Nursing Care of Families With Parents Who Are Lesbian, Gay, Bisexual, or Transgender

TOPIC:  Families in which parents are lesbian, gay, bisexual, or transgender are more diverse than they are similar. The numbers of parents and children in these families appear to be increasing with implications for nurses and other clinicians.
PURPOSE:  This paper reviews the current literature to determine the fundamental issues facing alternate families that include sexual minority parents and their children. It also explores the unique nursing needs of families with gay, lesbian, transgender, or bisexual parents in the field, which are critically examined for direct relevance to psychiatric nursing practice.
SOURCES USED:  Current theoretical and research literature in nursing, child development, family law, and healthcare professional journals.
CONCLUSIONS:  Despite a relative lack of pathology noted in the literature related to families with sexual minority parents, nurses, and other healthcare professionals can incorporate current knowledge of unique child developmental, parenting, and legal issues into their work with these families. Assessments and interventions that address the unique needs of these families may help parents and children to deal with social stress from being perceived as "different" by other children, or as "problematic and threatening" by other parents.     

Coaching: a different approach to the nursing dilemma

While the current nursing shortage continues, many new approaches from sign-on bonuses to "fast track training" are being suggested and implemented to ameliorate the situation. Yet, even with these expanded opportunities turnover is still too high. Recent studies suggest embedded factors called fit, links, and sacrifice exist between the employer and employees including nurses that account for current employees staying on their job. Creating a better understanding of embedded issues and creating an open but confidential environment to deal with conflict issues and job problems is suggested as a way to reduce turnover. A specific issue such as an unfavorable job assignment or more complex issues such as unmet expectations can cause conflict and job dissatisfaction. It is suggested that a coaching model can be used to understand the issues that create conflict and provide a method for resolution of job dissatisfaction.     

Medical futility and appropriate medical care in patients whose death is thought to be imminent

 Often it is very difficult to make decisions involving the termination of aggressive cancer care in the case of patients who are no longer benefiting. Among these patients, our ability to "do everything possible" to continue life is in conflict with "doing the right thing"; the greatest benefit to these patients derives from delivering excellent supportive care and assisting them in understanding and accepting end-of-life issues. Furthermore, in a cost-conscious environment with limited resources, all patients and, indeed, all of society, benefit when aggressive and often costly cancer care is limited to those patients who are likely to benefit. However, these issues are complex, blending treatment science and ethics, and thus, the physician frequently has no objective reference point on which to base the decisions. This paper integrates the principles of ethics (respect for autonomy, beneficence, nonmaleficence, and justice) and three difficult issues encountered by physicians in clinical decision-making in terminal cancer patients in the American healthcare system. These issues include: medical futility and appropriate care, applications of outcomes research in clinical decision-making, and impact of cost, particularly in a managed care environment, on treatment choice. These topics are illustrated with reference to patients presenting to our emergency center with stage IV lung cancer and dyspnea, and the application of an outcomes model under development to predict imminent death in these patients is discussed. Outcomes models may provide patients, their families, and their physicians with objective data on which to base end-of-life decision-making. Minimizing aggressive treatment of terminally ill patients may provide better life quality and will reduce costs during the patients' end of life. Ethics plays a crucial role in integrating medical science, patient choice, and cost in making appropriate decisions.     

An occupational therapy protocol for assessing infants and toddlers who fail to thrive

Children who "fail to thrive" are frequently referred to occupational therapists. Yet there is no organized protocol that therapists could use to assess these children. This paper reviews criteria that distinguish organic from nonorganic "failure to thrive" and describes the occupational therapist's contribution to the evaluation process. An occupational therapy protocol is presented to facilitate a thorough assessment, emphasizing feeding issues and caretaker-child interaction.     

Experiences of recently relocated residents of a long-term care facility in Ontario: assessing quality qualitatively

BACKGROUND: Canadians overwhelmingly support universal coverage for health services and seniors' entitlement to high standards of care in long-term care facilities (LTCFs). Government rhetoric reflects these values, but claims of fiscal prudence often means translation into policy and improved care is uneven. Ontario is moving towards standardized "quality of care" measures, but such measures often ignore residents' views and socio-psychological issues. OBJECTIVES AND SETTING: Assessment of residents' experiences in a new "state of the art" LTCF and their understanding of "quality of care" shortly after relocation from two older hospital style facilities. DESIGN AND METHODS: Unobtrusive observations of activities of residents and staff in the LTCF by several researchers generated an analysis of field notes. In addition, one-on-one, in-depth, semi-structured interviews with residents generated qualitative interview data, analyzed utilizing a grounded theory approach. PARTICIPANTS: All residents deemed either moderately cognitively impaired or not impaired were invited to participate. Of these two groups, 18 seniors (five male and 13 female) with a mean age of 84.35yr agreed to be interviewed. Participants were all Caucasian and from a wide variety of social-economic levels. RESULTS: Two meta-themes "Relationships are the foundation of quality care" and "Waiting, activity & grieving loss of personhood" best explained residents' experiences of the LTCF. The two meta-themes were inter-connected and reflected the centrality of socio-psychological "quality of life" issues, especially resident-staff relationships as prominent aspects of seniors' understanding of quality of care. Improvements in facilities and programs were undermined by inattention to staff-patient ratios and continuity in staffing. CONCLUSIONS: Seniors said little regarding the fabulous new facility, but discussed quality of care as a socio-psychological concept intimately connected to staff relations. Government and administrative inattention to issues of sufficient funding for staff, relationship needs and continuity of care for seniors threatened to undermine residents' experiences of meaning, as well as any potential benefits from facilities and program improvements.     

Nursing practice problems in private hospitals in Jordan: students' perspectives

This paper grew from an exploration of clinical practice problems in a private hospital in Jordan. Senior nursing students in a governmental university studied these issues while focusing on leadership and management issues. The private sector is of a secondary focus in nursing research. In Jordan, nursing studies that explore the nursing profession and its related issues have been limited in the literature. A student assignment in the "Nursing Leadership and Management" course required the students to work in groups to identify a nursing practice problem, and its contributing causes and suggested solutions. The nursing shortage; job dissatisfaction; burnout; and turnover were the identified nursing practice problems. Causes and solutions of these problems were explored.     

Legal issues in alternative health care

This article reviews the use of alternative and complementary health care practices by orthodox medical practitioners. Many alternative modalities such as chiropractic, acupuncture, naturopathic, and homeopathic treatments are available, and modern patients who are increasingly "consumer-oriented" and educated may inquire about these treatments. The article examines issues of informed consent, standards, procedures, and liability as they relate to a medical practice that opts to provide alternative treatments.     

Monitoring versus interim analysis of clinical trials: a perspective from the pharmaceutical industry

The definitions of "interim analysis" and "monitoring" of clinical trials are often ambiguous in the current literature. The resulting confusion can lead to erroneous conclusions and misguided decisions, especially when activities that are operational or observational are evaluated in a probabilistic sense as inferential. The authors seek to define "interim analysis" and "monitoring" in a mutually exclusive fashion. These definitions will then provide the opportunity to review and categorize existing clinical trial practices and procedures. This will clarify such issues as "when to look" and "when to pay a price" (e.g., test size and power) and characterize such issues in the context of pharmaceutical industry drug development.     

Echoes of things to come. Ultrasound in UK emergency medicine practice

Ultrasound is widely used in the US and continental Europe in the immediate assessment of patients after blunt abdominal trauma. There are also now other recognised "primary" indications for ultrasound in emergency medicine. In this paper current evidence supporting the implementation and use of emergency ultrasound in these primary conditions and possible other indications are assessed. The issues surrounding introduction of the technology into the practice of emergency medicine in this country are considered. It is accepted that further debate is necessary but the establishment of a robust evidence base in the UK will help to clarify the place of ultrasound.     

Challenges and opportunities for nurse-midwives.

This article reviews the major indicators of the growth in nurse-midwifery practice and education over the past 10 years. The major issues the profession has addressed are identified, as well as future challenges and opportunities. These challenges and opportunities are identified within the major dimensions of nurse-midwifery, that is, in practice, education, research, and within the public sector. The two major issues facing nurse-midwives are legislative initiatives related to the practice of nurse-midwives, such as reimbursement, and the mixed societal image of midwifery as a contemporary, cost-effective practice versus a peripheral activity by "old fashioned," informally educated individuals. The professional organization of nurse-midwives, the American College of Nurse-Midwives (ACNM), is addressing these issues through interdisciplinary and interorganizational legislative and marketing initiatives.     

Understanding adolescent depression in ethnocultural context

Asian-American adolescents often are regarded as a "model minority" and as being less likely to experience depression than adolescents of other ethnic groups. African-American adolescents are more often diagnosed with schizophrenia than depression. Do these epidemiologic phenomena reflect the real facts, or are these just artifacts shaped by cultural bias or insensitivity prevailing in this society? This article explores the diagnostic bias resulting in misdiagnosis of adolescent depression and reviews the role of culture/ethnicity in mental health and the ethnocultural variations in depression among African-American, Hispanic-American, and Asian-American adolescents. By discussing the issues, this article guides nurses to enhance cultural competence in nursing care.     

Migration of health workers

The discussion and debate stimulated by these papers focused across a range of issues but there were four main areas of questioning: "measuring" and monitoring migration (issues related to comparability, completeness and accuracy of data sets on human resources); the impact of migration of health workers on health systems; the motivations of individual health workers to migrate (the "push" and "pull" factors) and the effect of policies designed either to reduce migration (e.g "self ufficiency") or to stimulate it (e.g active international recruitment). It was recognised that there was a critical need to examine migratory flows within the broader context of all health care labour market dynamics within a country, that increasing migration of health workers was an inevitable consequence of globalisation, and that there was a critical need to improve monitoring so as to better inform policy formulation and policy testing in this area.     

Microsurgery in the urgent and emergent management of the hand

Appropriate use of microsurgical techniques in the emergency management of injured hands increases the salvage rate of complex upper limb injuries. Over time, the indications for replantation, both major and minor, have expanded and techniques refined to get better functional outcomes. The wide choice of free flaps available has made primary reconstruction possible to obtain a good functional and aesthetic outcome. The benefits microsurgery offers in the emergent management of the injured hand are now firmly established. The challenge is to create and maintain centers which can provide around-the-clock, high quality microsurgery services. The issues of adequate training opportunities, obtaining adequate work load to maintain high skill levels, attracting talent into the field are the challenges faced in maintaining high levels of service. In the developing countries, in addition to these issues, increasing the awareness of the potential of microsurgical services among the medical personal and the public has to be addressed.     

The quality/quantity-of-life distinction and its moral importance for nurses

In this paper we reject the "sanctity-of-life" view, which holds that all human lives, irrespective of their quality or kind, are equally valuable and inviolable. We argue that health-care professionals intent on acting in the patients' best interests cannot avoid quality-of-life judgments--for there is a close link between the quality, and kind of life, a patient has and her best interests. This paper reflects on some of these issues.     

Everyday ethics in assisted living facilitites: a framework for assessing resident-focused issues

This article describes and illustrates a framework that may be used when assessing the moral basis of everyday issues that can affect residents of assisted living facilities. The "taxonomy of everyday ethical issues" was an outcome of ethnographic research focused on care of nursing home residents with dementia. However, in this article it is shown to be equally relevant for conceptualizing issues affecting cognitively intact as well as cognitively impaired residents across these two settings. The taxonomy is grounded in some of the more common cultural characteristics of congregate living arrangements for elderly individuals who have needs for varying levels of compensatory and therapeutic oversight by a staff of service providers.     

Multidimensional impacts of transitional mid-life healthcare

Mid-life transition is a passage from young adulthood to old age, which can be expressed from transition concept--five attributes and four types of transitions. Mid-life changes that occur over several years, usually between the ages of 40 and 60. Common "disconnectedness" issues during this period such as menopause will occur during mid-life. Individuals become increasingly aware of the special nature of physiological and psychological changes that take place, and express a complex combination of feelings and response patterns in light of these changes. Middle-aged adults often face multidimensional issues related to developmental transition, changes in family structure related to organization transitions, life events related to situational transitions, and perimenopausal changes related to health transitions. Nurses who provide care to middle-aged clients need to consider transitional issues from a multidimensional and holistic perspective.     

Nursing management in an endoscopy setting.

Textbooks and articles that address the issues and responsibilities of a nurse manager generally focus on the role of the nurse manager in a hospital setting. While many of the principles set forth in these publications may be appropriately used by the nurse manager working in an endoscopy setting, certain characteristics of GI nursing are unique in terms of managing the delivery of patient care, managing staff, and managing self. This article describes these critical "3Ms" of nursing management and offers practical guidelines to the GI nurse manager.     

Primary care health issues among men who have sex with men

PURPOSE: The purpose of the article is to examine "appropriate" health care for men who have sex with men (MSM), which is not to suggest "special" health care. As a group, MSM are at increased risk for sexually transmitted infections, anal cancer, and mental health disorders. Focus areas in this article will address health issues that the primary care nurse practitioner (NP) may encounter in clinical practice: anal carcinoma, sexually transmitted diseases (STDs), high-risk sexual practices, depression, and substance abuse were topics chosen for inclusion in this article. These topics were among those highlighted in the Healthy People 2010 Companion Document for LGBT Health, which served to examine the healthcare disparities and lack of access to needed services related to sexual orientation. DATA SOURCE: Extensive literature review of research articles, journals, clinical practice guidelines, books, and public health department Internet Web sites. CONCLUSIONS: There are unique health disparities that exist for MSM related to social, emotional, and mental health factors, in addition to physical issues such as STDs. There is an increasing need for primary care providers to be aware of these disparities, as well as the factors that influence these disparities, in order to provide multidimensional care and health counseling that is unique to NP practice. IMPLICATIONS FOR PRACTICE: Both the primary care NP and the patient should be aware of the unique healthcare issues among MSM that should be incorporated into the patient's routine health maintenance program. As primary care providers, it is within the standards of practice for NPs to provide culturally competent care, along with health promotion and disease prevention for MSM.     

General practitioners’ self-reported competence in the management of sexual health issues – a web-based questionnaire study from Finland

Objective Although sexual problems are common, they are rarely brought up in appointments with general practitioners (GPs). We aimed to assess the barriers that hinder GPs from bringing up sexual health issues and to evaluate the need for education on sexual medicine. Design A web-based questionnaire was used. Setting Four fields were included: A) the self-reported competence in discussing sexual health and treating patients with these issues, B) the barriers to bringing up patients’ sexual health problems, C) the source of education on sexual medicine and D) the need for education on sexual medicine. Subjects A random sample of 1000 GPs in Finland (a response rate of 43.5%, n = 402). Main outcome measures GPs’ self-assessed competence in discussing and treating sexual health issues, related barriers to bringing up the topic and the reported need for education. Results The main reasons reported for not bringing up sexual health issues were shortness of the appointment time (85.6%), a lack of knowledge (83.6%) and a lack of experience with sexual medicine (81.8%). The male GPs reported better competence in discussing the issues and treating male patients, whereas the female GPs reported better competence in discussing the issues with female patients. No differences emerged between genders regarding treating female patients. Nearly 90% of the GPs expressed needing more education about sexual medicine. Conclusions Although the GPs reported good competence in discussing sexual health issues with their patients, several barriers to bringing up sexual health issues emerged. Continuing education was desired and could lessen these barriers.

Key points

• Only a few studies have evaluated the competence of general practitioners (GPs) in addressing sexual health issues with their patients.
• In our study, the GPs reported a high competence in discussing patients’ sexual health issues regardless of the patient’s gender.
• However, several barriers to bringing up sexual health issues in appointments emerged.
• A majority of the GPs expressed a need for continuing education about sexual medicine.