ANS. Advances in nursing science

Published by Lippincott, Williams & Wilkins
Print ISSN: 0161-9268
This article describes the conceptual development and measurement of hardiness as a motivating factor in adaptation. The health-related hardiness concept is further refined to include theoretical and operational indicators that can be used to investigate the effect of hardiness on adaptation to actual and potential health problems. Empirical support is presented for both the direct and indirect effects of hardiness. A valid and reliable instrument has been developed for health-related research with both well and ill populations. Implications for theory and research are discussed with emphasis on contributing to the knowledge base of nursing and developing interventions in practice.
This article presents historical research into the origins of the Henry Street Settlement on the lower East Side of New York City. It is about Lillian D. Wald and her contributions. Wald used techniques and approaches to deal with problems that exist today: health care equity and financial support from public and private sources. Keys to her success include effective leadership, assertive management, and knowledge of the power structure. The Henry Street Settlement, from its humble origins, set precedents for innovations in public health nursing that have profoundly affected health care in the United States.
This study was designed to explore the relationship between the minutes of the alumnae association of a training school for nurses, from 1895 to 1916, and the occupational evolution of nursing. The members of the St Luke's Alumnae Association, even in their initial statement of purpose, consistently affirmed their ties to other nurses, thus implicitly supporting the cause of trained nursing. But the cause of trained nursing was not the same as that of professional nursing. These findings support the usefulness of the "work group" paradigm vs the paradigm of professionalization in attempting to describe accurately the occupational evolution of nursing as portrayed in the minutes.
The editorial position and content of each issue of the first 20 years of the American Journal of Nursing were explored in relation to the emergence of nursing as a profession. Themes identified reflect professional issues, socialization of nurses, and the influences between other major social/political movements. The evidence of the study reveals strong nursing leadership toward (1) legitimatizing nursing as a self-controlled profession and (2) generating reform in nursing and society at large. The evidence of this study contradicts many prevalent popular views about the history of nursing.
Public health nurses provided leadership for the advancement of public health in Canada in the early decades of this century, although leadership by nurses is not celebrated in public health history. The historical period (1918-1939) selected for this inquiry is one in which public health nurses created a legacy of achievements in public health nursing education, practice, and the organization of community health services within the most challenging of social, economic, and political contexts. The practice of public health nursing in Canada during the interwar years included strategies that were then and still are integral to the discipline--those of forming connections with the community, providing leadership in the public health movement, and facilitating community organization. It is vital to understand the significance of these origins of public health nursing as forces in the present context of practice threaten to alter fundamentally the nature of public health nursing's connection with the community. The purpose of this article is to highlight aspects of this historical legacy so that its influence can be more fully understood and strengthened in current health system transitions.
This study analyzes the activities of religious sister nurses as they confronted racism in the American South from 1940 to 1972. Selma was chosen as a case study because, in the 1960s, events in that southern town marked a turning point in the civil rights movement in the United States. This is a story about the workings of gender, race, religion, and nursing. The sisters' work demonstrates how an analysis of race in nursing history is incomplete without an understanding of the roles that a number of Catholic religious women took in reaching out to African Americans in the Deep South.
This article examines the development of critical care nursing from 1950 to 1965 through the lens of a local story--the development of the critical care unit at the Hospital of the University of Pennsylvania (HUP) in Philadelphia, Pennsylvania. The methodology used is social history. The data for the analysis were derived from oral history interviews, archival material, and secondary sources. The study concludes that powerful social contextual factors, such as work force and economic issues, architectural changes, and an increasingly complex hospital population--rather than new technology--supported the development of critical care. The study also provides parallels to contemporary nurse work force issues.
This article examines the initial development of the American Nurses Association's Social Policy Statement (SPS). The methodology used is the Social History of Technology. This approach provided the means to treat the SPS as an information practice or tool that resides within a technological system composed of skills, tools, and knowledge. The data for analysis include archive material and secondary sources. This study concludes that development of the SPS was inherently a local exercise in prioritizing, organizing, and promoting certain skills, tools, and knowledge associated with nursing practice, an exercise that integrated contextual influences with local realities. The study also provides a means to reflect on the development of contemporary information practices.
The extent to which theory and research were interrelated in 142 gerontologic nursing studies was examined using the Theory-Research Linkage Inventory, an instrument developed by the authors. Forty-six percent of the studies reviewed were related in varying degrees to a specific theory or model. Strengths and limitations were identified for the conceptual, empirical, and interpretive phases of the studies. However, the most problematic was the interpretive phase, where study findings and implications for practice should be linked to theory. Factors influencing the primarily unidirectional theory-research linkage are examined, and recommendations for the advancement of gerontologic nursing science are offered.
Despite past progress in the development of nursing theory, a theoretical nursing perspective is not yet common to the practice of nursing administration. Such a perspective could serve as a catalyst both to advance knowledge development for administrative nursing practice and to align clinical and administrative practice within a common framework. In this article assumptions, concepts, and questions common to both clinical and administrative nursing practice are identified. Select domain concepts are used to exemplify the themes shared by nurse clinicians and nurse administrators. The article concludes with a five-item agenda as a guide for future theory development.
This report of a postmodern feminist oral history tells a contemporary story of the success of nursing in overcoming the impediments of tradition, organizing and acting as an identifiable group, and speaking out with clarity as advocates for the health of American society. This was an important historical, transitional, and celebratory time for nursing. Continuing advocacy for health care for all Americans requires developing expertise in both traditional and feminist leadership, understanding how political theories and history affect policy development, and active participation in American democracy. Future actions require incorporation of lessons from the recent past.
Within the profession of nursing, nursing theory, conceptual models, and knowledge development continue to be points of discussion and debate. Some suggest that nursing research must either test or develop nursing theory, whereas others believe that research germane to practice can legitimately incorporate what is commonly referred to as borrowed theory. This descriptive analysis of nursing doctoral dissertations (N = 207) conducted from 2000 to 2004 focused primarily on the inclusion or exclusion of nursing theories. Almost half (45.4%) of the dissertations studied theories from fields other than nursing, 27.1% of the researchers studied nursing theories, and 27.5% of the dissertation studies engaged in theory generation. Implications for nursing knowledge development and research specific to practice are discussed.
The purpose of this study was to evaluate the methodological quality of quantitative lesbian, gay, bisexual, and transgender nursing research from 2000 to 2010. Using a key word search in Cumulative Index to Nursing and Allied Health Literature, 188 studies were identified and 40 met the criteria, which included descriptive, experimental, quasi-experimental, or observational (case control, cohort, and cross-sectional) design. The methodological quality of these studies was similar to that reported for medical and nursing educational research. The foci of these lesbian, gay, bisexual, and transgender studies were biased toward human immunodeficiency virus, acquired immunodeficiency syndrome, and sexually transmitted diseases, and 58.5% of the funded research was related to human immunodeficiency virus or acquired immunodeficiency syndrome. To provide evidence-based health care to these populations, an understanding of the current state of research is crucial.
What is passionate scholarship? According to students and graduates from a nursing doctoral program interviewed 10 years ago, passionate scholars must risk committing to a personally meaningful and socially relevant topic close to the heart. This insight spawned a string of exploratory inquiries and educational interventions in search of the "ideal conditions" that foster passionate scholarship. Updating the findings of that original study published in Advances in Nursing Science in 2001, this article describes a 3-year, faculty development initiative. Beyond increasing scholarly productivity, the findings suggest that turning faculty groups into communities of scholarly caring can make academic environments safer for passionate risk-takers.
The purpose of this article is to raise awareness, inspire action, and open dialogue about professional values and workplace conditions. Results of the Nurse Manifest 2003 Study are presented through meta-synthesis of group summaries answering the questions: What is it like to practice nursing? and, What changes do nurses desire to support practice? The results illuminate the underlying framework of professional values that splits our profession, nursing units, and educational institutions. An analysis of the similarities and differences within and between groups reflect values which are rooted in the history of our profession and affected by present working conditions.
This historical article considers nursing's work for social justice in the 1960s civil rights movement through the lens of religious sisters and brothers who advocated for racial equality. The article examines Catholic nurses' work with African Americans in the mid-20th century that took place amid the prevailing social conditions of poverty and racial disempowerment, conditions that were linked to serious health consequences. Historical methodology is used within the framework of "bearing witness," a term often used in relation to the civil rights movement and one the sisters themselves employed. Two situations involving nurses in the mid-20th century are examined: the civil rights movement in Selma, Alabama, and the actions for racial justice in Chicago, Illinois. The thoughts and actions of Catholic sister and brother nurses in the mid-20th century are chronicled, including those few sister nurses who stepped outside their ordinary roles in an attempt to change an unjust system entirely.
This historical study analyzes 2 disasters in Texas in the early 20th century: the 1937 school explosion in New London and the 1947 Texas City ship explosion. Disaster narratives and commemoration activities are examined as means of healing and restoration after a catastrophic event. Specifically, this article discusses contextual factors of time and place, Coastal and East Texas between 1937 and 1947, and shows how these factors shaped the ways in which people made sense of their disaster experiences. This included not only the influence of geography but also economics, social position, racial characterizations, and religious beliefs. The article also considers conflicting and biased factors that can occur regarding time and place and how these factors influenced narrative constructions.
Generating new knowledge through science is one of the most valued contributions of American universities, and is wholly dependent on the tenets of academic freedom. This article provides an overview of academic freedom in the United States, lack of attentiveness to academic freedom in the discipline of nursing, and its relevance for advancing nursing science. Three issues are critically evaluated as they relate to "the free search for truth" that is imperative for scientific progress to occur, including (a) its importance in a liberal science system, (b) recent trends to politically manipulate science, and (c) movements to restrict speech on campus.
Health care reform, layoffs, and hospital closures have created substantial stress for both nursing leadership and nursing staff. History suggests that nursing staff and leaders have not felt closely aligned and mutually supportive. An environment that provides a means for renewal of caregivers and administrators is needed to sustain caring practice. A new leadership paradigm, connective leadership, is proposed to address the problems of the past. Connective leaders, by empowering staff at all levels, facilitate the collaboration and synergism needed in the reformed health care environment of the future.
This article explicates a framework for nursing knowledge development that incorporates both modernist and postmodernist philosophies. The framework derives from an "open philosophy" of science, which links science, philosophy, and practice in development of nursing knowledge. A neomodernist perspective is proposed that upholds modernist values for unified conceptualizations of nursing reality while recognizing the dynamic and value-laden nature of all levels of theory and metatheory. It is proposed that scientific inquiry extend beyond the postmodern critique to identify nursing metanarratives of nursing philosophy and nursing practice that serve as external correctives in the critique process. Philosophic positions related to the science, philosophy, and practice domains are put forth for continued dialogue about future directions for knowledge development in nursing.
The purpose of this study was twofold: (1) to explore potential changes in the Brazelton Neonatal Behavioral Assessment Scale (BNBAS) from 40 to 44 weeks postconceptional age (PCA) and (2) to determine the relationship between the BNBAS scores and feeding behaviors in preterm infants at 40 and 44 weeks PCA. The BNBAS and sucking behavior measurements were completed on 104 preterm infants at 40 and 44 weeks PCA. The Orientation (p = .001), Motor (p = .001), Range of State (p = .001), Autonomic Regulation (p = .01), and Reflexes (p = .00) clusters were significantly more mature at 44 weeks PCA than at 40 weeks. Infants that were extremely early born (n = 24) had a significantly larger change in BNBAS scores over time as compared to the more mature preterm infants (n = 77), largely catching up with their more mature preterm counterparts. At 40 and 44 weeks PCA, the BNBAS cluster scores for orientation (p = .02), motor (p = .048), range of state (p = .048), and regulation of state (p < .001) were significantly related to the average maximum pressure, adjusted for gestational age and weeks PCA. Significant neurobehavioral maturation takes place between 40 and 44 weeks PCA in preterm infants, with the greatest changes occurring in the most preterm infants. These findings highlight the relationship between neurobehavioral maturation and feeding behaviors.
Women with urinary incontinence (UI) report that the disease negatively impacts their quality of life but, paradoxically, under-report symptoms. A predictive model using Orem's self-care deficit theory was developed exploring the effect of body experience on self-care agency to manage UI. A sample of postmenopausal women was drawn from a larger trial. Structural equation modeling was used to test the proposed model. Minor modification of the model produced a well-fitting model (chi(9) = 3.20, P = .96, n = 235). Results supported the positive effect of nursing agency on self-care agency. Group education about UI may increase self-care agency in postmenopausal women.
A recent union drive by the faculty at the University of Illinois at Chicago sparked controversy among academic nurses in the College of Nursing. Background on the union drive and the history of nursing labor organizing is provided to demonstrate the fit of union representation for nurses in all settings today, including academia.
Home health care nurses are facing the ethical dilemma of discontinuing care to nonpaying needy patients or facing agency economic demise. Nurses perceive discontinuing care under such circumstances as patient abandonment. Ethical analysis of the dilemma yields two conclusions: (1) discontinuing care under non-life-threatening circumstances is not abandonment and does not violate the duty of beneficence, and (2) nurses do have an obligation to inform society of such instances so that public policy decision makers can be armed with that information when making allocation decisions.
Upstream thinking considers the social, economic, and environmental origins of health problems that manifest at the population level. The upstream thinking perspective is applied to an examination of environmentally associated health problems and the opportunities that citizens have (or do not have) to access information and resources to make health-promoting choices in response to environmental health risks. A proposed framework for nurses to reduce environmental health risks includes distributive and strategic actions. Distributive actions include tracking, embedding, and translating; strategic actions include discovering through etiologic research, discovering through community-based research, advocating, and reframing. Together these actions can help formalize nursing's role in responding to citizens' concerns about environmental health problems.
Because of the questionable applicability to extant health promotion models and middle-range theories to aboriginal peoples, foundational inquiries examining the nature of cultural beliefs and ways of knowing about health within the cultures of various ethnic groups are imperative. This article describes the ways of knowing about health reported by Ojibwe people during an ethnographic inquiry in the Great Lakes region. These ways included stories from the oral tradition, authoritative knowledge of elders, "commonsense" models of illness and health, spiritual knowledge, and knowing oneself. The health-world view, a conceptual orientation for investigating health beliefs, is offered.
Poor access to prenatal care for Aboriginal people is well documented, and is explicated as an unethical barrier to care resulting from colonial and neocolonial values, attitudes, and practices. A postcolonial standpoint, participatory research principles, and a case study design were used to investigate 2 Aboriginal organizations' experiences improving care for pregnant and parenting Aboriginal people. Data were collected through exploratory interviews and small-group discussions with purposefully selected community leaders, providers, and community members. The study found that safety in healthcare relationships and settings, and responsiveness to individuals' and families' unique experiences and capacities must be brought into the forefront of care. Results suggest that the intention of care must be situated within a broader view of colonizing relations to improve early access to, and relevance of, care during pregnancy and parenting for Aboriginal people.
Although most women find it difficult to provide care to an older family member, some women face additional challenges and health risks because the care recipient is abusive or aggressive toward them. This study tested a 12-week psychoeducative nursing intervention intended to decrease the frequency and intensity of physical and verbal/psychological aggression toward older caregiving wives and daughters by care recipients and improve selected abuse-related outcomes. The intervention, which focused on pattern identification, advocacy counseling, reframing of the caregiving situation, and nonconfrontational caregiving strategies, was individualized and highly interactive with emphasis placed on mutual problem solving and mutual planning. Subjects included women older than 50 who provided care to elders older than 55. Subjects were randomly assigned to group (intervention, N = 38; control, N = 45) and data collectors were "blinded" to group assignment. Findings indicated the intervention significantly reduced frequency of verbal/psychological aggression, and feelings of anger for caregivers providing care to fathers or husbands. It was not effective for caregivers providing care to mothers, and it did not reduce burden. Implications for nursing include raising awareness about the special vulnerabilities of older caregivers, providing provocative new information about the gender-based power dynamics in caregiving situations and underscoring the need for nurses to assume a stronger leadership role in building science with regard to family caregiving.
The ethics of mandatory elder abuse reporting statutes are analyzed in terms of beneficence, autonomy, and nonmaleficence. The statutes, based on the ethical principle of beneficence, are now the law in 37 states. However, evidence to support that the statutes actually fulfill rules derived from beneficence is weak. As a result, the strength of rules derived from autonomy and nonmaleficence, already strong within nursing, is increased, and potential conflicts between the rules to remove harm but to obtain consent, to prevent harm but to maintain confidentiality, and to provide benefits but to inflict no harm are created.
Abuse Pathways model. 
Disability composition of the sample * Other Spinal SCI Cord † Deaf/HOH Arthritis ‡ Vision Seizure D/O CA HIV Hepatitis C COPD
Types and forms of abuse experienced by women with physical disabilities
The purpose of this article is to provide an overview of an empirically based theoretical model of abuse of women with physical disabilities. The Abuse Pathways model was developed from a critical disability life history research study conducted with 37 women who had simultaneously experienced abuse and physical disability. The model begins to address the complexity of abuse of women with physical disabilities by identifying the interactive components of the phenomenon. These components include (1) the social context of disability; (2) women's abuse trajectories; and (3) vulnerability factors for abuse. The article concludes by discussing potential applications and limitations of the model.
The characteristics, immediate and long-term aftereffects, and methods of adapting to father-daughter incest were examined. Twenty-one women with a past history of childhood or adolescent paternal incest were interviewed. The findings suggest that the female victim of paternal incest may endure more emotional, social, physical, self-identity, familial, and interpersonal difficulties during and shortly after the incest has been terminated. Relationships with men and sexuality were more adversely affected with time. Positive coping mechanisms of incest and factors contributing to the victims' adjustment to the incest were documented. Implications of findings for nursing practice and research are discussed.
As survivors of childhood sexual abuse (CSA) struggle to grasp and reclaim their selves, their stories, and their futures from the grip of aftereffects of trauma, the processes of recovery and rehabilitation are interwoven with remembering. Questions about women's delayed memories of CSA have stirred a controversy that places clients' credibility at stake. Nurses need to understand the historical and political roots of this controversy and to be familiar with the empirical knowledgebase that exists about traumatic memory. This article is a critical feminist analysis of the topic. Its purposes are to provide a historical context for the current debate about "true" and "false" CSA memories; to discuss selected literature about conventional understandings of memory and their relevance to this debate; to present an integrative, phenomenological approach to memory in the recovery and rehabilitation of women CSA survivors; and to use the insights gained to draw conclusions from a nursing perspective about the authenticity of delayed CSA memories. Phenomenological concepts of reminding, reminiscing, recognition, body memory, place memory, and commemoration are discussed as they illuminate the complexity of traumatic memories and the recovery and rehabilitation needs of survivors of childhood sexual abuse.
This article explores the geography of childhood sexual abuse by describing characteristics of the home, school, and community environments in which abused girls grew up. Results of this focused life story research involving 20 women survivors who narrated their childhood experiences suggest a topography of 20 distinct characteristics integral to the milieux of these abusive childhood homes. Dynamics of the home environment were reinforced in school and community environments. Implications for prevention and early, environmentally based interventions for girls at risk of abuse and retraumatization are discussed.
Mindfulness-Based Stress Reduction (MBSR) programs are becoming more integrated into the treatment of persons with substance use disorders (SUDs). A focus of MBSR is to increase awareness of sensations in the body and accept them in the moment without judgment. Little is known about the readiness of women, with posttraumatic stress disorder (PTSD), and their level of comfort to participate in MBSR programs. Habermas' ideal speech situation guided a cooperative inquiry with 45 women at 3 treatment centers. Women engaged in activities of MBSR and shared opinions on how to develop a manual that would address the readiness of women with SUDs-PTSD to participate in MBSR.
Unitary appreciative inquiry was used to explore healing in the lives of 11 women abused as children using a model of participatory dreaming. Aesthetics, imagery, and journaling were used in a participatory design aimed at the appreciation of healing in the lives of the participants as it related to the abuse. Using Cowling's theory of unitary healing, research and practice were combined within a unitary-transformative framework. Participatory dreaming was useful in illuminating the life patterning in the lives of the women and promoted the development of new knowledge and skills that led to change and transformation, both individually and collectively.
Roy's adaptation model and its utility as a conceptual framework for research and clinical practice with abused women is described through research and clinical examples. The research with a sample of 40 abused women focuses on their help-seeking patterns, whereas the clinical practice with a larger sample focuses on the interrelationships of the constructs. The apparent strengths and weaknesses of Roy's model are discussed. Based on this critique, specific modifications are made, and propositions suggested, for follow-up studies and intervention.
Although intimate partner violence is a significant global health problem, few tested interventions have been designed to improve women's health and quality of life, particularly beyond the crisis of leaving. The Intervention for Health Enhancement After Leaving is a comprehensive, trauma informed, primary health care intervention, which builds on the grounded theory Strengthening Capacity to Limit Intrusion and other research findings. Delivered by a nurse and a domestic violence advocate working collaboratively with women through 6 components (safeguarding, managing basics, managing symptoms, cautious connecting, renewing self, and regenerating family), this promising intervention is in the early phases of testing.
The troubled-teen industry has come under federal scrutiny after over a decade of reported abuses and the reported deaths of at least 10 children. This article provides a brief overview of the development of the troubled-teen industry, addresses the thorny issue of parents' right to send their children to these facilities vis-a-vis the rights of their children, and argues that nurses and other health professionals have a collective obligation to speak out against them in the strongest possible terms. Suggestions for action by nurses are proposed that could protect vulnerable children against this continuous cycle of institutionalized child abuse masquerading as therapy.
About 110 million American adults are looking for health information and services on the Internet. Identification of the factors influencing healthcare consumers' technology acceptance is requisite to understanding their acceptance and usage behavior of online health information and related services. The purpose of this article is to describe the development of the Information and Communication Technology Acceptance Model (ICTAM). From the literature reviewed, ICTAM was developed with emphasis on integrating multidisciplinary perspectives from divergent frameworks and empirical findings into a unified model with regard to healthcare consumers' acceptance and usage behavior of information and services on the Internet.
Top-cited authors
Afaf Meleis
  • University of Pennsylvania
Carol Estwing Ferrans
  • University of Illinois at Chicago
Eun-Ok Im
  • University of Pennsylvania
Janice M Morse
  • University of Utah
Deanne Karen Hilfinger Messias
  • University of South Carolina