Social capital,health, health behavior,and utilization of healthcare services among older adults: A conceptual framework

Meeting the health needs of Americans must change as the population continues to live longer. A strategy that considers social well‐being is necessary. One way to improve social well‐being is through increased social capital, which includes networks among individuals and norms of reciprocity and trust between them. Supporting attainment of bonding social capital from close‐knit groups, such as family, and bridging or linking social capital from those who are dissimilar are vital. Research shows there is a relationship among social capital and self‐reported mental and physical health, health behaviors, healthcare utilization, and mortality. Because older adults are often dependent on others for their healthcare needs, it is posited that social capital plays a key role. Nurses can be instrumental in investigating levels of social capital for individuals and determining what type of social support is needed and who in the individual's network will provide that support. When support is absent, the nurse serves as the link between patients and available resources. The purpose of this article is to introduce a conceptual framework that can assist nurses and other healthcare providers to consider social capital in older adults in the context of relationships and the social environments to which they belong.     

Do you use social media? A study into new nursing and midwifery graduates' uptake of social media

Social media use is expanding rapidly, so too is its use within hospitals and amongst healthcare professionals. This study describes the use of social media by Australian and New Zealand nursing and midwifery graduates of the Graduate e‐Cohort study; there were 112 (93%) respondents from a 2014 sample of 121 nurses and midwives. Findings suggest that the professional peak body goal of using social media as a vehicle for professional education requires consideration of the social media platforms that are actually being used by new graduates. We recommend that work by the respective professions at both an undergraduate and graduate level needs to focus on the implications of social media use or policy and practice to ensure that everyone is aware of when and how to engage in social media platforms and what to do and how to behave when using social media.     

“The Emperor's new clothes”: discourse analysis on how the patient is constructed in the new Swedish Patient Act

The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient‐centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig's analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values‐based healthcare discourse. Neo‐liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient's entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act's provisions in daily healthcare work.     

Factors associated with quality of life in Arab patients with heart failure

The aim of this study was to examine the relationships of demographic characteristics, medical variables and perceived social support with quality of life (QOL) in Arab patients with heart failure. A cross‐sectional study was conducted to identify factors associated with QOL in Arab patients with heart failure. Participants with heart failure (N = 99) were enrolled from a nonprofit hospital and an educational hospital. Data were collected on QOL using the Short Form‐36 survey. Perceived social support was measured with the Medical Outcomes Study Social Support Survey. The majority of the patients reported significant impairment in QOL as evidenced by subscale scored. Left ventricular ejection fraction was the strongest correlate of most QOL domains. Tangible support was significantly associated with most QOL domains. Other social support dimensions were not significantly related to QOL domains. Most patients with heart failure had significant disrupting pain and limitations in performing activities which interfered with their usual role. Due to the importance of understanding QOL and its determinants within the context of culture, the outcomes of this study may provide valuable guidance to healthcare providers in Arabic countries as well as Western society in caring for these patients. Further studies are needed to explore the relationship between social support and QOL among patients with heart failure in the Arabic culture.     

Social media opposition to the 2022/2023 UK nurse strikes

Previous research has established that the success of strikes, and social movements more broadly, depends on their ability to garner support from the public. However, there is scant published research investigating the response of the public to strike action by healthcare workers. In this study, we address this gap through a study of public responses to UK nursing strikes in 2022–2023, using a data set drawn from Twitter of more than 2300 publicly available tweets. We focus on negative tweets, investigating which societal discourses social media users draw on to oppose strike action by nurses. Using a combination of corpus-based approaches and discourse analysis, we identified five categories of opposition: (i) discourse discrediting nurses; (ii) discourse discrediting strikes by nurses; (iii) discourse on the National Health System; (iv) discourse about the fairness of strikers' demands and (v) discourse about potential harmful impact. Our findings show how social media users operationalise wider societal discourses about the nursing profession (e.g., associations with care, gender, vocation and sacrifice) as well as recent crises such as the Covid-19 pandemic to justify their opposition. The results also provide valuable insights into misconceptions about nursing, strike action and patient harm, which can inform strategies for public communication.     

Secondary traumatization and personal growth of healthcare teams in maternity and neonatal wards: The role of differentiation of self and social support

It is of utmost importance to examine the consequences of healthcare teams' daily exposure to stress. This quantitative cross‐sectional study examined the connection between exposure, secondary traumatization (stress deriving from helping suffering others), and personal growth. It compared the teams in maternity and neonatal wards with colleagues exposed to different levels of illness and death and examined the contribution of social support and self‐differentiation to personal growth. One hundred forty‐nine Israeli physicians and nurses participated, comprising three groups (maternity and neonatal wards, exposed to suffering as well as to new life; high; and moderate‐to‐low exposure to illness and death). Data were collected through an online program (64.78% response rate). Whereas no group differences in secondary traumatization were found, personal growth was higher among individuals from maternity and neonatal wards. The higher the social support and self‐differentiation, the higher was the personal growth. The findings highlight the necessity to design interventions to empower social support and investing in its development on both the organizational and personal level, especially for the maternity and neonatal wards' healthcare teams.     

How nurses’ use of language creates meaning about healthcare users and nursing practice

Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses’ use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing practice. We argue that the language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person‐centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses’ compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power‐laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others.     

The moderating role of job resources in the relationship between job demands and interleukin‐6 in an Italian healthcare organization

In this study we examined the association between job demands (JD), job resources (JR), and serum levels of a possible biomarker of stress, the pro‐inflammatory cytokine interleukin‐6 (IL‐6). According to the buffer hypothesis of the Job Demands‐Resources (JD‐R) model, we expected that job resources—defined as job autonomy and social support from supervisor—might buffer the relationship between job demands, defined as emotional demands and interpersonal conflict with colleagues, and IL‐6. Data from 119 employees in an Italian public healthcare organization (acute care hospital) were analyzed using multiple regression. In predicting IL‐6, the interactions between emotional demands and JR and between interpersonal conflict with colleagues and job autonomy (but not social support) were significant, after controlling for the effect of age and gender. The association between JD and IL‐6 was stronger for individuals with low levels of JR, so that levels of IL‐6 were highest when JD were high and JR were low. Overall, these results are consistent with the buffer hypothesis of the JD‐R model and also extend previous research, showing that the exposure to stressful situations at work, measured as high JD and low JR, is associated with higher levels of IL‐6 in hospital employees.     

Health and Psychiatric Disparities in Children with Cognitive and Developmental Delays: Implications for Health Policy in Quebec

Background Previous research on psychiatric and health disparities according to level of cognitive functioning has focused on adults within an American healthcare context. The current study compares children with and without cognitive and developmental delays in Quebec, Canada, using physician billing data from a longitudinal study of low‐income, francophone families. Canada is an ideal context for studying medical billing data as its equal access healthcare system removes many socioeconomic biases. Methods A large sample (n = 1050) of children is used to describe psychiatric and health disparities, as well as differences in Ambulatory Care Sensitive (ACS) conditions and primary healthcare, between children with (n = 107) and without (n = 943) diagnoses in their billing history indicative of delays. Results The findings demonstrated a relatively high level of psychiatric diagnoses for children with delays. However, no difference was found between children with and without delays in regard to emergency room visits and hospitalizations for ACS conditions and primary healthcare. Conclusions The findings suggest that, within a universal healthcare system, disparities in primary healthcare may not emerge until adulthood in individuals with delay status.     

Legitimate family violence as represented in the print media: textual analysis

Aim. This paper reports a study of how issues around the use of smacking by parents are represented in the print media. Our purpose was not to state a case for or against the use of smacking. Rather, within the contemporary social context we sought to answer the question, ‘Why is smacking considered to be a legitimate part of parenting in the United Kingdom?’ Background. Although a number of government proposals aiming to ban the use of smacking by parents have been presented in the United Kingdom parliament and Scottish Executive, current legislation allows parents to use this form of physical discipline as long as it does not result in physical injury to the child. For the purposes of this discussion, smacking is considered as a social phenomenon rather than an activity simply to be favoured or to be opposed. Method. A sample of 244 articles from five different United Kingdom newspapers was examined during 2004. Schema analysis that drew upon semiotics was used to analyse these print media representations about the use of legitimate violence by parents towards children. Findings. Newspaper reportage about the parental use of physical discipline has increased over the past 20 years. Only one newspaper (The Independent) published on this topic prior to 1994. The discourse about the use of physical discipline by parents has changed over time from one that focuses on the effectiveness of smacking to one that about the human rights of the child. The main themes identified in the print media discourse were the rights of the child, the effectiveness of smacking, long‐term effects and consequences, and the role of the state. Conclusion. Media texts can influence and reinforce social dimensions of the label. The beliefs and attitudes of healthcare professionals and parents about smacking may be influenced by such representations.     

Interactions between persons—Knowledge,decision making,and the co‐production of practice

There is now broad agreement that ideas like person‐centred care, patient expertise and shared decision‐making are no longer peripheral to health discourse, fine ideals or merely desirable additions to sound, scientific clinical practice. Rather, their incorporation into our thinking and planning of health and social care is essential if we are to respond adequately to the problems that confront us: they need to be seen not as “ethical add‐ons” but core components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. This, the tenth philosophy thematic edition of the journal, presents papers conducting urgent research into the social context of scientific knowledge and the significance of viewing clinical knowledge not as something that “sits within the minds” of researchers and practitioners, but as a relational concept, the product of social interactions. It includes papers on the nature of reasoning and evidence, the on‐going problems of how to ‘integrate’ different forms of scientific knowledge with broader, humanistic understandings of reasoning and judgement, patient and community perspectives. Discussions of the epistemological contribution of patient perspectives to the nature of care, and the crucial and still under‐developed role of phenomenology in medical epistemology, are followed by a broad range of papers focussing on shared decision‐making, analysing its proper meaning, its role in policy, methods for realising it and its limitations in real‐world contexts.     

Ethical and moral considerations of (patient) centredness in nursing and healthcare: Navigating uncharted waters

This discussion paper aims to explore potential ethical and moral implications of (patient) centredness in nursing and healthcare. Healthcare is experiencing a philosophical shift from a perspective where the health professional is positioned as the expert to one that re‐centres care and service provision central to the needs and desires of the persons served. This centred approach to healthcare delivery has gained a moral authority as the right thing to do. However, little attention has been given to its moral and ethical theoretical grounding and potential implications for nurses, persons served and the healthcare system. Based upon a review of academic and grey literature, centredness is proposed as a value‐laden concept in nursing inquiry. Potential moral and ethical implications of centredness on nurses/healthcare providers, persons served and the healthcare system are discussed. These challenges are then considered within the context of normative and relational ethical theories. These perspectives may offer guidance relative to how one should act in those circumstances as well as an understanding as to how interdependency and engagement with the other person(s) can help navigate the challenges of a centred care approach. Viewing centredness through an ethical theoretical lens provides a valuable discourse to nursing in efforts to expand the knowledge base and integrate centred approaches into practice and policy.     

Nursing scholars appropriating new methods: the use of discourse analysis in scholarly nursing journals 1996-2003

Nursing scholars appropriate the analysis of discourse. "Discourse analysis" covers a wide spectrum of approaches to analysing meaning and language and there is no widely accepted definition of either a concept or an analysis of discourse. A sample of the discourse analyses indexed in the CINAHL database was analysed in order to identify what notions of discourse and discourse analysis are preferred by nursing scholars. The results showed that nursing scholars prefer approaches to discourse that resemble mainstream qualitative research avoiding social life and interaction. Explanations for these findings are briefly outlined.     

Self-harm and the words that bind: a critique of common perspectives

The issue of self-harm is not only a widespread phenomenon but also a challenging one. Nurses in particular are faced with this challenge, as they tend to be the primary professional group when working with people who self-harm within health service provision. The purpose of this paper is to offer a critical appraisal of common perspectives as reported in the existing literature. Having highlighted these areas, the paper will attempt to address the challenges faced by nurses and other healthcare professionals through the proposal of strategies, including the suggestion that self-harm may be considered from a position of social constructionism to achieve a more informed and effective response when working with someone who self-harms.     

Using primary care-based mental health registers to reduce social exclusion in patients with severe mental illness

Reducing social exclusion and improving mental health are key themes within the government's modernization programme. Despite this, little is known about the social exclusion experienced by people with severe and enduring mental illness living in specific communities, apart from their over-representation amongst various socially excluded groups. This paper describes a 3-year research study that focused on the impact of introducing mental health registers into general practices in an English health district. The registers were expected to facilitate improvements in linking patients with appropriate services and so improve the healthcare they received. The overall result should have been reductions in the levels of social exclusion experienced by these patients; however, findings revealed a lack of change in unmet needs and quality of life, even amongst those in contact with a community mental health nurse.     

Social representation of a healthcare team on family planning and female sterilization

The objective in this qualitative study was to obtain the discourse of the members of a healthcare team on family planning and female sterilization, and those practical effects on the work of the team. Marxist dialectic and social representations were used as references. Data were obtained by interviews and observations of certain activities of the members of the healthcare team and were subjected to analysis of the discourse. Family planning and female sterilization were considered to be rights, which pertained to the women, although the exercise of those rights is hindered by the limitations of access to contraceptive methods in general.     

Frontline healthcare providers’ views of depression and its prevention in older adults

Aims and objectives.  To describe healthcare providers’ views on depression and its prevention in older people. Background.  There is an urgent need to develop public health approaches to depression prevention in older adults because of the growing older population and the high rate of depression among community‐dwelling older adults in Taiwan. Prior studies have focused on the prevalence of and risk factors for depression in Taiwanese community‐dwelling older adults. Research from the viewpoints of prevention and healthcare providers is needed to guide these approaches. Design.  A qualitative study involving semi‐structured interviews. Methods.  A purposive sample of 25 healthcare providers was recruited from a city in northern Taiwan. Data were collected through in‐depth individual interviews and analysed using thematic analysis. Results.  Results were embedded within four major themes: lack of children’s support, maladaptation to distressing life circumstances in late life, innate vulnerability in the individuals and being unaware of or reluctant to accept an illness. Conclusions.  Participants’ accounts of depression and its prevention were conceptualised within the family and socio‐cultural contexts older adults lived in. Lack of children’s support was reported as a main contributor to depression in older adults. Society was reported as the main context in which depression prevention intervention should take place. Communal activities were described as important for mental wellness and depression prevention. Relevance to clinical practice.  Study findings show how family, Chinese culture and socio‐economic circumstances influence accounts of depression and its prevention in older adults. Attention to the cultural construction of meanings may help extend our vision beyond a focus on the biomedical discourse and promote innovative ways of tackling depression that match the policy goals with the needs of older adults and community.     

Depressive symptoms among older residents at nursing homes in Taiwan

Aims and objectives. To examine the depressive symptoms of older residents at nursing homes and the relationship between their depressive symptoms and certain selected variables. Background. Depression has become a major healthcare concern among the older people, but nursing home‐based studies on risk factors of depression have still hardly been well performed in Taiwan. Design. A cross‐sectional design was developed and implemented. Methods. A research sample of 138 older residents was recruited from eight nursing homes located in southern Taiwan. During face‐to‐face interviews, the Center for Epidemiological Studies Depression Scale, Social Support Scale, Chronic Condition Checklist and Socio‐demographic Inventory were used for data collection. Results. The results showed that 81·8% of those residents were identified as being depressed. It was further discovered that the length of residency, number of chronic conditions, perceived health status and the amount of social support from their family and relatives could explain 38·8% of the total variances in depressive symptoms. Conclusions. Our study suggests that, in Taiwan, older people who live in nursing homes suffer from more depressive symptoms than those in community dwellings. To maintain and improve the health status for the elderly as much as possible, it is suggested that healthcare providers at nursing homes should develop an effective health promotion program for these older peoples. Relevance to clinical practice. There exists a high rate of depressive symptoms among older residents at nursing homes. It is imperative that a proper identification and its correspondent treatment for this health problem on the older residents are required. In late life, to maintain a higher level of quality of life, it is important to suggest that the health providers should regularly screen older people to increase the likelihood of diagnosis and improved treatment of late‐life depressive symptoms.     

Pursuing common agendas: a collaborative model for knowledge translation between research and practice in clinical settings

There is an emerging discourse of knowledge translation that advocates a shift away from unidirectional research utilization and evidence-based practice models toward more interactive models of knowledge transfer. In this paper, we describe how our participatory approach to knowledge translation developed during an ongoing program of research concerning equitable care for diverse populations. At the core of our approach is a collaborative relationship between researchers and practitioners, which underpins the knowledge translation cycle, and occurs simultaneously with data collection/analysis/synthesis. We discuss lessons learned including: the complexities of translating knowledge within the political landscape of healthcare delivery, the need to negotiate the agendas of researchers and practitioners in a collaborative approach, and the kinds of resources needed to support this process.