinical and advocacy roles.” This article is available to download at no cost while it is featured; I join the authors in inviting you to return here to share your responses and comments!  Dr. Grundy shared this background about her work:

The Physician Payments Sunshine Act, passed as part of the Affordable Care Act, came into effect just at the time I was selecting an area of focus for my PhD dissertation. This legislation required pharmaceutical and medical device companies to publicly report all payments made to physicians and teaching hospitals and issued in a new era of transparency in United States healthcare. What surprised me, however, was that nurses were omitted from the mandate. This caused me to question whether nurses did not have these types of relationships with industry? Or, whether policymakers did not believe they warranted the same level of scrutiny?

Under the supervision of Dr. Ruth Malone, my co-author on this week’s featured article, I conducted an ethnographic investigation into the ways that registered nurses interact with industry in their day-to-day clinical practice at 4 hospitals in the western United States. What we found couldn’t have been more different than what the policy climate suggested.

Often on a daily basis, nurses interacted with industry representatives from multiple medically-related industries including

Quinn Grundy

pharmaceutical, medical device, information technology and infant formula companies. These interactions including attending drug company-sponsored dinners, receiving payments for speaking or consulting, and receiving gifts at conferences or other sponsored events. Among physicians, these types of relationships have been associated with negative changes in prescribing habits including increased prescribing of brand-name, heavily marketed medicines with lower safety profiles.

However, to our surprise, nurses were mystified at the attention of sales representatives and wondered at their inclusion in marketing activities like drug dinners. They explained that as health professionals who cannot prescribe medicines, there was no decision-making for marketing to attempt to sway. Yet, these same nurses described their roles on hospital purchasing committees, narrated multiple instances where they had recommended treatments to providers, and described powerful influence over patient care within the hospital.

This article explores the conditions under which nurses’ considerable influence and power to affect change within clinical practice becomes invisible, even at times to nurses themselves. We call this the “as-if” world of nursing practice — a well-constructed, institutionally-preserved myth that nurses do not make decisions in the absence of doctor’s orders.

We hope this article will stimulate a conversation in the profession about the nature of conflict of interest in nursing practice and the need to recognize, and safeguard, nurses’ considerable decision-making power from marketing influence.


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