Patient, Caregiver, and Clinician Perceptions of Palliative Care that Influence Access and Use: A Qualitative Meta-Synthesis.

Objective: Benefits of integration of palliative care early in the trajectory of a patient's serious illness are well established in the literature. Yet, barriers to palliative care access in the US continue to exist. The purpose of this study is to synthesize existing qualitative data of patient, caregiver, and clinician perceptions of palliative care (PC) that influence PC access and use in the US. Methods: A formal qualitative meta-synthesis was completed. The meta-synthesis included 1) a systematic literature search of qualitative studies conducted from 2016 to 2021, 2) a critical appraisal of the included studies, and 3) a reciprocal translation of the study's findings through an interpretive thematic analysis. Results: Seven articles met inclusion criteria resulting in a sample size of patients (n=18), caregivers (n=15), and clinicians (n=118). Three themes emerged with associated subthemes: knowledge and opinions of PC (subthemes of patient and caregiver knowledge and awareness and clinician knowledge and beliefs); care coordination and collaboration (subthemes of communication and trust); and social and structural drivers (subthemes of socioeconomic demographics and time and resources). Conclusions: This qualitative meta-synthesis identifies barriers and facilitators to palliative care access and use. The study findings illuminate the commonalities and differences of the perceptions of the three key stakeholder groups. In addition, this qualitative meta-synthesis reveals the complexities within the US healthcare system, and the challenges patients and their caregivers face accessing PC.

Aesthetic Knowing: Cut-Ups and Haiku Poems.

Enhancing course design and pedagogy to encourage engagement and creativity is fundamental in doctoral education. Using poetry is an innovative way to enrich nursing education through aesthetic knowing. The authors in this paper aim to describe an educational exercise utilizing the Cut-Up Method to create haiku poems. PhD nursing students used the Cut-Up Method to produce haiku poems describing the meaning of nursing science. Themes from the haiku poems include relationship building, caring and caring relationships, and the evolution of nursing. Learning activities promote aesthetic knowing to facilitate engagement, creativity, and collaboration. The Cut-Up Method and haikus are creative ways of developing aesthetic knowing.

Medical-Surgical Nursing.

This specialty provides fertile ground for professional development.

Conceptualizing transgender and gender-diverse older adults as a vulnerable population: A systematic review.

BACKGROUND: While extant literature clearly illustrates the negative experiences of transgender and gender-diverse (TGD) people, the intersection between TGD identity and older age in producing vulnerability is poorly understood. The Vulnerable Populations Conceptual Model (VPCM) provides a framework for identifying vulnerable communities. Understanding access to resources, relative risks, and health status experienced by TGD older adults is critical in developing person-centered interventions. METHODS: A systematic review using PRISMA guidelines was used. CINAHL, Medline, PubMed, and PsycINFO were searched for studies published from 2017 to 2022. RESULTS: Of the seventeen articles included, no articles were based from a nursing journal. Synthesis of findings described TGD older adults as a vulnerable population with limited access to resources and several risks leading to poor health status. CONCLUSION: Identifying TGD older adults as a vulnerable population is critical to understand their unique needs. The findings underline implications in nursing education, practice, and research.

Nursing, Social Justice, and Health Inequities: A Critical Analysis of the Theory of Emancipatory Nursing Praxis.

Walter's theory of emancipatory nursing praxis (ENP) was created to explore nurses' social justice-related transformational learning process. We analyzed the theory within the context of stigma-related health inequities faced by transgender and gender-diverse (TGD) people. The theory of ENP provides a theoretical framework to incorporate social justice in nursing practice, research, education, and policy. We also determined the theory bridges the gap in understanding the role of nurses in advancing social justice through embodied actions and social activism. The theory of ENP underscores the moral, ethical, and professional obligations for nurses to abolish health inequities for TGD people.

Modifying Outdated Blood Donation Restrictions on Men Who Have Sex with Men.

Current practices are discriminatory and no longer supported by science.

Stigma and healthcare access among transgender and gender-diverse people: A qualitative meta-synthesis.

AIM: To describe the experience of stigma among transgender and gender-diverse (TGD) people accessing care. DESIGN: A qualitative meta-synthesis. DATA SOURCES: CINAHL, Medline, PubMed and PsycINFO were used to retrieve English-language, peer-reviewed qualitative studies from September 2016 to September 2021. REVIEW METHODS: The methods for this qualitative meta-synthesis included four steps. Step 1: Form the clinical question and purpose of synthesis to define and refine search terms. Step 2: Evaluate the literature using PRISMA. Step 3: Appraise the literature using Lett's Critical Review Form. Step 4: Conduct a reciprocal translation to synthesize the results. RESULTS: Of the 12 articles that met the inclusion criteria, 3 were from nursing journals. The articles included were studies conducted in U.S.A., Brazil, Canada, Colombia, Mozambique, Sweden, Uganda and United Kingdom, and most recruited transfeminine-identifying participants. Three main themes emerged: stigma experienced within the individual, interpersonal and structural socio-ecological levels among TGD people accessing care. CONCLUSION: Stigma is a significant public health issue as it limits healthcare access among TGD people. Stigma experienced at various socio-ecological levels contributes to health disparities. Nurses must create and implement interventions informed by the lived experiences of TGD people. IMPACT: Extant literature on this topic is limited in the nursing literature. This qualitative meta-synthesis illuminates TGD identity stigma-related experiences using a socio-ecological framework. While stigma is often experienced at the individual and interpersonal levels, oppressive systems that value cisgender cultural norms over other gender identities allow structural-level stigma to occur. Nurses are morally, ethically and professionally responsible for challenging systems that create and sustain stigma. Understanding how stigma is experienced when accessing care can help deliver critical information needed to improve healthcare access among TGD people and other historically oppressed communities.

Stigma among transgender and gender-diverse people accessing healthcare: A concept analysis.

AIM: To provide a timely analysis around the concept of stigma among transgender and gender-diverse people accessing healthcare. BACKGROUND: While research on stigma has been prolific in other disciplines, the literature on stigma-especially among transgender and gender-diverse people-have been limited in nursing. A clear definition of stigma among transgender/gender-diverse people is also lacking in the nursing literature. DESIGN: Walker and Avant's method of concept analysis. DATA SOURCES: PubMed and CINAHL databases were used to retrieve English language records from February 2016 to February 2021. Influential literature from sociology and psychology and an online dictionary and thesaurus were also used to clarify the concept. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to search the scientific literature to clarify and describe the antecedents, defining attributes, consequences and empirical referents of stigma among transgender/gender-diverse people accessing healthcare. RESULTS: A clear definition of stigma was identified. The defining attributes of stigma-labelling, stereotype, separation, status loss and discrimination-reflect its definition. Without asymmetrical power relationships, stigma will not exist. The consequences of stigma include negative and positive outcomes. CONCLUSION: While this concept analysis provides clarification of stigma, further exploration of the concept is needed. Furthermore, this concept analysis illustrates how nurses are strategically positioned to disrupt the power structures that allow stigma to operate. Understanding the concept of stigma also enables nurses to create equitable and multifaceted inventions to improve healthcare access among transgender and gender-diverse people.