Disrupting the epistemic arrangements of nursing education canon: Reflections about a prelicensure Community Engagement series.

Nursing education, as with professionalization projects, is fraught with epistemicide, false separations, and a focus on expertise over relations and accountability. This is a critical reflection of the first 5 years of a four-semester prelicensure Community Engagement course series. As the course lead, I have consistently initiated adjustments, based on experiences teaching multiple sections and synthesizing comments and feedback from students and faculty, with an eye toward longstanding and pressing concerns in the world around us. Two broad epistemic arrangements emerge from this critical excavation: (1) naturalized hierarchy, false separations, and appraisals of relevance and (2) relationality and reflection as unsettling. There is a need for sustained collective examination and shift in how the nursing education and healthcare industries curate the meanings and practice of "community," "health," and "nursing," peering out from the regulatory oversight of neoliberal forces. How might we situate student progression, program implementation, institutional contracts, and curricular standards within the contexts of nursing programs' responsibilities to local communities in light of unfolding events locally and globally and their historical antecedents? How are we all, as faculty, disrupting siloes, false separations, and the contradictions of professionalism and the biomedical model to intentionally advance health equity? May we continue to illuminate the presence of community as being everywhere, not merely in juxtaposition to acute care. May we unsettle the prevailing theorization and practices of community throughout nursing education and commit to imagining and practicing relational praxis.

Screen time, mute, mixed messages, and panic: An international auto-ethnographic study of knowledge workers during a pandemic.

The coronavirus pandemic provoked worldwide changes to the workplace, leading to rapid changes in lifestyles and working conditions. While organizations and governments struggled to develop regulations and policies, individuals were forced to find ways to manage work and life. During the pandemic and quarantine, a group of knowledge workers from around the world convened virtually and agreed to use qualitative autoethnographic methods to study how the quarantine disrupted their conventional patterns of work and care. In this article, we apply two communication perspectives-uncertainty reduction theory and re-silience-to participant diaries to understand how participants represent internal and external stressors, the efforts diarists employed to overcome those stressors, and their varying success in doing so. Post-hoc application of these communication concepts suggests that the diarists, though privileged in some ways, were not exempt from the social, professional, and emotional consequences of the pandemic and that their efforts to enact resilience were unevenly successful, especially in relation to their use of communications technology. Diarists reported struggling with uncertainty at numerous levels and that uncertainty contributed to individual emotional and cultural distress. Disruptions to work, home, and communities significantly affected wellbeing and ability to cope with challenges. Added to this were the complex and competing roles that diarists felt as they struggled to work from home, parent, and remain engaged.

Operationalizing Anti-Racism Accountability with Equitable Admissions in Nursing Education Accreditation.

For decades, health professional organizations have recommended increased diversity in the workforce and education. To address persistent inequities in health care, the racial composition of the nursing workforce needs be congruent with the U.S. population. Without first addressing structural inequity in nursing education programs, the nursing profession cannot begin to address structural racism in health care. The lack of nursing student diversity is reflective of barriers in program admissions. This article is a call to nursing accreditation bodies to operationalize anti-racism to improve U.S. nursing workforce diversity by introducing accountability structures that require evidence-based holistic admission review and analysis of admission data to ensure that student cohorts are diverse across nursing programs, thereby ensuring a future workforce that reflects the diversity of the U.S. population.

Time-motion observations to characterize the developmental environment in a paediatric post-acute care hospital.

BACKGROUND: Chronically hospitalized children are at risk for neurodevelopmental delay, compounded by restricted social interactions, movement and environmental stimulation. We measured patients' movements and interactions to characterize developmentally relevant aspects of our inpatient environment and identify opportunities for developmental enrichment. METHODS: As part of a quality improvement initiative to inform neurodevelopmental programming for children with medical complexity at our paediatric post-acute care specialty hospital, we conducted >232 hours of time-motion observations. Trained observers followed 0- to 5-year-old inpatients from 7 am to 7 pm on weekdays, categorizing observations within five domains: Where, With, Position, State and Environment. Observations were collected continuously utilizing REDCap on iPads. A change in any domain initiated a new observation. RESULTS: Patients were median 1 year and 8 months of age (range 2 months to 3 years 9 months) with a median length of hospitalization of 514 days (range 66-1298). In total, 2636 unique observations (or median 134 observations per patient-day [range 95-210]) were collected. Patients left their rooms up to 4 times per day for median 1 h and 34 min (range 41 min to 4 h:30 min). Patients spent 4 h:6 min (2 h:57 min to 6 h:30 min) interacting with someone and 3 h:51 min (57 min to 6 h:36 min) out of bed each day. Patients were simultaneously out of their beds, interacting with someone and awake for 2 h:21 min (51 min to 4 h:19 min) each day. CONCLUSIONS: Despite a care model prioritizing time out of bed and social interaction, time-motion observations indicate patients spent many of their waking hours in bed and alone. Quantifying our inpatients developmental opportunities will inform neurodevelopmental programming initiatives.

A Critical Discourse Analysis of AACN's Tool Kit of Resources for Cultural Competent Education for Baccalaureate Nurses.

American institutions of nursing education have integrated cultural competence as a pillar approach to addressing health disparities. The theoretical frameworks, priorities, and solutions that national organizations pursue and endorse have far-reaching implications. The American Association of Colleges of Nursing (AACN) is one such organization. The purpose of this project was to critically analyze the AACN's Tool Kit of Resources for Cultural Competent Education for Baccalaureate Nurses to excavate dynamics related to language, power, and inequality. Findings of this critical discourse analysis indicate: (1) the centrality of the AACN's assumed authority and lack of relationality with readers, (2) nursing insularity and narrow theorization of culture and power, and (3) the harm of whiteness and colonialism as pedagogy. Accountability and repair include transparency, taking note of resources and viewpoints available and endorsed on organization websites, and updating (or refuting) outdated and harmful approaches.

Health equity: A concept analysis.

BACKGROUND: Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions. PURPOSE: Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy. METHOD: Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity. FINDINGS: Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology. DISCUSSION: Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.

Governmentality Versus Community: The Impact of the COVID Lockdowns.

The COVID lockdowns were characterised by new forms of governmentality as lives were disrupted and controlled through the vertical transmission of biopolitics by the state. The paper considers how this was experienced by academics in 11 different countries through analysis of diaries written during the first lockdown. The paper asks if communities can offer an alternative to governmentality by looking at three levels: the national, the neighbourhood and the personal. Whilst at a national level the idea of community was instrumentalised to encourage compliance to extraordinary measures, at the local level community compassion through helping neighbours encouraged horizontal connections that could offer a "space" within the dominant logic of governmentality. At the level of personal communities, the digitalisation of social relationships helped to create supportive networks over widely dispersed areas but these were narrowly rather than widely focused, avoiding critical discussion.

What nursing chooses not to know: Practices of epistemic silence/silencing.

Drawing from a keynote panel held at the hybrid 25th International Philosophy of Nursing Conference, this discussion paper examines the question of epistemic silence in nursing from five different perspectives. Contributors include US-based scholar Claire Valderama-Wallace, who meditated on ecosystems of settler colonial logics of nursing; American scholar Lucinda Canty discussed the epistemic silencing of nurses of colour; Canadian scholar Amelie Perron interrogated the use of disobedience and parrhesia in and for nursing; Canada-based scholar Ismalia De Sousa considered what nursing protects in its silences; and Australian scholar Janice Gullick spoke to trans invisibility in nursing.

What nurses of color want from nursing philosophers.

Scholars of color have been instrumental in advancing nursing knowledge development but find limited spaces where one can authentically share their philosophical perspective. Although there is a call for antiracism in nursing and making way for more diverse and inclusive theories and philosophies, our voices remain at the margins of nursing theory and philosophy. In nursing philosophy, there continues to be a lack of racial diversity in those who are given the platform to share their scholarship. Five nurse scholars of color attended the International Nursing Philosophy Conference in August 2022. We established a collective system of support by sharing our experiences as researchers, scholars, and educators with each other. The theory of emancipatory nursing praxis informed this process. In this dialogue, we reflected on what it is like to present at and attend predominantly white nursing conferences. We shared our experiences of how we exist as nurse scholars, our philosophical views, and our thoughts on how we create spaces where scholars of color can feel welcomed and acknowledged for their contributions to advancing nursing knowledge.

Addressing The Interlocking Impact Of Colonialism And Racism On Filipinx/a/o American Health Inequities.

Within the monolithic racial category of "Asian American," health determinants are often hidden within each subgroup's complex histories of indigeneity, colonialism, migration, culture, and socio-political systems. Although racism is typically framed to underscore the ways in which various institutions (for example, employment and education) disproportionately disadvantage Black/Latinx communities over White people, what does structural racism look like among Filipinx/a/o Americans (FilAms), the third-largest Asian American group in the US? We argue that racism defines who is visible. We discuss pathways through which colonialism and racism preserve inequities for FilAms, a large and overlooked Asian American subgroup. We bring to light historical and modern practices inhibiting progress toward dismantling systemic racial barriers that impinge on FilAm health. We encourage multilevel strategies that focus on and invest in FilAms, such as robust accounting of demographic data in heterogeneous populations, explicitly naming neocolonial forces that devalue and neglect FilAms, and structurally supporting community approaches to promote better self- and community care.

'The Problem of the Color Line': Faculty approaches to teaching Social Justice in Baccalaureate Nursing Programs.

Social justice is put forth as a core professional nursing value, although conceptualizations within foundational documents and among nurse educators remain inconsistent and contradictory. The purpose of this study was to explore how faculty teach social justice in theory courses in Baccalaureate programs. This qualitative study utilized constructivist grounded theory methods to examine processes informing participants' teaching. Participants utilize four overarching approaches: fostering engaging classroom climates, utilizing various naming strategies, framing diversity and culture as social justice, and role modeling a critical stance. They deploy specific strategies, varying largely by race, educational background, and nursing specialty. A background in social sciences supports pedagogy that interrogates health inequities rather than merely raising awareness about disparities. Findings also reveal that faculty of color navigate institutional structures predicated upon colorblind racism and problematic views of culture, which many white faculty teaching non-Community Health Nursing courses described doing. To enact social justice and be answerable to our communities, concerted anti-oppression efforts are needed across education, research, practice, and policy. This includes sustained commitment to address colonialism and whiteness in every institution that defines, promotes, and claims to advance nursing so that we can fulfill our responsibility to address unjust systems and structures to serve our communities.

"Spinning Their Wheels "-Influences That Shape How Nurse Educators Teach Social Justice.

Despite institutional claims that social justice is a core professional nursing value, efforts to fulfill this claim remain uneven. The purpose of this study was to examine the circumstances that shape nursing educators' approaches to social justice. In-depth semi-structured interviews with 28 educators teaching theory courses in baccalaureate nursing programs shed light upon the influences that shape how educators integrate social justice. These include formative experiences, institutional factors, and curricular opportunities. Formative experiences include upbringing, educational background, and preparation to teach. Institutional factors consist of the type of institution, geographic location, and the specter of retention, promotion, and tenure. Finally, curricular opportunities and fit include the positioning of Community Health Nursing, fragmentation and tension between "content and context," and the "driving force" of the National Council Licensure Examination for Registered Nurses (NCLEX). Findings indicate that the capacity to uphold the value of social justice is shaped by experiences across the lifespan, institutional policies, and practices related to faculty hiring, development, career advancement, as well as curricular vision. This study calls for a concerted effort to enact social justice nursing education.

"Social justice is a dream": Tensions and contradictions in nursing education.

OBJECTIVE: The purpose of this study was to explore nurse educators' conceptualizations of social justice in theory courses. The findings contextualize the role of nurse educators in promoting social justice among future health care providers and the relevance of their perspectives on social justice. DESIGN: This descriptive qualitative study was completed utilizing constructivist grounded theory methods. SAMPLE AND MEASUREMENTS: I interviewed 28 nurse educators teaching theory courses in Baccalaureate nursing programs on the West coast of the United States. Initial and focused codes were constructed from interview transcripts to understand and contextualize statements about social justice. RESULTS: Participants' conceptualizations of social justice include equity, equality, self-awareness, withholding judgment, and taking action. CONCLUSIONS: Notable differences emerged along racial lines and, less so, in relation to educational background and nursing specialty. This study highlights areas of concern with respect to how nurse educators enact the claim that social justice is a core professional nursing value. The findings call attention to tensions and contradictions as individuals navigate the landscape of nursing with limited structural and institutional effort.

State of the Profession: The Landscape of Disability Justice, Health Inequities, and Access for Patients With Disabilities.

The nursing profession can both perpetuate inequities and elevate the discourse around disability. Our article uses an intersectional lens to discuss the scope, magnitude, and determinants of health inequities that people with disabilities experience and the ways in which theoretical models of disability used in nursing education can further contribute to inequities. Our article makes the case for an intersectional social justice approach to nursing education by contextualizing the current state of affairs within historical and contemporary models of disability. This has the potential to be a revolutionary leap toward promoting health equity and upholding the Code of Ethics.

Socially Inclusive Development: The Foundations for Decent Societies in East and Southern Africa.

This article is concerned with how social processes and social provision are conceptualised and measured in societies in order to offer guidance on how to improve developmental progress. Significant advances have been made in developing multidimensional measures of development, but they provide little guidance to governments on how to build sustainable societies. We argue for the need to develop a theoretically informed social and policy framework that permits the foundations for building decent societies to be put in place by governments. In our view the recently developed Decent Society Model provides such a framework. Our example is the assessment of government provision, by function, within fourteen countries of East and Southern Africa. The context is the current debates about socially inclusive development, but we argue that it is necessary to range more widely, as social processes of different kinds are multiply interrelated. Social inclusion is recognised by governments as well as international agencies, including the World Bank and the United Nations, as not only an ethical imperative but smart economics; socially inclusive societies are more stable and have greater potential for economic growth. Societies that can develop sustainably need not only to be inclusive, however, but to provide economic security for all, to be socially cohesive and to empower citizens so that as individuals and communities they can take control over their own lives.

Critical discourse analysis of social justice in nursing's foundational documents.

OBJECTIVE: Social inequities threaten the health of the global population. A superficial acknowledgement of social justice by nursing's foundational documents may limit the degree to which nurses view injustice as relevant to nursing practice and education. The purpose was to examine conceptualizations of social justice and connections to broader contexts in the most recent editions. DESIGN: Critical discourse analysis examines and uncovers dynamics related to power, language, and inequality within the American Nurses Association's Code of Ethics, Scope and Standards of Practice, and Social Policy Statement. RESULTS: This analysis found ongoing inconsistencies in conceptualizations of social justice. Although the Code of Ethics integrates concepts related to social justice far more than the other two, tension between professionalism and social change emerges. The discourse of professionalism renders interrelated cultural, social, economic, historical, and political contexts nearly invisible. CONCLUSION: Greater consistency would provide a clearer path for nurses to mobilize and engage in the courageous work necessary to address social injustice. These findings also call for an examination of how nurses can critique and use the power and privilege of professionalism to amplify the connection between social institutions and health equity in nursing education, practice, and policy development.

Attention-Deficit/Hyperactivity Disorder, Behavior Regulation and Virtual School Support.

CASE: Tony is a 6-year-old multiracial boy diagnosed as having attention-deficit/hyperactivity disorder-combined type who is followed in your primary care practice and has started on a stimulant medication. Tony continues to have difficulty with emotion regulation and impulse control both at home and at school. He was asked to leave his private school soon after beginning first grade because of physical fighting, emotional outbursts, and arguing with teachers.His mother made the decision to enroll Tony in online virtual schooling for the remainder of the academic year, with the plan to transition back to traditional school for the next academic year. They have enrolled in a program that offers lessons online and sends materials to the home for the child to use to complete certain types of assignments (e.g., science experiments). Virtual schools are different from traditional home schooling because children receive their instruction from teachers online with parental assistance as opposed to parents being responsible for teaching all material. Tony's mother comes to your practice requesting assistance with setting up an appropriate school environment for her son at home, where she can monitor and support his academic progress.Tony is a bright child, with an Intelligence Quotient in the superior range. He has advanced academic skills, but he becomes dysregulated if he is told he is wrong or that he has answered a question incorrectly. For example, if he answered a question incorrectly in class, he would become verbally abusive toward his teacher and often have temper tantrums. This challenging behavior occurred daily at school and was one of the factors leading to his expulsion. The behavior had predated the introduction of stimulant medication and had remained consistent after he began medication.Tony's parents are highly educated, and both parents hold professional jobs with steady income. His parents have good command of typical behavior management strategies such as the use of rewards, time out, and behavioral contingencies to target noncompliance and temper tantrums. However, Tony's difficulty identifying and regulating his emotions leads to emotional outbursts and shutdowns that have thus far been unresponsive to standard behavior management techniques. Tony continued to have outbursts even when the behavior was ignored. His mother is concerned not only about his learning during the coming year but also about his social relationships and the family dynamic. Tony's outbursts cause significant disruption in the home and are a source of tension among parents and siblings.His mother is asking for advice on how to support his behavior better at home now that he will be spending his entire day there. How might you assist this child and his mother by helping to integrate therapeutic goals into the academic environment?

Photoisomerization of ß-Ionone Protonated Schiff Base in the Gas Phase.

The photoisomerization of ß-ionone protonated Schiff base (BIPSB) is investigated in the gas phase by irradiating mobility-selected ions in a tandem ion mobility spectrometer with tunable radiation. Four distinguishable isomers are produced by electrospray ionization whose structures are deduced from their collision cross sections and photoisomerization behavior along with density functional theory calculations. They include two geometric isomers of BIPSB with trans or cis configurations about the polyene chain's terminal C═N double bond, a bicyclic structure formed through electrocyclization of the polyene chain, and a Z-retro-γ-ionone isomer. Although trans-BIPSB and 9-cis-BIPSB have similar photoisomerization action spectra, with a maximum response at 375 nm, they photoconvert to different isomers. The trans-BIPSB isomer transforms to the bicyclic form upon exposure to light over the 320-400 nm range, whereas the cis-BIPSB isomer is prevented by steric hindrance from forming the bicyclic BIPSB isomer following irradiation and is proposed instead to form the 7,9-di-cis isomer. Neither the bicyclic isomer nor the Z-retro-γ-ionone isomer respond strongly to near-UV light.

Attention-Deficit/Hyperactivity Disorder, Behavior Regulation and Virtual School Support.

CASE: Tony is a 6-year-old multiracial boy diagnosed as having attention-deficit/hyperactivity disorder-combined type who is followed in your primary care practice and has started on a stimulant medication. Tony continues to have difficulty with emotion regulation and impulse control both at home and at school. He was asked to leave his private school soon after beginning first grade because of physical fighting, emotional outbursts, and arguing with teachers.His mother made the decision to enroll Tony in online virtual schooling for the remainder of the academic year, with the plan to transition back to traditional school for the next academic year. They have enrolled in a program that offers lessons online and sends materials to the home for the child to use to complete certain types of assignments (e.g., science experiments). Virtual schools are different from traditional home schooling because children receive their instruction from teachers online with parental assistance as opposed to parents being responsible for teaching all material. Tony's mother comes to your practice requesting assistance with setting up an appropriate school environment for her son at home, where she can monitor and support his academic progress.Tony is a bright child, with an Intelligence Quotient in the superior range. He has advanced academic skills, but he becomes dysregulated if he is told he is wrong or that he has answered a question incorrectly. For example, if he answered a question incorrectly in class, he would become verbally abusive toward his teacher and often have temper tantrums. This challenging behavior occurred daily at school and was one of the factors leading to his expulsion. The behavior had predated the introduction of stimulant medication and had remained consistent after he began medication.Tony's parents are highly educated, and both parents hold professional jobs with steady income. His parents have good command of typical behavior management strategies such as the use of rewards, time out, and behavioral contingencies to target noncompliance and temper tantrums. However, Tony's difficulty identifying and regulating his emotions leads to emotional outbursts and shutdowns that have thus far been unresponsive to standard behavior management techniques. Tony continued to have outbursts even when the behavior was ignored. His mother is concerned not only about his learning during the coming year but also about his social relationships and the family dynamic. Tony's outbursts cause significant disruption in the home and are a source of tension among parents and siblings.His mother is asking for advice on how to support his behavior better at home now that he will be spending his entire day there. How might you assist this child and his mother by helping to integrate therapeutic goals into the academic environment?

Genome-wide methylation analysis identifies genes silenced in non-seminoma cell lines.

Silencing of genes by DNA methylation is a common phenomenon in many types of cancer. However, the genome-wide effect of DNA methylation on gene expression has been analysed in relatively few cancers. Germ cell tumours (GCTs) are a complex group of malignancies. They are unique in developing from a pluripotent progenitor cell. Previous analyses have suggested that non-seminomas exhibit much higher levels of DNA methylation than seminomas. The genomic targets that are methylated, the extent to which this results in gene silencing and the identity of the silenced genes most likely to play a role in the tumours' biology have not yet been established. In this study, genome-wide methylation and expression analysis of GCT cell lines was combined with gene expression data from primary tumours to address this question. Genome methylation was analysed using the Illumina infinium HumanMethylome450 bead chip system and gene expression was analysed using Affymetrix GeneChip Human Genome U133 Plus 2.0 arrays. Regulation by methylation was confirmed by demethylation using 5-aza-2-deoxycytidine and reverse transcription-quantitative PCR. Large differences in the level of methylation of the CpG islands of individual genes between tumour cell lines correlated well with differential gene expression. Treatment of non-seminoma cells with 5-aza-2-deoxycytidine verified that methylation of all genes tested played a role in their silencing in yolk sac tumour cells and many of these genes were also differentially expressed in primary tumours. Genes silenced by methylation in the various GCT cell lines were identified. Several pluripotency-associated genes were identified as a major functional group of silenced genes.