What has philosophy ever done for nursing: A discursive shift from margins to mainstream.

This paper is a personal dialogue of maneuvering the landscape of scholarship in the United States as a nurse faculty. The principal thesis of this paper is that a discursive shift from margins to mainstream literature has occurred within nursing discourse during the past 20 years as the result of a growing body of work by nurse philosophers. I utilize my own work in nursing philosophy as an exemplar and provide a narrative situated in a feminist-critical paradigm. This paper: (1) presents a historical background through a critical-feminist lens of the discursive shift using my own work and lived experiences as exemplars; (2) examines a contemporary mainstream 'authoritative' text as an exemplar of this discursive shift and (3) proposes both potential positive intersections and threats in the future development of nursing philosophy resulting from this discursive shift.

Validation of the Presence of Nursing Scale Using Data Triangulation.

BACKGROUND: Nursing presence has been developed as a distinct concept with identifiable behaviors but remains only partially defined as a quantifiable construct. OBJECTIVES: This study asked if the Presence of Nursing Scale (PONS) is a reliable and valid instrument to measure nursing presence from the patient's perspective. METHODS: A convenience sample of 75 adult acute care inpatients were verbally administered the 25-item PONS considering the registered nurse taking care of them on the day of data collection. Open-ended questions elicited the patients' explanations of their ratings. They also rated their overall satisfaction with the nursing care provided by the subject nurse using a 5-point scale. RESULTS: The mean PONS score was 104.5 (SD = 17.26) on the 25-125 scale. Instrument reliability reported as a Cronbach's alpha coefficient of .95 was .94 in this study. Instrument validity was tested correlating PONS scores to the satisfaction rating. The Spearman's rho correlation was large and statistically significant, r (73) = .708. The higher the PONS score, the more satisfied the patient was with care from that nurse. Nineteen narratives selected from the lower quartile PONS scores (PONS < 99) and 11 from the upper quartile (PONS > 116) were thematically analyzed. Lower PONS scores corresponded with themes of patients being objectified as the work of the nurse without a respectful and caring nurse-patient relationship. Higher PONS scores coincided with patients' perceptions of enhanced nurse-patient rapport, feelings of better coping, and decreased anxiety. DISCUSSION: These results demonstrate reliability and validity of the PONS and add to the body of evidence about nurse behaviors exhibited in the nurse-patient relationship, which influence patients' feelings of being cared for and satisfied with nursing care. These findings may be useful in the development of educational materials aimed at the advancement of nursing presence competency.

Correlates of Perinatal Post-Traumatic Stress among Culturally Diverse Women with Depressive Symptomatology.

Post-traumatic stress disorder (PTSD) is an important and often neglected comorbidity of pregnancy; left untreated, it can lead to serious health complications for the mother and developing fetus. Structured interviews were conducted to identify risk factors of PTSD among culturally diverse women with depressive symptomatology receiving perinatal services at community obstetric/gynecologic clinics. Women abused as adults, with two or more instances of trauma, greater trauma severity, insomnia, and low social support were more likely to present perinatal PTSD symptoms. Perinatal PTSD is prevalent and has the potential for chronicity. It is imperative healthcare providers recognize salient risk factors and integrate culturally sensitive screening, appropriate referral, and treatment services for perinatal PTSD.

Post-traumatic stress disorder in the perinatal period: A concept analysis.

AIMS AND OBJECTIVES: To report an analysis of the concept of perinatal post-traumatic stress disorder. BACKGROUND: Prevalence of perinatal post-traumatic stress disorder is rising in the USA, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal-child outcomes result in increased morbidity, mortality and healthcare costs. DESIGN: Concept analysis via Walker and Avant's approach. METHODS: The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier and PsychINFO were searched for articles, written in English, published between 2006-2015, containing the terms perinatal and post-traumatic stress disorder. RESULTS: Perinatal post-traumatic stress disorder owns unique attributes, antecedents and outcomes when compared to post-traumatic stress disorder in other contexts, and may be defined as a disorder arising after a traumatic experience, diagnosed any time from conception to 6 months postpartum, lasting longer than 1 month, leading to specific negative maternal symptoms and poor maternal-infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Antecedents were identified as trauma (perinatal complications and abuse), postpartum depression and previous psychiatric history. Consequences comprised adverse maternal-infant outcomes. CONCLUSIONS: Further research on perinatal post-traumatic stress disorder antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating perinatal post-traumatic stress disorder. RELEVANCE TO CLINICAL PRACTICE: Nurses are encouraged to increase their awareness of perinatal post-traumatic stress disorder for early assessment and intervention, and prevention of adverse maternal-infant outcomes.

The Lived Experience of Military Women With Chronic Pain: A Phenomenological Study.

INTRODUCTION: Chronic pain, a persistent or recurrent pain lasting more than 3 months, is a widespread problem among military women due to combat-related injuries and post-deployment stressors. Risk factors associated with chronic pain include gender, mental health, post-traumatic stress disorder, and prior physical or military sexual trauma. The most common prevalence of chronic pain is musculoskeletal (e.g., low back and neck), migraine, osteoarthritis, and fibromyalgia. Following deployment, 25% of military women are at risk for chronic pain. Military women are prescribed opioids for pain at a higher rate than men and are at risk for prescription opioid addiction. The unique medical needs of military women, including chronic pain, are poorly understood by health care providers and need to be addressed to achieve full integration into the military. The purpose of this study was to explore a typical day for military women living with chronic pain by examining the participants' daily life experiences. MATERIAL AND METHODS: Using van Manen's approach, 13 active duty, retired, and veteran women were interviewed to explore these lived experiences. The study was approved by the Institutional Review Board at the University of San Diego. RESULTS: Eight themes emerged from an analysis of the participants' experiences: (1) chronic pain is a frustrating, persistent, daily, and an hourly struggle; (2) resilience in living with chronic pain is the new normal; (3) mission first and the impact of invisible pain; (4) self-care management and internal locus of control with nonpharmacological therapies; (5) pain accepted and managed to improve quality of life; (6) coronavirus disease 2019 (COVID-19) diminished social interactions; (7) pain of sexual trauma is not reported; and (8) disparities in health care due to self-perception of provider bias as pain is not understood. CONCLUSIONS: The study generated new knowledge in Force Health Protection, ensuring (1) a fit and operational readiness force; (2) pre- to post-deployment care for women warriors; and (3) access to health care. The study findings supported previous research and could help direct future research into nursing, medicine, and allied health treatments for military and veterans' gender-specific health care, education, and training. Furthermore, the military women in this study provided insight into the need for future research to explore unconscious gender bias, health disparities, and a raised awareness of military women living with chronic pain. Findings from this study merit further exploration using other qualitative research methodologies including mixed methods.

Current state and future recommendations for faculty in PhD in nursing programs.

In 2020 the American Association of Colleges of Nursing (AACN) Board of Directors appointed a 9-member task force to revise AACN's 2010 position statement, The Research-Focused Doctoral Program in Nursing: Pathways to Excellence, with the goal of developing a vision for research-focused doctoral programs and graduates. This resulted in 70 recommendations in a new AACN position statement, The Research-Focused Doctoral Program in Nursing: Pathways to Excellence (2022). The new document is based on a review of the literature from 2010 to 2021 and 2 inaugural surveys sent to deans and PhD students in nursing. The new The Research-Focused Doctoral Program in Nursing Pathways to Excellence document focuses on the critical need for nurse scientists who can develop the science, steward the profession, and educate new nurse educators. Several manuscripts have been developed describing various components of the PhD Pathways document focusing on the role of faculty, students and curriculum, resources and post-doctoral education. This article focuses on the recommendations related to explicating the faculty role in PhD education and includes data from the AACN (2020) deans' survey, the current state of the professoriate involved in PhD education and the developmental needs of PhD faculty for the future.

Pain and Spiritual Distress at End of Life: A Correlational Study.

Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.

To a Centrality of Compassion: Operationalizing the Emancipatory Theory of Compassion.

The emancipatory theory of compassion, created by Dr Jane Georges, assumes the universality of suffering (physical, psychoemotional, socioeconomic, or biopolitical), and the means by which suffering can be alleviated: compassion. The theory also assumes that nurses can knowingly or unknowingly create environments in which suffering is perpetuated. Through critical review of Georges' work and major caring theories, an operationalized model was developed with which nurses may frame inquiry and practice focused on compassion, the alleviation of suffering through the deconstruction of power relations, and the promotion of health equity, social justice, and human rights.

Work-related burnout, job satisfaction, intent to leave, and nurse-assessed quality of care among travel nurses.

OBJECTIVE: This research study examines work-related burnout, job satisfaction, nurse-assessed quality of care, and intent to leave in travel nurses, a population that has not been studied previously. BACKGROUND: Travel nurses are frequently used to supplement nursing staff in acute care hospitals, especially in times of shortage--understanding their satisfaction with the job may further illuminate the problem of nurse job dissatisfaction in general. METHODS: Ordinary least-squares regression analyses were used to examine the influence of nurse and workplace characteristics on work-related burnout, job satisfaction, intent to leave, and perceived quality of care. RESULTS: Quality of care and job satisfaction were significantly influenced by whether a hospital held Magnet designation. As the number of patients cared for increases, there was a significant increase in work-related burnout. Work-related burnout was also significantly lower for nurses working in California. CONCLUSION: The results of this study suggest that different workplace characteristics influence the perceptions of quality of care provided at a hospital facility and the degree to which a nurse is either burned out or satisfied with his/her job.

Patient Activation and Glycemic Control Among Filipino Americans.

Purpose: Increasing patient activation facilitates self-management of health, improves health outcomes, and lowers health care expenditures. Extant research notes mixed findings in patient activation by race/ethnicity. The purpose of the study was to examine the relationships among patient activation, select patient characteristics, and glycemic control among Filipino Americans. Methods: A cross-sectional study was conducted with a convenience sample of Filipino Americans (n=191), with a diagnosis of diabetes mellitus type 1 or type 2, recruited from a southern California adult primary care clinic between December 2017 and March 2018. Patient activation, select characteristics, and hemoglobin A1c (HbA1c) levels were assessed. Bivariate and logistic regression analyses were used to identify correlates of glycemic control. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist was used to develop the study. Results: Participants with HgbA1C≤7.0% reported statistically higher patient activation measure (13 items) (PAM-13) natural log score (mean [M]=60.32, standard deviation [SD]=13.50) compared to those with an HgbA1C>7.0%, M=52.58, SD=10.19, F(1)=11.05, p<0.001. Multivariate logistic regression using age, low-density lipoprotein, and PAM-13 natural log was statistically reliable distinguishing between A1C≤7.0 and A1C>7.0, -2 LogLikehood=1183.23, χ 2(3)=15.44, p<0.001. Conclusions: Patient activation is an important factor in supporting glycemic control. Findings support interventions to target patient activation. Providers are encouraged to use racial/ethnic-centered engagement strategies in resolving health disparity with racial and ethnic minorities to facilitate patient activation and improve health outcomes in patients with diabetes.

Tales from the "hood:" placing reproductive health communication between African American fathers and children in context.

OBJECTIVE: To evaluate reproductive health communication between African American fathers and their children. DESIGN: In this qualitative ethnographic study, data were collected through tape-recorded individual interviews about the content and timing of reproductive health communication, the reproductive health values fathers intended to impart to their children, and their comfort level in doing so. SAMPLE: A total sample of 19 African-American fathers participated. MEASUREMENTS: Data were coded according to the qualitative analytic principles established by Miles and Huberman (1994), and analyzed using manifest and latent content analysis approaches. RESULTS: Although 10 fathers reported feeling uncomfortable having these conversations, 18 reported having reproductive health communication with their children, and most encouraged their sons and daughters to delay sex until adulthood. These conversations were primarily driven by the fear of HIV/AIDS and the negative consequences of sex; however, some conversations were inappropriate for developmental age. CONCLUSIONS: African-American fathers may benefit from education to help them have age appropriate reproductive health communication with their children. Registered Nurses and Nurse Practitioners are well positioned to educate African American adolescents and their fathers on reproductive health. Future dyadic African American father-child studies are needed to explore more fully African-American children's perceptions of reproductive health communication and the effect on delaying sex.

Social Capital: A Concept Analysis.

The concept of social capital appears in the literature of multiple disciplines as a social determinant of health, an important aspect of human interaction, and a means to support population health capacity. Little is known about the use of social capital within the context of nursing. This article's aim provides insight into the concept of social capital and nursing. Avant and Walker methodology was used to analyze a sample of 78 articles. Along with a variety of articles and content themes, findings from this concept analysis include critical attributes, an operational definition, and reflections regarding future use.

Racial and Ethnic Variations in Mortality Rates for Patients Undergoing Maintenance Dialysis Treated in US Territories Compared with the US 50 States.

BACKGROUND AND OBJECTIVES: In the United States mortality rates for patients treated with dialysis differ by racial and/or ethnic (racial/ethnic) group. Mortality outcomes for patients undergoing maintenance dialysis in the United States territories may differ from patients in the United States 50 states. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This retrospective cohort study of using US Renal Data System data included 1,547,438 adults with no prior transplantation and first dialysis treatment between April 1, 1995 and September 28, 2012. Cox proportional hazards regression was used to calculate hazard ratios (HRs) of death for the territories versus 50 states for each racial/ethnic group using the whole cohort and covariate-matched samples. Covariates included demographics, year of dialysis initiation, cause of kidney failure, comorbid conditions, dialysis modality, and many others. RESULTS: Of 22,828 patients treated in the territories (American Samoa, Guam, Puerto Rico, Virgin Islands), 321 were white, 666 were black, 20,299 were Hispanic, and 1542 were Asian. Of 1,524,610 patients in the 50 states, 838,736 were white, 444,066 were black, 182,994 were Hispanic, and 58,814 were Asian. The crude mortality rate (deaths per 100 patient-years) was lower for whites in the territories than the 50 states (14 and 29, respectively), similar for blacks (18 and 17, respectively), higher for Hispanics (27 and 16, respectively), and higher for Asians (22 and 15). In matched analyses, greater risks of death remained for Hispanics (HR, 1.65; 95% confidence interval, 1.60 to 1.70; P<0.001) and Asians (HR, 2.01; 95% confidence interval, 1.78 to 2.27; P<0.001) living in the territories versus their matched 50 states counterparts. There were no significant differences in mortality among white or black patients in the territories versus the 50 states. CONCLUSIONS: Mortality rates for patients undergoing dialysis in the United States territories differ substantially by race/ethnicity compared with the 50 states. After matched analyses for comparable age and risk factors, mortality risk no longer differed for whites or blacks, but remained much greater for territory-dwelling Hispanics and Asians.

The Veterans With Diabetes Transition Study. Veterans Experience of the Process of Transition Following Active Duty Diagnosis.

INTRODUCTION: Veterans face several potential difficulties upon leaving active duty. Among these is transition of healthcare to a different setting. The transition from active duty to veteran status is often a challenging time for veterans with diabetes. Changes in healthcare have been shown to decrease diabetes care compliance and diabetes self-management resulting in exacerbation in diabetes symptoms and increased healthcare expenditure. A seamless transition in healthcare management from active duty to veteran status has the potential to maintain or increase diabetes self-management. A gap in the literature exists regarding the transition process between healthcare systems, including the DoD and VA. This paper describes the transition experience of a sample of veterans with diabetes from active duty to veteran status. MATERIALS AND METHODS: A qualitative study was designed to document the experience of veterans diagnosed with diabetes while on active duty. A semi-structured questionnaire developed for the study served to elicit each veteran participant's general description of the transition process. Quantitative instruments S-TOFHLA and DDS were used as measurements of potential barriers to diabetes self-management and navigating or adjusting to a changed priority within a healthcare system. RESULTS: Two main themes, those of unplanned and undesired end of a military career and feeling prepared to leave the military, were expressed by participants. Four additional themes were also discovered. Responses to quantitative instruments lacked variability and did not allow for further analysis. Specifically, the S-TOFHLA indicated all participants had adequate health literacy and the DDS showed no distress from diabetes. CONCLUSIONS: Study participants reported consistent compliance in diabetes self-management. Skills and attitudes obtained during military service led to participant's desire to manage their healthcare with determination to cope with challenges accompanying diabetes. The healthcare transition process would benefit from additional exploration of veteran's needs. Improved processes may facilitate the healthcare management transition of personnel with diabetes from active duty to veteran status.

Pilot Evaluation of Auricular Acupressure in End-Stage Lung Cancer Patients.

BACKGROUND: Dyspnea is a common symptom in end-stage lung cancer patients and is only infrequently controlled. Currently, the use of complimentary therapies using traditional Chinese medicine (TCM), including auricular application of Vaccaria segetalis (a small seed), is understudied. Acupressure using auricular Vaccaria segetalis application has been reported as effective in reducing dyspnea when applied to a specific area of the ear associated with lung function in the TCM paradigm. OBJECTIVE: The purpose of this feasibility study was to evaluate the effects of standardized auricular acupressure therapy using Vaccaria segetalis on dyspnea intensity and distress and oxygen saturation in end-stage lung cancer patients. METHODS: The experimental design was three conditions with eight measurement points in time. Patients were randomly assigned to one of three treatment conditions: (1) Standard Care (SC); (2) SC with Vaccaria segetalis taped to random auricular locations (placebo); and (3) SC with Vaccaria segetalis taped to the auricular location deemed specific to lung function in TCM. Subjects were 11 hospice patients with advanced lung cancer and dyspnea. Dyspnea intensity and distress were measured by the Cancer Dyspnea Scale (CDS) and oxygen saturation was measured by pulse oximeter at eight time points. RESULTS: Non-parametric statistical analyses suggest the presence of acupressure effects with medium to large effects and significant effect for dyspnea effort. CONCLUSIONS: This pilot information suggests the need for further study of auricular acupressure using Vaccaria segetalis in the dyspneic advanced lung cancer population.

Adjusting Bowel Regimens When Prescribing Opioids in Women Receiving Palliative Care in the Acute Care Setting.

In palliative medicine, constipation is the third most common symptom after pain and anorexia, causing some patients to discontinue opioid therapy. Women experience higher incidence of constipation than men. The prevalence of infrequent bowel movements (<3 times/wk) and adherence to an established bowel regimen among women receiving opioids were studied. Referral to the palliative care team decreased the prevalence of infrequent bowel movements from 72% to 45%, and algorithm adherence increased from 38% to 78%. Education of oncology nurses decreased the prevalence of infrequent bowel movements among patients with cancer from 71% to 60%, and algorithm adherence increased from 0% to 10%. Patients benefit from stool softeners and stimulants when receiving opioids.

Linking nursing theory and practice: a critical-feminist approach.

Situated in a critical-feminist perspective, this article describes a pedagogical approach to linking nursing theory and practice. The inclusion of the critical humanities is emphasized in creating an environment in which this linkage can be reified for learners. Implications for the future of nursing theory and its links to practice in the context of current political realities in academia are considered.

Suffering: toward a contextual praxis.

Janice M. Morse's article in Advances in Nursing Science (24:1) revised and summarized the major findings of a research program exploring the behavioral-experiential nature of suffering. Using a feminist critical theory stance, this article addresses Morse's conceptualization of a praxis of suffering. First, it identifies the strengths and contributions of Morse's body of research to nursing science. Next, it undertakes a critique situated in feminist critical theory in which the limitations of Morse's work are explored using exemplars from the Western literary tradition. Finally, the article proposes a new conceptualization of an alternative contextual praxis of suffering in which nurses' responses to suffering are situated in an emancipatory paradigm of authentic presence.

An emerging discourse: toward epistemic diversity in nursing.

Grounded in a postmodern feminist methodology, this article undertakes an initial analysis of a newly emerging discourse in contemporary nursing academia in the United States. Two currently prominent discourses in nursing, a dominant discourse informed by the processes and values of "science" in the Enlightenment sense and a concurrent marginalized discourse informed by postmodernism, are described as a context for the emerging discourse. A genealogy informed by the work of Foucault is presented as a basis for an analysis of the power effects resulting from the conflict between these 2 discourses. Finally, 3 recent texts in nursing are analyzed and common themes identified as indicative of a new intertextual discourse, termed "epistemic diversity," emerging from this discursive conflict.

The politics of suffering: implications for nursing science.

Drawing on newly emergent conceptualizations of suffering in the social sciences that emphasize political dimensions, this article uses a critical-feminist, self-reflective approach to propose a reconceptualization of suffering for nursing science. Discourse analysis of local narratives and metanarratives is undertaken as a basis for proposing alternative methods, including a critical humanities approach, for nurse scholars to use in creating a transformed, politicized epistemology of suffering.