Ancient mitochondrial DNA and ancestry of Paquimé inhabitants, Casas Grandes (A.D. 1200-1450).

OBJECTIVES: The Casas Grandes (Paquimé) culture, located in the Northwest of Chihuahua, Mexico reached its apogee during the Medio Period (A.D. 1200-1450). Paquimé was abandoned by the end of the Medio Period (A.D. 1450), and the ancestry of its inhabitants remains unsolved. Some authors suggest that waves of Mesoamerican immigrants, possibly merchants, stimulated Paquimé's development during the Medio Period. Archaeological evidence suggests possible ties to groups that inhabited the Southwestern US cultures. This study uses ancient DNA analysis from fourteen samples to estimate genetic affinities of ancient Paquimé inhabitants. MATERIALS AND METHODS: DNA was extracted from 14 dental ancient samples from Paquimé. PCR and Sanger sequencing were used to obtain mitochondrial control region sequences. Networks, PCoA, and Nei genetic distances were estimated to compare Paquimé haplotypes against available past haplotypes data from Southwestern and Mesoamerican groups. RESULTS: Haplogroups were characterized for 11 of the samples, and the results revealed the presence of four distinct Amerindian mitochondrial lineages: B (n = 5; 45%), A (n = 3; 27%), C (n = 2; 18%) and D (n = 1; 10%). Statistical analysis of the haplotypes, haplogroup frequencies, and Nei genetic distances showed close affinity of Paquimé with Mimbres. DISCUSSION: Although our results provide strong evidence of genetic affinities between Paquimé and Mimbres, with the majority of haplotypes shared or derived from ancient Southwest populations, the causes of cultural development at Paquimé still remain a question. These preliminary results provide evidence in support of other bioarchaeological studies, which have shown close biological affinities between Paquimé and Mimbres, a Puebloan culture, in the Southwestern US.

Moral integrity and moral courage: can you teach it?

Nursing has been spared the ethical scandal of many other professions, but issues of compromised moral integrity are growing in practice and education. This study was structured to investigate faculty perceptions of the challenges encountered regarding moral integrity in academia and strategies to promote nursing students' moral integrity and moral courage. A content analysis of the responses to questions about challenges and strategies was completed. Themes identified from the data on student and instructor beliefs and behaviors correspond to those found in the literature. The need for instructors to model a high level of integrity and to create high-integrity classrooms and a community of learning were identified as essential. A finding different from other study results is that beliefs drive moral behaviors and must be the focus of strategies for change. A consensus was expressed that mechanisms are urgently needed to further identify and integrate strategies to enhance student moral integrity.

Mothering an extremely low birth-weight infant: a phenomenological study.

Mothers of preterm infants are reported to experience heightened levels of psychological stress, greater than mothers of full-term infants during the neonatal period. The purpose of this study is to describe the lived experience of what it is like to be a mother of an extremely low birth-weight infant during their stay with their infants in the NICU. Interpretive phenomenology articulated by Benner and Diekelmann is the method of qualitative research employed. Thematic analysis is the method of narrative analysis that is used to capture and describe the lived experience with emerging themes, patterns, and meanings. Participants were chosen by purposive sampling. Sample size was 9 participants. Repeated interviews of the participants were done to obtain "redundancy, clarity, and confidence" in the interpreted text. Understanding the themes offers guidance for future research and future programs to aid in the development of meaningful healthy mother-infant relationships and helpful relationships of and with NICU structure and staff.

The lived experience of Lebanese oncology patients receiving palliative care.

The purpose of this study was to uncover the lived experience of Lebanese oncology patients receiving palliative care. The study design was based on the Utrecht School of Phenomenology based on the Dutch school of phenomenology. This study followed purposeful sampling in which ten participants, six women, and four men, with a mean age of 54.4 years were selected. In-depth semi-structured interviews along with observation field notes were used as the source for data collection. Data were analyzed using the hermeneutic phenomenological approach based on the Utrecht School of Phenomenology. The participants highlighted their distress from being dependent; their dislike for pity; their worry for the family and the worry about the family's worry; their reliance on God and divinity; their dislike of the hospital stay; their need to be productive; their fear of pain; and their need to communicate. Specific nursing actions related to the themes would include exploring patients' ideas, beliefs, and experiences regarding pain, and improved communication among patient, family, and the health care providers.

Models of maternal-infant attachment: a role for nurses.

Two models of maternal-infant attachment, one related to full-term newborns (Goulet, Bell, St-Cyr Tribble, Paul, & Lang, 1998), and one including premature infants (Bialoskurski, Cox, & Hayes, 1999), are examined. The elements of both models are integrated into a more comprehensive model. Implicit organizational components are made explicit, and a discussion regarding the possibility of fit for the extremely low-birth-weight (ELBW) group is offered. This integrated model can serve as a basis for neonatal nurses to improve care for newly emerging families and especially those of the premature/low birth weight group.

Taxonomy of nursing practice: adding an administrative domain.

PURPOSE: To propose the addition of a fifth domain, Administrative, to the Taxonomy of Nursing Practice, and to introduce the related concept of organization nursing diagnoses. DATA SOURCES: The Taxonomy of Nursing Practice, organizational and nursing management/leadership literature, experience of the authors. DATA SYNTHESIS: Analyzing the concept of a taxonomy to capture nursing practice revealed an omission of the management/leadership roles assumed by nurses in organizational, nurse manager, and staff nurse practice levels. To incorporate this administrative practice, an additional domain, Administrative, was developed. Nursing diagnoses were oriented to the organization as client, hence the addition of organization nursing diagnoses. CONCLUSIONS: Including an Administrative Domain in the Taxonomy of Nursing Practice will cover the scope of nursing practice and will provide a basis for developing the diagnoses for which nurses are accountable within organizations. IMPLICATIONS FOR PRACTICE: Nurses' contributions to healthcare organizational function and their effect on patient care outcomes will be made more explicit and can more readily be measured with terminology that captures the nursing administrative roles at three levels of practice.

Living with breast cancer, a Lebanese experience.

AIM: The purpose of this qualitative phenomenological study is to provide in-depth understanding of the experience of Lebanese women living with breast cancer. BACKGROUND: Breast cancer is the most frequently diagnosed cancer in women worldwide. In Lebanon, a country of 4 million people, breast cancer is as well the most widespread type of cancer among Lebanese women. The meaning of cancer diagnosis, the meaning of childbearing and femininity all have cultural bases in Lebanon. The international literature lacks information on how Lebanese women live with breast cancer when compared with women of other cultures. METHOD: The study followed purposeful sampling and saturation principles in which 10 participants with a mean age of 51.3 years were chosen based on their actual knowledge of the phenomenon, and their readiness to share that knowledge. Data were collected between December 2007 and May 2008. All interviews were audio-taped and transcribed verbatim. Data were analyzed based on the Utrecht School of Phenomenology. FINDINGS: Four major core themes describing the participants' lived experience emerged from the interviews: Living with losses; living with guilt feeling; living with fears and uncertainty; Living with the need to know and to share that knowledge. CONCLUSION: The experience of Lebanese women with breast cancer revealed distinctive themes not reported by other women from other cultures. The results of this study challenge health care providers and educators to be aware of the difficulties that Lebanese women are facing when they are living with breast cancer.

Coping with breast cancer: a phenomenological study.

BACKGROUND: Breast cancer is the most common malignancy affecting women worldwide. In Lebanon, a country of 4 million people, breast cancer is also the most prevalent type of cancer among Lebanese women. OBJECTIVE: The purpose of this study was to gain a more in-depth understanding of the coping strategies espoused by Lebanese women with breast cancer. METHODS: The study followed purposeful sampling and saturation principles in which 10 female participants diagnosed as having breast cancer were interviewed. Data were analyzed following a hermeneutical process as described by Diekelmann and Ironside (Encyclopedia of Nursing Research. 1998:50-68). RESULTS: Seven main themes and 1 constitutive pattern emerged from the study describing the Lebanese women's coping strategies with breast cancer. The negative stigma of cancer in the Lebanese culture, the role of women in the Lebanese families, and the embedded role of religion in Lebanese society are bases of the differences in the coping strategies of Lebanese women with breast cancer as compared to women with breast cancer from other cultures. CONCLUSION: These findings cannot be directly generalized, but they could act as a basis for further research on which to base a development of a framework for an approach to care that promotes coping processes in Lebanese women living with breast cancer. IMPLICATIONS FOR PRACTICE: Nursing and medical staff need to have a better understanding of the individual coping strategies of each woman and its impact on the woman's well being; the creation of informal support group is indispensable in helping these women cope with their conditions.

The lived experience of Lebanese family caregivers of cancer patients.

The purpose of this study was to explore, through in-depth semistructured interviews, the lived experience of Lebanese family caregivers of cancer patients and acquire a better knowledge of the meaning and interpretation of their experience. The study design was based on the Utrecht School of Phenomenology. This study followed purposeful sampling, in which 9 participants with a mean age of 51 years were selected. Data were analyzed using the hermeneutic phenomenological approach based on the Utrecht School of Phenomenology. Eight core themes describing the participants' lived experience emerged from the interviews: living with fears and uncertainty, loss of happiness, feeling of added responsibility, living in a state of emergency, sharing the pain, living the dilemma of truth telling, disturbed by being pitied, and reliance on God. The results of this study challenge nurses to be conscious of the nature and difficulties that family caregivers are encountering.

Nursing diagnosis and nursing theory: exploration of factors inhibiting and supporting simultaneous use.

PURPOSE: To explore the values and philosophies of nursing theories that inhibit the simultaneous use of nursing diagnosis and nursing theory. SOURCES: Published articles, books, book chapters. DATA SYNTHESIS: Four factors in the literature and reflected in practice may have had a negative influence on the use of nursing diagnoses: (a) commitment to the uniqueness of each person, (b) an abandonment of the nursing process, (c) a perspective that nursing care is an evolving interaction, and (d) a belief that theory-derived language is more articulate and precise than standard classifications. PRACTICE IMPLICATIONS: Strategies for combining theory and diagnoses include emphasizing the diagnostic terms as professional shorthand and permitting flexibility in modifying diagnoses as needed; widely disseminating the concept that classification can be used effectively with newer iterations of the nursing process reflecting circular, simultaneous, and intuitive processes; developing classification language based on concepts of hypothesis and perception; and including diagnostic categories associated with theoretical perspectives.