Nursing Strategic Imperatives: Engaging Nurses in Strategy Development and Execution to Drive Value.

Strategic plans provide a roadmap for value creation by outlining key priorities that, when executed successfully, enhance quality and efficiency. Nurses are uniquely positioned to inform strategic planning because of their understanding of clinical operations and consumer needs. This article describes a multiphase process for engaging nurses, at all levels, in developing, implementing, and revising a nursing strategic plan over a 5-year period.

Ethics, health disparities, and discourses in oncology nursing's research: If we know the problems, why are we asking the wrong questions?

AIMS AND OBJECTIVES: To disrupt conflations between 'health disparities research' and critical engagement with racism, whiteness, other oppressions and our profession's ongoing roles in white supremacy. BACKGROUND: In Oncology Nursing Society's (ONS) 2019-2023 research agenda, health disparities are highlighted as a top priority for nursing knowledge generation and intervention. The document concludes needs for increased 'minority and vulnerable population' participation in cancer clinical trials, reduced financial toxicity, behavioural interventions for risk reduction, incorporation of social determinants of health and technology to promote rural access to high-quality care. DESIGN: In this critical resistive, theoretical and ethical analysis on current discourses on health disparities research in oncology nursing, we ask: (a) What forces (stated and unstated) shape current oncology nursing discourses about health disparities?; (b) What assumptions about health and power are embedded in these discourses?; (c) Are we, as nurses and scientists, asking the right questions? METHODS: Line-by-line analysis of the ONS Research Agenda for 2019-2023 'Health Disparities' section. RESULTS: The health disparities described in this report are not new to the literature, nor are many of the proposed solutions. As noted, disparities such as disproportionate cancer-related morbidity and mortality across identities (gender, race and sexual orientation) have not improved and some have worsened over several decades. CONCLUSIONS: That discourses on prioritising cancer-related health disparities persist while disparity-related outcomes remain largely unchanged presents challenges-both moral and pragmatic. We must ask, 'Rather than the concept of "health disparities," as presently understood in cancer nursing, what is the better approach to examine health equity and ethical nursing research practices?' RELEVANCE TO CLINICAL PRACTICE: This paper offers several starting places for nurses, especially with the following questions: 'Who does this harm?' Answer then revise: 'Who might this harm now?' Answer then revise: 'Are these harms worth the activity?' And repeat this process.

The Contested Whiteness of Arab Identity in the United States: Implications for Health Disparities Research.

In response to the Institute on Minority Health and Health Disparities' (NIMHD) new health disparities research framework, we call on the National Institutes of Health (NIH) to acknowledge Arabs in the United States as a health disparity population. Arab classification as White leads to their cultural invisibility and perpetuates a cycle of undocumented health disparities.We provide examples of how this contested identity reinforces challenges associated with identifying this population and contributes to enactments of structural violence and undocumented health disparities. Decades of research with Arabs in the United States provides consistent evidence that their health does not fit the health profile of White Americans and that Arabs do not benefit from Whiteness and White privilege associated with their White racial categorization. On the contrary, Arabs in the United States experience discrimination and health disparities that require urgent attention; this can be achieved only by identifying the population with a racial category other than White.We conclude with recommendations to NIH and NIMHD to revise their definition of health disparity populations to include Arabs in the United States.

Meaning Making and Religious Engagement Among Survivors of Childhood Brain Tumors and Their Caregivers.

PURPOSE: To describe how adolescent and young adult survivors and their mother-caregivers ascribe meaning to their post-brain tumor survivorship experience, with a focus on sense making and benefit findings and intersections with religious engagement. PARTICIPANTS & SETTING: Adolescent and young adult survivors of childhood brain tumors and their families, living in their community settings. METHODOLOGIC APPROACH: Secondary analysis of simultaneous and separate individual, semistructured interviews of the 40 matched dyads (80 total interviews) occurred using conventional content analysis across and within dyads. Meaning is interpreted through narrative profiles of expectations for function and independence. FINDINGS: Participants made sense of the brain tumor diagnosis by finding benefits and nonbenefits unique to their experiences. Meaning was framed in either nonreligious or religious terms. IMPLICATIONS FOR NURSING: Acknowledging positive meaning alongside negative or neutral meaning could enhance interactions with survivors, caregivers, and their families. Exploring the meaning of their experiences may help them to reconstruct meaning and reframe post-tumor realities through being heard and validated.

Impacting Health Disparities in Urban Communities: Preparing Future Healthcare Providers for "Neighborhood-Engaged Care" Through a Community Engagement Course Intervention.

It is well known that health disparities exist and that a significant majority of patients who suffer disproportionately from them are lower income, non-white residents of dense, and diverse urban neighborhoods. It is our belief that factors hindering the reduction of health disparities in these neighborhoods are a lack of a framework and preparation needed to engage these communities in identifying specific health care needs. This paper describes one curricular intervention, a graduate level community engagement course, developed within an academic medical center located in an urban setting, that demonstrates promise in effecting change in the extent to which clinicians are able to engage communities and practice "neighborhood-engaged care" with the central goal of mitigating disparities.

Mother-caregiver expectations for function among survivors of childhood brain tumors.

PURPOSE: Children diagnosed with brain tumors increasingly survive to adulthood, although they do so with needs often requiring continued parental caregiving. We sought to describe the nature of caregivers' expectations about survivors' function and how expectations connect to ongoing management and decision-making. METHODS: Forty-five qualitative interviews with mother-caregivers were conducted and coded for themes related to expectations for their adolescent/young adult children living post-childhood brain tumors. RESULTS: Five main themes emerged as integral to mother-caregiver expectations: realizing a difference in the survivor, noticing limitations to independence in the survivor, memories of learning about clinical prognoses as understood from consent meetings and education, managing these realizations, and acknowledging unresolved challenges. CONCLUSIONS: Caregiver expectations are influenced by both initial clinical interactions and contemporary family dynamics and require individual- and family-specific survivorship planning. As caregiver expectations can influence management behaviors that impact outcomes and possibly independence, implications for clinician-caregiver shared decision-making are substantial.