Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American Academy of Nursing.

BACKGROUND: The 2019-2020 American Academy of Nursing (Academy, 2019) policy priorities document states that "they have a clear and distinct focus on social determinants of health and uses this lens to advance policies and solutions within each of the three overarching priorities" PURPOSE: This consensus paper seeks to establish conceptual clarity and consensus for what social determinants of health mean for nursing, with emphasis on examples of health policies that advance planetary health equity and improve planetary health-related quality of life. METHODS: Volunteers from five Expert Panels of the Academy met via videoconference to determine roles and refine the focus of the paper. After the initial discussion, the first draft of the conceptual framework was written by the first three authors of the paper and, after discussion via videoconference with all the co-authors, successive drafts were developed and circulated for feedback. Consensus was reached when all authors indicated acceptance of what became the final version of the conceptual framework. FINDINGS: A conceptual framework was developed that describes how the social determinants of health can be addressed through nursing roles and actions at the individual, family, and population levels with a particular focus on the role of health policy. The paper provides a specific health policy example for each of the six key areas of the social determinants of health to illustrate how nurses can act to improve population health. DISCUSSION: Nursing actions can support timely health policy changes that focus on upstream factors in the six key areas of the social determinants of health and thus improve population health. The urgent need to eliminate systematic and structural racism must be central to such policy change if equity in planetary health-related quality of life is to be attained.

Chief Nursing Officer Perspectives on Nursing Theory-Guided Practice.

OBJECTIVE: The purpose of this study was to identify what guides nursing practice. BACKGROUND: Change occurred when the Magnet Recognition Program® no longer required a nursing theory. METHODS: This was a mixed-methods study to identify the process used to implement nursing theory-guided practice and the relationship to professional practice recognition. Deidentified quantitative data were collected from 36 chief nursing officers (CNOs). Seventeen CNOs participated in the qualitative interview. RESULTS: Thirteen CNOs were from a Magnet®-designated facility. Ten CNOs were on the Magnet journey, and 2 had no intent to seek Magnet recognition. Two CNOs were from a Pathway to Excellence®-designated facility. One CNO was on the Pathway to Excellence journey. The majority of respondents who were Magnet® recognized who participated in the survey used Watson's Theory of Human Caring. Themes were identified that share the benefits and strategies to integrate nursing-guided theory into nursing processes, structures, and outcomes. CONCLUSION: Findings will benefit CNOs as they make decisions related to pursuing Magnet status recognition.

Exploring Nurse Leaders' Policy Participation Within the Context of a Nursing Conceptual Framework.

This study was designed to describe and quantify the experiences of nurse leaders working to influence policy and to build consensus for priority skills and knowledge useful in policy efforts within the context of a nursing conceptual framework. The conceptual model for nursing and health policy and the Adams influence model were combined into a conceptual framework used to guide this two-round modified Delphi study. Twenty-two nurse leaders who were members of a state action coalition participated in the Round 1 focus group; 15 of these leaders completed the Round 2 electronic survey. Round 1 themes indicated the value of a passion for policy, the importance of clear communication, and an understanding the who and when of policy work. Round 2 data reinforced the importance of clear communication regarding policy engagement; knowing the who and when of policy closely followed, and having a passion for policy work was identified as least important. These themes inform learning objectives for nursing education and preparation for interactions with public officials because influencing policy requires knowledge, skills, and persistence. Study findings begin to describe how nurse leaders influence policy within the context of a nursing conceptual framework and generate implications for research, education, and professional practice.

A Staged Approach to Educating Nurses in Health Policy.

Nurse leaders and health-care experts agree that nurses have a responsibility to address the health problems facing the nation by participating in health policy development. However, nurses have not fully realized their potential when it comes to engaging in health policy advocacy and leadership. Nurse leaders, professional nursing organizations, accrediting bodies, and the Institute of Medicine have all identified the need to educate nurses in heath policy. Valuable recommendations for content and learning activities in health policy have been made. We argue that nursing education in health policy and the many recommendations offered have been broad and overly ambitious. This article presents a proposal for a staged approach to educating nurses. This approach would tailor content to the role of the nurse at each level of nursing education. The focus of health policy content would progress from the organizational level to local, state, and finally national level health policies. The goal of this approach is to better prepare all levels of nursing students to participate in shaping effective health policies.

Storytelling/narrative theory to address health communication with minority populations.

PURPOSE: To explain the development and application of storytelling/narrative theory in health disparities intervention research as a way to promote health communication and behavior change among racial, ethnic, and minority populations. FINDINGS: The proposed storytelling theory helps explain that storytelling affects changes in attitude and health behavior of the viewer through realism, identification, and transportation. CONCLUSIONS: The proposed storytelling/narrative theory can be a guide to develop culturally grounded narrative interventions that have the ability to connect with hard-to-reach populations. CLINICAL RELEVANCE: Narrative communication is context-dependent because it derives meaning from the surrounding situation and provides situation-based stories that are a pathway to processing story content. Although storytelling is grounded in nursing practice and education, it is underutilized in nursing interventional research. Future efforts are needed to extend theory-based narrative intervention studies designed to change attitude and behaviors that will reduce health disparities among minorities.

A proposed conceptual model of nursing and population health.

OBJECTIVE: To describe a Conceptual Model of Nursing and Population Health about the intersection of nursing and population health. METHODS: Review of literature and derivation of a new conceptual model. RESULTS: The conceptual model concepts are upstream factors, population factors, health care system factors, nursing activities, and population health outcomes. Nursing activities mediate the indirect relations of upstream, population, and health care system factors with population health outcomes; in addition, health care system factors and nursing activities are directly related to population health outcomes. Implications for research methods, revisions in all levels of nursing education, and population-focused advances in nursing practice are identified. CONCLUSION: The strength of the model is its emphasis on attainment of the highest possible quality of life for populations, by means of nursing activities directed to promote or restore and maintain wellness across the life course and to prevent disease.

HBV-related health behaviors in a socio-cultural context: perspectives from Khmers and Koreans.

PURPOSE: The aim of this study is to explore factors influencing health and health care within the sociocultural context of Cambodian Americans (CAs or Khmers) and Korean Americans (KA) and to examine intergroup similarities and differences between CAs and KAs, focusing on hepatitis B virus (HBV) and liver cancer prevention behaviors. METHODS: The study used a qualitative design guided by the revised Network Episode Model (NEM) and informed by ethnographic analysis. Focus group interviews with key informants among CA community health leaders (CHLs, n=14) and individual interviews with key informants of KA CHLs (n=9) were audiotaped and transcribed. RESULTS: Three categories that influenced HBV and liver cancer prevention emerged from both CAs and KAs: the socio-cultural, individual, and behavioral. Four additional subcategories (sub-themes) of sociocultural were identified as socio-history, socio-medicine, socio-linguistic, and socio-health resources. Both CAs and KAs, however, have low levels of knowledge and significant misunderstandings about HBV infection. CONCLUSIONS: The study identifies and compares the social-cultural determinant for HBV and liver cancer and highlights the factors of education, intercultural communication, and interactions within socio-cultural contexts of CA and KA subgroups. In general, conceptual overlaps are apparent between Khmers (from now on, the terms, CA and Khmer, will be used interchangeably) and Koreans except for the sub-theme of socio-history. However, differences in concept-specific attributes point to the need to account for differing conceptualizations and implications of specific ethnic groups' sociocultural contexts, and to design contextually-relevant outreach and educational interventions for targeted AAPI subgroups.

More Thoughts About Environment.

The purpose of this essay is to present more thoughts about the environment. This essay is about the internal environment whereas a previous essay published in 2022 was about the external environment. This essay includes an overall understanding of internal environment as well as descriptions or definitions of internal environment given in selected nursing conceptual models. A possible interpretation of internal environment from a Native American perspective is mentioned. A call is issued for understanding of internal environment by persons from diverse cultures.

More Thoughts About the Evolution of the Metaparadigm of Nursing: Addition of Culture as Another Metaparadigm Concept and Definitions of All the Concepts.

This essay is an extension of my previous essay about my recent thoughts about the evolution of the metaparadigm of nursing. In this essay, I introduce the concept of culture as an additional metaparadigm concept and provide definitions for all of the metaparadigm concepts.

Evolution of the Language in the Science of Unitary Human Beings.

This article presents a discussion of the evolution of the language of the Science of Unitary Human Beings from the terms used by Martha Rogers in her 1970 book to changes in terms Rogers introduced in her publications over the ensuing years to new terms and language offered by Rogerian scholars before and after Rogers' death in 1994. The article follows from Rogers' insistence that the language of a science, which evolves from general language, should be specific to the level of abstraction of the relevant concepts.

More Thoughts About Culture as a Metaparadigm Concept: Rejection of the Reality of Subcultures.

This essay is an extension of a previous essay in which culture was identified as a distinct concept of our disciplinary metaparadigm. Here, we define subculture and discuss our rationale for rejection of the reality of subcultures.

Thoughts About the Metaparadigm of Nursing: Contemporary Status and Recommendations for Evolution.

In this essay, I present my original and most recent versions of nursing's disciplinary metaparadigm, along with others' versions of the metaparadigm. I conclude the essay by joining others in issuing a call for decolonization of nursing knowledge, with an emphasis in this essay on decolonizing nursing's metaparadigm by asking if a metaparadigm is needed and, if so, what its content should be.

More Thoughts About Health Policies: Focus on Conceptual Models.

The purpose of this essay is to demonstrate how existing conceptual models of nursing designed for clinical research, education, practice, and administration also can be used to guide health policy development, analysis, evaluation, and research by nurses. The concept of each of various nursing conceptual models that might be represented by health policies is identified.

Gender Minority Persons' Perceptions of Peer-Led Support Groups: A Roy Adaptation Model Interpretation.

Literature addressing gender minority health has documented adverse behavioral health outcomes. "Gender minority" recognizes identities that include, but are not limited to, transgender and gender nonconforming. Although gender minority affirmative counseling exists, most continue to focus on pathology and diagnosis, leading people in the gender minority community to mistrust services. Sources of social support can ameliorate gender minority psychological distress by providing an environment that affirms gender identities. The purpose of this study was to identify gender minority peoples' perceptions of their experiences in a peer-led support group. The themes were then interpreted within the context of Roy's Adaptation Model.

Thoughts About Measuring Concepts: Using Single-Item Indicators and Multiple-Item Indicators.

This essay presents a discussion about using a single item to measure a concept versus using multiple items. The discussion is data-based, using the results from a cross-sectional pilot study of correlates of functional status of women and their male partners who were experiencing high-risk childbearing.

Created Environment: Evolution of a Neuman Systems Model Concept.

In this essay, we trace the evolution of the definition of the Neuman systems model concept of created environment from its inception in 1989. The created environment is one of three categories of environment in the Neuman systems model; the other two are the internal environment and the external environment. The most recent definition of created environment is offered in this essay as the following: The created environment is a synthesis of the internal and external environments that encompasses the client system's ever-changing awareness of the physiological, psychological, sociocultural, developmental, and spiritual variables, and the intrapersonal, interpersonal, and extrapersonal stressors as beneficial or noxious. As a protective shield, the created environment represents the client system's perceptions and understanding of what is real and what is safe, as discussed with the nurse.