Nutritional Beliefs and Practices of Arabic-Speaking Middle Eastern Mothers Living in the United States.

INTRODUCTION: Culture and acculturation influence nutritional beliefs. Little is known about the Arabic population in the United States. In this study, Arabic-speaking Middle Eastern mothers' perceptions of motherhood and childhood nutritional beliefs and practices are explored. METHOD: Semi-structured interviews with 12 mothers from Arabic-speaking Middle Eastern countries. RESULTS: Food and family are central to everyday life. Mothers worked hard to maintain traditional nutritional practices with their school-age children. DISCUSSION: Findings can enhance school nurses' ability to collaborate with mothers in nutritional education and address any issues in the classroom.

The impact of approachable nurses: An exploratory study, the voice of hospitalized children with cancer.

PURPOSE: The right of children to be heard was acclaimed at the 1989 Convention on the Rights of the Child, with subsequent research conducted in various settings, but with few in hospitals. This study explores the perceptions of children hospitalized with cancer and the impact of approachable nurses. DESIGN & METHODS: The impact of approachable nurses was explored using a qualitative, descriptive research design, including semi-structured interviews with seven school age children in a pediatric oncology service. Audio recorded interviews were content analyzed using immersion/crystallization and editing organizational styles. RESULTS: Children felt a sense of genuine concern when the nurses took time to talk and listen to them and the positive impact of fun and laughter in the midst of difficult and challenging circumstances. They had a lasting feeling of gratitude for creative ways nurses cared for them. Individualized attire created an immediate openness and avenue to conversation. Children were less worried about a rehospitalization because approachable nurses made them feel at home while in the hospital. IMPLICATIONS: Nursing administration and managers are urged to provide training and regularly evaluate communication competencies. Nurses need to be accountable for the impact of their presence and actions on children both inpatient and following hospitalization. The need to promote an environment of comfort and trust supports positive impact for present and future hospitalization experiences.

Perceptions of health and illness among older Hispanic adults.

BACKGROUND: Understanding perceptions of health and illness among older Hispanic adults is vital for nurses when designing effective health promotion programs. PURPOSE: The purpose of this study was to explore the perceptions of health and illness and how health was maintained during times of illness. METHOD: This inductive qualitative descriptive study used a single focus group with interviews over three sessions. All eight members of the focus group were Spanish-speaking, older adults living in the community. Immersion/crystallization and editing analytic styles were used to analyze the data. RESULTS: Participants were parishioners at a local church and knew each other from participating in community events. Perceptions of health mainly focused on both the absence of illness and physical limitations. Maintaining health included a healthy lifestyle and being physically active; however, food was central to maintaining health. Perceptions of illness were described as "feelings of sickness" such as sadness and worry. Dealing with illness was equated with physical limitations, with strategies suggested, including going to the doctor, preparing natural and folk remedies, spirituality, and support from family and friends. CONCLUSION: Nurses have an important role in assessing the health management strategies of older Hispanic adults and need to incorporate the older adults' understanding of health and illness into their plan of care.

Nurse practitioners' and certified nurse midwives' experiences providing comprehensive early abortion care in New England, USA.

Access to abortion is linked to better maternal health and is essential to advancing women's economic and social equality. Globally, nurses and midwives have been identified as key for increasing access to this service. In this qualitative study we describe the experiences of nurse practitioners and nurse midwives who provide comprehensive early abortion care in the New England region of the United States. In contrast to much of the existing literature from around the world on nurses who deliver abortion care, we found participants' experiences providing comprehensive early abortion was generally positive. The study has implications for theory development, research, and policy.

A description of approachable nurses: An exploratory study, the voice of the hospitalized child.

PURPOSE: The 1989 Convention on the Rights of the Child drew international attention to the right of a child to be heard. Researchers have enhanced the child's voice in many settings, albeit few in the hospital. Nurse researchers investigating the hospital experiences of children have identified positive and negative patterns of communication. Potential characteristics of an approachable nurse were hinted at, although none explored the concept of approachability. DESIGN AND METHODS: A qualitative, descriptive research design, including semi-structured interviews with seven school age children (ages 8-12, four girls and three boys) in a pediatric oncology service, was used to gain children's perceptions and descriptions of approachable nurses. Drawings were used to supplement and glean a greater understanding of descriptive characteristics. All but one child had endured multiple hospitalizations related to their diagnosis of cancer. Interviews were recorded and data were content analyzed using immersion/crystallization and editing organizational styles. RESULTS: The children had experiences with more than one approachable nurse and described approachable nurses as smiling and happy, playful, creative, competent and willing to talk and listen to them. CONCLUSION AND PRACTICE IMPLICATIONS: The school age children in this study were able to describe their perceptions of an approachable nurse. The voices of these children illuminate the importance of nurses' words and behaviors and provide exemplars of approachable nurses. It can be argued that the responsibility remains with nurses to create an environment where in hospitalized children feel their voices are heard, they are understood and respected with unprecedented dignity.

Coping with mental health issues among older Hispanic adults.

Access to mental health services for older Hispanic adults is limited and often older Hispanic adults must rely on their own resources in dealing with mental health issues. The aim of this study was to understand how older Hispanic immigrants cope mental health issues (e.g. stress, anxiety, and/or depression). A qualitative, descriptive approach was used to interview 17 older Hispanic immigrants from Guatemala, Dominican Republic and Colombia. Interviews were audio recorded, transcribed and translated verbatim by bilingual research assistants. Data were analyzed using content analysis with a combination of immersion/crystallization, editing and template organizing styles. Ways of coping included spiritual beliefs and religious practices, social support, distraction, medications and professional help. Primary care providers may be more effective if they build upon the cultural constructs that undergird older Hispanic immigrants' ways of coping in addressing emotional distress and mental health issues in this population.

The Role of the Nurse Scientist as a Knowledge Broker.

PURPOSE: This article introduces the importance and nature of the role of the nurse scientist as a knowledge broker. DESIGN: A systematic literature review was completed using a modified version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) appraisal tool to trace the emergence and characteristics of the knowledge broker role across disciplines internationally and in the United States. METHODS: Salient publications were identified using PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Sociological Abstracts, and ProQuest Dissertations & Theses, as well as hand searches and searches of the grey literature. Authors used these resources to define the knowledge broker role and with their role-related experiences developed the Thompson Knowledge Brokering Model. FINDINGS: A knowledge broker is one who connects science and society by building networks and facilitating opportunities among knowledge producers and knowledge users. The knowledge broker role includes three components: forming and sustaining partnerships; facilitating knowledge application; and creating new knowledge. There are five major strategies central to each role component: establish, engage, educate, empower, and evaluate. CONCLUSIONS: The knowledge broker role has been increasingly recognized worldwide as key to translating science into practice and policy. The nurse scientist is ideally suited for this role and should be promoted worldwide. The Thompson Knowledge Brokering Model can be used as a guide for nurse scientists. CLINICAL RELEVANCE: The role of the knowledge broker is to facilitate translation of useful research to practice and policy by connecting stakeholders through meaningful engagement.

Perceptions of Mental Health Among Hispanic Older Adults: Findings Among Immigrants from the Dominican Republic, Colombia, and Guatemala.

Disparities exist in the recognition and treatment of mental health issues among Hispanic community-dwelling older adults. Previous researchers have focused on accessing mental health services, with limited attention to older Hispanic immigrants' perceptions of mental health issues. A qualitative descriptive research design was used to understand older Hispanic immigrants' perceptions of mental health issues, especially those related to stress, anxiety, and depression. Seventeen older adults from the Dominican Republic, Colombia, and Guatemala were interviewed. Despite having experienced significant personal tragedies, participants did not initially describe emotional distress or any mental health issues. When specifically questioned, depression was the most recognized illness. Depression was commonly described as sadness, whereas stress and anxiety had multiple definitions among participants. Understanding older Hispanic immigrants' perceptions of mental health issues and establishing a therapeutic relationship between the health care provider and patient may be helpful in recognizing and treating individuals who may be at high risk for emotional distress, anxiety, and depression. [Journal of Gerontological Nursing, 44(11), 44-50.].

Ageing out of place: The meaning of home among hispanic older persons living in the United States.

AIM: To explore the meaning of home among older Hispanic immigrants who are "aging out of place." BACKGROUND: Emerging evidence supports the concept of older persons ageing in place. Nurse researchers have demonstrated that older person who age in place have better physical, psychological and cognitive outcomes. Less, however, is known about older persons who are "aging out of place," meaning out of their country of origin. With the growth of home health care, there is a need to understand the older immigrants' meaning of home when ageing out of their country of origin. DESIGN AND METHOD: An inductive, qualitative descriptive research design was used. Seventeen Hispanic participants, ranging in age from 65 to 83 years were interviewed using a semi-structured interview protocol. FINDINGS: Two major finding of the study focused on participants' descriptions of home in their country of origin and in the USA. The majority of participants described their home in their native country as the community, countryside or town (pueblo) and in the U.S.A. as family. The level of social isolation and loneliness among participants was evident. CONCLUSIONS: Older Hispanic immigrants who are "aging out of place" integrate their past experiences of sense of place in their native country with their present experiences of home in the USA. The need to understand the role of the community and the family in the provision of nursing care in the home may be more important than the physical structure or setting in which it is delivered. Further intra- and cross-national studies are needed to provide a framework for understanding the issues of ageing and immigration globally. IMPLICATIONS FOR PRACTICE: Gerontological nurses need to recognise the complexity of family relationships for older Hispanic persons who are ageing out of place of origin and their risk of depression, social isolation, and loneliness.

The concept of exposure in environmental health for nursing.

AIM: To report an analysis of the concept of exposure in environmental health for nursing. BACKGROUND: The importance of the environment has long been recognized in nursing, although the nature and scope of the concept and how it influences health have varied over time. Exposure is the sufficient and necessary link between environment and health. In nursing practice, the word 'exposure' has been used frequently with no clear standard definition. DESIGN: Concept analysis using Kim's first-level analytics. DATA SOURCES: Chronological review (1980-2015) of the nursing science literature was conducted through ProQuest Dissertations and Theses and CINAHL, followed by a multi-disciplinary search through PubMed (1980-2015), texts and the Internet to compare definitions and measurements of exposure and related concepts. METHODS: Explicit and implicit conceptual definitions and measurements of exposure were identified, categorized and analysed. RESULTS: The newly defined concept of 'exposure' is a process involves three phases: 1, contact is made between a target and one or more agents in the same environment; 2, the agent accesses the target by one or more routes of entry; and 3, the agent enters the target by crossing a barrier or boundary. Existing measurements related to each phase are identified and discussed. Definitions of 'target' and 'agent' were refined for congruency. CONCLUSION: Consistent use of terms as defined is critical to development of nursing knowledge. These concepts should be incorporated into nursing-related research to evaluate their usefulness to nursing. Alignment of this concept with relevant theories should be critically examined.

Residential Instability Among Low-Income Families: A Concept Analysis.

Residential instability is relatively common among low-income families and is associated with a host of negative outcomes, especially for children and adolescents. Psychiatric nurses, especially those in the advanced practice role, observe the consequences of residential instability within the clinical setting. Yet, to-date, the concept is somewhat vague and its essential meaning and definition remain unclear. The aim of this paper is to develop a definition of residential instability using Wilson's method of concept analysis. An overview of historical perspectives is included. The paper concludes with recommendations for future research and application within clinical practice.

Exploring the Use of Critical Reflective Inquiry With Nursing Students Participating in an International Service-Learning Experience.

BACKGROUND: Increasing interest in providing international educational experiences for nursing students has led to a variety of short-term international service-learning experiences. However, the impact of these experiences has not been clearly articulated. METHOD: In this qualitative descriptive research study, Kim's critical reflective inquiry model was used to help guide students in reflecting on and identifying the impact of an international service-learning program in the Dominican Republic. RESULTS: The model was helpful in promoting in-depth description and reflection on the students' underlying assumptions and values, as well as identifying beginning strategies for emancipation in specific patient care situations. CONCLUSION: Providing a group process for critical reflection may optimize the perspective transformations in meeting the goals and objectives of the experience.

Exploring problems encountered among experienced nurses using critical reflective inquiry: implications for nursing professional development.

This study explored problems encountered by nurses using critical reflective inquiry to examine clinical situations and the impact of group discussion on the reflective process. Secondary qualitative analysis of 19 reflective situations, rom a reflection continuing education program, revealed that nurses had problematic pauses in reflection and were stuck in cyclical self-questioning. Peer group discussion prompted deeper reflection. Experienced nurses may need assistance to enhance the comprehensiveness, depth, and scope of reflection on practice situations.

A mixed methods evaluation of an international service learning program in the Dominican Republic.

OBJECTIVE: To examine the impact of an international service learning experience (ISL) using a quantitative and qualitative approach. DESIGN AND SAMPLE: A descriptive study was used to explore the impact of an ISL experience on global awareness, professional and personal growth with 11 baccalaureate nursing students in the Dominican Republic. INTERVENTION: Students participated in a three credit ISL program in the Dominican Republic which included pre- and postexperience seminars and a 2-week, on-site immersion experience. MEASURES: The International Education Survey (IES) was used as the quantitative measure. Content analysis of Critical Reflective Inquiry (CRI) narratives was used as the qualitative method. RESULTS: Students reported a high overall impact (M = 5.9) using the IES with high means for the Professional Student Nurse Role (M = 6.10, SD: 0.74), Personal Development (M = 6.08, SD: 0.76), International Perspectives (M = 6.03, SD: 0.71), and a lower mean for Intellectual Development (M = 5.40, SD: 0.69). CRI narratives revealed specific areas of impact, for example, increased empathy and ability to communicate effectively with patients from life situations very different from their own. CONCLUSIONS: Further exploration of the usefulness of various evaluation tools and methodological designs is warranted to understand this type of pedagogy and its' impact on student learning outcomes short- and long-term.

A qualitative study of the perceived value of membership in The Oley Foundation by home parenteral and enteral nutrition consumers.

BACKGROUND: Support and educational organizations have been shown to improve quality of life of consumers of home nutrition support. One such organization, The Oley Foundation, offers resources for the home parenteral and enteral nutrition (HPEN) consumer. While research has shown proven benefits to HPEN consumers affiliated with The Oley Foundation, no studies have investigated the perceived value of membership to the consumer or the way in which consumers are introduced to the organization. METHODS: Qualitative methodology was used to gain a deeper understanding of the perceived value of membership in The Oley Foundation. Audiotaped, in-depth, semistructured telephone interviews were conducted to explore participants' experiences with The Oley Foundation and HPEN. Inductive content analysis was used to analyze data and identify themes associated with membership value. RESULTS: The value of The Oley Foundation lies in programs and resources and the competency, inspiration, normalcy, and advocacy gained from membership, helping individuals adjust to life with HPEN dependency. More than half of participants found the organization through self-initiated Internet searches, but all participants clearly expressed the desire "I wish I knew about it sooner." CONCLUSION: This study identifies the value of membership in The Oley Foundation and the important role the organization has in the lives of HPEN-dependent consumers. Nutrition support clinicians should introduce the organization to patients when the need for HPEN is established and prior to hospital discharge.

The recovery process after day surgery within the symptom management theory.

PURPOSE: The aim was to illustrate two cases in a postoperative situation following day surgery within the framework of the symptom management theory. METHOD: Template analysis using the symptom management theory. RESULT: Neither the woman nor the man was able to return to their normal activities, health status or functional status, within a week. CONCLUSION: The results illustrate how a postoperative situation may involve personal suffering up to 3 months. PRACTICAL IMPLICATION: To obtain an outcome following day surgery, as optimal as possible, improving clinical practices and routines, such as discharge criteria, guidelines, and care pathways, is necessary.

Perceptions of emotional eating behavior. A qualitative study of college students.

Approximately one-third of college students are overweight or obese and the average student gains 5 kg during college. Previous research has identified a relationship between emotional eating and weight gain in young adults, but outside the realm of eating disorders, few studies qualitatively capture why individuals cope with emotions by eating. Exploratory qualitative research was conducted, including 3-day food journals and indepth interviews, with proportionate quota sampling of eight male and eight female undergraduate students to gain an understanding of students' perceptions of their emotional eating behaviors. Participants were purposively selected based on their emotional eating scores on the Weight Related Eating Questionnaire from a larger survey assessing student eating behaviors. Participants' (n=16) mean age was 19.6 ± 1.0 years and all self-reported their race to be white. Mean Body Mass Index (BMI) for females and males was 24.1 ± 1.2 kg/m(2) and 24.8 ± 1.7 kg/m(2), respectively. Findings from the qualitative analyses indicated gender differences and similarities. Females identified stress as the primary trigger for emotional eating, frequently followed by guilt. Males were primarily triggered by unpleasant feelings such as boredom or anxiety turning to food as a distraction; however, males were less likely to experience guilt after an emotional eating episode than females. During emotional eating episodes, both genders chose what they defined as unhealthful foods. These findings indicate a multidisciplinary intervention focusing on emotion and stress management in addition to dietary behavior change should be developed to reduce the potential for weight gain associated with emotional eating in the college-aged population.

Exploring reflection as a process embedded in experienced nurses' practice: a qualitative study.

AIM: This article is a report of a study aimed at obtaining an in-depth description of how experienced acute care staff nurses perceive and use reflection in clinical practice. BACKGROUND: Reflection is viewed as a critical component of professional practice. The basic assumption is that reflection involves a deliberate process of thinking about a clinical situation which leads to insight and a subsequent change in practice. Several prescriptive models for reflection exist to provide a guide for reflection, however, few are grounded from an empirical examination of reflection in practice. There is a dearth of empirical data on what is actually happening in practice. DESIGN: Descriptive, qualitative. METHODS: In-depth interviews with 12 experienced acute care staff nurses in a community hospital in Northeastern USA was used to address the study aims. Data were collected between November 2009-May 2010. RESULTS/FINDINGS: Examples of reflection were embedded in patient situations needing immediate nursing intervention. Reflection was a process involving four phases: Framing of the Situation, Pausing, Engaging in Reflection, and Emerging Intentions. CONCLUSION: Experienced nurses used a process of reflection-on-action in practice. They gained insight and formulated intentions for change in nursing practice. Structured facilitated reflection might assist nurses in achieving a depth of reflection necessary to move from their intentions to changes in practice.

Development and evaluation of an international service learning program for nursing students.

OBJECTIVES: (1) Using Riner's framework, the development of an international service learning program in the Dominican Republic (DR) for Baccalaureate nursing students will be described, and (2) an initial impact of the students' experiences will be examined. DESIGN AND SAMPLE: A qualitative descriptive research design was used to examine its impact. The international service learning program included (1) didactic (five, 2 hr and one full day educational sessions) prior to (2) immersion (2 weeks in country), and (3) posttrip debriefing session. Ten females, senior nursing students participated in the program. Students' daily journals were examined using thematic analysis. RESULTS: Five major themes that emerged were as follows adapting physically, encountering frustration in their inability to fully meet patients' needs, increasing confidence in speaking Spanish and assessing health problems, and increasing cultural awareness. Students were descriptive regarding their daily activities, and did some, but limited, critical reflection. CONCLUSIONS: Models of reflection need to be explored to select the most appropriate technique to facilitate students' critical reflection in meeting the goals and objectives of the experience. Curriculum integration of global learning, social consciousness, and global cultural competence development is needed.

Home: the place the older adult cannot imagine living without.

BACKGROUND: Rapidly aging populations with an increased desire to remain at home and changes in health policy that promote the transfer of health care from formal places, as hospitals and institutions, to the more informal setting of one's home support the need for further research that is designed specifically to understand the experience of home among older adults. Yet, little is known among health care providers about the older adult's experience of home. The aim of this study was to understand the experience of home as experienced by older adults living in a rural community in Sweden. METHODS: Hermeneutical interpretation, as developed by von Post and Eriksson and based on Gadamer's philosophical hermeneutics, was used to interpret interviews with six older adults. The interpretation included a self examination of the researcher's experiences and prejudices and proceeded through several readings which integrated the text with the reader, allowed new questions to emerge, fused the horizons, summarized main and sub-themes and allowed a new understanding to emerge. RESULTS: Two main and six sub-themes emerged. Home was experienced as the place the older adult could not imagine living without but also as the place one might be forced to leave. The older adult's thoughts vacillated between the well known present and all its comforts and the unknown future with all its questions and fears, including the underlying threat of loosing one's home. CONCLUSIONS: Home has become so integral to life itself and such an intimate part of the older adult's being that when older adults lose their home, they also loose the place closest to their heart, the place where they are at home and can maintain their identity, integrity and way of living. Additional effort needs to be made to understand the older adult's experience of home within home health care in order to minimize intrusion and maximize care. There is a need to more fully explore the older adult's experience with health care providers in the home and its impact on the older adult's sense of "being at home" and their health and overall well-being.