Healthy body image is critical to adolescent development, and teens often diet and worry about their weight and appearance. However, for some youth these concerns become fixed and distorted, resulting in psychopathology. Eating disorders, particularly binge-eating disorder, anorexia nervosa, and bulimia nervosa, are serious, complex chronic disorders, which can be life-threatening. Differential diagnoses for eating disorders include: cardiac valvular disease, malabsorption syndromes; inflammatory bowel disease; chronic infections; thyroid disease; hypopituitarism, Addison disease; central nervous system lesions; cancer; and other psychiatric disorders including depression, obsessive-compulsive disorder, anxiety, and substance abuse. Eating disorders are difficult to treat, especially when presenting with comorbid diagnoses, and treatment depends on the severity of the illness. Primary health care providers play a critical role in assessment, monitoring of treatment progress, screening for and managing medical complications, and coordinating care with psychiatric and nutritional professionals.
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This chapter reviews prevention, including genetic counseling. It discusses genetic testing for diagnosis as opposed to screening and the treatment for genetic disease. Methods of prevention begin with education of the public and health care professionals and identification of those at risk. Genetic counseling is the process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. The malignant cells often exhibit aneuploidy as well as translocations that are found only within the tumor cells. Genetic errors that arise from specific cell lines are somatic mutations. It is suggested that there is a thorough collection of family, genetic, and medical history for children entering the adoption process. Nurses may play a variety of roles in genetic counseling that reflect their preparation, area of practice, primary functions, and setting. The chapter explains the incidence of chromosome abnormalities.
The initial recognition of the need for a genetics referral may arise when a nurse suspects a genetic contribution to disease because of personal or family medical history and/or findings from a physical assessment. Family history is a valuable and cost-effective tool that is often underutilized in clinical practice. Many common genetic conditions result from complex interactions between genetic and environmental factors. It is critical to collect information about potential environmental exposures to help inform a patient’s risk assessment. Health care professionals should become familiar about toxic environmental agents that are common in their specific geographic location. A growing number of Food and Drug Administration (FDA) approved drugs have labeling that includes pharmacogenomic information, which can be used to optimize drug dosage and prevent adverse and life-threatening drug reactions in a patient or family member.
Nurses working in the field of obstetrics must have a greater depth and breadth of genetic knowledge over any other subspecialty. In gestation, nurses should include education on the effects of teratogens, prenatal screening options, and prenatal diagnoses. After delivery, early recognition of genetic disorders is important for immediate initiation of potentially life-saving therapies. Preconception education is a critical component of health care for women of reproductive age. The Centers for Disease Control and Prevention (CDC) recommend that all women of childbearing age consume 0.4 mg of folic acid daily to prevent neural tube defects (NTDs). Counseling can still be useful in terms of optimum pregnancy management in a setting best able to cope with any anticipated problems. Complex and multifaceted maternal and fetal factors influence the consequences of drugs, radiation, and chemical and infectious agents to the developing fetus.
This chapter provides a guide to conducting a life history from conceptualization to dissemination. Life history is used to explain an individual’s understanding of social events, movements, and political causes, that is, how individual members of groups or institutions see certain events and how they experience and interpret those events. As it is unlikely that nurses will be conducting traditional fieldwork to gather life histories because of the extensive periods of time involved, the chapter describes the process for collecting focused life histories by researchers whose only purpose is to document the story of the participant and not to frame this life history within a broader ethnography. It considers life history as a sociocultural methodology and leave oral history on historical research and life review to the one on clinical literature.
Grounded theory is a systematic qualitative research method of data collection and analysis, ultimately leading to a theoretical explanation (a “grounded theory”) that is grounded in those data and that explains a phenomenon of interest. Widely used in nursing, grounded theory enables researchers to apply what they learn from interviewees to a wider client population. This book describes traditional and focused grounded theory, phases of research, and methodology from sample and setting to dissemination and follow-up. The grounded theory method was developed by Glaser and Strauss, in response to Blumer’s call for a method founded on concepts of symbolic interactionism, the social psychological theoretical framework that provides the guiding tenets of grounded theory methodology. Over the years, grounded theory has undergone an evolution of sorts. An alternate method of grounding data in qualitative research is dimensional analysis. Other scholars have developed variants of grounded theory, such as constructivist grounded theory and situational analysis. The book describes the extent to which nurse researchers have published grounded theory and presents an overview of the process of conducting a qualitative study using grounded theory as the method. Varied case studies range from promoting health for an overweight child to psychological adjustment of Chinese women with breast cancer to a study of nursing students’ experiences in the off-campus clinical setting, among many others. The book also discusses techniques whereby researchers can ensure high standards of rigor. Examples from published nursing research, with author commentary, help support new and experienced researchers in making decisions and facing challenges.
This book provides school personnel with information on how concussion (mild traumatic brain injury) can affect learning, mental health, and social-emotional functioning, skills in developing and leading a school-based concussion support team, tools for school-based concussion assessment, and information on a safe, gradual process of returning to the academic environment. It explains what happens to the brain at the moment of impact, terminology, prevalence rates, causes, risk factors, and issues related to underreporting of concussions. Educators will learn about developmental effects, how concussions can affect students of different ages, as well as difficulties that can result from concussions such as postconcussion syndrome and second impact syndrome. This book presents a school-based concussion team model, including the specific responsibilities of the concussion team leader (CTL), and a discussion of maintaining student privacy through regulations like the Health Insurance Portability and Accountability Act of 1996. Readers are familiarized with checklists that can be used within the school and assessment tools such as Acute Concussion Evaluation (ACE) and neuropsychological assessment. Readers are also familiarized with how physical and cognitive rest can be balanced with a return to activity during the recovery period. This book also book gives concussion team members guidance on the selection of appropriate strategies, as well as decision making during a student’s return to academics, and discusses concussion prevention information by providing guidance on how readers might train others on concussion recognition and response. Case studies are integrated throughout the chapters.
This chapter includes information related to the clinical evaluation of a concussion that a child might receive in a medical setting. It discusses guidelines for appropriate use of smartphone concussion evaluation apps. This chapter examines a brief section on the future of concussion assessment. The Acute Concussion Evaluation (ACE) can help the school concussion team obtain information regarding the injury, including the cause, severity, any amnesia, loss of consciousness (LOC), and any early signs. The computerized neurocognitive assessment typically measures player symptoms, verbal/visual memory, attention span, working memory, processing speed, response variability, nonverbal problem solving, and reaction time. Neurocognitive tests, sideline assessments, and smartphone apps can help district staff and parents determine the severity of a student’s symptoms. A neuropsychological assessment to assess cognitive functioning, memory, speed, and processing time may also be administered.
The purpose of the life histories is to introduce doctoral students to a methodology that is not usually covered in qualitative texts but that has applicability to the study of nursing phenomena. Three doctoral students conducted abbreviated life history interviews as a class assignment for their course on qualitative methods. Their interviews were part of a larger study by de Chesnay on successfully overcoming adversity, for which she obtained institutional review board (IRB) approval from the university. The first publication was a set of life histories with successful African American adults. The second publication was a series of life histories conducted by master’s degree students on clinical topics related to their interests. These topics were surviving colostomy surgery, multiple sclerosis, and bereavement. The third publication involved undergraduate nursing students who interviewed affluent adolescents about their experiences of substance abuse.
This chapter presents an overview of the state of the art ethnographies conducted by nurses and highlights a few works by the early generation. An extensive search of the literature was conducted to identify ethnographies completed by nurses. Nursing knowledge was a common thread throughout the literature reviewed. The literature review revealed the progress nursing is making in recognizing this gap and attempting to close it. Nursing knowledge is essential in patient care. Using the ethnographic method of inquiry, nurses have been able to identify areas of need both in knowledge and practice and make recommendations for enhanced practice. Caring and patient advocacy were other common themes in the literature. Caring is the essence of nursing and consequently should be incorporated in nursing research. The common purpose of the ethnographic studies reviewed was to explain or understand a phenomenon to increase nursing knowledge.