Development of macrosomia resulting from gestational diabetes mellitus: physiology and social determinants of health.

This integrative review sought to advance understanding of the literature pertaining to gestational diabetes mellitus (GDM) and subsequent lifestyle changes in Canadian and American populations. Gestational diabetes mellitus includes glucose intolerance identified during pregnancy and affects approximately 7% of all pregnancies worldwide or more than 200,000 cases annually. Depending upon the population studied and the diagnostic tests employed, the prevalence may range from 1% to 14% of all pregnancies. The article comprises 2 parts in which internal and external factors are discussed concerning pathophysiologic pathways and psychosocial influences. Social determinants of health affect the development of GDM. Gestational diabetes mellitus is increasing in all socioeconomic strata, particularly because of stress, sedentary lifestyle, and poor nutritional choices. Questions are raised about future research directions.

A narrative study of the experiences of student nurses who have participated in the Hearing Voices that are Distressing simulation.

The aim of this study was to provide nursing students with an experiential learning opportunity which simulated living with the challenge of voice hearing. The purpose was to access understanding and insights of nursing students who completed "Hearing Voices that are Distressing: A Training Experience and Simulation for Students" (Deegan, 1996). Using a narrative research design and a convenience sample of 27 nursing students, participants were asked to respond in written format to three open ended prompts immediately following their participation in the simulation. Data generated was subjected to a thematic content analysis using a manual cut and paste approach to inductively find meanings and insights elicited from the respondents' actual words. Affirmed in this study was the use of this teaching tool to assist the students in their understanding of the challenges posed by voice hearing.

Mood and narrative entwinement: some implications for educational practice.

Moods are one way of existentially reading the authenticity of people and are entwined within any narrative. Attunement between narrative and its mood is crucial for understanding the implicit message of the narrator. Sometimes, a master narrative is interrupted by counternarratives, so that narrative recognition becomes problematic. People can disguise their existential state when narrating, but the mood discloses it nonetheless. The authors explore the relationship between mood and narrative, and how the two are connected with how a person acts authentically or inauthentically. They provide selected empirical examples of narratives from medical students to support their argument. The educational relevance of their discussion comprises the final section. Educators in any educational program must first reflect on, then make explicit the manner in which narrative and mood are used to communicate knowledge.

Breast cancer genetic testing: more than a medical management tool.

BACKGROUND: Knowing whether a harmful hereditary mutation exists in BRCA1 and BRCA2 can enable women to make informed decisions regarding surveillance and surgery options to manage risk. Given the attention in the media about BRCA genetic testing, nurses need to revisit how this knowledge may affect a woman's sense of self and the forces that may influence this decision. OBJECTIVES: This article aims to understand how complex the decision to undergo genetic testing may be for some women by exploring the impact of genetic knowledge on the self, changes to customary definitions for health and illness, and ethical issues and social forces that may influence genetic testing decisions. METHODS: A review of the literature was undertaken to understand how genetic knowledge may alter meanings attached to the breast and how health is defined, and to identify ethical concerns and social forces that may affect a woman's decision to undergo or decline an offer for genetic testing. FINDINGS: An understanding and awareness of the potential benefits and harms of BRCA1 and BRCA2 genetic testing, as well as the social forces that may influence a woman's decision to undergo or decline an offer for genetic testing and the commitment to remain open to the uniqueness of each woman's situation, may enhance the nurse-patient relationship and result in a decision that is ethically in the best interest of the patient.

From diagnosis to birth: parents' experience when expecting a child with congenital anomaly.

Of 350,000 Canadian children born each year, 2% to 3% will have a serious congenital anomaly. Because of recent ultrasound diagnostic improvements and increased frequency of prenatal scans, many anomalies are determined prenatally, with more parents receiving disturbing, unanticipated news of an anomaly. This article highlights the experiences, concerns, and healthcare needs of parents who receive a prenatal diagnosis of congenital anomaly during routine ultrasound and choose to continue with the pregnancy. Examples from parent interviews describing their experience complement the sparse literature dealing with this phenomenon. Parents describe their experience from antenatal diagnosis and preparation for the child's birth and subsequent admission to the neonatal intensive care unit. Attention is paid to how neonatal nurses can positively influence this process by attending to parents' feelings or moods. The conclusion includes recommendations for neonatal nursing care for these vulnerable parents.

Evaluation of the nursing care model for children victimized of violence / Avaliação de um modelo de cuidado de enfermagem para crianças vítimas de violência / Evaluación de un modelo de cuidado de enfermería a niños víctimas de la violencia

The nursing care model represent important possibilities to develop the knowledge of nursing. However, there is no proposition that allow to verify the legitimacy of the care models. So, the objective of this study was to evaluate the Nursing Care Model for Children Victimized of Violence. The model was elaborated from a study of qualitative approach, the Convergent Assistant type. The study consists of evaluative study utilizing the instrument for evaluation of nursing care models, and conducted by a panel of 18 specialists. The analysis includes analysis of objective responses and other texts prepared by experts as part of its assessment process. The result shows that the Nursing Care Model, still needs tweaking and adaptations.

Modelos de cuidado de Enfermagem representam importante possibilidade de desenvolvimento do conhecimento de Enfermagem. Todavia, não há uma proposição que permita verificar a legitimidade dos modelos de cuidado. Assim, o objetivo deste estudo foi avaliar o Modelo de Cuidado de Enfermagem para Crianças Vítimas de Violência. O modelo foi elaborado a partir de uma pesquisa de abordagem qualitativa, do tipo Convergente-assistencial. O presente estudo consistiu em uma pesquisa avaliativa utilizando o instrumento para avaliação de modelos de cuidado de enfermagem, e efetuada por um painel de 18 especialistas. A análise abrange análise das respostas objetivas e dos textos elaborados pelas especialistas como parte do processo de avaliação que efetuaram. Os resultados evidenciaram que o Modelo de Cuidado para Crianças Vítimas de Violência, pode ser considerado um modelo de cuidado para a enfermagem, embora ainda necessite de ajustes e adequações.

Los modelos de cuidado de enfermería representan una importante oportunidad para desarrollar el conocimiento de enfermería. Sin embargo, aún no existe una proposición que permita verificar la legitimidad de esos modelos. El objetivo de este estudio fue evaluar el Modelo de Cuidado de Enfermería a Niños Víctimas de la Violencia. El modelo se hizo a partir de una investigación cualitativa, convergente asistencial. En este estudio se realiza una investigación evaluativa mediante el instrumento de evaluación de modelos de cuidado de enfermería, analizada por un panel de 18 especialistas. El análisis incluye el análisis de respuestas objetivas y otros textos elaborados por expertos como parte del proceso de evaluación que realizaron. Los resultados mostraron que el Modelo de Cuidado a Niños Víctimas de la Violencia, puede considerarse como un modelo para el cuidado de enfermería, pero aún necesita retoques y ajustes.