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.

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.

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.

Nursing theory as a guide into uncharted waters: Research with parents of children undergoing cancer treatment.

Being a parental caregiver for a child who is undergoing cancer treatment profoundly impacts significant numbers of parental caregivers and their well-being. This article focuses on the use of theory, philosophy, and empirical knowledge in guiding research designed to both describe and explain influences on well-being of parental caregivers of children undergoing cancer treatment. Other aspects of the research are discussed as well, including practice-relevant findings. Findings indicated the co-existence of both positive and negative well-being and that each has unique predictors. Self-transcendence mediated the relationship between resilience and well-being in parental caregivers. Clinical implications for these findings are also presented.

Self-transcendence, spiritual perspective, and sense of purpose in family caregiving relationships: a mediated model of depression symptoms in Korean older adults.

OBJECTIVES: This study used structural equation modeling to test the mediated model of late-life depression to understand the mechanisms that account for the direct and indirect effects of spiritual variables and purpose in life on depression within the context of Korean family caregiving relationships. METHOD: A secondary analysis study design used data from a study that tested a theory of family interdependence of 157 Korean elder-family caregiver dyads in Seoul, Korea. RESULTS: Both caregivers' and elders' self-transcendence was positively related to their own sense of purpose in life. However, only elders' spiritual perspective was related to purpose in life. Also, elders' purpose in life was positively associated with caregivers' purpose in life. Furthermore, there was a strong negative relationship between elders' purpose in life and their depressive symptoms, but there was not a significant negative relationship between caregivers' purpose in life and elders' depressive symptoms. Last, elders' purpose in life mediated the negative effects of elders' self-transcendence and spiritual perspective and of caregivers' self-transcendence and purpose in life on elders' depression. CONCLUSION: The findings suggest that purpose in life for both the caregiver and elder played an important role in elders' depression. Self-transcendence also was related to decreased depression in elders. It is suggested that more attention be given to caregiver and elder purpose in life in developing interventions to reduce or avoid elder depression in Korean elders.

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.

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.

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.

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.

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.

Family caregiving of older Chinese people with dementia: testing a model.

BACKGROUND: The process of taking care of older people with dementia at home is complex and influenced by cultural factors, necessitating a better understanding of the interrelationships of factors within the context of culture. OBJECTIVES: The aim of this study was to test the proposed Dementia Caregiving Model, specifying how caregiving appraisal, coping, perceived social support, and familism influence the impact of caregiving stressors on the psychological health of caregivers. METHODS: A cross-sectional correlational design with a convenience sample (n = 96) from three outpatient clinics of hospitals in China was used. Questionnaires were utilized to measure the variables in the model. Path analysis was used to assess model fit and paths. RESULTS: The original proposed model did not fit the data, butminor modifications produced a very good model fit (χ(10, n = 96) = 8.14, p = .62; goodness-of-fit index = .98, comparative fit index = 1.00, and root mean square error of approximation < .001). Care recipients' behavioral problems had direct and indirect negative effects on caregivers' psychological health. Perceived social support had direct and indirect positive effects on caregivers' psychological health. Familism had indirect positive effects on caregivers' psychological health in relation with caregiving satisfaction and coping. Caregiving appraisal and coping were mediators in the model. CONCLUSIONS: The model findings lend support that caregivers' cognitive appraisal and coping explain some observed individual differences in stress response and outcomes. The findings broaden understanding of the effects of familism on caregivers' psychological health. In the future, programs should include interventions for caregivers, as well as interventions for care recipients.

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.

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.

Spirituality and psychological well-being: testing a theory of family interdependence among family caregivers and their elders.

The family spirituality-psychological well-being model was developed and tested to explore how spirituality influences psychological well-being among elders and caregivers in the context of Korean family caregiving. The sample consisted of 157 Korean elder-family caregiver dyads in Seoul, Korea. The intraclass correlation coefficient and the actor-partner interdependence statistical model were used to analyze the data. There were significant correlations between elders' and caregivers' spirituality and between elders' and caregivers' psychological well-being. Elders' and caregivers' spirituality significantly influenced their own psychological well-being. The caregiver's spirituality significantly influenced the elder's psychological well-being, but the elder's spirituality did not significantly influence the caregiver's psychological well-being. Findings suggest that elders' and caregivers' spirituality should be assessed within the family to provide holistic nursing interventions.

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.

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.

Oncologist preferences for health states associated with the treatment of advanced ovarian cancer.

BACKGROUND: For advanced epithelial ovarian cancer, oncologists are faced with multiple treatment options that differ in terms of possible clinical and patient-reported outcomes. OBJECTIVE: To explore oncologists' preferences for hypothetical outcome scenarios (i.e. health states) resulting from various treatment options. METHODS: Six hypothetical health states reflecting varying levels of toxicity, treatment efficacy and emotional well-being were developed representing advanced ovarian cancer treatment. During face-to-face interviews, oncologists provided their relative preferences for these health states using a visual analogue scale and Standard Gamble exercise. RESULTS: The 34 participating oncologists consistently preferred health states reflecting high treatment efficacy over low efficacy for patients with newly diagnosed disease, regardless of toxicity or emotional well-being. In the setting of recurrent disease, physicians preferred a heath state only if it reflected both high efficacy and positive emotional well-being. CONCLUSIONS: These data suggest that oncologists may choose treatments that maximize clinical efficacy only when not associated with severe toxicities or low emotional well-being unless associated with a large improvement in efficacy. Physicians may prefer a more toxic chemotherapy regimen that improves survival, and are more willing to compromise emotional well-being for a large survival advantage in the setting of newly diagnosed disease. Slight improvements in clinical efficacy may not be acceptable to oncologists unless associated with higher emotional well-being for the patient.

End-of-life caregiver interactions with health care providers: learning from the bad.

This qualitative study examined caregivers' perceptions of and stories about their interactions with nonhospice health care providers. The sample included 27 family caregivers who provided the majority of in-home physical care and emotional support to the elders for at least 6 months. Caregivers described some startling interactions that suggest the need to reevaluate health care professionals' abilities and attitudes concerning their treatment and communication with family caregivers and their elders dying from life-limiting illnesses.

Parental perceptions of risk and protective factors associated with the adaptation of siblings of children with cystic fibrosis.

When a child is diagnosed with a chronic, life-threatening illness, there is a significant impact on the healthy siblings. Few studies have addressed the adaptation of well siblings in diagnoses other than cancer. The purpose of this descriptive correlational study was to examine the relationships between the risk and protective factors that affect the psychological adaptation of healthy siblings of a child with cystic fibrosis. Findings from this study suggest family environment, especially parental stress and perceived social support, may affect the adaptation of the well sibling. Adolescent well siblings were more at risk for environmental influences than their younger counterparts.