Experiences of vulnerability and uncertainty during the Iraq and Afghanistan wars: Stories of wounded service members and the nurses who cared for them.

BACKGROUND: The findings reported in this paper were derived from a secondary analysis of selected data from a large clinical knowledge study designed to document the experiential learning of military and federal nurses caring for critically wounded service members (WSMs) of their experience of care from point of injury in the combat zone through their rehabilitation. FINDINGS: This article describes a picture of vulnerability and uncertainty in both WSMs and their nurses throughout the health care continuum. The concepts of vulnerability and uncertainty had distinct meanings for each group. In many cases, nurses who were deployed revealed a dual encounter with the vulnerability of war along with personal uncertainty about themselves and their patients. DISCUSSION: To support optimized health care of WSMs and the well-being of caregivers, health care professionals and policy makers must understand the effects and dynamics of serving in a warzone.

Use of Cancer Genetics Services in African-American Young Breast Cancer Survivors.

INTRODUCTION: African-American women have higher rates of early-onset breast cancer compared with their Caucasian counterparts; yet, when diagnosed with breast cancer at a young age, they underuse genetic counseling and testing to manage their risk of developing future cancers. METHODS: Self-reported baseline data were collected between September 2012 and January 2013 and analyzed in 2014 from a subpopulation of 340 African-American young breast cancer survivors (YBCSs) enrolled in an RCT. YBCSs were diagnosed with invasive breast cancer or ductal carcinoma in situ between ages 20 and 45 years and were randomly selected from a statewide cancer registry. Logistic regression examined predictors of using cancer genetics services. RESULTS: Overall, 28% of the sample reported having genetic counseling and 21% reported having genetic testing, which were significantly lower (p≤0.005) compared with white/other YBCSs participating in the parent study. In a multivariate analysis, income was positively associated with counseling (B=0.254, p≤0.01) and testing (B=0.297, p≤0.01), whereas higher education levels (B=-0.328, p≤0.05) and lack of access to healthcare services owing to cost (B=-1.10, p≤0.03) were negatively associated with genetic counseling. Lower income and lack of care because of high out-of-pocket costs were commonly reported barriers. CONCLUSIONS: Despite national recommendations for genetic evaluation among women with early-onset breast cancer, few African-American YBCSs reported undergoing genetic counseling and testing. Most reported that their healthcare provider did not recommend these services. Interventions addressing patient, provider, and structural healthcare system barriers to using genetic counseling and testing in this population are needed.

Reflections on the face of the person with mental illness: an american perspective / Reflexiones sobre la cara de la persona enferma mental: una perspectiva estadounidense

One in five adults and children in the United States experience some form of mental illness. Although there have been amazing developments in science, improved education of a cadre of mental health professionals, enhanced drug therapy, more public funding, and innovative trauma informed care, significant mental health disparities persist. Enduring myths about mental illness, separate but unequal physical and mental health delivery systems, lack of mental health parity in benefits, payments and access to health insurance, inadequate and un-coordinated community-based services, and an established mode of health delivery that values profit margins and rewards high technology medicine contribute to the burden of the person with mental illness. Poor individuals and families, members of minority groups, children in foster care, and persons who experience or witness violence are most at risk for mental disorders. These groups are untreated and lack access to the Social Determinants of Health. The great promise of the Community Mental Health Act of 1963 remains unfulfilled. Will the Affordable Care Act of 2010 and Medicaid expansion enable persons with mental disorders to obtain health insurance and find community-based delivery systems to help them cope with their treatable chronic disease? Good will is not enough. Social justice is an action theory. It invites us to stand in solidarity with the mentally oppressed and share their burdens. We are invited us to look into the faces of persons with mental illness with respect.

Uno de cada cinco adultos y niños en los Estados Unidos sufre algún tipo de enfermedad mental. Aunque se han producido avances asombrosos en la ciencia con la mejora de la educación de un grupo de profesionales de la salud mental, terapia de drogas mejorada, más fondos públicos y de atención de trauma innovadora, las disparidades significativas de salud mental persisten. Los mitos perdurables sobre las enfermedades mentales, los sistemas de salud física y mental separados pero desiguales, falta de paridad de salud mental en los beneficios, pagos y el acceso al seguro de salud, los servicios inadecuados y poco coordinados basados en la comunidad, y una vía reconocida de prestación de salud que los valores márgenes de beneficios y recompensas médicas de alta tecnología contribuyen a la carga de la persona con enfermedad mental. Los individuos y las familias pobres, los miembros de los grupos minoritarios, los niños en hogares y las personas que experimentan la violencia o testigo de ella están en riesgo de trastornos mentales. Estos grupos son tratados y no tienen acceso a los Determinantes Sociales de la Salud. La gran promesa de la Ley de Salud Mental de la Comunidad de 1963 no se ha cumplido. ¿La Ley de Asistencia Asequible de 2010 y la expansión de Medicaid de las personas con trastornos mentales para obtener un seguro de salud hacer frente a su enfermedad crónica tratable? La buena voluntad no es suficiente. La justicia social es una teoría de la acción. Nos invita a ser solidarios con los oprimidos mentales y compartir sus cargas. Los invitamos a mirar con respeto la cara de las personas con enfermedad mental.

Graduate Clinical Nurse Preceptors: Implications for Improved Intra-Professional Collaboration.

Advanced practice nurses have increased in number and public acceptance. Students preparing for these roles require quality clinical education so they are prepared to assume collaborative roles in healthcare settings. Although graduate clinical preceptors have a vitally important role in the clinical education and professional socialization of advanced practice students, there is a paucity of evidence about factors that influence their role commitment. In this article, the authors review the literature related to graduate-level, clinical-preceptor experiences; describe their study of 91 graduate clinical preceptors that identified factors influencing graduate clinical preceptors' role commitment; report and discuss their findings; as well as the limitations of this study. They conclude that the graduate clinical preceptor role needs to be more visible and better integrated into schools of nursing and healthcare organizational structures, and identify the need for intra-professional collaboration among nursing faculty, administrators, and clinicians to facilitate the recruitment, cultivation, and retention of graduate clinical preceptors.

Challenges for nursing in the 21st century.

Nurse leaders face a myriad of challenges in the 21st century such as nursing workforce shortages, negative affectivity, generation workforce concerns, changing delivery systems, and increasing clinical practice complexity, to name a few. Visionary and strategic thinking centered on patients' well-being are needed to tackle these challenges and shape a more humane and compassionate health care system.

Revisiting the American Nurses Association's first position on education for nurses.

This article presents arguments in support of the ANA's first position on education for nurses written in 1965 and discusses the effect of this statement on nursing education and practice over the past four decades. The similarity of the issues discussed at policy tables in 1965 and 2002 are addressed. The article ends with a challenge for nurses to advocate for better educated nurses with stakeholders, their patients and clients, in public and private sectors.