Gastrointestinal (GI) symptoms including nausea, vomiting, diarrhea, constipation, abdominal discomfort/pain, and heartburn are ubiquitous and as such are often the focus of nursing interventions. The etiologies of these symptoms include GI pathology (e.g., cancer, inflammation), dietary factors (e.g., lactose intolerance), infection, stress, autonomic nervous system dysregulation, medications, as well as a host of diseases outside the GI tract. This review focuses on a common condition (irritable bowel syndrome [IBS]) that is linked with both bowel pattern and abdominal discomfort/pain symptoms. Family and twin studies give evidence for a role of genetic factors in IBS. Whether genes are directly associated with IBS or influence disease risk indirectly by modulating the response to environmental factors remains unknown at this time. Given the multifactorial nature of IBS, it is unlikely that a single genetic factor is responsible for IBS. In addition, gene–gene (epistatic) interactions are also likely to play a role. Four genes coding for proteins involved in neurotransmission (i.e., the serotonin reuptake transporter [SERT], tryptophan hydroxylase [TPH], alpha

Significant maternal, fetal, and newborn morbidity and mortality can be attributed to complications of pregnancy. There are direct links between perinatal complications and poor fetal/newborn development and impaired cognitive function, as well as fetal, newborn, and maternal death. Many perinatal complications have pathophysiologic mechanisms with a genetic basis. The objective of this chapter is to focus on perinatal genomics and the occurrence of two specific complications: preterm birth and dysfunctional placental phenotype. This chapter includes discussions of genetic variation, mutation and inheritance, gene expression, and genetic biomarkers in relation to preterm birth, in addition to the impact of maternal tobacco smoke exposure on placental phenotype. The concept of epigenetics is also addressed, specifically the regulation of gene expression in the placenta and fetal origins of adult health and disease. There is great potential for nurse-researchers to make valuable contributions to perinatal genomics investigations, but this requires perseverance, increased genetics-based understanding and skills, as well as multidisciplinary mentorship.

Simulation pedagogy and the operations of simulation-based experiences have become an integral part of healthcare education. Academic and healthcare institutions constructed simulation centers or dedicated simulation spaces to provide simulation-based experiences for multiple health professions. Architectural designs resemble acute care settings that have the flexibility to change or include virtual reality and enhanced technology. Professional organizations have standards of best practice, credentialing requirements, and accreditation standards that support the need for high-quality, high-fidelity simulation experiences. Within healthcare education, simulation operation has become a specialty in itself that requires knowledge and experience of healthcare, education, and simulation pedagogy (INACSL Standards Committee, 2017). Simulation center administration needs an understanding of personnel management, including standardized patients (SPs), staff, faculty, and learners, as well as knowledge of budgeting, revenue streams, and technology. Personnel with unique skills and knowledge in engineering, healthcare, or information technology are required to support the simulation activities. Resources that manage inventory, supplies, equipment assets, and audiovisual requirements will increase efficiency and enhance fiscal responsibility. Technology assets such as high-fidelity human patient simulators can be used to enhance high-quality simulation, while audiovisual and data capturing software can be used for assessment, evaluation, and quality improvement. Simulation operations provides the infrastructure that supports the daily activities of simulation-based education.

Traumatic brain injury (TBI) is the leading cause of mortality and morbidity in the younger population worldwide. Survivors of TBI often experience long-term disability in the form of cognitive, sensorimotor, and affective impairments. Despite the high prevalence in, and cost of TBI to, both individuals and society, some of its underlying pathophysiology is not completely understood. Animal models have been developed over the past few decades to closely replicate the different facets of TBI in humans to better understand the underlying pathophysiology and behavioral impairments and assess potential therapies that can promote neuroprotection. However, no effective treatment for TBI has been established to date in the clinical setting, despite promising results generated in preclinical studies in the use of neuroprotective strategies. The failure to translate results from preclinical studies to the clinical setting underscores a compelling need to revisit the current state of knowledge in the use of animal models in TBI.

Animal models are a critical component of biomedical and biobehavioral research and have contributed to the exponential expansion of our understanding of human disease. Now, as we move onward into the era of genetics and genomics research, the importance of animal models to the research process will become even more acute as we explore the significance of genetic differences that are found in the presence and absence of disease. The decision to use an animal model is not one that can be taken lightly; but, rather, requires careful thought and consideration. In this review, we will address (a) why we should consider using animal models, (b) several caveats that are associated with using animals for research, and (c) some of the common genetic tools that are used in animal research.

Newborn Dried Blood Spot Screening (NBS) is a core public health service and is the largest application of genetic testing in the United States. NBS is conducted by state public health departments to identify infants with certain genetic, metabolic, and endocrine disorders. Screening is performed in the first few days of life through blood testing. Several drops of blood are taken from the baby's heel and placed on a filter paper card. The dried blood, on the filter cards, is sent from the newborn nursery to the state health department laboratory, or a commercial partner, where the blood is analyzed. Scientific and technological advances have lead to a significant expansion in the number of tests—from an average of 6 to more than 50—and there is a national trend to further expand the NBS program. This rapid expansion has created significant ethical, legal, and social challenges for the health care system and opportunity for scholarly inquiry to address these issues. The purpose of this chapter is to provide an overview of the NBS programs and to provide an in-depth examination of two significant concerns raised from expanded newborn screening, specifically false-positives and lack of information for parents. Implications for nursing research in managing these ethical dilemmas are discussed.

The purpose of this chapter is to present an analysis of selected published nursing workforce studies published between the years of 2005 and 2010. Thirteen nursing workforce studies were reviewed and analyzed using a modification of the method suggested by Ganong (1987). Nursing workforce studies were selected based on the following criteria: (1) the date of publication was between the years of 2005 and 2010; (2) the primary focus was on nurses working in practice; or, as students or faculty in nursing educational programs. When reviewed, the 13 studies (1) lacked uniform measures among databases; (2) lacked longitudinal studies that followed the respondent over time from the beginning of their career to retirement; (3) had response rates that contributed to small sample sizes or sampling frame that did not take into consideration all characteristics of interest; (4) lacked attention to an interdisciplinary mix of providers; and (5) implied the need for future study on intergenerational characteristics due to shifting demographics in the profession and nursing workforce.

Overweight and obesity in youth with type 1 diabetes (T1D) is now prevalent and accounts for significant health consequences, including cardiovascular complications and dual diagnosis of type 2 diabetes. Physical activity and lifestyle are modifiable and play an important role in the prevention and management of excessive weight, but it is unclear how these factors relate to overweight and obese youth with T1D. Thus, a systematic review was conducted to examine how physical activity, sedentary behavior, sleep, and diet are related to overweight/obesity in youth with T1D. Seven observational and intervention studies published between 1990 and 2013 were included in the review. Prevalence of overweight ranged from 12.5% to 33.3%. Overweight in youth with T1D was associated with infrequent napping, increased screen time, and skipping breakfast and dinner but was not related to time engaged in physical activity. Weight-related interventions indicated modest weight loss along with improved glycemic control. In light of this review, there is a need for high quality research that examines all levels of activity in youth with T1D to identify lifestyle modification targets for weight prevention and management.

Over the past 30 years, the health-care context as well as the roles and responsibilities of nurses have drastically changed. Leaders in nursing around the world recognize that the health-care system is stressed and the well-being of the nursing workforce plagued by the pressures and challenges it faces in everyday practice. We do not intend to make a strong normative argument for why nursing ethics education should be done in a certain way, but instead show from where we have come and to where we can go, so that educators are positioned to address some of the current shortcomings in ethics education. Our goal is to provide an illustration of ethics education as an interwoven, ongoing, and essential aspect of nursing education and professional development. By developing professional identity as character, we hope that professional nurses are given the skills to stand in the face of adversity and to act in a way that upholds the core competencies of nursing. Ultimately, health-care organizations will thrive because of the support they provide nurses and other health-care professionals.

Palliative care teams require multidisciplinary support. While this is an emerging area in anesthesia practice, there are many avenues for certified registered nurse anesthetists (CRNAs) to share their unrivaled clinical knowledge. CRNAs may become involved with or consult on palliative sedation, medical management, interventional pain management, terminal wean/extubation, and organ donation. Additionally, CRNAs need to understand the unique needs of this patient population so that they can appropriately care for palliative care patients presenting to the operating room for palliative surgery. More research is needed to further explore CRNA involvement in palliative care. However, CRNAs have a specialized knowledge of pharmacology and physiology that perfectly complements the multidisciplinary palliative care team.

The intersection of the genomic era and information age has created novel ethical, legal, and social issues that may be beyond the reach of existing guidelines for children and adolescents in research. By taking the opportunity to s

Simulation is an integral component of undergraduate nursing education because it allows for a safe, timely, and prescriptive approach to meet learning objectives at the levels of individual simulations, courses, and academic programs. This review of the literature provides an overview of steps taken to move simulation forward in undergraduate nursing education, and it highlights educational theories, research, best practices, and policy statements underpinning modern nursing simulation. This chapter outlines simulation and curriculum integration approaches and provides examples of participant, course, and program outcomes.

It is clear that technology and informatics are becoming increasingly important in disasters and humanitarian response. Technology is a critical tool to recording, analyzing, and predicting trends in data that could not be achieved prior to its implementation. Informatics is the translation of this data into information, knowledge, and wisdom. Combining technology and informatics applications with response efforts has resulted in various enhanced biosurveillance efforts, advanced communications, and information management during disasters. Although these efforts have been well described in the literature, research on the impact of technology and informatics during these efforts has been limited. As a result, this chapter will provide an overview of these technology and informatics solutions and present suggestions for further research in an era when disaster and humanitarian response efforts continue to increase as well. A literature search was performed using PubMed search tools with the National Library of Medicine Medical Subject Headings (MeSH) terms of “disasters,” “disaster planning,” “disaster medicine,” “technology,” “informatics,” and “research.” Search limitations were set for 5 years and in English. Because of the limited number of research articles in this field, the MeSH term research was deleted.

Historically, mechanical ventilation of the lungs utilizing relatively large tidal volumes was common practice in the operating room and intensive care unit (ICU). The rationale behind this treatment strategy was to yield better patient outcomes, that is, fewer pulmonary complications, and a reduction in morbidity and mortality. As evidence-based practice has evolved, potential harmful effects of traditional, nonphysiological mechanical ventilation (ventilation with larger tidal volumes and the tolerance of high airway pressures) even in shortterm treatment have been shown to correlate with systemic inflammation and the development of ventilator-associated lung injury. Lung-protective ventilation principles using more physiological tidal volumes, avoiding high inspiratory plateau pressures, along with appropriate levels of positive end-expiratory pressure have been shown to decrease pulmonary complications and improve outcomes in patients with acute respiratory distress syndrome requiring ongoing ventilatory support in the ICU. In addition, current research is beginning to validate the benefit of providing more physiologic ventilator support in the operating room, particularly for high-risk patients undergoing major abdominal surgery, in minimizing acute lung injury. A review of lung-protective ventilation measures including benefits and potential side effects is presented. Additional treatment modalities and therapeutic considerations are offered for inclusion in optimal patient management.

This chapter outlines the guiding theoretical framework of EcoJustice Education (EJE), research questions, semistructured interviews with nursing scholars that begin to question the perceptions that lead us to the crisis and recommendations of how sustainability efforts can help to address the vital relationality of human beings to water. It highlights the profession of nursing education in order for nurses to understand their roles within the context of the crises. The EJE theoretical framework will help nurse educators reimagine a new understanding and a powerful discovery that includes the awareness of a broad set of historically constructed and politically motivated power knowledge relations in nursing. The chapter provides examples and discussions of four dominant discourses predominant within the Flint Water Crisis and Detroit Water Shutoffs: anthropocentrism, ethnocentrism, individualism, and mechanism. These discourses are related to nursing education to further explain how they are pervaded in nursing.

The abstract consideration of ethical questions in family and informal caregiving might rightly be criticized for ignoring the lived experience of people. This chapter seeks to avoid such oversight by reflecting on ethical issues in family care in a way that is based on careful social scientific inquiry into the well-being of caregivers. The chapter draws on our research and experience in working with family caregivers, both professionally and personally. We step back from a practical concern with policies to support the well-being of caregivers to consider ethical issues associated with their typically hidden role. The chapter begins by noting the growing reliance on family care today. It proceeds to outline the dynamic experience of moving into and out of the caregiver role, before discussing key ethical issues associated with family care. Many of these stem from the risk that caregivers can come to share in the reduced circumstances and vulnerability of those for whom they care. Critical ethical issues are related to the typically "unboundaried" responsibility of family caregivers for the well-being of the cared-for person, something that can be contrasted with the more boundaried and intermittent responsibility of formal caregivers. Additionally, all too often, family caregivers encounter situations where their responsibilities exceed their capacities, but where a choice to not provide care will result in harm to the cared-for person. In discussing these issues, this chapter seeks to make the case for developing more responsive forms of support that promote positive benefits for both caregivers and care recipients.

Nurses serve as leaders in disaster preparedness and response at multiple levels: within their own homes and neighborhoods, at disaster scenes, and the workplace, which can vary from a health care facility, in the community, or at the state, national, or international level. This chapter provides an overview on theories of leadership with a historical context for nursing leadership; setting the context for nursing leadership in disaster preparedness and response. Although few research studies exist, there are numerous examples of nurses who provide leadership for disaster preparedness and response. To define the current state of the science, the research studies cited in this chapter are supplemented with case studies from particular disasters. The major finding of this review is that nursing leadership in disaster preparedness and response is a field of study that needs to be developed.

In 2014, the Institute of Medicine published a meta-analysis on current military reintegration programs, suggesting they have failed to improve postdeployment behavioral health. In this chapter, I explore some of the issues associated with the two paradigm reintegration programs supported by the Department of Defense (DoD), namely, BATTLEMIND postdeployment debriefings and Master Resilience Training. My discussion will be located within a subpopulation of military personnel I call warriors, particularly those men who have been exposed to combat. In performing a normative analysis of current reintegration programs, I rely on an ethics of embodied personal presence as a derivative focus of both nursing ethics and the just war tradition. Using an interdisciplinary approach to evaluate warriors' experiences of training across the military life cycle illustrates how reintegration challenges have been construed as potential pathology because disembodied reintegration programs do not consider the influence of military training and lifestyle in the development of certain health behaviors. When compared to the warrior's lived experience, a broader set of reintegration challenges emerge that cannot be fully captured by the symptoms of posttraumatic stress. Therefore, new reintegration programs need to be developed. Although I do not provide explicit details concerning what these reintegration programs should look at, I suggest that the DoD turn to something akin to the Healthy People campaign.

Scientific advances in genetics and genomics will be incorporated into health care soon. The tailoring of treatment to an individual's genetic make up has been termed Personalized Medicine. These advances are promising and are receiving significant attention; however, many nurses are caught in the gap between technologic advances and clinical diffusion and uptake. Aiming to reduce this gap, this chapter provides an overview of the science driving Personalized Medicine, outlines areas of research and clinical translation where nurses may expect to see its fruits, and briefly identifies obstacles preventing its full realization. Four scientific elements of Personalized Medicine are described: (1) discovery of novel biology that guides clinical translation mechanisms, (2) genetic risk assessment, (3) molecular diagnostic technology, and (4) pharmacogenetics and pharmacogenomics. Successful design and implementation of Personalized Medicine will hinge on the roles of nurses conducting or participating in collaborative initiatives that are furthering genetic/genomic applications within these contexts.

Self-neglect is a significant international public health issue. Estimates suggest that there may be over one million cases per year in the United States. Aging populations will put more people at risk of self-neglect. This chapter presents background literature, self-neglect definitions and policy context, risk factors, and a brief overview of research on perspectives of self-neglect from both clients and community health and social care professionals. A case study is presented from the perspective of an individual and is used to explore ethical issues therein. A person-centered assessment within a multidisciplinary team approach is required for building a therapeutic relationship with clients. Capacity is a central issue in the management of responses to self-neglect. Ethical considerations of importance for community health and social care professionals include beneficence and nonmaleficence, autonomy and capacity, and respect for people's rights and dignity. A model of ethical justification is presented to explain dilemmas, challenges, and actions. Competence of professionals, multidisciplinary team working, informed consent, privacy, confidentiality, and best interest are also critical considerations. Effective decision making by an interdisciplinary team of professionals needs to be person-centered and give due consideration to the best interest of self-neglecting clients. The purpose of this chapter is to provide an in-depth discussion and examination of ethical issues and challenges relating to self-neglecting clients.

Hispanics/Latinos represent the largest, fastest growing, and youngest minority group in the United States. Although data suggest that most Hispanics/Latinos in the United States tend to be in better health than non-Hispanic Whites (the so-called "Hispanic Paradox"), these relative advantages in health status decrease markedly with the number of years of residence in the United States. Hispanic women or Latinas, in general, report less than recommended levels of physical activity (PA), putting them at greater risk for the development of cardiovascular disease (CVD) and other chronic illnesses associated with sedentary lifestyles.

As the only burn center in the Department of Defense, the U.S. Army Institute of Surgical Research is the primary location for care of service members with burn injuries. The combat operations in Iraq and Afghanistan during the past decade have caused an increase in burn patients. As a result of this increased need, advancements in care were developed. The speed and precision of transporting patients from the battlefield to the burn center has improved over previous conflicts. Technological advancements to support treating complications of burn wound healing were leveraged and are now integrated into daily practice. Clinical decision support systems were developed and deployed at the burn center as well as to combat support hospitals in combat zones. Technology advancements in rehabilitation have allowed more service members to return to active duty or live productive civilian lives. All of these advancements were developed in a patient-centered, interdisciplinary environment where the nurses are integrated throughout the research process and clinical practice with the end goal of healing combat burns in mind.

In 1977, the federal government launched the nation's largest and most significant program to collect data on the registered nurse (RN) workforce of the United States—the National Sample Survey of Registered Nurses (NSSRN). This survey is conducted by the U.S. Health Resources and Services Administration, first in 1977 and then every 4 years since 1980. This article offers the history of the NSSRN and a review of the ways in which the NSSRN data have been used to examine education, demographics, employment, shortages, and other aspects of the RN workforce. The influence this body of research has had on policymaking is explored. Recommendations for future research are offered, in the hope that future waves of the NSSRN will continue to be used to their fullest potential.

Secondhand smoke (SHS) is the third leading cause of preventable death in the United States and a major source of indoor air pollution, accounting for an estimated 53,000 deaths per year among nonsmokers. Secondhand smoke exposure varies by gender, race/ethnicity, and socioeconomic status. The most effective public health intervention to reduce SHS exposure is to implement and enforce smoke-free workplace policies that protect entire populations including all workers regardless of occupation, race/ethnicity, gender, age, and socioeconomic status. This chapter summarizes community and population-based nursing research to reduce SHS exposure.

Most of the nursing research in this area has been policy outcome studies, documenting improvement in indoor air quality, worker’s health, public opinion, and reduction in Emergency Department visits for asthma, acute myocardial infarction among women, and adult smoking prevalence. These findings suggest a differential health effect by strength of law. Further, smoke-free laws do not harm business or employee turnover, nor are revenues from charitable gaming affected. Additionally, smoke-free laws may eventually have a positive effect on cessation among adults. There is emerging nursing science exploring the link between SHS exposure to nicotine and tobacco dependence, suggesting one reason that SHS reduction is a quit smoking strategy. Other nursing research studies address community readiness for smoke-free policy, and examine factors that build capacity for smoke-free policy. Emerging trends in the field include tobacco free health care and college campuses. A growing body of nursing research provides an excellent opportunity to conduct and participate in community and population-based research to reduce SHS exposure for both vulnerable populations and society at large.

Patient safety has become a major concern for both society and policymakers. Since nurses are intimately involved in the delivery of medications and are ultimately responsible during the medication administration phase, it is important for nursing to understand factors contributing to medication administration errors. The purpose of this chapter is to identify the incidence of these errors and the associated factors in an attempt to better understand the problem and lessen future error occurrence. Literature review revealed both active failures and latent conditions established in Reason’s theory remain prevalent in current literature where active failures often display themselves in the form of incorrect drug calculations, lack of individual knowledge, and failure to follow established protocol. Latent conditions are evidenced as time pressures, fatigue, understaffing, inexperience, design deficiencies, and inadequate equipment and may lie dormant within a system until combined with active failures to create opportunity for error. Although medication error research has shifted in emphasis toward identification of system problems inherent in error occurrence, no one force emerges as a clear antecedent, reinforcing the need for further research and replication of existing studies with emphasis placed on more dependable reporting measures through which nurses are not threatened by reprisal.

In this chapter, the research on uncertainty in acute illness is reviewed and critiqued. Both qualitative and quantitative studies are included. The review considers the cause and consequences of uncertainty from research on adults and from research on parents of acutely ill children.

The nervous system as well as the endocrine system maintain extensive communication with the immune system through the influence of hormones and neurotransmitters and also by way of the hardwiring of sympathetic and parasympathetic nerves to the lymphoid organs. There is now convincing evidence that the communication between these three body systems is bidirectional. This chapter will provide a succinct review of how neuroendocrine and immune functions are affected in factors that impact vulnerability, such as aging, acute infection, and central nervous system injury. Given that the relevant literature on these topics is vast, the presentation in this chapter will serve to highlight primary references that reflect state of the science in these systems of focus.

The National Institute for Nursing Research (NINR) has been active in developing a research portfolio of investigator-initiated studies in addressing the cause and consequences of menstrual cycle and menopause-related health problems, This chapter provides an overview of the nature and level of research activity funded by NINR since its inception in 1986, major findings generated by the most successful award recipients, the impact on the broader field of women’s reproductive health and directions for future research. Presented here is an analysis of research designs and methodologies framed within the context of 4 stages of scientific development in the field: exploratory, descriptive studies in well women; illness as a biobehavioral phenomenon; knowledge generation in understudied populations; and the development and testing of clinical therapeutics for symptom management and health promotion strategies. Nursing science contributions to the NINR portfolio of women’s health research has been focused primarily on the definition and management of the symptoms of premenstrual syndrome and menopause. The increasing numbers of intervention studies suggests a coming-of-age in nursing science with respect to the development of evidence-based outcome data for the management of menstrual cycle and menopause-related symptoms. Clearly, the range and diversity of NINR grant-funded activity suggest that menstrual cycle research is a strong area of interest in nursing science.

In Crossing the Quality Chasm, the Institute of Medicine (IOM) Committee on Quality of Health Care in America identified the critical role of information technology in designing a health system that produces care that is “safe, effective, patient-centered, timely, efficient, and equitable” (Committee on Quality of Health Care in America, 2001, p. 164). A subsequent IOM report contends that improved information systems are essential to a new health care delivery system that “both prevents errors and learns from them when they occur” (Committee on Data Standards for Patient Safety, 2004, p. 1). This review specifically highlights the role of informatics processes and information technology in promoting patient safety and summarizes relevant nursing research. First, the components of an informatics infrastructure for patient safety are described within the context of the national framework for delivering consumer-centric and information-rich health care and using the National Health Information Infrastructure (NHII) (Thompson & Brailer, 2004). Second, relevant nursing research is summarized; this includes research studies that contributed to the development of selected infrastructure components as well as studies specifically focused on patient safety. Third, knowledge gaps and opportunities for nursing research are identified for each main topic. The health information technologies deployed as part of the national framework must support nursing practice in a manner that enables prevention of medical errors and promotion of patient safety and contributes to the development of practice-based nursing knowledge as well as best practices for patient safety. The seminal work that has been completed to date is necessary, but not sufficient, to achieve this objective.

The potential for man-made or natural disasters is a reality that exists within the confines of the global setting. Man-made and/or natural disasters, although devastating to the human population, offers researchers the ability to explore and advance current preparedness, response, and recovery practices. When conducting research, consideration must be given to the ethical treatment of vulnerable populations and the protection of privacy for those affected by the disaster.

Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops following exposure to a traumatic event. The prevalence and symptom severity of PTSD is greater in military combat Veterans than the civilian population. Although PTSD is a psychiatric disorder, in Veterans, it is associated with several physical comorbidities, chronic pain, substance abuse, and worse self-reported health status which may predispose them to greater perioperative morbidity and mortality. At present, the effect of surgery on the severity of PTSD is largely unknown. However, the perioperative clinician should consider PTSD a chronic illness associated with the accumulation of risk factors across the life span.

Evidence-based practice is critical for the improvement of interventions for culturally diverse and disadvantaged groups in the community. Nurses are strategically located in the line of patient care and must be grounded in knowledge related to the delivery of culturally appropriate intervention strategies. Although many of the health care disciplines have failed to conduct or disseminate culturally competent interventions among vulnerable populations, it is important to note that nursing has long been engaged in such activities. Clearly, all health care professionals must be provided with the tools that they need to give appropriate and effective care to patients and to conduct and disseminate relevant research about vulnerable populations. This chapter focuses on culturally competent interventions for ethnic and racial minority groups, women, and the mentally ill.

Although, human simulation methodology has its origins in medical education, nursing education has increased its use of simulated patient (SP) methodology to improve the education of nursing students across the curricula. This chapter will review the history of human simulation, introduce the human simulation continuum, and review different applications of SP methodology in undergraduate and graduate nursing education.

Since the onset of war in Iraq and Afghanistan in April 2002, much attention has been given to the effect of war on servicemen and servicewomen who have now been serving in combat for over thirteen years, the longest sustained war in American history. Many service members have served multiple tours in Iraq and Afghanistan and suffered from the visible and invisible wounds of war. Much work has been done in the Veterans Administration, the Department of Defense, and the civilian sector after observing the effects of multiple deployments and overall military service on the service member. A survey of the literature revealed that the ethics of conducting research on programs to assist these brave men and women is fraught with ethical concerns based on a military culture that often precludes autonomy and privacy. While strides have been made in developing strategies to assist service members deal with their military service issues, a serious lack of information exists on the impact of a parent's service on the health and well-being of military children. A discussion of current research on services for children is presented with an analysis of the ethical problems that have precluded adequate study of those who need society's help the most.

This chapter reviews 60 published research reports about maintaining and improving physical function in elders. Reports were identified through searches of MEDLINE and CINAHL using the following search terms: Activities of Daily Living, aged, nursing care, nurse-patient relations, geriatric nursing, nursing assessment, geriatric assessment, behavior therapy, disability evaluation, exercise, and physical. Reports were included if published in English between 1985 and 2000, if conducted in adults over age 60, and if the first author was a nurse or the reported intervention was implemented by nurses. Descriptive and experimental studies of physical function in elders were included. The results of this synthesis showed that nurse scientists have developed new instruments to measure physical function, including scales sensitive to changes in physical function caused by dementia. Nursing studies have described many of the physical and psychological factors associated with poor physical function in elders, though environmental factors and ethnic differences in physical function merit further study. Many nurse scientists are currently investigating behavioral interventions, exercise interventions, and changes in nursing care that could improve the physical function of both community-dwelling elders and those who live in residential facilities.

Inequalities with respect to the distribution of societal resources can predispose people to vulnerability, which has led to a growing concern across America. The Federal Government has taken a leadership role and has launched several initiatives to combat health inequalities experienced by vulnerable populations. The National Institute of Health and all of its institutes, including the National Institute of Nursing Research, have written strategic plans to reduce, and ultimately, eliminate such health disparities. Nursing research has been conducted in the setting of vulnerable populations; several theoretical models for studying vulnerability have been created; and interventional studies designed to reduce health disparities have been implemented. This introduction includes the following: (a) a definition of the concept of vulnerability and health disparities; (b) a discussion of the conceptual models of vulnerability and health disparity and their applications; (c) a description of the impact of federal funding on vulnerable populations research; (d) a synopsis of the contributions made by nurse researchers in the field of vulnerable populations research; and (e) an overview of the volume.

Professional development in simulation methodologies is essential for implementation of quality, consistent, simulation-based experiences. Evidence demonstrates that participation in comprehensive training positively impacts learner outcomes. There are many benefits to professional development, however, challenges exist requiring thoughtful planning, administrative buy-in, and fiscal support. While there are no established guidelines, the literature provides an ongoing consensus related to overall concepts and strategies for training in simulation. We describe a continuum of growth for simulationists, ranging from novice/advanced beginner, competent/proficient, to expert. As a novice, one must conduct a self-assessment of current strengths and create a development plan to advance simulation skills and knowledge. A simulationist should use evidenced-base guidelines, mentorship, and feedback to inform simulation practices. They should be knowledgeable of the standards of best practice, modalities, simulation design, learning theories, and professional integrity. Simulationists must seek ongoing advancement through certification, scholarship, and lifelong learning. This chapter describes the continuum of education and methodologies for the development of simulationists.

Nearly 300,000 children and adults are hospitalized annually with traumatic brain injury (TBI) and monitored for many vital signs, including intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Nurses use these monitored values to infer the risk of secondary brain injury. The purpose of this chapter is to review nursing research on the monitoring of ICP and CPP in TBI. In this context, nursing research is defined as the research conducted by nurse investigators or research about the variables ICP and CPP that pertains to the nursing care of the TBI patient, adult or child. A modified systematic review of the literature indicated that, except for sharp head rotation and prone positioning, there are no body positions or nursing activities that uniformly or nearly uniformly result in clinically relevant ICP increase or decrease. In the smaller number of studies in which CPP is also measured, there are few changes in CPP since arterial blood pressure generally increases along with ICP. Considerable individual variation occurs in controlled studies, suggesting that clinicians need to pay close attention to the cerebrodynamic responses of each patient to any care maneuver. We recommend that future research regarding nursing care and ICP/CPP in TBI patients needs to have a more integrated approach, examining comprehensive care in relation to short- and long-term outcomes and incorporating multimodality monitoring. Intervention trials of care aspects within nursing control, such as the reduction of environmental noise, early mobilization, and reduction of complications of immobility, are all sorely needed.

Chronic kidney disease (CKD) is becoming a serious health problem throughout the world and is one of the most potent known risk factors for cardiovascular disease (CVD) which is considered the leading cause of morbidity and mortality in this cohort of patients. Additional independent risk factors for poor health outcomes among many include diabetes, physical inactivity and physical dysfunction. Physical inactivity partly contributes to the accelerated deterioration of physical function in people in all stages of CKD, to levels that significantly impact on clinically and patient important outcomes such as morbidity, employment, quality of life (QoL) and ultimately survival. Ongoing research aims to determine the effectiveness and impact of exercise rehabilitation on reducing/managing the risk of CVD, alleviating physical function limitations, preventing disability and enhancing QoL. Current research also aims to elucidate the mechanisms via which exercise therapy may contribute to clinically relevant benefits.

Alcohol use in children and adolescents continues to be a major health concern. There is a rich literature on correlates and antecedents of alcohol use in children and adolescents, and concerted efforts have been made to develop, implement, and evaluate intervention strategies. This chapter provides a review of the intervention studies to prevent alcohol use in these groups. The interventions are categorized by their primary focus: school, family, and community. The studies were limited to those with either an experimental or a quasi-experimental design and published results.

A systematic review was conducted to evaluate the association between coping (as measured by the Ways of Coping Questionnaire [WOCQ]) and psychological adjustment in caregivers of individuals with traumatic brain injury (TBI). A search conducted using the CINAHL, Medline, and PsycINFO databases yielded 201 citations between 1974 and 2014. A total of seven articles met the inclusion criteria; namely, the respondents who completed the WOCQ were family caregivers of individuals with TBI (including 66-item, 42-item, or 21-item versions). Reviews were conducted in accordance with the American Academy of Neurology guidelines (2011) for classifying evidence. The results found no Class 1 or Class II studies but only four Class III and three Class IV studies. The major finding across the better-rated Class III studies was that the use of emotion-focused coping and problem-focused coping was possibly associated with psychological adjustment in caregivers. The Class IV studies were determined to be inadequate or conflicting in determining the association between coping and psychological adjustment. Future studies need to employ carefully crafted designs, adhere to statistical procedure, apply advanced analytic techniques, and employ explicit models of coping, which will increase the accuracy and generalizability of the findings.

Discovery of the genetics/genomics underpinnings of health, risk for disease, sickness, and treatment response have the prospects of improving recognition and management of at risk individuals; improving screening, prognostics, and therapeutic decision-making; expanding targeted therapies; and improving the accuracy of medication dosing and selection based on drug metabolism genetic variation. Thus, genetics/genomics science, information, and technologies infl uence the entire health care continuum and are fundamental to the nursing profession. Translating the benefi ts of genetics and genomics into health care requires that nurses are knowledgeable about and able to integrate this information and technology into their practice. This chapter explores the development of essential nursing competences in genetics and genomics and outcome indicators. Included is an overview of projects aimed at measuring and/or supporting adoption and integration of such competencies. Included as well is an update reviewing current evidence of the state of genomics nursing education in the United States and recommendations for next steps.

The en route care environment is dynamic and requires constant innovation to ensure appropriate nursing care for combat casualties. Building on experiences in Iraq and Afghanistan, there have been tremendous innovations in the process of transporting patients, including the movement of patients with spinal injuries. Advances have also been made in pain management and noninvasive monitoring, particularly for trauma and surgical patients requiring close monitoring of their hemodynamic and perfusion status. In addition to institutionalizing these innovations, future efforts are needed to eliminate secondary insults to patients with traumatic brain injuries and technologies to provide closed-loop sedation and ventilation.

Early research in malignant hyperthermia (MH) focused on the autonomic nervous system (ANS) as a primary trigger of the syndrome. This hypothesis was based on the initial signs and symptoms of MH such as tachycardia, cardiac arrhythmias, hypertension, and signs of increased metabolism in patients who developed MH. Supporting these early links between MH and the ANS were case reports from anesthesia providers who reported that patients who subsequently developed MH after a nontriggering previous anesthetic had appeared unusually stressed prior to the surgical procedure in which they triggered. There is no disagreement in the scientific community that a primary disorder in MH lies in the inability to control myoplasmic calcium levels in skeletal muscles. However, considering the variability in genetic and clinical presentation, the timing of intraoperative triggering, and the unexplained phenomenon of nonanesthetic triggering, the identification of cofactors in MH triggering remains paramount. A careful review of existing research supports the hypothesis that the autonomic nervous system plays a significant role as a cofactor in the triggering and progression of an MH episode. If a differentiation can be made and a link can be demonstrated between abnormalities in receptor sensitivity for or release, reuptake, or metabolism of catecholamines in malignant hyperthermia susceptible individuals, we may be able to use these as additional markers/predictors of disease.

The purpose of this chapter is to report the findings gathered in an author-designed survey of new nurse graduates in Connecticut of their confidence in the application of environmental health in their nursing practice. An invitation to the survey was included in newsletters of Connecticut Nurses Association sent to all practicing nurses in Connecticut. New nurse graduates' confidence level regarding incorporation of environmental health vary substantially among the aspects of environmental health and this confidence decreases as they progress through the steps of the nursing process.

The tourniquet is a simple device that has been used since the Middle Ages. Although different variations have been designed throughout its history, the simplicity of design has remained. The history of tourniquets follows two distinct paths—the operating room and the prehospital setting. From the earliest recorded history, tourniquets have been used for surgical procedures which were originally to amputate war-ravaged limbs and then to create a bloodless field for routine limb surgery. This history has continued uninterrupted since the early 1900s with continued research to foster advances in knowledge. The history of tourniquets in the prehospital setting, however, has not progressed as smoothly. The debate regarding the use of a tourniquet to save a life from excessive limb hemorrhage began in the 1600s, and continues to this day. This chapter will explore the prehospital use of tourniquets, which may shed some light on where this debate originated. The current state of the knowledge regarding tourniquets will then be discussed with a focus on prehospital use, using the operating room literature when needed to fill knowledge gaps. The chapter will conclude with recommendations for prehospital tourniquet use and some areas for future research. Tourniquets are used for operative procedures within accepted clinical guidelines throughout the world as the standard of care. Current science supports a similar stance for the use of prehospital tourniquets within clinical guidelines.

Simulation is used in advanced practice nursing education for both formative learning experiences and summative competency testing. However, there has been a lack of cohesive data to support the use of simulation as a replacement for direct patient care hours. This chapter presents an overview of research designs and the leveled Kirkpatrick framework used in simulation research. Research articles evaluating the effect of simulation on advanced practice learners are presented by research design and Kirkpatrick level. There is evidence that simulation has a positive impact on Kirkpatrick Level 1 (Reactions) and Kirkpatrick Level 2 (Changes in Knowledge, Skills, and Attitudes). However, there is a tremendous need for evidence that simulation can impact Kirkpatrick Level 3 (Behavior) and Level 4 (Results and Outcomes).

The purpose of this chapter on biological models for studying and assessing tobacco use is to provide an introduction to some of the common concepts and biomarkers in this arena to ultimately inform intervention research by nurse scientists. An overview of selected biomarkers of tobacco exposure in individuals includes exhaled carbon monoxide, cotinine (the proximate metabolite of nicotine), and measurement of an individual’s puffing pattern termed smoking topography. Common tobacco contents discussed include tobacco specific nitrosamines (TSNA) and polycyclic aromatic hydrocarbons (PAH) some of which increase disease risk including cancer. Exemplars of additives to cigarettes by the tobacco industry will be described including menthol, one additive marketed by the industry. Genetics and tobacco addiction has emerged as a rapidly expanding field. Illustrative of this area are twin studies, nicotinic receptors, CYP2A6 polymorphisms, and genes that impact dopamine receptors. The cadre of nurse scientists conducting research in this much needed area is small. The opportunity for nurse scientists educated in biological inquiry in tobacco-related research is great. Nurse scientists actively involved in multidisciplinary translational teams to address nicotine addition are needed.

Cannot intubate/cannot ventilate (CICV) situations during anesthesia are rare, potentially catastrophic to the patient, and difficult to predict. Widely adopted practice guidelines advocate an algorithmic approach to CICV situations in which the anesthetist: (a) recognizes the CICV situation, (b) calls for help, (c) steadily progresses through a variety of methods to ventilate the patient and secure the airway, (d) restores ventilation via an infraglottic airway if the patient cannot be safely awakened prior to becoming moribund. Despite widespread consensus that rapid progression to placement of an infraglottic airway is critical to the survival of the patient in a CICV situation, the rarity of CICV is a substantial barrier for anesthetists attempting to gain and maintain skill at placing infraglottic airways.

This review was undertaken to present and critique the most recent (1990-2000) empirical evidence about end-of-life care for older adult patients in ICUs, their families, and care providers. The studies (including descriptive, correlational, longitudinal, and intervention) were found using a combination of these terms: (a) intensive care (units) or critical care (units), and (b) critical illness, critically ill patients, terminally ill, terminal care, life support care, or palliative care. The computerized databases searched were CINAHL and MEDLINE. Only published studies of persons 44 years of age or older, written in English, and conducted in the U.S. or Canada were included. Research was not limited to studies conducted by or written by nurses. Excluded were articles focused on physiology, for example, studies of treatment for specific conditions, and articles focused on predictors of ICU outcomes.

Findings and Implications for Research

There is little research specifically focused on end-of-life care of older adults in ICUs. Most research has been retrospective, and most has involved either providers or patients and families but not both.

Research is needed in many areas. The mechanism by which age affects choice of care needs further exploration. The experience of patients, families, and providers and how those experiences change with interventions needs investigation. The influence of the ICU culture, variation in decisions made and reasons for that variation, the decision-making process, and variations in care, all require further attention. Four domains were identified for research needed to improve care for older adults at the end of life in intensive care: symptom relief, communication improvement, psychological support, and relationship improvement. No one has assessed whether the ICU is a good place for transition to palliation to occur, or whether it would be better to transfer patients to another type of unit.

Nurse scientists have made important contributions to evidence-based practice in tobacco control. This chapter will discuss recent tobacco control developments in the United States and globally, such as legislation giving the U.S. Food and Drug Administration regulatory authority over tobacco products manufacturing, marketing and sales, the World Health Organization Framework Convention on Tobacco Control, and a brief review of research that has guided policy advances and nursing research in tobacco control. Suggestions for future research based on the update of the U.S. Public Health Services Treating Tobacco Use and Dependence clinical practice guideline will be explored. These developments offer nursing researchers a wealth of opportunities and challenges to advance nursing and tobacco control knowledge, address research gaps, and bring a unique nursing perspective to tobacco use prevention, reduction of exposure to secondhand smoke, tobacco dependence treatment, and tobacco control policies. Additionally, we will address how nursing scholarship can and should be supported by academic and organizational leadership to support nurses in realizing their full potential in mitigating the global epidemic of tobacco-caused death and disease.

Tobacco use (primarily cigarette smoking) continues to be the most preventable health risk in the United States and the second greatest health threat around the world. In 2020 the global burden is expected to exceed nine million deaths annually. Nursing, with the largest numbers of health care professionals has an opportunity to make a significant reduction in tobacco use through its research and client-focused care. This chapter addresses why and how monitoring the tobacco epidemic with population-based databases and meta-analyses is important for nurse researchers and for evidence-based nursing practice. Population-based surveys permit an examination of trends in tobacco use and the progress in tobacco control with some confidence across time, places (i.e., states, nations, communities, etc.), and large numbers of participants. Included in this review are a description of the numerous national and international databases and other resources that nurse researchers can use to build the science of tobacco use. Additionally, research reviews and meta-analyses are described as other vehicles for providing a basis for making evidence-based decisions about nursing intervention. Nurse scientists have an obligation to use and evaluate these diverse resources to determine the gaps in knowledge, provide a foundation for clinical practice, and identify the needs and directions for future research in the field.

Racial and ethnic minorities, women and infants, youth, and other special needs populations have been found to be disproportionately affected by infectious disease morbidity and mortality, particularly Human Immunodeficiency Syndrome/Acquired Immunodeficiency Syndrome (HIV/AIDS) and other sexually transmitted diseases (STDs). Being a vital component of the health care delivery system, nurses play an important role in improving the health of these vulnerable populations. Twenty-six studies reporting results from evaluations of prevention strategies targeting HIV/AIDS and other STDs among vulnerable populations were reviewed. The more effective interventions appeared to be those that tailored their program content to the specific risk factors of their target population and included skills training in their curriculum. Although nurses have contributed significantly in understanding the risk factors of vulnerable groups in the United States through cross-sectional research studies, more research is needed in the evaluation of intervention programs that use this knowledge to develop and implement prevention programs, particularly at a population-based level.

This chapter reviews 94 published research reports on transitional care of older adults by nurse researchers and researchers from other disciplines. Reports were identified through searches of MEDLINE, CINAHL, HealthSTAR, Sociological Abstracts and PsycINFO using combinations of the following search terms: transitional care, discharge planning, care coordination, case management, continuity of care, referrals, postdischarge follow-up, patient assessment, patient needs, interventions, and evaluation. Reports were included if published between 1985 and 2001, if conducted on samples age 55 and older, if relevant to nursing research, and if published in English. Intervention studies had to have a control or comparison group and a test for statistical significance. Four key findings from this review were identified. A high proportion of elders and their caregivers report substantial unmet transitional care needs, with the need for information and increased access to services consistently among the top priorities. Differences in expectations between and among patients, families, and health care providers, and the need for increased patient and family involvement in decision making, are common themes in discharge planning studies. Gaps in communication have been identified through the discharge planning process. Evidence about the effects of innovations in transitional care on quality and cost outcomes is sparse. Four main recommendations are made. Differences in older adults’ transitional care needs based on race, ethnicity, and educational level, with attention to potential disparities, require further study. Studies of strategies to promote effective involvement of patients and families in decision making throughout discharge planning are needed. The development and testing of referral and other information systems designed to promote the transfer of accurate and complete information across sites of care should be a research focus. A priority for future research should be continued study of strategies to improve transitional care outcomes of older adults and their caregivers.

This chapter focuses on promoting cultural competence in research and the care of vulnerable populations by establishing inter-university nursing partnership centers for health disparities research between historically Black universities and minority-serving institutions and research-intensive majority institutions. The Hampton-Penn Center to Reduce Health Disparities (HPC), an inter-university collaborative center funded through the National Institutes of Health (NIH) National Institute of Nursing Research (NINR) P20 funding mechanism, is discussed as the exemplar. The mission of the Hampton-Penn Center is to promote culturally competent research on health promotion and disease prevention and the examination of how culture, race and ethnicity and their interactions with the health care system and the larger society influence health outcomes and the occurrence of health disparities. The history, goals, and conceptual model underlying this collaborative effort between the University of Pennsylvania and Hampton University Schools of Nursing are described as are the accomplishments and lessons learned to date. Based upon the Hampton-Penn experience, recommendations for similar collaborations to reduce health disparities among vulnerable populations are made in three major areas: (a) increasing the study of the multi-system level factors that contribute to health disparities among vulnerable populations, (b) promoting the development of culturally competent research on health disparities, and (c) promoting the recruitment and training of health researchers who are themselves members of vulnerable populations.

Qualitative research methods are increasingly used by nurse scientists to explore a wide variety of topics relevant to practice and/or health policy issues. The purpose of this chapter is to review the contributions of nurse scientists to the field of tobacco control through the use of qualitative research methods. A systematic literature search strategy was used to identify 51 articles published between 1980 and 2008. The majority (84%) of reviewed articles were authored by North American nurse scientists. Cessation was the most commonly (85%) studied aspect of tobacco control. Six qualitative research approaches were used: qualitative descriptive (55%), narrative analysis (8%), phenomenology (6%), grounded theory (14%), ethnography (12%), and case study (6%). Qualitative descriptive methods were primarily one-off studies to address practical problems or issues encountered in practice, and often validated current understandings related to tobacco. Researchers who used other types of qualitative methods and who conducted qualitative studies as part of programs of research were more likely to make more substantive contributions to the evolving field of tobacco control. These contributions related to how smoking intertwines with personal and social identities, the influence of social context on tobacco use, and nurses’ involvement in tobacco control (both of their own tobacco use and in assisting others). Nurse scientists interested in exploring tobacco-related issues are encouraged to consider the full range of qualitative research approaches. Qualitative research methods contribute to our understanding of tobacco use arising from nursing practice, health care and policy, along with the field of tobacco control in general.

The purpose of this chapter is to discuss how genetics will affect gerontological nursing. The chapter will answer two questions: (1) Which aspects of genetics will be most relevant to future gerontological nursing practice? and (2) What will be the impact of genetics on the future of gerontological nursing education and research? MEDLINE was searched for relevant articles from 1995 to 2001 using the key words aging, genetics, geriatrics, nursing education, research, and gerontology. CRISP was searched using the thesaurus terms education/planning, genetics, health education, model design/development, psychological model, pubic health curriculum, behavioral/social science research, and research nursing/genetics. A total of 101 nursing and nonnursing articles were reviewed. Research reports were selected if they focused on issues related to gerontological nursing. Articles were reviewed that had application to genetic nursing, complex diseases, and genetics.

The evolution of the science of genetics will revolutionize gerontological nursing and affect future nursing education and research as the concepts of genetic science and the technology they generate are translated into everyday clinical practice. Genetic discoveries in common complex diseases will affect care provided by gerontological nurses in the 21st century. Gerontological nurses must move quickly to recognize this genetic paradigm shift and to incorporate genetics issues into their nursing practice.

Simulation has been used in nursing education and training since Florence Nightingale's era. Over the past 20 years, simulation learning experiences (SLEs) have been used with increasing frequently to educate healthcare professionals, develop and increase the expertise of practicing professionals, and gain competency in key interprofessional skills. This chapter provides a brief overview of simulation evaluation history, beginning in the late 1990s, and the initial focus on learner self-report data. Using Kirkpatrick's Levels of Evaluation as an organizing model, four types of SLE evaluation are reviewed as well as suggestions for future research.

A large proportion of Americans report binge or heavy drinking. The human and economic costs of alcohol misuse are extensive, with hundreds of thousands of lives lost or disrupted and billions of dollars spent due to impaired productivity, crime, and adverse health consequences. In an effort to reduce costs such as these, scientists and clinicians have developed brief interventions, characterized by their low intensity and short (5–60 minutes) duration, as well as by their intent to provide early intervention before drinkers develop alcohol abuse or dependence. The purpose of this review, therefore, is to analyze research studies related to brief intervention and critically analyze and critique their findings. In addition, both prospective randomized controlled trials and meta-analyses will be used to discuss the implications for clinical practice and make recommendations for future research.

The purpose of this chapter is to review and critique the literature on risky drinking, driving, and sexual behaviors. To complete this review, electronic searches using databases from the disciplines of nursing, medicine, and psychology were used with keywords alcohol and risky behavior, risky drinking, risky driving, risky sex, and sexual aggression, as well as other relevant terms.

The basic tenets of contemporary theoretical models of risky behaviors are used as a framework for reviewing the literature. Most relevant to the discussion are the relationships among the behaviors, risk and protective factors, and major unresolved theoretical and methodological issues. In the literature, sensation seeking was differentially associated with risky drinking, driving, and sex, but causal assertions are premature.

Important conceptual and physiological issues are clarified. First, unconventionality contributes to risky drinking, risky driving, and, among adolescents, risky sex. Second, the pharmacologic effects of alcohol on cognitive processing contribute to risky sex, but only among persons who feel conflicted about risky sex (e.g., condom use). This perception may be particularly true for men who have a belief that alcohol will enhance sex. Third, sexual aggression appears to stem from a variety of factors, including the pharmacologic effects of alcohol on aggression and stereotypes about drinking women.

Exploration of risk and protective factors adds breadth and depth to the discussion of risk taking. Risk factors include (1) high tolerance for deviance, (2) unconventional attitudes and behaviors such as early alcohol use and precocious sex, (3) peer norms for deviance, (4) high sensation seeking, and, to a lesser extent, (5) disturbed risk perception and positive beliefs about alcohol. Protective factors appear to mitigate risk and include (1) conventional attitudes and behaviors and (2) having peers that model conventional attitudes and behaviors. Although empirical evidence suggests that risky behaviors tend to covary, most intervention trials to date have focused on single behaviors, and often are based on clinical information rather than existing theoretical and empirical knowledge.

An examination of women’s transition through menopause provides a remarkable example of nursing’s contributions to feminist scholarship. The predominant biomedical model perpetuates the idea that menopause is a deficiency disease, whereas feminist and nurse scholars have deconstructed this paradigm and have reclaimed menopause as a part of midlife women’s developmental stage. We begin this chapter with a review of the birth of women’s health scholarship as it is the foundation for theory that undergirds feminist nursing research. We then discuss the tenets of feminist scholarship. The historical context of menopause is reviewed briefly to highlight the ways in which menopause was transformed from a normal physiological event to a disease. Using this as a backdrop, we reviewed nursing studies in two emerging bodies of knowledge. We reviewed 10 studies in the area of “women reclaiming menopause” and found that over all women believe the menopausal transition is a normal developmental stage. The second area of new research looks at “menopause across cultures.” The studies of Korean, Indian, and Thai women reviewed demonstrate that similar to other health issues, the experience of Western women cannot be universalized, and most important, researchers must take into consideration the social, political, economic, and cultural forces that impact women’s experience of the menopause transition.