The lived experiences of persons with chronic venous insufficiency and lower extremity ulcers.

PURPOSE: The aim of this qualitative study was to describe the lived experience of chronic venous insufficiency (CVI) sufferers and to explore how this chronic disease affected their health-related quality of life. SUBJECTS AND SETTING: Participants included persons with a history of venous insufficiency and leg ulcers or active venous insufficiency patients. The research setting was a hospital-based outpatient wound care clinic in a small naval community approximately 1 hour from Seattle, Washington. A convenience sample of 10 patients participated in the study; 6 were women and their mean age was 66 years. Nine were white and 1 was African American, and all were currently retired, disabled, or unemployed. INSTRUMENT: A 9-item interview guide was developed consisting of open-ended questions intended to elicit the lived experiences of persons with CVI. METHODS: Respondents participated in 1 focus group or individual interviews. Interpretive phenomenological analysis was used to guide data collection and analysis. Three patients participated in individual interviews and 7 patients participated in a 1-hour focus group. Data obtained from personal interviews were handwritten and data from focus group were audio-recorded. Audio-recorded data from focus group participation were transcribed, analyzed, and compared with the handwritten interviews using interpretive phenomenological analysis. RESULTS: Four themes identifying the various emotional, physical, and social implications of living with CVI were identified. They were (1) knowledge deficit, (2) discomfort, (3) inconvenience, and (4) coping. Participants identified concerns with knowledge deficits surrounding CVI among nonwound specialized providers. Physical discomfort and issues around the inconvenience presented by the frequency of physician visits and the nature of the treatments for CVI were also noted as a great concern among all participants. Participants provided insight into the importance of a strong social network of friends and family as well as the importance of a good relationship with your medical providers to assist sufferers in coping with the disease process. CONCLUSION: Participants cited knowledge deficits regarding CVI among nonspecialized health care providers and the discomfort, pain, and inconvenience of suffering from CVI as contributors to poor health-related quality of life. Participants described family, friends, and caregiver relationships as being especially important in helping them cope with the disease process.

Hispanic nurses' experiences of bias in the workplace.

PURPOSE: The continuing issue of health inequity for Hispanics highlights the importance of retaining Hispanic nurses in the workplace. This article describes the use of short answers such as "Describe the bias you experienced" and "If a patient refused care, what was the reason given?" to increase understandings about bias through the descriptions of Hispanic nurses. In this study, bias was defined as those implicit negative stereotypes and attitudes that negatively affect judgments about, evaluations of, and actions toward others. DESIGN/METHOD: For this qualitative component of a descriptive study employing both qualitative and quantitative methods, 111 Hispanic nurses responded to open-ended questions about experiences of bias that were included with a survey tool and demographic questionnaire. FINDINGS: Three themes emerged: being overlooked and undervalued, having to prove competency, and living with "only-ness." Respect was an overarching concept. DISCUSSION/CONCLUSIONS: The written descriptions of bias provided depth and understanding to the quantitative findings. Nurse leaders are well positioned to develop and implement strategies to more effectively support Hispanic nurses and to promote nonbiased interactions in the workplace. IMPLICATIONS: Retaining Hispanic nurses is a vital component to address issues of health inequity for Hispanic patients.

Nurses' knowledge and attitudes toward pain in the emergency department.

INTRODUCTION: The purpose of this study was to investigate emergency nurses' knowledge and attitudes about pain. METHODS: A descriptive design was used for this study. A validated tool, the Knowledge and Attitudes Survey Regarding Pain (KASRP), was administered to nurses working in 5 U.S. emergency departments. Demographic data also were collected from each participant. RESULTS: Ninety-one emergency nurses completed the survey. The mean total KASRP score was 76%. No significant differences were found in mean total scores by age, education level, years of nursing experience, or years of ED experience. Eight questions were answered incorrectly by more than 50% of participants. Five of these questions were related to opioid pharmacology and dosage, 2 concerned understanding of addiction and dependence, and one was linked to nurse assessment and patient report of pain level. Analysis of these 8 questions revealed that higher education levels had a weak positive association with correct answers. DISCUSSION: Participants taking the survey scored comparably or better than participants in other reported studies using the KASRP. Years of nursing experience was not correlated with correct responses. Findings from this study underscore the Institute of Medicine's Pain in America recommendation to increase pain management education for all providers.

Bias in the nursing workplace: implications for Latino(a) nurses.

The nursing shortage coupled with health inequities makes it imperative to retain nurses from diverse backgrounds in the workplace. Since Latinos are the fastest growing racial/ethnic group in the U.S., the issue is of particular importance. Thus, the purpose of this study was to measure the prevalence of bias in the nursing workplace as experienced by Latino(a) nurses. This descriptive study of Latino(a) nurses measured the prevalence of bias, its relationship to nurse retention in the nursing workplace, and additional factors in the workplace that were associated with bias. Results included that Latino(a) nurses both experienced and witnessed bias on a regular basis, along with negative comments by peers about their ethnicity. Significant correlations were found between experiences of bias and the study variables of witnessing bias, perceived levels of support, and time planning to remain in the workplace. As the nursing shortage continues and increases in severity, retaining nurses becomes as important as creating new nurses. Nurse managers, hospital administrators, and nurse educators must develop strategies to educate staff and promote non-biased interactions between nurses in the workplace, as well as to support nurses from diverse backgrounds.

The importance of social connectedness in building age-friendly communities.

The purpose of this paper is to further elucidate the importance of social relationships and social connectedness with aging in place and in developing elder-friendly communities. The process used in this study was inclusive of younger adults (age 40-65) as well as older adults (65+) in order to further understand how they envision a community that could support their own aging in place. A community forum, using the World Café format, was conducted in order to engage community members, 40 years and older, in conversation about the importance of social connectedness in elder-friendly communities. A second purpose of this forum was to obtain data on what would keep aging boomers in their community as they age. Three major themes emerged from qualitative analysis of the forum: social reciprocity, meaningful interactions, and structural needs/barriers. The results of this study reinforce the importance of social connectedness in creating and maintaining elder-friendly communities for older adults, as well as soon-to-be retired individuals, wishing to maintain life connectedness to their community. The study suggests the possibility of using more nontraditional research techniques (such as the World Café process) for gathering community level data.

Being cabezona: success strategies of Hispanic nursing students.

Hispanic registered nurses (RNs) are poorly represented in professional nursing, comprising only 1.7% of RNs despite representing 15% of the population of the United States. Furthermore, their numbers are actually decreasing in nursing at the same time the Hispanic population is experiencing serious health disparities. This descriptive, interpretive study explores strategies used by Hispanic nursing students to overcome obstacles from the perspectives of 13 currently enrolled students and recent graduates through focus groups and individual interviews. Successful students were highly motivated to succeed, while at the same time able to maintain strong cultural ties and family responsibilities, and used a strategy they called being cabezona(stubborn) in the face of numerous obstacles, including discrimination. Recommendations for nurse educators are presented, including the need for increased flexibility, mentoring support, and including curricular content about issues of privilege and oppression in nursing programs.