A concept analysis of nurses in conflicts after World War II.

AIM: We analysed nurses' experiences during military conflicts since World War II. BACKGROUND: Nurses have successfully reduced morbidity and mortality in populations affected by wars; despite centuries of nurses' global involvement in wars, there is limited knowledge about their experiences. METHOD: We used Rodger's evolutionary concept analysis methodology to understand the antecedents, attributes, consequences, context and implications of nurses' war-related experiences. We analysed data from quantitative and qualitative research, media reports, editorials, historical reviews and published accounts of nurses' experiences in many locations, including Afghanistan, Bosnia, Croatia, Korea, Kosovo, Iran, Iraq, Israel, Palestine, Russia, Somalia, Ukraine and Vietnam. FINDINGS: Two antecedent conditions preceded nurses' war involvement: actively responding to human suffering and having resources for readiness. Nurses were defined by five attributes: sacrifice, resourcefulness, tunnel-vision, survival mindset and comradery. We also found evidence for seven consequences; nurses saved lives (reduced morbidity and mortality), however, some nurses faced professional burnout/disillusionment, restricted practice authority, isolation and post-traumatic stress after war. In addition, growth and pacifism were consequences for some nurses who were exposed to war. CONCLUSION: The findings of our concept analysis illustrate how nurses have fulfilled critical life-saving roles, but some nurses' post-war experiences were debilitating, stigmatized and unsupported. We conclude that research about the resourcefulness, innovations and resiliency nurses have developed during wars is essential, and professional support mechanisms must be developed to prevent post-traumatic stress, burnout and attrition from the profession. Governments can use utilize the knowledge nurses developed during wars to expand emergency preparedness skillsets and promote nurses as the leaders of international efforts to promote peace. NO PATIENT OR PUBLIC CONTRIBUTION: Patients, service users, caregivers and members of the public were not involved in conducting this concept analysis or preparing the manuscript. IMPACT STATEMENT: By understanding nurses' involvement with post-WWII conflicts, we have demonstrated the significant public health contributions, challenges and personal and professional growth experienced by nurses. Nurses' war-related knowledge should be utilized to innovate healthcare practices during disasters and to advise policymakers in developing, implementing and evaluating peace-promoting operations.

Island communities and disaster resilience: Applying the EnRiCH community resilience framework.

OBJECTIVE: To explore the beliefs, attitudes, and perspectives of community resilience in St. Kitts and Nevis. DESIGN: Qualitative Interpretive Phenomenological Analysis using the EnRiCH Community Resilience Framework for High-Risk Populations (EnRiCH Framework) to identify factors that enhance or create barriers to community resilience to disasters in St. Kitts and Nevis. SAMPLE: Twenty-one key informants and 23 community informants provided insight into the history of disasters. RESULTS: Unique strengths and barriers that significantly influenced this high-risk population's adaptive capacity were identified. A discrepancy between the way disaster preparedness was perceived by government officials and the local population was noted. Cultural factors promoted connectedness and communication and created barriers to empowerment and collaboration. Innovative strategies were suggested that could enhance upstream leadership, downstream management, and resource management during disasters. CONCLUSIONS: Island communities represent a unique opportunity to examine risk reduction and vulnerability within the context of community and societal characteristics. This research addresses a significant gap in the literature on interventions that utilize a strengths-based approach to building adaptive capacity and resilience to disasters among at-risk populations. The EnRiCH Framework can be used to develop an approach to strengthen adaptive capacity and improve resilience to disasters.

The Emergency Nurses Association: 50 Years of Advocacy and Advancement.

To commemorate the 50th anniversary of the Emergency Nurses Association, this article describes the 3 most enduring and impactful policy initiatives in the organization's history. These initiatives were identified through a comprehensive review of the articles published in the Journal of Emergency Nursing as well as in other publications of the Emergency Nurses Association, including position statements and press releases. The top 3 policy issues throughout the Emergency Nurses Association's history were identified as provision of care for vulnerable populations, trauma and injury prevention, and patient quality and safety. The Emergency Nurses Association also worked hard to professionalize emergency nursing within the realms of nursing and emergency services during the first half of its history, and since then the Emergency Nurses Association has promoted issues related to the emergency nursing workforce and to ensuring a safe and sustainable environment in which nurses practice. This article includes critical constructs such as the professionalization of emergency nursing; advocating for vulnerable populations such as children, older adults, and people experiencing sexual violence or human trafficking; improvements in trauma care and injury prevention; promoting quality and safety through nursing certifications, efficient and accurate nurse triage, and disseminating best practices in evidence-based care; and supporting the nursing workforce by championing issues such as workplace violence, ED crowding, and healthy work environments.

Comparing Two Early Child Development Assessment Tools in Rural Limpopo, South Africa.

BACKGROUND: Providing increased cognitive stimulation or learning opportunities to young children significantly increases cognitive and social-emotional competence later in life. This study aims to determine the acceptability of a pediatric assessment tool to track early child development (ECD) in a rural health district in Limpopo, South Africa. METHODS: A total of 11 primary health nurses from the region in two focus groups were selected to learn and compare two ECD assessment tools: the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) and Ages and Stages Questionnaire (ASQ). Data were analyzed using versus coding to compare between the two focus groups and between ASQ and CAT/CLAMS. RESULTS: The major categories that emerged from the discussion were current practice, usability, resource management, cultural adaptation, patient and parent factors, and new knowledge. CONCLUSIONS: This study illustrates the challenges related to adapting and implementing ECD assessment in an environment where ECD is largely unknown by local residents, and differs from the environment in which the tool was initially developed. Further work is needed to develop new tools or alter existing tools that can be adapted to diverse settings and cultures.

Partnership integration for rural health resource access.

Increasing numbers of older adults are residing in rural areas of the USA. Many of these individuals experience greater rates of chronic diseases and lower income levels compared to their urban-residing counterparts. Aging in rural environments creates greater challenges in the provision of funding, staff and resources to meet the needs of these older adults, and contributes to immense health disparities and health inequities. Urban and rural older adult residents alike need healthcare, gerontological and public health resources to promote successful aging in place. Due to the nature of rural environments, many of these resources often exist great distances from these residents, which creates access challenges. There are also limitations in locally available facilities and trained practitioners, resulting in resource shortages for addressing chronic health conditions. The creation and use of interdisciplinary partnerships provides this much-needed support while addressing ever-increasing funding and staffing limitations. This article provides an innovative conceptual interdisciplinary partnership model that combines nursing, public health and gerontology to address the health and social challenges that rural-residing older adults face. Although well-trained practitioners who work within their discipline are an important contributor to assist with the needs of rural-residing older adults, this silo approach is expensive, inefficient, and clearly cannot support all of the needs for older adults in this type of environment. There is a need to blend the complementary skills provided by each of the presented disciplines so that the focus of the interdisciplinary partnership is on person-centered care addressing the health disparities and health inequities experienced by these older adults. To illustrate the integration of nursing, public health and gerontology disciplines, these disciplines are initially combined and presented as dyads, and are then incorporated into the full conceptual model. The dyads are public health and gerontology, public health and nursing, and gerontology and nursing. Steps are provided for the development of this (or any) interdisciplinary partnership. An example of the model's use through clinical and non-clinical disciplines and a community engagement framework is also described. Interdisciplinary approaches focused on person-centered care provide more well-rounded health and social support for rural older adults than any one discipline in isolation. Allocation of shared resources, roles, responsibilities and expenses allows practitioners engaged in interdisciplinary teams to provide superior economic and capacity efficiency. This efficiency is crucial at a time when many entities experience limitations in sustainable resources. Thus, practitioners and community agencies collaborating through interdisciplinary partnerships are better able to address the complex issues experienced by rural-residing community members.

Remembering Pearl Harbor at 75 Years.

: On December 7, 1941, the Sunday-morning quiet of the U.S. naval base in Pearl Harbor, Hawaii, was shattered by dive-bombing Japanese fighter planes. The planes came in two waves-and when it was all over, more than 2,400 were killed and more than 1,100 were injured.Nurses were stationed at U.S. Naval Hospital Pearl Harbor, Tripler General Hospital (now Tripler Army Medical Center), Hickam Field Hospital, Schofield Barracks Station Hospital, and aboard the USS Solace, and witnessed the devastation. But they also did what nurses do in emergencies-they responded and provided care to those in need. Here are the stories of a few of those nurses.

Grace Under Fire: The Army Nurses of Pearl Harbor, 1941.

OBJECTIVE: Much has been written about the military events of December 7, 1941; however, little has been documented about the nurses' work and experience at Pearl Harbor, Hawaii. The aerial assault on Pearl Harbor was the first time in US history that Army nurses had been on the front line of battle. Nurses quickly triaged and stabilized those who could be saved, and provided compassion and comfort to those who were dying, in an environment where the nurses were unsure of their own survival. METHODS: Traditional historical methods and a social history framework were used in this investigation. Primary sources included oral histories from the US Army Medical Department Center of History and Heritage and the State of Hawaii's website, Hawaii Aviation. Secondary sources included published books, newspaper articles, military websites, and history texts. RESULTS: Due to the limited bed capacity, Hickam Field Hospital converted to an evacuation hospital. Nurses, physicians, and medical corpsman triaged, stabilized, and transported those likely to survive, while staging the dead behind the building. The emergency room at Tripler Hospital was quickly flooded with patients from the battlefield, but the staff was able to sort patients appropriately to the wards, to the operating room, or provide comfort care as they died. At Schofield Hospital, collaboration between tireless doctors, nurses, and corpsmen was key to providing life-saving surgery and care.

Qualitative Analysis of Student Perceptions of Bachelor of Science-to-Doctor of Philosophy in Nursing Programs.

BACKGROUND: To address the shortage of Doctor of Philosophy (PhD)-prepared nursing faculty, universities in the United States offer direct-entry Bachelor of Science in Nursing (BSN)-to-PhD nursing programs. Little research has been conducted to explore students' perceptions of these programs and to formally evaluate the successes and opportunities for growth of this academic track. METHOD: Focusing on the perceptions and experiential reflection of BSN-to-PhD education, a survey with open-ended questions was distributed among voluntary participants who are current BSN-to-PhD students or recent graduates (within 5 years) from various universities in the United States. Textual data were analyzed using a qualitative descriptive approach with thematic analysis. RESULTS: This article elaborates on opportunities, challenges, and suggestions related to this educational route, as recognized by 21 participants from seven universities. CONCLUSION: The study findings may facilitate discussion among nurse educators to revise programs to be congruent with the needs of current students while paving the way for future scholars.

Neighborhood: A Conceptual Analysis.

Researchers interested in measuring neighborhood-level effects should understand how "neighborhood" is defined within nursing sciences and other sciences, and the inherent strengths and weaknesses of current research methodologies. This concept analysis provides clarity around the concept of neighborhood within the context of health, analyzes the current state of development of the neighborhood concept, and proposes areas for future nursing research. Using the Rodger's Method of analysis, the concept of neighborhood within nursing and public health research is described based on existing literature. The concept's attributes, related concepts, antecedents, and consequences are given from the literature. Comparisons of the use of neighborhood are made between nursing, public health, sociology, and other sciences. The evolution of the concept of neighborhood throughout history is described, and important implications for future research are discussed.

Description of healthcare needs at an episodic clinic in rural southwest Virginia.

INTRODUCTION: The objective of this study was to describe the population served at an episodic clinic in Southwest Virginia to better understand patient needs at a yearly episodic Remote Area Medical (RAM) clinic that provides free healthcare services. METHODS: The dataset was compiled retrospectively from 2834 medical records from RAM patients between 1 July 2006 and 31 July 2008. Information was de-identified and manually recorded from paper records. The data were analyzed using descriptive statistics and compared to pre-existing estimates from the region. FINDINGS: The number and type of services rendered at the RAM clinic each year varied greatly, and was dependent on the availability of staff and supplies. Diabetes, hypertension, and other prevalent diseases were reported, and an overwhelming majority (74%) of patients were overweight or obese. In 2008, 62% of patients were uninsured, 44% had no primary care physician, and a majority of patients were diagnosed with hypertension or poorly managed diabetes. CONCLUSIONS: Chronic diseases including obesity, hypertension, diabetes, and arthritis plague the Appalachian region. However, better knowledge of the medically underserved in this region can help address the patient's needs through RAM clinics and other accessible health clinics by increasing patient and physician awareness of available services, decreasing patient waiting time, and improving medical recordkeeping.