Showing papers in "Nursing Forum in 2012"

Wellness in older adults: a concept analysis.

Abstract: PURPOSE. The purpose of this analysis is to examine the concept of wellness within the context of older adulthood. Identifying characteristics of wellness will clarify and develop conceptual strengths and limitations, providing a step toward evaluating its relevance in older adults and increasing utility in geriatric nursing. ORGANIZING FRAMEWORK. Rodger's evolutionary perspective. METHODS. Computer and manual searches were conducted of articles in the English language from 1950 to 2010, addressing wellness across the life span or among older adult populations. An inductive analysis of articles produced descriptive themes. FINDINGS. A historical time line traced the evolution of the wellness concept and its operationalization. Wellness has evolved from a little used concept to one commonly applied across many industries. Antecedents, attributes, and consequences of wellness are described. Concepts related to wellness are also identified. CONCLUSIONS. This concept analysis adds clarity to wellness in older adults. The state of wellness development as a concept in geriatric nursing is moving from conceptualization to use and testing in nursing theory and interventions. Increased knowledge of wellness will enable geriatric nurses to discover the strengths of older adults thereby promoting their ongoing growth and development while simultaneously guiding care for their changing and diverse health.

Exploring the concept of HIV-related stigma.

Abstract: BACKGROUND. HIV infection is a chronic, manageable illness. Despite advances in the care and treatment of people living with HIV infection, HIV-related stigma remains a challenge to HIV testing, care, and prevention. Numerous studies have documented the impact of HIV-related stigma among various groups of people living with HIV infection, but the concept of HIV-related stigma remains unclear. PURPOSE. Concept exploration of HIV-related stigma via an integrative literature review was conducted in order to examine the existing knowledge base of this concept. METHODS. Search engines were employed to review the existing knowledge base of this concept. CONCLUSION. After the integrative literature review, an analysis of HIV-related stigma emerged. Implications for future concept analysis, research, and practice are included.

Complexity Leadership: A Healthcare Imperative

Abstract: Problem The healthcare system is plagued with increasing cost and poor quality outcomes. A major contributing factor for these issues is that outdated leadership practices, such as leader-centricity, linear thinking, and poor readiness for innovation, are being used in healthcare organizations. Solution Complexity leadership theory provides a new framework with which healthcare leaders may practice leadership. Complexity leadership theory conceptualizes leadership as a continual process that stems from collaboration, complex systems thinking, and innovation mindsets. Conclusion Compared to transactional and transformational leadership concepts, complexity leadership practices hold promise to improve cost and quality in health care.

Self-efficacy with application to nursing education: a concept analysis.

Abstract: TOPIC. Concept analysis and self-efficacy. PURPOSE. This article analyzes the concept self-efficacy and its relationship to nursing education using Walker and Avant's methodology. SOURCES. Published literature. CONCLUSION. Nursing literature suggests increasing students' perceived self-efficacy will help to narrow the theory–practice gap. Self-efficacy is a cognitive variable that affects performance behaviors and affective processes. Perceived self-efficacy can be influenced by a direct experience, vicarious experience, or verbal persuasion. Individuals with high levels of self-efficacy demonstrate the defining attributes of confidence, perceived capability, and perseverance.

The relationships between safety climate, teamwork, and intent to stay at work among Jordanian hospital nurses.

Abstract: PURPOSE. The purpose of the present study is to examine the relationships among safety climate, teamwork, and intent to stay at work as perceived by Jordanian hospital nurses. METHODS. A descriptive correlational design was used to investigate these relationships among a convenience sample of 381 hospital nurses. Data were collected through a self-administered questionnaire that included the Safety Climate and Teamwork Scale and the McCain's Intent to Stay Scale. Descriptive statistics, Pearson correlation, analysis of variance, and hierarchical regression analysis were used to analyze the data. RESULTS. The findings showed (a) a strong positive correlation between safety climate and teamwork; and (b) moderate positive correlations between safety climate and intent to stay at work, and between teamwork and intent to stay at work. Moreover, the overall model of hierarchical regression showed that 45% of the variation in the level of intent to stay at work was explained by background variables, leadership styles, decision-making styles, and safety climate. CONCLUSION. The findings emphasized the positive effect of safety climate and teamwork on the level of nurses' intent to stay. IMPLICATIONS FOR NURSING MANAGEMENT. Nurse administrators should design and implement strategies that create a culture of safety climate and teamwork in their organizations.

Perceptions of academic integrity among nursing students.

Abstract: Purpose Academic dishonesty is growing among nursing students. Reasons for this growth can be categorized into student, faculty, and system factors. Nursing faculty designed a study to explore this problem. Conclusions We identified three themes: characteristics of students with academic integrity, patient safety, and professional outcomes. Exploring student perceptions of academic integrity can help faculty design measures to prevent dishonesty in these three areas. Practice Implications We recommend fostering culture change through strategies that target students, faculty, and systems. These strategies include peer mentoring, role modeling integrity, enhancing awareness of what constitutes cheating, and developing policies that promote honesty.

An exploratory study about meaningful work in acute care nursing.

Abstract: OBJECTIVE. To develop deeper understandings about nurses' perceptions of meaningful work and the contextual factors that impact finding meaning in work. BACKGROUND. Much has been written about nurses' job satisfaction and the impact on quality of health care. However, scant qualitative evidence exists regarding nurses' perceptions of meaningful work and how factors in the work environment influence their perceptions. The literature reveals links among work satisfaction, retention, quality of care, and meaningfulness in work. METHODS. Using a narrative design, researchers interviewed 13 public health nurses and 13 acute care nurses. Categorical-content analysis with Atlas.ti data management software was conducted separately for each group of nurses. This article reports results for acute care nurses. RESULTS. Twenty-four stories of meaningful moments were analyzed and categorized. Three primary themes of meaningful work emerged: connections, contributions, and recognition. Participants described learning-focused environment, teamwork, constructive management, and time with patients as facilitators of meaningfulness and task-focused environment, stressful relationships, and divisive management as barriers. Meaningful nursing roles were advocate, catalyst and guide, and caring presence. CONCLUSIONS. Nurse administrators are the key to improving quality of care by nurturing opportunities for nurses to find meaning and satisfaction in their work. Study findings provide nurse leaders with new avenues for improving work environments and job satisfaction to potentially enhance healthcare outcomes.

When Nurses Become the “Second” Victim

Abstract: PURPOSE: Well-intentioned, conscientious nurses make medication errors. The subsequent feelings of guilt, remorse, and loss of personal and professional self-esteem these nurses experience are well documented. In this paper, we analyze the concept of "second victim" within the context of medication administration errors. We also examine factors that contribute to nurses becoming second victims after making an error. PRACTICE IMPLICATIONS: Implications for nurses and nursing practice include nurses being given a greater degree of authority in designing the nursing work environment. Implications for nurses and nursing practice are presented. CONCLUSION: Further study is needed to more fully understand this phenomenon and to discover appropriate support mechanisms and interventions to minimize the harm to nurses. Language: en

Concept analysis: case management role confusion.

Abstract: AIM. This paper is a report on the concept of role confusion as it applies to nurse case management. BACKGROUND. Nurse case managers (NCMs) play an important role in the delivery of quality health care. There has been considerable discussion and debate as to the exact role of the NCM. Research has not produced a conceptual model for the NCM. A clear and concise definition of the role of the NCM is not available from published literature. METHODS. This analysis was conducted using the Walker and Avant method. Literature searches were conducted using Cumulative Index of Nursing and Allied Health, ProQuest, PsychInfo, PubMed, Academic Search Premier, and ERIC. Time line covered the period of 1980–2010. FINDINGS. Based on the analysis, role confusion occurs when there is no clear set of expectations for the NCM. Organizations have created positions that often are not patient centered and underutilize the nursing aspect. Nursing literature does not report significant investigation of the phenomena of role confusion in nurse case management. CONCLUSION. There needs to be a conceptual model for the role of the NCM. A skill set designated exclusively to nurses who practice case management would emphasize the patient–nurse relationship and provide clarity of the role and function of NCMs.

Facilitating Scholarly Writer Development: The Writing Scaffold

Abstract: UNLABELLED: PROBLEM OF INTEREST: Nursing faculty at a private, medium-sized university noted that students in their online Registered Nurse to Bachelor of Science in Nursing, hybrid Master of Science in Nursing, and online Doctor of Nursing Practice programs displayed varying scholarly writing abilities. PURPOSE: This article proposes an evidence-based comprehensive support framework, or scaffold that can be used in nursing education to facilitate the development of scholarly writing abilities in students. PRACTICE IMPLICATION: The writing scaffold is recommended for use by nursing faculty to facilitate the development of scholarly writing abilities within nursing, across nursing program levels, and across disciplines.

Sleep Quality of Hospitalized Patients in Surgical Units

Abstract: AIM. The aim of this study was to determine the sleep quality of the patients hospitalized in surgical units and the factors that influence it. METHOD. The research was a randomized descriptive study. It was conducted in the surgical clinics of Sivas Cumhuriyet University Health Services Research Hospital. A total of 411 patients participated in the study. The research data were gathered by means of the Pittsburgh Sleep Quality Index (PSQI) and the Questionnaire aimed at capturing personal information about the participant patients and the factors influencing their sleep. RESULTS. The sleep quality score of the patients “during the last week” (8.090 ± 3.504) was higher than their score in the “preadmission” period (4.229 ± 2.726) (p= .000). The sleep quality scores of “the patients with previous hospitalization and operation experience” (p= .000), “those who had undergone a major surgical procedure” (p= .000), “those who had been hospitalized for a week” (p= .022), and “those undergoing medical intervention during sleeping hours” (p= .000) “during the last week” were high. Patients who had a chronic illness history and whose operations were postponed had poor quality of sleep in both the hospitalization and preadmission period (p= .000). CONCLUSIONS. It could be suggested that the patients in preoperative and postoperative periods cannot get adequate rest due to low sleep-quality levels. IMPLICATIONS FOR PRACTICE. Nurses can prepare an environment aiding sleep as a way to increase surgical patients' sleep quality in hospital.

Heterosexism and Health Care: A Concept Analysis

Abstract: BACKGROUND. The concept of heterosexism is used in a variety of ways in healthcare literature. The lack of consensus of the term makes identifying when and how it impacts the health care of lesbian, gay, and bisexual people difficult. A lack of clarity of the concept could also hinder effectiveness of education, awareness, and research tool development efforts. PURPOSE. The purpose of this concept analysis is to offer a synthesized definition of the term heterosexism, including its relation to and distinction from related concepts like homophobia and heteronormativity. METHODS. The authors use Walker and Avant's eight-step concept analysis method: select a concept, determine the aim of analysis, identify all uses of the concept, determine defining attributes, construct a model case, construct additional cases, identify antecedents and consequences, and define empirical referents. CONCLUSION. The results of the analysis reveal focus areas for future research, tool development, and suggestions for improvements in nursing clinical practice.

Quality Improvement in Nursing: Administrative Mandate or Professional Responsibility?

Abstract: For professionals, providing quality service and striving for excellence are ethical responsibilities. In many hospitals in the United States, however, there is evidence indicating that current quality improvement (QI) involving nurses is not always driven by their professional accountability and professional values. QI has become more an administrative mandate than an ethical standard for nurses. In this paper, the tension between QI as nurses' professional ethics and an administrative mandate will be described, and the implicit ideal-reality gap of QI will be examined. The threat to professional nursing posed by the current approach to QI will be examined, and ways to incorporate nursing professional values in a practical QI effort will be explored.

Simulating care: technology-mediated learning in twenty-first century nursing education.

Abstract: PROBLEM. The increased reliance on simulation classrooms has proven successful in learning skills. Questions persist concerning the ability of technology-driven robotic devices to form and cultivate caring behaviors, or sufficiently develop interactive nurse–client communication necessary in the context of nursing. METHODS. This article examines the disconnects created by use of simulation technology in nursing education, raising the question: “Can learning of caring-as-being, be facilitated in simulation classrooms?” FINDINGS. We propose that unless time is spent with human beings in the earliest stages of nursing education, transpersonal caring relationships do not have space to develop. Learning, crafting, and maturation of caring behaviors threatens to become a serendipitous event or is no longer perceived as an essential characteristic of nursing. CONCLUSIONS. Technology does not negate caring–the isolation it fosters makes transpersonal caring all the more important. We are called to create a new paradigm for nursing education that merges Nightingale's vision with technology's promise.

From Documentation to the Problem: Controlling Postoperative Pain

Abstract: PROBLEM. Adequate pain control continues to be an enigma in the face of the Joint Commission (TJC) well-intended pain management standards. Notable in the pain standards is the mandate to make pain the fifth vital sign to increase pain visibility and awareness. METHOD. The following databases were searched: EBSCOHost, CINHAL, PubMed Central, Medline, and government/societies sites for guidelines on pain control. Various search terms used included pain, post operative pain, pain control, pain as the 5th vital sign, pain documentation, pain assessment, Joint Commission Pain Standard, PRN effectiveness, and pay-for-performance. FINDINGS. Accredited facilities are mandated to have plans to assess for pain and evaluate pain management effectiveness. These mandates have necessitated a flurry of initiatives and programs by hospitals and healthcare facilities focusing on documentation processes to meet TJC compliance. Notable programs include Pain as the 5th Vital Sign and PRN (as needed) effectiveness documentation. Many facilities have programs to assess and document pain but lack programs that effectively control patient's pain. CONCLUSION. This article is a call for facilities to refocus on pain control. A need to evaluate current programs by facilities is evident. Studies show that Pain as the 5th Vital Sign and PRN effectiveness documentation are not effective and invariably have not met the goals of TJC pain standard—adequate and effective pain control.

Caring Theory and Practice—Entering a Simultaneous Concept Analysis

Abstract: PROBLEM. To better understand the approach of caring in nursing and the role of theory in practice, we wanted to consolidate the caring theory of Watson with the empirical findings from the three ...

A Concept Analysis of Self-Efficacy Among Chinese Elderly with Diabetes Mellitus

Abstract: Aim This paper is a report of concept analysis of self-efficacy in elderly with diabetes in China. Methods Literature was systematically retrieved from 2000 to 2011 using five databases: Cumulative Index to Nursing and Allied Health Literature, MEDLINE, OVID, PsycInfo, and Web of Science. The key words used in the search were self-efficacy, diabetes, type 2, aged, self-care, and China. The electronic search was supplemented by a manual search of current issues of periodicals and follow-up of other cited materials, where appropriate. A total of 45 articles were retrieved. After a careful review of the 45 articles most relevant to the topic, 31 articles remained. They were used to complete a concept analysis using Walker and Avant's technique. Results Four defining attributes of self-efficacy were identified: (a) cognitive recognition of requisite specific techniques and skills required to undertake diabetes self-management, (b) perceived expectations of the outcomes of self-management, (c) confidence in the capability to perform self-management, and (d) sustained efforts in self-management of diabetes. Conclusions Self-efficacy has been an important determinant in self-management among elderly with diabetes. The application of self-efficacy should be incorporated into decision-making and problem-solving procedures when caring for older adults with diabetes.

A concept analysis about temporality and its applicability in nursing care.

Abstract: Topic: Concept analysis of temporality. Purpose: To develop a comprehensive definition of temporality applicable to nursing care. Source: Published literature. Conclusions: Temporality is a central component of our experience of the world. Phenomena such as the passage of time, time cycles, the trajectory of aging, transitions toward something, something being, and life as a limited time are integral to human experience. Temporality could be seen as lived time, and as such it is subjective time as opposed to clock time or objective time. The temporal dimensions of past, present, and future constitute the perspective of a persons temporal world. © 2012 Wiley Periodicals, Inc.

Nurse Manager Engagement: A Concept Analysis

Abstract: AIM. This concept analysis examines the visibility of nurse manager engagement in the healthcare work environment. BACKGROUND. The term employee engagement was derived from studies of morale or the willingness of a group to accomplish objectives in the 1920s. “Following World War II group morale scores were used as predictors of speed, quality, and militancy by US Army researchers. The goal was to identify star, or high performers. A term was needed to describe emotional attachment of an individual to the organization, fellow associates, and the job” (“Employee engagement origins,” 2010, p. 1). DATA SOURCES. The CINAHL, MEDLINE, ABI INFORM, PsycINFO, and Ovid databases and the Internet were searched for the period of 2005–2010 for literature published in English with a focus on peer-reviewed journals from disciplines of health sciences, health administration, business, and psychology. METHODS. The Walker and Avant method was used for this analysis. The experience of the author as a current and previous nurse manager was also used for this analysis. RESULTS. Nurse manager engagement was assumed to be present based indirectly on empirical referents and consequences, such as low or high vacancy rates for staff nurses. CONCLUSION. Further research is needed to explore the identity of the nurse serving in the role of manager/leader who is able to demonstrate the skills and talents necessary to visibly demonstrate engagement and facilitate a culture of engaged nurse managers.

Sex Work in Trucking Milieux: “Lot Lizards,” Truckers, and Risk

Abstract: Background: Long-haul truckers often engage in risk-laden sexual mixing and drug exchanges with female sex workers while on the road, which increase their vulnerability to sexually transmitted infections/blood borne infections (STI/BBI). Objective: An ethnoepidemiological study of STI/BBI in trucker-centered populations was conducted at four truckstops in the United States. This article reports findings from an analysis of the female sex worker data, which show how mobility and transience, as well as poverty, homelessness, and exposure to violence, have the potential to exacerbate the occupational health risks of female sex workers. Methods: Phase 1 involved nonparticipant observation of trucker risk network groups in public and semi-public settings at two Arizona truckstops. Phase 2 was a large-scale ethnoepidemiological study of STI/BBI risk among trucker networks at two Georgia truckstops. Ten sex workers in Phoenix and 29 in Atlanta were interviewed individually or in focus groups. Textual data were analyzed using QSR NVivo 8 and serological data collected from the Georgia sample were analyzed for STIs/HIV. Results: Infections occur within these populations, where the existence of multiple risks delivered via multiple channels within physical proximity maintains infection and transmission. Conclusions: Environmental-level interventions, such as better security at truck stops, and individual-level interventions, such as STI/BBI infection education and testing for FSWs and truckers, can contribute to safer settings for truckers, sex workers, and their sex and drug partners.

Calculating nurse staffing in community mental health and community health settings in South Australia.

Abstract: AIM. The article reports the development of and data from a preliminary evaluation of a staffing methodology equalization tool (SMET) designed for the South Australian Department of Health to equalize the workload of community mental health and community health nurses working within multidisciplinary teams. BACKGROUND. Shorter admissions, increasing patient acuity, and shortages of beds have intensified the work of community nurses. Existing workload models have limitations for community nursing settings. METHOD. A workload tool for community mental health and community nurses was developed in consultation with a reference group of nurses. A trial was conducted at six sites, and the tool was evaluated using qualitative and quantitative data. RESULTS. The tool increased transparency and equity of workloads in community teams and provided a means of reducing workload through demonstration of a capacity to take new clients, however, further work is required to factor the intensity of caseload into the tool. CONCLUSIONS. The tool needs further evaluation to determine its applicability to a range of clinical settings.

Creating a safe haven for employees who are victims of domestic violence.

Abstract: PROBLEM: Intimate partner violence is a danger to American employers as well as costly for American businesses. BACKGROUND: Because one in four women is battered at some point in her lifetime and the percentage of employed women is over 50%, employers should address the issue of domestic violence at the workplace in an effort to keep employees safe while at work and to manage the financial burden that accompanies this problem. AIM: The author provides an overview of the problem and corresponding interventions that should be implemented to avoid violence in the workplace and to promote a culture of safety for all employees, particularly in a hospital setting. Language: en

A concept development of the village health worker.

Abstract: PROBLEM. Village health workers (VHWs) promote health and provide basic health care in areas of the world where basic health knowledge and health professionals are scarce. The 1960s–1980s saw a dramatic increase in the training of VHWs in resource-limited environments. Politics changed, disillusionment set in, and enthusiasm waned. Recently, increased pressures on health resources have led to the resurgence of VHWs. Until the shortage of health professionals is alleviated, the need for VHWs to extend the reach of scientifically verified health care into remote and conflict areas will remain acute. This need provides a compelling reason to pursue research concerning VHWs. Village health workers are usually trained by professional nurses and refer patients to them, so nursing is positioned to lead this important research. METHODS. The author developed the concept of the VHW using Meleis's Integrated Approach. Meleis's approach was chosen because it is appropriate for undeveloped concepts, emphasizes exploration and discovery, and can begin with clinical practice, taking advantage of the author's experience with VHWs. RESULTS. The resultant concept definition, with antecedents and consequences, provides a foundation other nurse researchers can build upon. Existing research concerning VHWs was reviewed and gaps suitable for future nursing research were identified.

Clinical trial nurse's role in safety reporting.

Abstract: The clinical trial nurse (CTN) can have a substantial amount of responsibility for clinical trials and can perform many roles in the management of clinical trials Although new opportunities for the registered nurse in clinical trials have emerged in recent years, there remains to be a dearth of literature surrounding the important roles of the CTN in clinical trials The CTN is a specialty-nursing role that is unfamiliar to many, including some nurses Therefore, it is important to address this gap in the literature and enlighten the nursing profession and others about the roles of the nurse in clinical trials This article aims to explore and provide an overview of the CTN's role in safety reporting Safety reporting is a significant component of clinical trials by protecting the rights, safety, and welfare of subjects The CTN integrates and utilizes his or her knowledge, experience, skills, and sound ethical principles when performing the duties of this role This allows the CTN to be a vital member in the safety-reporting process and in the protection of subjects

Medication administration by enrolled nurses: opinions of nurses in an Australian healthcare organization.

Abstract: OBJECTIVE. This study examined the opinions of nurses about the introduction of enrolled nurse medication administration and analyzed its impact on the medication error rate. METHODS. Data were collected using a survey and examination of incident reports regarding nursing medication errors. Nurses (registered nurse, enrolled nurse with medication endorsement, enrolled nurse) responded to survey items regarding the introduction of enrolled nurse medication administration. Data analysis included descriptive statistics, Fischer’s exact test, and chi-square analysis where appropriate. RESULTS. The majority of nurses (75.2%) supported enrolled nurse medication administration. However, differences in opinion were observed between registered nurse (RN) and enrolled nurse with medication endorsement (ENME) regarding clear understanding of responsibility and accountability (RN: 47.2% vs. ENME: 77.8%; p = .033), and whether suitable education was provided (RN: 34.7% vs. ENME: 73.7%; p = .012). Moreover, less than one-third of RNs agreed that the assessment process for EN medication endorsement clearly identified the competence of the ENME to administer medications. Nonetheless, nursing medication errors did not increase in the 12-month period after the introduction of enrolled nurse medication administration (pre: 314, post: 302). CONCLUSIONS. The findings of this study suggest areas that should be addressed in the future, including assessment of competence and focused education about accountability and responsibility.

Clinical teleconferencing: bringing the patient to the classroom.

Abstract: Problem The confidence to act on clinical judgment, ask for help, and juggle multiple competing priorities is best developed within a clinical setting. Traditional classroom learning, which is often static, does not support learning these skills or help new students learn how to "be" a nurse. Student nurses need frequent and repeated exposure to expert nurses and clinical environments. Traditional teaching methods may not be sufficient to meet these needs. Method This project employs a strategy that supplies situated, context-driven learning with the aim of improving clinical reasoning by bringing real-world, real-time clinical scenarios into the classroom via audio conferencing. This classroom teaching strategy is based on the principles of learner-centered teaching, and the aim is to incorporate real-world clinical information into the classroom. Students are introduced to "real-time report" from special care areas as the basis for class activities and discussion. Findings Feedback on this model was sought through course evaluation data, focus groups with students, and participating nurses. NCLEX pass rate remained unchanged as a result of this teaching strategy. Conclusion In this model, the classroom changes from being a physical place where knowledge is acquired to a place where knowledge is translated from and applied to practice.

A review of the literature: evaluating dietary intake of Filipino Americans at risk for type 2 diabetes.

Abstract: The purpose of this literature review is to investigate the research on the dietary intake of Filipino Americans. Evaluating the dietary practices of Filipino Americans may have an effect on the development of type 2 diabetes. Data collection was obtained, and four databases were included: Pub Medical, Cumulative Index of Nursing and Allied Health Literature, Journals at OVID, and Medline. The key words used in the search were "diet,""type 2 diabetes," and "Filipinos." A total of nine articles were relevant and met the inclusion criteria. The following articles were excluded: studies in a foreign language, letters to the editor, and program descriptions.

Critical access health care: a concept analysis.

Abstract: PURPOSE The purpose of this paper is to provide a concept analysis of critical access health care A common understanding of critical access health care would benefit those who legislate, provide, and consume health care METHODS A review of the literature was conducted using an identical set of search terms that yielded a variety of sources; however, none were specifically related to critical access health care FINDINGS No literature of concept analysis of critical access health care could be found CONCLUSIONS A concrete and measurable understanding of the concept will provide a common foundation to assist public and private entities in developing viable methods to understand healthcare policies, problems related to access, disparities in health care, and ways to increase health promotion and disease prevention

Elders Adapting to a Chronic Diagnosis Within a Nursing Refuge

Abstract: PROBLEM. The increasing numbers of people seeking care for chronic disease has placed unparalleled demands on nurses who journey with them as they grasp the meaning of their altered health status. The complexity of the newly diagnosed chronic disease can be overwhelming. Newly diagnosed elder patients need a refuge in which to explore the uncertainties and challenges in managing a chronic illness. Reactions to a new diagnosis are uniquely shaped by the elder person's culture, age, life circumstances, and previous coping strategies. Six dichotomous response pairs are posed: relief versus devastation, courage versus cowardice, disease obsession versus disease aversion, rational thinking versus intuition, reawakening versus stuck, and self-reliance versus dependence. Nurses can create a sanctuary for elderly patients with protected space, presence, partnership, past to future orientation, and perspective on life. Nurses who embrace this mission may find themselves returning to the reasons they sought a nursing career, to support and strengthen elderly people in the most vulnerable moments of their lives.

Concept Analysis: Awareness of Discrimination Based on Genetic Information

Abstract: PROBLEM. All nurses have the responsibility to deliver nondiscriminatory genetic health care. Patients perceive discriminatory nursing practices when they are being treated differently and unfairly. Nurses are expected to integrate genetic information about their patients into their clinical decision making. Thus, it is both timely and imperative that nurses have an operational definition of the concept “awareness of discrimination based on genetic information.” METHOD. An operational definition of the concept was derived and Wilson's method of concept analysis was utilized to show how the operational definition may be applied in three different case models. FINDINGS. Awareness of discrimination based on genetic information can be operationally defined as “to know differences against people or distinguish between people based on the ancestral, heritable, communicated facts or knowledge”. CONCLUSION. This concept analysis of words and terms used in genetic health care may serve as a framework for further genetic/genomics healthcare concepts under exploration.