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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.
- Go to article: The Impact of the Political and Policy Cultures of Washington, DC, on the Affordable Care Act
- Go to article: Animal Models of Traumatic Brain Injury: Is There an Optimal Model That Parallels Human Brain Injury?
Animal Models of Traumatic Brain Injury: Is There an Optimal Model That Parallels Human Brain Injury?
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.
- Go to article: Military Personnel With Traumatic Brain Injuries and Insomnia Have Reductions in PTSD and Improved Perceived Health Following Sleep Restoration: A Relationship Moderated by Inflammation
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.
- Go to article: Leininger’s Culture Care Diversity and Universality Theory: Classic and New Contributions
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.
- Go to article: The Crisis and the Shutoffs: Reimagining Water in Detroit and Flint, Michigan, Through an EcoJustice Analysis
The Crisis and the Shutoffs: Reimagining Water in Detroit and Flint, Michigan, Through an EcoJustice Analysis
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.
- Go to article: Nursing Research on Death, Dying, and Terminal Illness: Development, Present State, and Prospects
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.
- Go to article: Postdeployment Reintegration: The Ethics of Embodied Personal Presence and the Formation of Military Meaning
Postdeployment Reintegration: The Ethics of Embodied Personal Presence and the Formation of Military Meaning
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.
- Go to article: Nursing Research in Community-Based Approaches to Reduce Exposure to Secondhand Smoke
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.
- Go to article: Psychoneuroimmunology and Related Mechanisms in Understanding Health Disparities in Vulnerable Populations
Psychoneuroimmunology and Related Mechanisms in Understanding Health Disparities in Vulnerable Populations
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.
- Go to article: Female Troubles: An Analysis of Menstrual Cycle Research in the NINR Portfolio As a Model for Science Development in Women’s Health
Female Troubles: An Analysis of Menstrual Cycle Research in the NINR Portfolio As a Model for Science Development in Women’s Health
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.