The shared decision-making model: Providers' and patients' knowledge and understanding in clinical practice.

BACKGROUND: Shared decision making (SDM) is a collaborative approach to patient care that facilitates patient engagement in self-care by upholding the patient's values and perspectives. The Affordable Care Act (2010) offers provisions for using SDM in clinical practice to improve care outcomes; however, inconsistent evidence exists about the provider-patient satisfaction and effectiveness of using SDM in Federally Qualified Health Centers (FQHCs), which offer care predominantly to the underserved. PURPOSE: This study assessed providers' and patients' knowledge and understanding of SDM in two FQHC in the Pacific Northwest. METHODOLOGICAL ORIENTATION: Descriptive phenomenological approach guided the investigation. Data were gathered through in-person interviews. Interviews were analyzed using the method discussed by Colaizzi (1978). SAMPLE: A purposive sample of 13 providers and 6 patients. CONCLUSIONS: Although providers and patients had divergent understandings of SDM, they highly valued this approach to care. An overarching theme "We use SDM as a Cornerstone of Patient Centered Care" and two subthemes: "We are partners in care" and "Being in the driver seat may not be comfortable but necessary" captured the providers' experiences. "They tell you what's up and we do it together" was a key theme that emerged from the patients' narratives. Several processes further described provider and patient experiences with SDM in the FQHC. IMPLICATIONS FOR PRACTICE: Findings suggest that the use of SDM in FQHC contributes to provider and patient satisfaction and improved patient engagement in self-care. Providers should therefore strongly consider using SDM model when working with the underserved.

A Dedicated Education Unit and a Novel Resident Nurse Transition-to-Practice Program in an Ambulatory Oncology Setting.

OBJECTIVE: To summarize an innovative initiative in oncology nurse workforce development that addresses critical current and future gaps and encompasses use of dedicated education units for student nurse rotation and a transition-to-practice residency program. DATA SOURCES: Review of institutional data including original pilot analysis and ongoing programmatic metrics (N=8 years), consensus, professional guidelines, and published literature. CONCLUSION: The dedicated education unit serves as a conduit for recruitment into institutional oncology nurse residency positions, and retention rates in the residency program continue to exceed national averages. Subsequent mentoring of these nurses in transition to practice has manifested high rates of promotion into nurse leadership roles year over year. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurse practice incorporates state-of-the-science approved therapies, early phase clinical trial implementation, and evidence-based complex oncology patient care management. A new model of student clinical nurse rotations in ambulatory settings, nurse resident transition to practice, and ongoing leadership mentoring is essential in creating a sustainable, highly skilled, and robust oncology nurse work force.

Hearing Distressing Voices Simulation: Students' Perspectives.

The aim of this qualitative study was to describe nursing students' experiences of hearing distressing voices through content analysis of essays regarding changes they encountered during simulation. Data, obtained from undergraduate (n = 237) and graduate (n = 128) students' short self-reflection papers, were analysed using a six-step thematic analysis. The following six themes emerged: (a) experiencing cognitive and perceptual challenges, (b) feeling unpleasant emotions, (c) dealing with functional changes and hardships, (d) experiencing somatic changes, (e) making attempts to cope, and (f) facing lingering impact. The findings suggest that students' experiences of voice-hearing simulation closely resembled the voice-hearers' actual experience. Simulation is an effective teaching modality to introduce nursing students to the world voice-hearers live in and to prepare them for clinical practice enlightened through understanding of what it is like to hear distressing voices.

Preparing nursing students for enhanced roles in primary care: The current state of prelicensure and RN-to-BSN education.

BACKGROUND: With the current emphasis on including registered nurses (RNs) on the primary care teams, it is essential that nursing programs prepare students for employment in these settings. PURPOSE: This study explored the current state of prelicensure and RN-to-Bachelor of Science in Nursing (BSN) online education regarding the implementation of primary care content in the curricula. METHODS: A sample of 1,409 schools and/or colleges from across the United States was invited to participate in an online survey. About 529 surveys were returned for an overall response rate of 37.5%. Summative content analysis was used to analyze survey data. DISCUSSION: Although most respondents have implemented some primary care content, some found it challenging and others have demurred from incorporating primary care content altogether. CONCLUSION: Nursing leaders and faculty in academia must collaborate with clinical partners to design and expand didactic and clinical learning experiences that emphasize primary care content in the prelicensure and RN-to-BSN education.

Perinatal experiences of Somali couples in the United States.

OBJECTIVE: To explore the perspectives of Somali couples on care and support received during the perinatal period in the United States. DESIGN: Descriptive phenomenology. SETTING: A private room at the participants' homes or community center. PARTICIPANTS: Forty-eight immigrant women and men from Somalia (26 women and 22 men) who arrived in the United States within the past 5 years and had a child or children born in their homelands or refugee camps and at least one child born in the United States. All of the participants resided in the Pacific Northwest. METHODS: Semistructured individual interviews, interviews with couples, and a follow-up phone interview. Colaizzi's method guided the research process. RESULTS: Data analysis revealed an overarching theme of Navigating through the conflicting values, beliefs, understandings and expectations that infiltrated the experiences captured by the three subthemes: (a) Feeling vulnerable, uninformed, and misunderstood, (b) Longing for unconditional respect and acceptance and (c) Surviving and thriving as the recipients of health care. CONCLUSIONS: Integration of new Somali immigrant couples into the Western health care system can present many challenges. The perinatal experience for new Somali immigrant couples is complicated by cultural and language barriers, limited access to resources, and commonly, an exclusion of husbands from prenatal education and care. Nurses and other health care providers can play an important role in the provision of services that integrate Somali women and men into the plan of care and consider their culture-based expectations to improve childbirth outcomes.

Conception, pregnancy, and birth experiences of male and gender variant gestational parents: it's how we could have a family.

INTRODUCTION: Like members of any other population, transgender and gender variant people--individuals whose gender identity varies from the traditional norm or from the sex they were assigned at birth--often seek parenthood. Little is known about the decision making and experiences of these individuals, including male-identified and gender-variant natal females who wish to achieve parenthood by carrying a pregnancy. This pilot qualitative study used grounded theory methodology to explore the conception, pregnancy, and birth experiences of this population of parents. METHODS: A grounded theory methodology was used to guide data collection and analysis. Eight male-identified or gender-variant gestational parents participated in the study. Data collection included individual 60-minute to 90-minute interviews conducted by recorded online video calls, as well as a self-administered online demographic survey. Data were collected from September 2011 through May 2012. Data saturation was achieved at 6 interviews, after which 2 more interviews were conducted. The interviews were transcribed verbatim, and a constant comparative method was used to analyze the interview transcripts. RESULTS: Loneliness was the overarching theme that permeated participants' experiences, social interactions, and emotional responses during every stage of achieving biologic parenthood. Within this context of loneliness, participants described complex internal and external processes of navigating identity. Navigating identity encapsulated 2 subthemes: undergoing internal struggles and engaging with the external world. The preconception period was identified as participants' time of greatest distress and least involvement with health care. DISCUSSION: The findings of this study suggest that culturally-sensitive preconception counseling could be beneficial for transgender and gender-variant individuals. The grounded theory produced by this pilot investigation also provides insights that will be useful to health care providers and others working with male-identified and gender-variant prospective parents.

Outcomes of the Evidence-Based Pitocin Administration Checklist at a Tertiary-Level Hospital.

Pitocin, a synthetic form of the hormone oxytocin, is a high-alert medication that heightens patient harm when used incorrectly. This investigation examined the outcomes of an evidence-based Pitocin administration checklist used for labor augmentation at a tertiary-level hospital. Data came from patient records. Using the Perinatal Trigger Tool, N = 372 clinical records (n = 194 prior to and n = 178 following checklist implementation) were reviewed. Checklist implementation resulted in statistically significant reductions in the duration of hospitalization (1.72 vs. 2.02 days, p = .0005), presence of meconium (23.7% vs. 6.7%, p < .001), maternal fevers (7.2% vs. 2.3%, p = .030), and episiotomies (8.8% vs. 1.7%, p = .002), and clinically important reduction in APGAR scores < 7 at 5 min (3.6%-0.6%, p = .069) and instrumented deliveries (11.9%-8.4%, p = .307). A universal Pitocin checklist implementation can improve birth outcomes and costs of care.

Experiences of preconception, pregnancy, and new motherhood for lesbian nonbiological mothers.

OBJECTIVE: To describe the experiences of preconception, pregnancy, and new motherhood from the perspective of lesbian nonbiological mothers. DESIGN: Descriptive phenomenology. SETTING: A private room at the study site and participants' homes. PARTICIPANTS: Twenty-four self-identified lesbian nonbiological mothers in a committed relationship and whose partner gave birth within the past 2 years participated. All of the participants were from urban or suburban areas in the Pacific Northwest. METHODS: Women participated in semistructured in person interviews that were audio recorded and transcribed verbatim for analysis. Coliazzi's method guided the process. RESULTS: An overarching theme of "feeling different" permeated the experiences of preconception, pregnancy, and new motherhood for the participants. The women's narratives revealed seven themes that illustrated their experiences: (a) Launching pregnancy: A roller coaster ride; (b) Having legal and biological concerns: Biology prevails; (c) There is a little person in there: Dealing with pregnancy issues; (d) Losing relationships over pregnancy: The elephant in the room; (e) Feeling incomplete as a mother; (f) Carving a unique role: There are very few of us out there; and (g) Sadness and regret: Nonbiological mothers get the postpartum blues, too. CONCLUSIONS: The experience of preconception, pregnancy, and new motherhood for nonbiological lesbian mothers is complicated by the lack of biological and legal substantiation to the infant, few role models, and limited social support. Nurses and health care providers cognizant of these issues can play an important role in facilitating a positive transition to motherhood for this population.

Confronting the inevitable: a conceptual model of miscarriage for use in clinical practice and research.

In spite of scientific evidence that miscarriage has negative psychological consequences for many individuals and couples, silence and dismissal continue to surround this invisible loss in North American culture and beyond. The grief and sorrow of miscarriage has important implications for clinical practice. It indicates a need for therapeutic interventions delivered in a caring, compassionate, and culturally sensitive manner. This research, based on data from 3 phenomenological investigations conducted with 42 women from diverse geographical locations, sexual orientations, and cultural backgrounds offers a theoretical framework for addressing miscarriage in clinical practice an research.

Resolution of depression and grief during the first year after miscarriage: a randomized controlled clinical trial of couples-focused interventions.

AIMS: The purpose of this randomized controlled clinical trial was to examine the effects of three couples-focused interventions and a control condition on women and men's resolution of depression and grief during the first year after miscarriage. METHODS: Three hundred forty-one couples were randomly assigned to nurse caring (NC) (three counseling sessions), self-caring (SC) (three video and workbook modules), combined caring (CC) (one counseling session plus three SC modules), or control (no treatment). Interventions, based on Swanson's Caring Theory and Meaning of Miscarriage Model, were offered 1, 5, and 11 weeks after enrollment. Outcomes included depression (CES-D) and grief, pure grief (PG) and grief-related emotions (GRE). Differences in rates of recovery were estimated via multilevel modeling conducted in a Bayesian framework. RESULTS: Bayesian odds (BO) ranging from 3.0 to 7.9 favored NC over all other conditions for accelerating women's resolution of depression. BO of 3.2-6.6 favored NC and no treatment over SC and CC for resolving men's depression. BO of 3.1-7.0 favored all three interventions over no treatment for accelerating women's PG resolution, and BO of 18.7-22.6 favored NC and CC over SC or no treatment for resolving men's PG. BO ranging from 2.4 to 6.1 favored NC and SC over CC or no treatment for hastening women's resolution of GRE. BO from 3.5 to 17.9 favored NC, CC, and control over SC for resolving men's GRE. CONCLUSIONS: NC had the overall broadest positive impact on couples' resolution of grief and depression. In addition, grief resolution (PG and GRE) was accelerated by SC for women and CC for men.

Phenomenology: an exploration.

Investigators who use phenomenological approaches to understand experiences of human healing, caring, and wholeness need to consider the differences that exist between descriptive and hermeneutic phenomenology. In this article, these two approaches are compared and contrasted with respect to roots, similarities, and differences. Guidelines are offered to assist prospective investigators in selecting the approach most suitable to personal cognitive style and beliefs about the ways humans experience and find meanings during transitions through wellness and illness to advance nursing knowledge in a holistic view.

Optimal healing environments in nursing.

The purpose of this paper is to explore nursing's historical legacy as a caring-healing profession, and the meaning, significance, and consequences of optimal healing environments for modern nursing practice, education and research. Described are the core foci of nursing as a discipline: what it means to be a person and experience personhood; the meaning of health at the individual, family, and societal levels; how environments create or diminish the potential for the promotion, maintenance, or restoration of well-being; and the caring-healing therapeutics of nursing. Each of these domains are described and discussed in the context of caring, healing environments. It is argued that caring and healing are phenomena difficult to confer or enact in isolation from one another. For nursing, embracing a caring-healing framework incorporates attending to the wholeness of humans in their everyday creation and sustenance of a meaningful life.