Nursing Outlook最新文献

Background

The rate of preterm birth (PTB) is high in the United States and Black infants remain disproportionately affected, with the disparity between Black and White infant deaths greater today than it was under antebellum slavery.

Purpose

The National Institute on Minority Health and Disparities Research Framework reflects a unique set of determinants relevant to the understanding and promotion of minority health.

Methods

We have applied this framework to better understand the effects of PTB on Black parents and the distribution of the social determinants of health, including structural determinants and root causes of inequities.

Discussion

This adaptation shows the intersection in maternal and infant health that shapes individuals’ experiences, drives disparities and impacts perinatal outcomes in critical periods over the lifecourse.

Conclusion

In our efforts to achieve health equity, it is imperative that we study the underlying mechanisms and recognize that policies, institutional structures, and social factors are drivers of racism.

Background

A conceptual, methodological, and theoretical framework is needed in Nursing Education to center racism, in the curriculum, as a root cause of health inequity.

Purpose

To provide Nursing and health professions’ educators with a comprehensive unifying framework to fundamentally conceptualize and deliver a curriculum which positions racism’s impact as a root cause of health inequities.

Methods

Critical race theory is the underpinning for a historical analysis of racism and a critique of scientific racism, whiteness, and white supremacy ideologies that perpetuate harmful and lethal outcomes for racialized individuals and communities.

Results

This framework conceptualizes learning, unlearning, relearning, and reflective practice as the fundamental process needed to transformative nursing education and advance health equity.

Discussion

Methodological application is given for 1) unlearning harmful white supremacy ideology 2) learning that racism as it is embedded in every sector of American life and racial inequities are inherent in the health care system 3) relearning the importance of counternarratives and building structural competency and 4) engaging in reflective practice to challenge deficit paradigms assigned to racialized people and their communities.

Conclusion

The Antiracism Framework provides foundational principles, guiding steps, and rationale for curricula that acknowledges the critical role of racism as a barrier to achieving health equity.

Xylazine-associated wounds are a distinct, novel clinical entity characterized by co-occurrence with substance use, progressive necrosis of skin, muscle, tendon, and bone, and slow healing. In Philadelphia, the specter of limb loss, stigma, and shame has hung over hospital-based care for xylazine-associated wounds among people who use drugs (PWUD) and kept many people away from engaging in care. Continued engagement in harm reduction wound care nursing, however, offers an opportunity for PWUD to address their wounds and their fears with members of the medical world. In the absence of established best practices, harm reduction’s model of risk-reductive care offers a way forward for patients and practitioners alike. Here, “harm reduction” describes an ethic of practical, trauma-informed, patient-centered care. It is this integration of harm reduction into medicine and public health that effectively promotes the safety, survival, and recovery of PWUD across all spectrums of drug use habits and housing stability.

Background

In January 2021, the Commonwealth of Massachusetts granted nurse practitioners (NPs) full practice authority (FPA). Little is known about how care delivery changed after FPA legislation.

Purpose

To understand the NP perception of early implementation of FPA in Massachusetts.

Methods

Qualitative descriptive design using inductive thematic analysis of open-ended responses to a web-based survey of NPs in Massachusetts from October to December 2021.

Findings

Survey response rate was 50.3% (N = 144). Inductive thematic analysis of open-ended responses identified four themes, including: (a) internal and external barriers obstructed FPA implementation, (b) employer communication about scope-of-practice changes was minimal, (c) NPs led initiatives to implement FPA, and (d) some efforts effectively implemented FPA.

Discussion

Almost 1 year after FPA was passed, external policies persisted that financially incentivized employers to not change NP scope-of-practice. Concerted efforts are needed to ensure that federal and payer policies, such as incident-to billing, are aligned with state law to encourage the implementation of FPA.

Nursing is renowned for its high ethical standards and is considered one of the most trusted professions globally, yet it has deep historical ties to Eurocentric and white supremacist ideologies. These entrenched ideologies in nursing raise significant concerns regarding equity, diversity, and inclusion within the profession as they shape nursing education, research, and practice. Western nursing institutions are deeply engrained in a system designed to center and uphold whiteness, which frequently serves to safeguard dominant groups in power while detrimentally affecting faculty from underrepresented backgrounds. Consequently, faculty members from underrepresented groups depart academia due to systemic racism and inadequate institutional accountability and support. To decenter whiteness in nursing, we have shared our experiences to underscore how systems of oppression marginalize underrepresented faculty in nursing academia.

Background

The Robert Wood Johnson Foundation Future of Nursing Scholars program supported nurses to complete PhDs in 3 years. Support mechanisms included mentoring by the program office and school faculty, and leadership development activities.

Purpose

To describe scholars’ perspectives of mentoring received by faculty during the accelerated timeline.

Methods

Of 201 scholars, 157 (78%) completed exit surveys, providing qualitative data on their experiences working with faculty mentors.

Discussion

Scholars highlighted strong mentorship (i.e., accessibility, emotional support) as the most important facilitator to program completion. Mentor challenges were identified as the second-most mentioned barrier to success, while the first was the accelerated timeline.

Conclusion

The scholars’ most-reported mentor-provided facilitators to success were availability and emotional support. Among scholars who noted barriers to their success caused by their mentor relationship, the most-reported issue was lack of access to their mentors.

Background

Tobacco use remains the leading cause of preventable disease, disability, and death in the United States and is a significant cause of health disparities.

Purpose

The purpose of this paper is to update the Tobacco Control policy paper published over a decade ago by the American Academy of Nursing’s Health Behavior Expert Panel Tobacco Control subcommittee.

Methods

Members reviewed and synthesized published literature from 2012 to 2024 to identify the current state of the science related to nurse-led tobacco dependence treatment and implications for nursing practice, education, and research.

Findings

The results confirmed that nurse-led tobacco dependence treatment interventions are successful in enhancing cessation outcomes across settings.

Discussion

Recommendations for nursing leaders include: promote tobacco dependence treatment as standard care, accelerate research on implementation of evidence-based treatment guidelines, reduce health disparities by extending access to evidence-based treatment, increase nursing competency in providing tobacco treatment, and drive equity-focused tobacco control policies.

The nursing profession is engaged in robust national dialogue on how to implement competency-based education. This dialogue often conflates the concept of “competency-based education” with nursing “competence” or “practice readiness.” Our aim is to discuss the potential harms of conflating “competency-based education” with “competence” or “practice readiness.” This commentary explores the possible risks of issue conflation. Risks include (a) suggesting that nurses who have successfully obtained licensure are not “competent” or “ready to practice,” and (b) de-emphasizing the importance of safe and sustainable work environments for new graduate nurses. We discuss the need to separate conversations about “competency-based education” and “practice readiness”; the need to increase the clarity and specificity of discourse surrounding competency-based education; and the need for strategic alignment across academia and practice.

Background

The recent push to “decolonize nursing” has become a critical movement to address institutional racism, but the term has circulated through nursing circles enough to risk becoming a buzzword.

Purpose

This article clarifies “decolonizing nursing” by addressing the following questions: (a) How has “decolonizing nursing” been discussed in nursing research? (b) What specific projects have been implemented to decolonize nursing? (c) How has decolonizing nursing been related to health equity?

Methods

We conducted a scoping review and searched CINAHL, PubMed, and PsycINFO databases. A total of N = 56 records were included.

Discussion

“Decolonization” has referred to a range of ideas related to resisting Western ideals, legitimizing Indigenous knowledge, and repatriating land and territory especially to Indigenous and dispossessed communities. Few empirical studies have examined the relationship between decolonization or colonialism and specific health outcomes.

Conclusion

Decolonization differs from other social justice initiatives. To clarify what decolonizing nursing means, researchers can engage with historical, interdisciplinary, and community-based participatory research. In turn, nursing research will understand colonialism’s historical context, provide evidence that supports policies that protect Indigenous territory, and design clinical interventions that promote health equity for dispossessed populations.

Background

In healthcare, family engagement has been recognized as critical to improved nursing care and outcomes. However, the practice of family engagement in corrections is unknown, despite the large amount of nursing care delivered there.

Purpose

The study’s aim was to describe correctional nurses’ perceptions of family engagement and the extent to which it is practiced.

Method

A qualitative descriptive study design was used, composed of semistructured interviews. Thematic analysis was conducted, including line-by-line coding.

Discussion

The main themes of the study were: (a) Family engagement is rare, and (b) Systems friction which describe the lack of family engagement in correctional nursing practice, and the need to balance advocating for patients while maintaining a collegial relationship with correction staff.

Conclusion

Despite the lack of family engagement in correctional nurses’ practice, most participants felt that family engagement would be beneficial for incarcerated patients but would require changes to institutional policies.