From miasma to fractals: the epidemiology revolution and public health nursing

If public health nursing is truly a synthesis of public health science and nursing science, then nurses must keep track of current developments in public health science. Unfortunately, the public health nursing literature has not kept pace with revolutionary developments in epidemiology, one of the sciences that informs population-focused nursing practice. Most epidemiology chapters in community health nursing texts do not reflect the intellectual development that has taken place in epidemiology over the past two decades. The purpose of this article therefore is to facilitate an updated synthesis by (a) reviewing the development of epidemiology and the focus of public health nursing practice through three historical eras, (b) discussing current controversies and tensions within epidemiology, (c) introducing an emerging paradigm in epidemiology based on an ecosocial perspective, and (d) discussing the congruence of this perspective with the evolving theory and practice of public health nursing.     

Conceptual parameters of acculturation within the Asian and Pacific Islander American populations: applications for nursing practice and research

TOPIC. Asian and Pacific Islander Americans (A&PIAs) are experiencing health inequities. For example, A&PIA is the only racial/ethnic group in America to experience cancer as their leading cause of death. Several studies within the A&PIA population have pointed to acculturation as a significant variable to explain their health and health‐seeking behaviors. Acculturation is a key construct in understanding the health of the A&PIA population. OBJECTIVE. The purpose of this concept analysis is to provide a current conceptual understanding of the relationship between acculturation and health, especially within the A&PIA populations, which will serve as a pragmatic guideline for nursing practice and research. Understanding the contemporary issues surrounding the conceptual application of acculturation will aid in the development of appropriate programs to reduce health inequities. METHODS. Acculturation was explored using the Morse method of concept analysis. An iterative historical and contemporary literature review across the disciplines of anthropology, sociology, psychology, medicine, and nursing was completed. Analytical questions asked of the resultant data provided the theoretical definition, antecedents, key attributes, outcomes, and implications. RESULTS. The concept analysis resulted in a new theoretical definition that includes multidimensional concepts of acculturation. Dilemmas in the measurement of key attributes of acculturation include unidirectional and bidirectional analysis, psychometric issues, and the appropriateness of proxy measurements. Outcomes of acculturation on health can be positive or negative and depend on an individual's or group's ability to navigate freely with necessary supports. Results of the conceptual analysis resulted in recommendations for nursing practice and future acculturation research. CONCLUSION. While debate continues about the appropriate use and definition of acculturation, researchers agree that it is an important construct in understanding the health of migrating individuals and groups. Currently there is no testable framework that delineates the role of acculturation in health. Further research is indicated to clarify the relationship between acculturation and health.     

Health Behavior: Evolution of Two Paradigms

Public health nursing is a synthesis of professional nursing and public health science. To assist people effectively to determine and enhance their health capabilities, it is essential that public health nurses have a sound understanding of the behaviors that improve or jeopardize health. This concern arises from the profession's increased emphasis on health behavior and from nursing's stated goal of health promotion. To examine the topic from the perspectives of public health and professional nursing, we examine several issues related to the concept and its definition. We hope that the discussion will stimulate analysis both to clarify the concept and to contribute to the development of public health nursing science.     

Whistleblowing: A concept analysis

The concept of whistleblowing, which began to emerge in the 1970s, has gained significant traction over time and across disciplines, including law, management, public administration, sociology, psychology, and health sciences. Interestingly, nurses and nursing students account for the majority of the participants in studies pertaining to whistleblowing. Nursing research conducted in the past two decades provide a good foundation on which to build a better understanding of the context in which whistleblowing takes place, the process of whistleblowing itself, and the repercussions experienced by whistleblowers, but major conceptual gaps remain. In fact, limited attention has been given to the conceptual underpinnings and the use of the concept of whistleblowing in nursing. The goal of the present conceptual analysis was to start addressing this gap and raise some critical questions about the future application of this concept in nursing, including potential opportunities and limitations. Our analysis allowed us to identify a number of antecedents, attributes, and consequences of whistleblowing in nursing. It also revealed three areas needing more attention: the concept itself, organizational culture, and research into the complexities of whistleblowing.     

Physical restraint in mental health nursing: A concept analysis

ObjectivePhysical restraint is frequently used in medical services, such as in mental health settings, intensive care units and nursing homes, but its nature varies in different institutions. By reviewing related literature, this study aims to clarify the concept of physical restraint in mental health nursing.MethodThree databases (PubMed, PsycINFO and CINAHL) were retrieved, and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing.ResultsPhysical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement. It should be the last option used by qualified personnel. Antecedents of physical restraint are improper behavior (violence and disturbance) of patients, medical assessment prior to implementation and legislation governing clinical usage. Consequences of physical restraint are alleviation of conflict, physical injury, mental trauma and invisible impact on the institution.DiscussionThis study defined the characteristics of physical restraint in mental health nursing. The proposed concept analysis provided theoretical foundation for future studies.     

Shepherding: A concept analysis

The purpose of this analysis was to explore the concept of shepherding as it applies to nursing. Shepherding is a term used in chaplaincy literature to describe the guidance and protection a chaplain offers. While this term may be appropriate to the relational work of nurses, it has yet to be defined in the nursing literature. Walker and Avant's eight-step method for concept development was utilized. An electronic search using “shepherd/shepherding and nursing or health or inpatient” was performed in eight databases related to nursing, medicine, health, social sciences, and chaplaincy. Scholarly articles, in English, with substantive references to shepherding were included. Four defining attributes related to shepherding were identified: relational interaction, safety and comfort, reciprocal guidance, and transformation through possibilities and actualization. The operational definition of shepherding was thus identified as a relational interaction between the nurse and a patient or family during a transformational crisis. The nurse accompanies the patient, ensuring safety, and comfort and, through reciprocal guidance, the nurse supports the patient to understand possibilities and actualize possibilities based on the patient's preferences.     

Energy: A concept analysis from a nursing perspective

The term “energy” is common in day‐to‐day language and denotes a myriad of different meanings depending on context. Energy is one of the most significant concepts for nearly all of the sciences including nursing, and yet it continues to be ambiguously defined. This article utilizes a modified version of Walker and Avant's framework for concept analysis (2011) to identify the characteristics, attributes, and antecedents of the concept of energy and provides a practical and theoretical application to nursing. The defining attributes discussed are power, productivity, effort, and activity. Model and contrary cases are presented to better provide a representation of the concept of energy. Empirical referents or a proper measurement or assessment of energy are nonspecific and poorly defined. Opportunities for future research related to the concept of energy in nursing include implementation of new terminology or theory development.     

Application of a Model for Public Health Nursing Program Planning

Abstract Community health nurse (CHN) specialists have advanced educational preparation in both nursing and the public health sciences. They are called on to perform numerous advanced practice roles in public health and other community agencies, one of which is program planning. To perform this role effectively, CHN specialists should use conceptual models to guide application of the nursing process in a population-based practice. One such model developed by a nurse for use in planning community health programs is the McLaughlin model. It was used to address the community diagnosis of risk for childhood lead poisoning, a long-standing public health problem currently receiving renewed attention from federal public health authorities. Applications of conceptual models in practice settings can test such model's efficacy, enrich the scientific basis of community health nursing practice, and ultimately improve the health of the community.     

The model of cultural competence through an evolutionary concept analysis.

Becoming a culturally competent health professional is a demanding prerequisite in this multicultural society. Cultural competence is explored and abstracted as a conceptual framework through a concept analysis using the evolutionary method. Its model is constructed from a systemic, comprehensive literature review and analysis. Taking into account how cultural competence is viewed by other disciplines (medicine, psychology, education, and social work), a comprehensive definition, antecedents, and consequences of cultural competence in nursing are described and diagrammed. Additionally, two model cases and future implications are discussed. The broader American society is composed of a mosaic of discrete cultural groups existing within the context of their values and identities. Those distinct cultures affect each patient's ways of thinking and his or her perceptions on health care and health behaviors. The proposed model of cultural competence provides a theoretical guide for developing strategies to achieve culturally competent care in nursing practice and research.     

Nursing Theory and Public Health Science: Is Synthesis Possible?

The American Public Health Association (APHA) and the American Nurses' Association (ANA) have gone on record to define public health nursing as a synthesis of knowledge (APHA) and practice (ANA) from nursing and public health. If this synthesis is to be consistent with nursing, knowledge will have to be congruent with the concepts of nursing's metaparadigm. Disease is not included within the concepts of person, environment, health, and nursing. The focus of the public health tradition is reflected in the concepts of the epidemiologic model (agent, host, environment). Disease and its prevention are the focus of public health science. Reformulation of concepts from public health to be consistent with concepts of person and environment, replacing the concept of illness with that of health, and using methods for study of aggregates are strategies for achieving a synthesis of these two bodies of knowledge.     

Actor‐Network Theory as a sociotechnical lens to explore the relationship of nurses and technology in practice: methodological considerations for nursing research

Actor‐Network Theory is a research lens that has gained popularity in the nursing and health sciences domains. The perspective allows a researcher to describe the interaction of actors (both human and non‐human) within networked sociomaterial contexts, including complex practice environments where nurses and health technology operate. This study will describe Actor‐Network Theory and provide methodological considerations for researchers who are interested in using this sociotechnical lens within nursing and informatics‐related research. Considerations related to technology conceptualization, levels of analysis, and sampling procedures in Actor‐Network Theory based research are addressed. Finally, implications for future nursing research within complex environments are highlighted.     

Time to think: temporal considerations in nursing practice and research

AIMS OF THE STUDY/PAPER: To explore the meaning of nursing time, both as it is represented in the literature and interpreted within nursing practice. To explore how nursing time may be better conceptualized through exploring non-nursing literature and the use of theory derivation. BACKGROUND/RATIONALE: The dynamic of time is one of the most important influences upon nursing behaviour, yet temporal issues have attracted very little attention in the literature regarding nursing practice, theory and research. DESIGN/METHOD: In the course of this literature review an attempt is made, via the process of theory derivation, to clarify the meaning of 'nursing time', and how nursing time is valued and perceived by others. RESULTS/FINDINGS: The literature reveals misconceptions and a lack of value of nursing time, possibly indicative of the dominance of linear models of time (such as clock and calendar time), and the historical ascendancy of medicine and the positivistic sciences over nursing. It is proposed here that nurses exist and practice within nonlinear, complex and parallel temporal worlds; these are considered by examining research data that illustrates a moment in nursing time. Exploring this moment gives an opportunity to introduce some terms and concepts that may be useful in the future conceptualization of nursing time. CONCLUSIONS: It is recommended that attention to such factors as the complex temporal dynamics inherent within health care in general, and nursing in particular, should be considered within the domains of nursing practice and research. This may help in distinguishing the fundamental identity and nature of nursing within health care and health care professions.     

Chronic Pain Transition: A Concept Analysis

Chronic pain is common, costly, and potentially disabling. According to the Medical Expenditure Panel Survey in 2008, approximately 100 million adults were affected by chronic pain, with national costs estimated between $560 and $635 billion annually. Published point-prevalence estimates of adult onset chronic pain from population-based surveys vary widely, with worldwide estimates ranging from 2% to over 55% and, within the United States, from 14.6% to 64%. Among patients who seek out a health care professional after initial injury, pain, and function typically improve substantially in the first month; however, those who do not improve account for the bulk of individual and economic burden (Slater et al., 2009). This improvement or lack thereof has been linked to prognostic variables deemed responsible for the transition to chronic pain. The purpose of this analysis is to examine the concept of chronic pain transition in the context of adult onset non-cancer chronic pain. Defining the concept of chronic pain transition is essential to the future of pain research, as chronic pain transition has not been researched in the context provided here. Using Rodgers' inductive method of concept analysis, the concept of chronic pain transition was studied. A random sample of nursing, medical, psychology, and allied health literature published between 1982 and 2012 was analyzed to identify a consensual definition of chronic pain transition. The attributes, antecedents, consequences, related concepts, and surrogate terms of chronic pain transition are described, and the implications of the findings for practice and future research are discussed.     

Evaluation of the concept of supervision related to public health nurses in Norway

AIM: The aim of the study is to clarify the concept of supervision by means of concept analysis, in order to evaluate the concept's application to the practise of public health nurses. BACKGROUND: According to the World Health Organization, a change in strategies for improving public health is necessary. This change demands new strategies. There exists little research concerning intervention strategies in public health. The concept of supervision is well used, but neither well-defined nor well described, either within the nursing discipline or across disciplinary boundaries. METHODS: The method is a review of literature. Twenty scientific papers covering the years 1996-2001 are analysed, using a concept-analysis methodology. FINDINGS: Supervision can be defined as a formal, pedagogical, relational enabling process, related to professional competence. Relationship and dialogue are central aspects. Supervision is based on theory and humanistic values, has a normative, formative and restorative function. The supervisor's competence is of great importance. Supervision has unclear boundaries with concepts such as psychotherapy, consultation and counselling. CONCLUSION: The concept of supervision as described in the selected papers is applicable to public health nurses' supervision of clients, with adaptation caused by the contextual variation of the relationship. Related to clients, supervision can be defined as a formal, pedagogical, relational enabling process with the purpose to strengthen resources, enhance assertiveness and improve independence and coping. It is necessary that registered public health nurses have the competence to supervise.     

Creating a quadruple aim model for nursing education

Baccalaureate nursing education is moving to adopt the new American Association of Colleges of Nursing Essentials for Professional Nursing Education. As identified in two of the six domains of the essentials, graduates need to be prepared to address population health and utilize informatics and healthcare technologies. Community/public health nursing also has eight domains for generalist nurses linked to population health which will help prepare a skilled nursing workforce for the 21st century. The Institute for Healthcare Improvement's Triple Aim which evolved into the Quadruple Aim is focused on improving health outcomes within healthcare delivery. Through a literature review, a need for a Quadruple Aim model for nursing education was identified. Mirroring the Institute for Healthcare Improvement's Triple Aim for healthcare delivery, a Quadruple Aim for Nursing Education Model was developed. The model dimensions include (1) Population-focused Care, (2) Maximize Student Learning Experience, (3) Cost-effective Pedagogy, and (4) Nurse Educator Well-being. The Quadruple Aim for Nursing Education Model supports nursing education to prepare future nurses effectively and efficiently bridging population health concepts and issues with nursing informatics. Nurse educators are encouraged to utilize the model to transform nursing education.     

Emancipation in decision-making in women's health care

Background. Emancipation as a nursing concept is derived from a long‐standing history of social oppression and is easily addressed by both critical social theory and feminist theory. It is the apparent concept to describe a phenomenon witnessed in nursing when caring for women in the decision‐making process about health care issues. Emancipation has been recognized by expert clinical observation. Aim. The aim of this paper is to define the concept of emancipation for possible future application to nursing practice for the promotion of humanistic nursing care in women's health, specifically applied to the decision‐making process. Method. A literature search was carried out using the CINAHL database and the keywords nursing and emancipation, and covering the period 1985–2003. The Rodgers and Knafl (2000) method of concept analysis was then used to derive a conceptual meaning of emancipation that benefits patient care as well as professional nursing development. Emancipation is broken down into antecedents, attributes and consequences. Related concepts are also explored, compared and discussed to synthesize relevant characteristics. Findings. This concept analysis identifies emancipation in decision‐making as a nursing phenomenon by discussing the antecedent of oppression and exploring the identified attributes: (a) empowerment, (b) personal knowledge, (c) social norms, (d) reflection and (e) flexible environment. The consequence of emancipation is free choice. It is a futuristic concept with strong historical ties in need of exploration and development within the context of women's health care in relation to decision‐making. Conclusions. The concept model illustrates emancipated decision‐making, with its five attributes in relation to oppression as a non‐linear phenomenon. Areas for further study include the exploration of the contribution of each critical attribute and its relationship to emancipated decision‐making, and the decision‐making process in relation to patient satisfaction and how long the person continues to adhere to the decision. Also the professional nursing role in promotion of emancipated decision‐making is virtually unexplored, but is an important concept in the paradigm of shared decision‐making about health care alternatives.