Stress and coping on the home front: guard and reserve spouses searching for a new normal.

During deployment of National Guard or reserve troops to Iraq or Afghanistan, spouses on the home front have been largely invisible to our collective consciousness. A total of 18 spouses living in rural Wisconsin were interviewed to identify sources of stress and coping strategies. Stressors varied from predeployment through postdeployment, as did coping responses. During predeployment, spouses articulated that the primary stressor was their lives being "on hold." During deployment, five stressors summarize the experience: worrying, waiting, going it alone, pulling double duty, and loneliness. Communication technology made it possible for most spouses to stay in touch using telephone, e-mail, or even Webcam. Keeping busy-managing personal, family, and household responsibilities-was the most commonly identified coping strategy. Postdeployment was a period of adjustment while couples searched for a new normal. Throughout all deployment phases, skilled and astute nurses can assist families toward health and healing.

Consequences of uninsurance in Wisconsin.

BACKGROUND: More than 9% of Wisconsin residents are without health insurance. Several states have passed legislation to increase access to health care and move toward universal coverage. Wisconsin legislators are also considering health care reform proposals that present alternatives to the current system. OBJECTIVE: To describe experiences and concerns of individuals who are uninsured as compared to individuals with health insurance. The purpose is to contribute to the current policy debate on health care reform in Wisconsin. METHODS: Participants in this qualitative study were selected from a set of individuals in west-central Wisconsin who completed a health care survey (n = 222) and gave consent to be contacted for an interview. The interviews were conducted in the spring of 2008; the sample (n = 18) includes equal numbers of individuals with and without health insurance. RESULTS: Regardless of insurance status, participants in this study reported worries about affordability, access to health care, and the influence that health insurance coverage has on their choices in life. Participants agreed that all citizens have a right to health care and favor health care reform to make that right a reality. CONCLUSION: Wisconsin residents, both insured and uninsured, experience worries and uncertainties about health care access and affordability. These qualitative findings provide evidence of public support for health care reform.

A descriptive analysis of health care coverage and concerns in West Central Wisconsin.

This study examines the level of health care coverage and health care concerns among a sample of 222 West Central Wisconsin residents. More than 68% of respondents felt that Wisconsin health care has at least major problems, and only 2.7% felt that there were no problems. Approximately 60% were extremely or very worried about not being able to afford health care services, whereas more than 70% were extremely or very worried that insurance companies care more about profits than patient care. These concerns translate into a desire for reform, with more than 90% of respondents saying it is extremely or very important for Wisconsin to make health care more affordable and accessible for all residents. Despite some differences between the insured and uninsured, the call for action to expand access and control costs was significant among both groups. These results can help guide the current policy debate on health care reform.

Spiritual crisis: a concept analysis.

AIM: This paper is a report of an analysis of the concept of spiritual crisis. BACKGROUND: The term spiritual crisis has been used ambiguously in the literature, resulting in lack of clarity. A holistic approach includes spirituality in nursing care of the whole person. DATA SOURCES: Papers available online between 1998 and 2007 in the CINAHL, Medline and PsycInfo databases were retrieved for analysis. The search engine Google was also used to examine additional references to 'spiritual crisis'. REVIEW METHODS: Spiritual crisis, spiritual emergency and life crisis were the terms initially used to search each database. The search was expanded to include spirituality to draw more literature into the review. FINDINGS: Using Walker and Avant's method of concept analysis, a definition of spiritual crisis was identified. Spiritual crisis can be described as a unique form of grieving or loss, marked by a profound questioning of or lack of meaning in life, in which an individual or community reaches a turning point, leading to a significant alteration in the way life is viewed. Possible antecedents include sudden acute illness and loss of important relationships. Potential consequences may include physical and emotional responses. CONCLUSION: People with terminal illness, depression, and those who are grieving losses may be at special risk of spiritual crisis. The literature suggests an interdisciplinary approach, nurses' self-exploration of spirituality, and refraining from defining spirituality by religious affiliation as part of improving practice.

Preparing for practice: students' reflections on their final clinical experience.

Nursing students in their last clinical experience before graduating often encounter stressful situations and face unique challenges. To help students prepare for their transition into practice, both faculty and nurses in the clinical setting need a thorough understanding of what nursing students are thinking and feeling as they near the end of their academic program. This study was conducted to explore the cognitive and emotional responses of baccalaureate nursing students during their final clinical experience. Thirty-two senior nursing students wrote "thinking-in-action" reflections weekly during a 6-week period in the last semester of their nursing program. Reflections were analyzed using qualitative methods; seven themes emerged: being aware of human vulnerability, feeling the weight of registered nurse (RN) responsibility, recognizing limits, evaluating self, seeing the patient/family perspective, confronting ethical issues, and facing reality versus expectations. These findings help nurses in education and practice more fully understand the issues that students face in preparing for practice and may lead to strategies to smoothen the stressful transition from being a student to becoming an RN.

Examining the role of technology in learning: an evaluation of online clinical conferencing.

The rapidly expanding use of instructional technology requires faculty openness to new teaching and learning situations. This study compared two instructional methods of conducting clinical conferences for baccalaureate nursing students: online versus face-to-face. Quantitative and qualitative data were collected from 77 students in 10 clinical sections of a senior capstone nursing course. Mean scores for all 11 items on the clinical evaluation tool were higher for students who had conferences online than those in face-to-face conferences. Four of the 11 items were statistically significant, reflecting greater participation and convenience for online participants. Online students also reported greater opportunities to reflect on ethical issues. There were no significant differences in quiz scores between the groups when students were tested on content covered in their clinical conferences. Students identified advantages including opportunities for flexibility and equal participation. Barriers included unfamiliarity with technology and lack of face-to-face-contact. The findings suggest that students can successfully achieve the intended purpose of clinical conferences through an online instructional technique. Ongoing research in the use of technology is necessary to meet student needs, enhance student learning, and support evidence-based practice in nursing education.

Oral history: Validating contributions of elders.

Recording memories of World War II is an intervention that can humanize geriatric care in addition to the historical significance provided. Participants in this oral history project described memories of World War II and expressed themes of patriotism, loss, tense moments, makeshift living, self-sufficiency, and uncertain journey. Their ethnic roots were primarily Scandinavian, Dutch, German, and English. The nursing home participants were slightly older than the community participants (mean ages: 85.5 and 82.4 years, respectively). More women (58%) than men (42%) participated, and 35% of the participants were veterans (eight men one woman). Nursing home and community residents participated in this project, and reciprocal benefits were experienced by participants and listeners alike. Memories of World War II provide a meaningful topic for oral histories. Listening and valuing oral history supports, involves, and validates elders. Oral history has reciprocal benefits that can create a culture to enhance a therapeutic environment.