Tobacco control is central to reducing death and disability and improving quality of life worldwide and nursing action is imperative. This article addresses tobacco as a global health issue with implications for nursing practice, education, research, and policy development. The lack of knowledge and skills, lack of expectation for clinical intervention, limited research, an absence of professional policies, and minimal nursing leadership have diminished the critical role that nurses can play in confronting this epidemic. Swift action is needed to ensure that all nurses are prepared to effectively engage in activities to prevent tobacco use, provide evidence-based cessation interventions, and support efforts to prevent exposure to secondhand smoke. Increased opportunities are needed to support creative nursing research efforts that test interventions and strategies to reduce barriers to tobacco control within different cultures, subcultures, and countries.
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This literature review explores the range and nature of medication adherence interventions tested with older adults. The unique needs of older adults require specifically designed and tailored interventions. Low medication adherence rates among some elderly contribute to inadequate pharmacological management of illnesses. Searches were conducted to identify randomized controlled trials of medication adherence; computerized databases, journal hand searches, and ancestry searches yielded 63 studies published between 1977 and 2005 where participants’ mean age was > 60 years. Interventions were categorized by focus (patient, medication, and administration factors). Most were geared toward promoting knowledge and skills for medication-taking and adherence. Gaps were noted in addressing memory aids and self-monitoring strategies; further development of interventions addressing medication and administration factors influencing adherence are also needed. Identified interventions are geared toward self-medicating patients and fail to address caregivers administering medications. Finally, interventions do little to address variations in patterns of adherence among older adults.
- Go to article: A Qualitative Study of Older Patients' and Family Caregivers' Perspectives of Transitional Care From Hospital to Home
A Qualitative Study of Older Patients' and Family Caregivers' Perspectives of Transitional Care From Hospital to Home
Background and Purpose
The need for high-quality long-term healthcare services is increasing across the globe as the population ages. Strategies for improving transitional care from hospital to home are needed. This study aimed to explore the perspectives of patients aged 65 years and over and their family caregivers transitioning from hospital to home in an urban area of Turkey.
Thematic analysis of in-depth semi-structured interviews was conducted with older patients (n = 14), with at least one chronic disease and admitted to the hospital for a minimum of 3 days, and family caregivers (n = 11) who voluntarily participated.
Main themes were “confused feelings of safety and stress”; “worried about being left alone”; and “disrupted healthcare journey.” The proactive rehabilitation model was used to elaborate on the study findings and interpret the perspectives and experiences of older patients and their family caregivers, which can be used for improving the quality of care after discharge from hospital.
Implications for Practice
A high-quality transitional care program requires taking care of the feeling of safety in older patients and their family caregivers by the multidisciplinary team and their enhanced involvement in care initiatives after hospital discharge.
Moral distress, a complex human experience, has lacked a clear, complete definition. Intuitively, clinicians know that moral distress might be occurring for patients with increasing frequency due to technological advances that alter the natural order of life and death. Yet clinicians have not been able to evaluate the presence or extent of moral distress. To date, moral distress has been investigated mainly as an occupational issue using Jameton’s (1984) definition, which has been problematic for several reasons. Without an adequate definition, moral distress can be unrecognized, yet have a silent, clinically significant impact on health. The literature is discussed from several perspectives to show the current state of the science in this topical area, and its potential future.
- Go to article: Uncaring Nurses: Mobilizing Power, Knowledge, Difference, and Resistance to Explain Workplace Violence in Academia
Uncaring Nurses: Mobilizing Power, Knowledge, Difference, and Resistance to Explain Workplace Violence in Academia
Background and Purpose:
Violence among nurses and in nursing academia is a significant issue, with attention increasingly focused on damage resulting from psychological violence, such as bullying, harassment, aggression, and incivility. Each workplace’s interpretation of violence will impact individual behavior within the organization. Organizational and environmental factors can contribute to violent behaviors becoming normalized in the workplace. When violent behaviors go unconstrained, they become imbedded within the workplace culture. An increased understanding of workplace culture is required to address workplace violence. The purpose of this article is to demonstrate how the use of this theoretical framework can provide greater understanding of the role of workplace culture in sustaining violent behaviors in nursing academia.
The theoretical perspectives of Gail Mason on interpersonal violence and Michel Foucault on power were utilized to inform the research process and guide data analysis.
The framework makes possible the exposure of a dominant discourse perpetuating violence in nursing academia. Power and violence were found to work together to shape knowledge and influence group norms and behaviors.
Implications for Practice:
The framework is useful in providing greater understanding of how the concepts of power, knowledge, difference, and resistance support the enactment of workplace violence. Investigating the influence of these concepts in the development of accepted practices and discourses may allow greater insight into ways violence and power are used to negotiate and enforce organizational rules and norms.
Background and Purpose: Interpersonal trust is trust between two people and is an important component of the nurse-patient relationship in the hospital setting. Interpersonal trust entails good will, familiarity, risk, power imbalance, and vulnerability. This grounded theory study was undertaken to explain how interpersonal trust develops with the nurse from the perspective of the hospitalized adults. Methods: Face-to-face interviews were conducted with 20 hospitalized adults in their private hospital room. Data analysis was conducted concurrently with data collection using constant comparison. Results: The resulting model had six categories within the core category Taking the Time which reflected nursing presence. The beginning phase had two categories reflecting the patient Feeling Vulnerable and Relying on the Nurse. The middle phase had three categories reflecting the nurse Having a Positive Vibe, Seeing Me as a Person and Caring About Me. The endpoint of developing trust was the patient Feeling Comfortable. Patients perceived the nurse as in control of trust development in the hospital setting. Implications for Practice: The nurse conveying a positive attitude was a principal facilitator to trust development. A barrier to trust development was the nurse seeing the patient as a checklist and not as a person. When trust was established, the patient was more willing to ask questions. When trust did not develop, the patient avoided the nurse and attempted to complete activities on their own such as ambulating to the bathroom. The nurse taking the time and establishing trust contributes to safe patient care.
- Go to article: Nonverbal Communication Behaviors of Internationally Educated Nurses and Patient Care
Background: Because of language barriers and cultural differences, internationally educated nurses (IENs) face documented communication challenges in health care delivery. Yet, it is unknown how and to what extent nonverbal behaviors affect patient care because of research gap in the existing nursing literature. Methods: This is an exploratory study evaluating nonverbal communication behaviors of IENs interacting with standardized patients (SPs) in a controlled clinical setting through videotape analysis. Participants included 52 IENs from two community hospitals in the same hospital system in a southwestern metropolitan area in the United States. Twelve nonverbal behaviors were rated using a 4-point Likert scale with 4 indicating the best performance by the research team after watching videos of SP–IEN interactions. The global communication performance was also ranked in four areas: genuineness, spontaneity, appropriateness, and effectiveness. The relationships between these four areas and the nonverbal behaviors were explored. Finally, a qualitative analysis of two extreme cases was conducted and supplemented the quantitative findings. Results: The IENs received average scores under 2 in 5 out of the 12 nonverbal behaviors. They were “hugging” (1.06), “lowering body position to patient’s level” (1.07), “leaning forward” (1.26), “shaking hands” (1.64), and “therapeutic touch” (1.66). The top three scores were for “no distractive movement,” “eye contact,” and “smile” (3.80, 3.73, and 3.57, respectively). The average overall global impression score was 2.98. The average score for spontaneity was 2.80, which was significantly lower than the scores for genuineness (3.15), appropriateness (3.11), but comparable to the average score for effectiveness (2.85). Finally, therapeutic touch, interpersonal space, eye contact, smiling, and hugging were all significantly correlated with one or more of the global impression scores, with therapeutic touch showing moderate correlations with all of the scores as well as the overall global impression score. Implications: The IENs’ nonverbal behaviors in areas such as hugging, lowering body position to patient’s level, leaning forward, shaking hands, and therapeutic touch have room for improvement. Targeted interventions focusing on norms and expectations of nonverbal behaviors in the U.S. health care setting are called for to improve quality of care.
- Go to article: Efficacy of Warm Showers on Postpartum Fatigue Among Vaginal-Birth Taiwanese Women: A Quasi-Experimental Design
Efficacy of Warm Showers on Postpartum Fatigue Among Vaginal-Birth Taiwanese Women: A Quasi-Experimental Design
Background and Purpose: Postpartum fatigue is one of the most common complaints among women following childbirth. As a postpartum ritual practice, Taiwanese women refrain from taking showers while “doing the month.” However, warm showers are the systemic application of moist heat, and they maintain physical hygiene, stimulate blood circulation, mitigate discomfort, and provide relaxation. As Taiwanese society becomes increasingly receptive to scientific and contemporary health care practice, more and more women choose to take warm showers after childbirth. The purpose of this study was to evaluate the efficacy of warm showers on postpartum fatigue among vaginal-birth women in Taiwan. Methods: This was a two-group quasi-experimental design. Women took showers in warm water with temperatures ranging between 40 °C and 43 °C for approximately 20 minutes. Postpartum women’s fatigue is measured using the 10-item Postpartum Fatigue Scale (PFS). The intervention effect was analyzed using a generalized estimating equation (GEE) model. Results: The study population consisted of 358 vaginal-birth postpartum Taiwanese women aged 20–43 years. Postpartum women who took warm showers showed improvements from their pretest to posttest mean scores of postpartum fatigue compared to postpartum women who did not take warm showers. Warm showers helped to reduce postpartum fatigue among vaginal-birth women during the study period. Implications for Practice: Nurses have the unique opportunity to provide the intervention to Taiwanese women who have vaginal birth to help them relieve postpartum fatigue with warm showers while “doing the month” without the taboo of no-showering customary practices in the early postpartum period.
Purpose: To present a “contrasting perspectives” conceptual framework reflecting the typically strained experiences of many comorbid adults now interacting with primary care clinicians across the world. Background: More comorbidity-related needs are presented to primary care clinicians during typically shorter office-based health care encounters. The overall perceptual differences between many comorbid consumers and health care clinicians and systems in many countries are likely to worsen. Conclusions: Conceptual implications are discussed for primary care researchers testing interventions and attempting to influence the outcomes of increasingly comorbid primary care adults. Implications for Nursing Research and Practice: Three strategies are offered for researchers and clinicians considering how to include elements of comorbidity into their prospective primary care study interventions and care delivery processes.