Advances in Nursing Science最新文献

Safety for transgender, non-binary, and gender-expansive (TGNE) individuals includes freedom from discrimination, stigma, and threats to psychological well-being. This paper presents an application of Roy's adaptation model (RAM) to examine safety across the physiological, self-concept, role function, and interdependence modes through a fictional case study of a TGNE patient in a nurse-client encounter. Our analysis reveals how nurses can foster affirming environments, address systemic barriers, and use theory to guide adaptive and equitable care. This application highlights the connection between nursing theory and practice and demonstrates how RAM can inform nurse-led interventions to support TGNE patients' adaptation, well-being, and experiences of safety.

Human-centered design (HCD) is increasingly applied in global sexual and reproductive health research to engage communities in creating person-centered interventions, yet it remains underutilized in the United States (US). A stronger theoretical understanding of HCD can support nurses to apply it as a novel approach to address persistent sexual and reproductive health inequities. This narrative review analyzes 10 US-based family planning HCD studies using the concept of epistemic stance to clarify how knowledge is created and evaluated through HCD. Findings show that HCD embodies a pluralistic stance grounded in creativity, context, and shared expertise, supporting nursing's philosophical commitment to relational, person-centered care.

Ectopic pregnancy (EP) is a serious and increasing health concern that remains poorly understood despite identified risk factors. This article introduces the N-GEM Theoretical Framework, a novel approach that integrates genomic, epigenomic, environmental, and microbiome factors to address the complex and multifactorial etiology of EP. By offering a comprehensive and dynamic model, the N-GEM framework supports the development of personalized prevention strategies and can enhance early detection methods. This situation-specific theoretical framework not only positions nursing at the forefront of EP research but also fosters interdisciplinary collaboration that can drive significant advancements in clinical practice and ultimately reduce EP-related morbidity and mortality.

Chronic kidney disease (CKD) inequities among midlife women in the U.S. arise from intersecting determinants across individual, interpersonal, community, and societal levels. This paper introduces the Kidney Health Inequities among Midlife Women Minority Group (KH-MWMG) Theory, a situation-specific theory (SST) developed using an integrative approach. The KH-MWMG theory illustrates how socio-ecological factors interact to influence CKD risks and outcomes over the life course. The KH-MWMG theory provides a structured framework to address CKD inequities. The SST needs to be further developed through its actual application in nursing research and practice with various minority groups of this specific population.

This paper proposes Technology-Enhanced Wisdom (TEW), a middle-range theory to guide nursing practice in the age of artificial intelligence. Building on Nelson's Data-to-Wisdom continuum and developed using Walker and Avant's theory synthesis method, TEW identifies 6 mediating concepts - context, perception, veracity, trust, usability, and competency - that shape how nurses integrate artificial intelligence (AI)-enhanced insights. TEW provides a framework for synthesizing internal knowledge with machine-generated information to support ethically grounded, human-centered decisions. As AI transforms health care, TEW offers a timely theoretical foundation for wisdom-driven, technologically informed nursing care, positioning technology not as a replacement for human wisdom but as a co-pilot in advancing it.

Overlapping identities, including race, sex, and disability, intersect with structural oppression to amplify maternal health inequities. This study uses Walker and Avant's 7-step theory analysis, examining origins, meaning, logical adequacy, usefulness, generalizability, parsimony, and testability, to evaluate intersectionality theory in pregnancy health inequities. The analysis shows the model's strengths in capturing complexity while identifying a critical gap: reproductive autonomy. The findings highlight that actual progress toward maternal health equity requires intersectional, autonomy-centered approaches in research, policy, and practice to ensure all pregnant women have the power and resources to make autonomous reproductive choices.

Behavioral (non-surgical/non-pharmacological) obesity treatments have poor-to-modest outcomes, largely due to inadequate foci on psychosocial correlates of requisite behaviors. Better understanding theory-driven interrelations and directionalities of self-regulation and self-efficacy changes can inform intervention methods. Women were randomized into community-based obesity-treatment programs emphasizing either cognitive-behavioral (n = 90) or traditional educational (n = 44) methods. Regression-based paths from treatment type→early change in self-regulation→later change in self-efficacy→6- and 12-month change in both diet and physical activity/exercise were significant, but not when change in self-efficacy was, reciprocally, entered as the predictor of self-regulation change. Findings indicated advantages in focusing on self-regulation skill development for behavioral changes and weight reduction.

Background: Self-care is essential in the management of chronic illness. In 2012, we published a middle-range theory addressing self-care as a process of maintaining health through health-promoting practices and managing chronic illness. Three key concepts in the theory were self-care maintenance, self-care monitoring, and self-care management. Self-care maintenance refers to those behaviors performed to improve well-being, preserve health, or maintain physical and emotional stability. Self-care monitoring is the process of routine vigilant surveillance, self-awareness, and body monitoring or body listening. Self-care management involves the response to signs and symptoms when they occur. In 2019, we updated the theory, specifying the important contribution of symptoms to self-care. Assumptions and propositions of the theory were specified in the original publication; both are expanded in this update.

Purpose: Here, we update the theory to reflect changes in our thinking and what has been learned from published literature and discussions with others. An important addition is a detailed discussion of 6 essential intrapersonal requirements for self-care: experience, knowledge, skills, reflection, decision-making, and motivation. These requirements interact dynamically; the order in which they are presented is not meant to reflect the order in which they are developed.

Implications for practice and research: These factors are particularly important in guiding the development of self-care interventions. Readers can now refer to this version instead of the 2012 publication.