Moral Distress as Moral Heuristic Missing the Mark.

I propose that moral distress may function as a moral heuristic, and one that misses its mark in signifying a fundamental source for nurses' moral suffering. Epistemic injustice is an insidious workplace wrongdoing that is glossed over or avoided in explicit explanations for nurse moral suffering and is substituted by an emphasis on the nurse's own wrongdoing. I discuss reasons and evidence for considering moral distress as a moral heuristic that obfuscates the role of epistemic injustice as a fundamental constraint on nurses' moral reasoning underlying moral suffering.

Exploring Psychedelics for Alleviating Existential and Spiritual Suffering in People With Serious Illnesses: Links to the Theory of Self-Transcendence.

The fields of palliative and holistic Nursing are dedicated to providing comprehensive care for the person, emphasizing special attention to the existential and spiritual aspects of care. Psychedelic-assisted therapy has emerged as a promising approach for symptom management in individuals with serious illnesses, particularly those of existential and spiritual origin. People who undergo challenging experiences, as is the case with serious illnesses, often undergo an identity crisis and question the purpose of their lives. Psychedelic therapy, when conducted properly by trained professionals, can facilitate self-exploration and self-transcendence, opening doors to states of expanded consciousness and fostering a profound connection with oneself. This experience can help patients develop a greater sense of self-awareness and a deeper understanding of their existential and spiritual issues, enabling them to find meaning and inner peace. The Theory of Self-Transcendence theory provides a Nursing framework for understanding how psychedelic-assisted therapy can facilitate, through self-transcendence, the journey of spiritual and existential healing, offering the possibility of achieving wellbecoming from a state of vulnerability.

A New Nursing Aesthetic.

Conceptions of the art and aesthetics of nursing traditionally focus on the nurse and nursing practice. My purpose here is to propose a shift in thinking from this traditional focus that dominates the "art of nursing" literature, to consider a new nursing aesthetic that focuses on human beings proper: health as wellbecoming. I present a framework based on everyday aesthetics, feminist aesthetics, and Deweyan perspectives, along with attention to the nursing disciplinary perspective of health and well-being. I conclude with a look ahead to philosophical questions and scientific issues regarding theorizing and scientific inquiry about the health as wellbecoming aesthetic to advance nursing knowledge.

Neurobiology of eating behavior, nutrition, and health.

Eating behavior and food-related decision making are among the most complex of the motivated behaviors, and understanding the neurobiology of eating behavior, and its developmental dynamics, is critical to advancing the nutritional sciences and public health. Recent advances from both human and animal studies are revealing that individual capacity to make health-promoting food decisions varies based on biological and physiological variation in the signaling pathways that regulate the homeostatic, hedonic, and executive functions; past developmental exposures and current life-stage; the food environment; and complications of chronic disease that reinforce the obese state. Eating rate drives increased calorie intake and represents an important opportunity to lower rates of food consumption and energy intake through product reformulation. Understanding human eating behaviors and nutrition in the context of neuroscience can strengthen the evidence base from which dietary guidelines are derived and can inform policies, practices, and educational programs in a way that increases the likelihood they are adopted and effective for reducing rates of obesity and other diet-related chronic disease.

Normative Ethical Theorizing.

Ethical issues are ubiquitous in nursing, yet there is a dearth of scholarship in normative ethics and ethical inquiry in nursing. In a concern to motivate interest in normative ethics and inquiry to build ethical knowledge, this article highlights some of the conceptual resources of normative ethics after describing the different types of ethics, including normative ethics. These conceptual resources of normative ethics include moral theories and the method of wide reflective equilibrium.

Loss of LRP1 in Adult Neural Stem Cells Impairs Migration to Ischemic Lesions.

After ischemia, cells in the brain parenchyma upregulate stromal derived factor 1 (SDF1), driving chemokine receptor CXCR4-mediated migration of adult neural stem cells to the ischemic injury. We discovered a novel regulator of CXCR4 in neural stem cells, low-density lipoprotein receptor related protein 1 (LRP1). We used Nestin-driven knockout of LRP1 and induction of td-tomato in neural stem cells of adult mice. We observed reduced localization of td-tomato positive cells to the lesion, and find disrupted CXCR4-mediated neural stem cell migration in vitro, which is likely driven by LRP1-mediated loss of CXCR4 expression in vivo. Our results suggest that LRP1 is a novel regulator of CXCR4 in neural stem cells. This heretofore unknown interaction between LRP1 and CXCR4 could have significant consequences for multiple aspects of neural stem cell physiology.

Developing a Preclinical Nurse-Nurse Communication Framework for Clinical Trial Patient-Related Safety Information.

Clinical trial trials have become increasingly complex in their design and implementation. Investigational safety profiles are not easily accessed by clinical nurses and providers when trial participants present for clinical care, such as in emergency or urgent care. Wearable devices are now commonly used as bridging technologies to obtain participant data and house investigational product safety information. Clinical nurse identification and communication of safety information are critical to dissuade adverse events, patient injury, and trial withdrawal, which may occur when clinical care is misaligned to a research protocol. Based on a feasibility study and follow-up wearable device prototype study, this preclinical nurse-nurse communication framework guides clinical nurse verbal and nonverbal communication of safety-related trial information to direct patient care activities in the clinical setting. Communication and information theories are incorporated with Carrington's Nurse-to-Nurse Communication Framework to encompass key components of a clinical nurse's management of a trial participant safety event when a clinical trial wearable device is encountered during initial assessment. Use of the preclinical nurse-nurse communication framework may support clinical nurse awareness of trial-related wearable devices. The framework may further emphasize the importance of engaging with research nurses, patients, and caregivers to acquire trial safety details impacting clinical care decision-making.

Social and Cultural Factors, Self-efficacy, and Health in Latino Cancer Caregivers.

BACKGROUND: Latino cancer caregivers are at risk of physical, mental, and emotional health issues. Sociocultural factors such as informational support, Anglo orientation, and spiritual practice may compound or protect against these risks. OBJECTIVE: The purpose of this research project was to examine self-efficacy as a mediator between sociocultural factors and health outcomes in Latino cancer caregivers. METHODS: This is a secondary analysis of baseline caregiver data from an experimental study testing two psychoeducational interventions in Latina individuals with breast cancer and their caregivers. Caregivers (N = 233) completed items assessing self-efficacy, informational support, Anglo orientation, spiritual practice, depression, and global health. Caregiver data were analyzed using hierarchical linear regression and mediation analysis. RESULTS: Spiritual well-being was not significantly associated with health outcomes or self-efficacy. In regression analysis, both informational support ( b = 0.32; 95% confidence interval [CI], 0.20 to 0.45; P < .001) and Anglo orientation ( b = 0.15; 95% CI, 0.11 to 2.48; P < .05) were significant predictors of global health, but informational support ( b = -0.43; 95% CI, -0.55 to -0.30; P < .001) was the only significant predictor of depression. There were indirect relationships through self-efficacy for symptom management for both informational support and Anglo orientation and health outcomes. CONCLUSIONS: Informational support and Anglo orientation were significantly related to health outcomes directly and indirectly through self-efficacy in Latino cancer caregivers. IMPLICATIONS FOR PRACTICE: Informational support through the health system and community, when provided with attention to culture and Spanish language translation, can increase Latino cancer caregivers' self-efficacy to care for themselves and improve health outcomes.

Disciplinary Maturity in Moving From Nurse Scientist to Nursing Scientist.

In this article, I discuss a provocative recommendation by the American Association of Colleges of Nursing for research doctorate education as it relates to nursing education and the broader question whether nursing scientists should be nurse scientists. I use tools from the tradition of analytic philosophy to examine issues and language underlying this discussion about nursing science, knowledge, and practice. I draw some conclusions based on my review of the association's documents and from philosophical perspectives on nursing science and practice.

Midrange Theory Evaluation to Advance Nursing Knowledge.

The author in this article presents a midrange theory evaluation framework as an update to nursing publications over the past 50 decades on theory evaluation criteria and incorporates recent philosophical perspectives on scientific theory and knowledge development. The intent also is to encourage a theorizing style that advances understanding and explanations of nursing phenomena for nursing practice as well as for the pure joy of knowing why something happens.

Selecting a theoretical framework to guide research on the COVID-19 pandemic impacts on nursing care delivery and the critical care work system (using Reed's Intermodern approach to theory critique).

Understanding the impact of COVID-19 on nursing care delivery in critical care work systems is urgently needed. Theoretical frameworks guide understanding of phenomena in research. In this paper, we critique four theoretical frameworks (Donabedian's Quality Model, the Quality Health Outcomes Model, the Systems Research Organizing Model, and the Systems Engineering (SEIPS) 2.0 Model) using (blinded) (2018) Intermodern philosophical perspective of nursing science. (blinded) (2018) Intermodern approach to theory critique was selected for its pragmatic perspective and focus on personal and professional health and wellbeing. The SEIPS 2.0 Model was ultimately selected to guide the study of the impact of the COVID-19 Pandemic on nursing care delivery in the critical care work systems.

Standpoint Epistemology and Nursing Science.

In this article, I propose that engagement in nursing practice affords an epistemic advantage and should be included in defining nursing science and as a warrant for scientific knowledge. I appeal to standpoint epistemology, a philosophical theory, to support my proposal. A new conception of objectivity, which aligns with the contemporary practice of science and standpoint theory, is discussed. The article presents a preliminary theory of nursing standpoint theory that explains epistemic advantage of a practicing nurse. Open questions about nursing science conclude the article.

Self-Transcendence: Moving from Spiritual Disequilibrium to Well-Being Across the Cancer Trajectory.

OBJECTIVES: To synthesize research results on self-transcendence among people affected by cancer and their caregivers to inform oncology nursing practices that promote well-being across the cancer trajectory. Self-transcendence is an inherent capacity to expand self-boundaries beyond the person's usual form to create something meaningful, whether it is a new purpose, perspective, situation, or artifact that fosters well-being. DATA SOURCES: Peer-reviewed, research-based publications, and peer-reviewed theoretical publications were used. CONCLUSION: Research results are consistent with Reed's self-transcendence theory that proposes self-transcendence as a healing process for application in nursing practice. Self-transcendence facilitates well-being through the creative experiences afforded by expanding self-boundaries intrapersonally, interpersonally, and transpersonally. Nurses may use this knowledge in various practices that support well-being among people who have cancer and their families. IMPLICATIONS FOR NURSING PRACTICE: Five comprehensive practice implications to support self-transcendence and foster well-being in individuals affected by cancer and their caregivers were synthesized from the research-based literature and aligned with Reed's self-transcendence theory.

The Philosophical Turn to Mixed Methods for Nursing Science.

In this article, I explore the turn to mixed methods in nursing. I examine the alignment of key characteristics (philosophical underpinnings and the concept of integration) of mixed methods with nursing's disciplinary perspective and its links with theory. I also provide a brief overview of the history and current status of mixed methods and conclude by looking to the future to suggest an additional twist in the turn to mixed methods for nursing science.

Self-efficacy in caregivers of adults diagnosed with cancer: An integrative review.

PURPOSE: Cancer caregivers experience health challenges related to their caregiving role, and self-efficacy can contribute to health outcomes through behavioral, environmental, and personal factors. The purpose of this integrative review was to examine self-efficacy in caregivers of adults diagnosed with cancer, including its association with health factors. METHOD: A systematic search of PubMed, CINAHL, and PsychInfo yielded 560 articles. Following duplicate removal, 232 articles were screened for inclusion criteria with 71 articles remaining for final review. RESULTS: Studies were generally quantitative (n = 67), with predominantly female (n = 55), White (n = 36) caregivers, between the ages of 45-60 (n = 48). Self-efficacy was significantly associated with quality of life, caregiver function, social support, hope, depression, anxiety, and burden as a predictor, mediator, and outcome. Physical health and social determinants of health (social support and financial well-being) were addressed among fewer studies than mental and emotional health outcomes. CONCLUSIONS: Addressing self-efficacy in diverse populations and within physical, mental, and social health contexts will enhance understanding of how self-efficacy impacts caregivers of adults diagnosed with cancer. Nurses and other health care professionals can then effectively address supportive needs of caregivers in the personal, behavioral, and environmental domains.

The Epistemic Dignity of Knowledge Developed Through Nursing Practice.

In this article, I revisit a philosophical idea from Intermodernism about generating knowledge through nursing practice and examine how this may enhance the epistemic dignity of knowledge. Epistemic dignity is an evaluation of knowledge (formalized in theories) as possessing quality and worth as scientific knowledge and as held in esteem by a disciplinary community and others. The philosophical turn toward the practice of science is discussed along with contemporary work on theoretical virtues as qualities of scientific theory. In addition, I suggest that what we may refer to as uniquely nursing knowledge is knowledge that is generated through nursing practice and ground in disciplinary perspective.

Explanatory Power and Nursing Theory.

A theme of this article is the theory-research link and its essential role in advancing nursing science and practice. Concern is expressed over the current status of nursing theory relative to the advances in research and practice. Soon-to-be and current theoreticians and scientists are encouraged to champion not just nursing theory proper but scientific nursing theories that have explanatory power. The role of the precision health movement in facilitating development of scientific theory is explored.

Moving On: From Metaparadigm to Midparadigm for Knowledge Development.

This column on Philosophical Issues introduces a conceptual innovation, the midparadigm, designed to facilitate continued development of nursing knowledge while moving beyond the metaparadigm. The midparadigm is a conceptual structure lower in abstraction than a metaparadigm consisting of an organization of concepts that reflect shared scientific and practical values for theory development in reference to a practice-relevant context. In this introductory article, I explain its philosophical rationale and provide other groundwork about the midparadigm. The feature article is authored by a team of doctoral students who present an exemplar of a midparadigm, which they have called their prismatic midparadigm of nursing.

Adaptive Preferences: A Philosophical Issue Raised by an Expanded Model of Health.

The concept of adaptive preferences, as a phenomenon that inhibits human flourishing, has received considerable attention in the philosophical literature but not so much in the nursing literature. Yet given the nursing perspective of health, it is a relevant, if not critical, problem for practice as well as an intriguing area for scientific inquiry. As background, I present a review of dominant philosophical models of health from which I synthesize an expanded model of health that integrates naturalist and normative philosophical dimensions. I then present current philosophical work on adaptive preferences and recommend that this philosophical concept represents an empirical health process in need of scientific study in nursing as a discipline focused on health and well-being.

Deriving the Practice-Primed Decision Model from a naturalistic decision-making perspective for acute care nursing research.

AIM: The purpose of this article is to present the derivation of the Practice Primed Decision Model from a naturalistic decision-making framework for use in guiding future nursing decision-making research. BACKGROUND: Acute care nurses make decisions in demanding environments under the influence of many factors. The influence of these factors on nurse decision-making is not well understood leading to gaps in understanding how to best support acute care nurse decision-making. METHODS: The strategy of theory derivation was used in the development of a new model for use in nursing research. This model incorporates important elements identified in naturalistic decision making, a Recognition Primed Decision Model and an integrative review of nurse decision-making literature. CONCLUSION: The new model, Practice Primed Decision Model, provides a new perspective to guide nurse decision-making research. This model includes factors influential to the nurse decision-making process that is more realistic in time limited, high stakes decision-making situations.