Title: Caring for the vulnerable : perspectives in nursing theory, practice, and research / Mary de Chesnay, Barbara A. Anderson's Caring for the Vulnerable: Perspectives in Nursing Theory, Practice and Research deals with the big questions about concepts and theories, research, practice and programs, teaching and learning, and policy regarding the care of vulnerable populations.
Acknowledgments
Her clinical practice and research programs mainly involve women and children who have been abused or trafficked. Her clinical practice and research has been on maternal health issues and nursing issues.
About the Editors
She has conducted ethnographic fieldwork and participatory action research in Latin America and the Caribbean. She has worked with vulnerable populations in more than 114 countries to design and evaluate public health, nurse-midwifery, and health worker education programs.
Afterword
Professor of Nursing and the Jacques Laval Chair for Justice for Vulnerable Populations Duquesne University.
Contributors
Roach, MSN, RN Klinisk assisterende professor Kennesaw State University Vanessa Robinson-Dooley, PhD, LCSW Assistant Professor of Social Work Kennesaw State University Sara Rowan, MSN, APRN Nurse Practitioner. Rachel Simmons, DNP-C Community Health Center Jason Smith, MSN, APRN Nurse Practitioner Anny Sosebee, RN, BSN, MSN Nurse Practitioner.
Concepts
Resilience in Health Care and Relevance to Successful Rehabilitation Among Registered Nurses with Substance
One is a focus on the individual, in which individuals are considered within a systemic context; the second is an aggregate view of "vulnerable groups". Much of the literature on vulnerability takes an aggregate view, and nurses certainly need to address the needs of groups. But nurses also treat individuals and must learn to care for individuals and groups.
OBJECTIVES
Vulnerable Populations
Vulnerable People
According to Aday (2001), vulnerable populations are those at risk for poor physical, psychological or social health. Immigrants and the poor (including the working poor) have limited access to health care because of the way health insurance is provided in the United States.
Vulnerability to Specific Conditions or Diseases
Depression
Schizophrenia
Eating Disorders
HIV/AIDS
Regarding the risk variables, anger was more common among caregivers of HIV-infected patients and was significantly related to depressed mood, which was also common among these caregivers. Gender differences among HIV-infected people may exacerbate their response to the disease. 2009) interviewed HIV-infected Zambian women about their reasons for taking or not taking antiretroviral drugs.
Substance Abuse
They also discovered that risk behaviors shape perceptions of vulnerability—people who engage in high-risk behaviors tend to see themselves as more likely to become infected with HIV than those who engage in low-risk behaviors. In a gender study of predictors of emotional distress, Van Servellen, Aguirre, Sarna, and Brecht (2002) found that although all subjects had scores indicating clinical levels of distress, HIV-infected women had more symptoms and poorer functioning than HIV-infected men.
Students and Faculty as Vulnerable Populations
Other Vulnerable Populations
Combat Veterans
Transgender Persons
Priorities for Research on Vulnerable Populations
Does depression before caregiving increase vulnerability to depressive symptoms among caregivers of persons with Alzheimer's disease? Self-guides, autobiographical memory, and anxiety and dysphoria: Toward a cognitive model of vulnerability to emotional distress.
Advocacy Role of Providers
The political nature of the healthcare system means that we often make decisions for the benefit of the organization rather than for the benefit of the patient. Provide an analysis of your patient cases from the point of view of the social worker or nurse.
The Patient Advocacy Concept
The paternalistic approach is especially common in settings where multidisciplinary teams are used to provide patient care. As one doctor put it, "Of course we are a team and I am the captain." Fortunately, the nursing profession has evolved from an individual perspective to a systemic perspective in which nurses act collectively to change the institutional culture (Mahlin, 2010).
The Patient Advocate’s Role
Counseling and support includes behaviors such as providing refreshments as well as the traditional counseling activities of listening and problem solving. System monitoring is an important action in terms of environmental problems such as poor room temperature.
Definitions
Schneider and Lester (2000) note that advocacy involves the relationship between the client and a particular system and the social worker working to influence the decision-making process on behalf of the client. Advocacy in this context involves the social worker intervening on behalf of the patient to access needed resources when the organization is not meeting his or her needs (Faust, 2008).
A Brief History of Advocacy and Social Work
It served as a form of advocacy for people with mental health issues by declaring that they deserve the same respect and rights as anyone else. The interdisciplinary team approach to service reduces the segmentation of client problems and can be found in many psychiatric and medical settings (Johnson, 1995).
CASE STUDY 2-1: KAYLA
The social worker came to the emergency room and met with Laura and her child. The clinical social worker called for a consultation from another member of the mental health team, the psychiatric nurse.
Intersection of Racial
The chapter also describes and provides strategies for combating racial disparities in women's health and provides case studies to help you apply the concepts from this chapter. The purpose of this chapter is to identify racial disparities in women's health and discuss the intersectionality of privilege.
Disparities and Privilege in Women’s Health
This chapter explores theories that help attempt to explain the continuing gap in achievement between racial and ethnic minorities and white women. Discuss the health disparities that exist between birth and family planning outcomes for racial and ethnic minorities.
Birth Outcomes
Maternal and Infant Mortality Statistics
Racism and Chronic Oppression
White privilege
Perceptions of Privilege
Critical Race Theory
Weathering
Younger African American mothers have been noted to have higher survival rates for their infants, which may indicate that the health of African American women declines in early adulthood due to their cumulative socioeconomic disadvantage (Geronimus, 1992).
Epigenetics
Health Disparities Framework
Patient Preferences and Behaviors
Healthcare System Factors
Provider Factors
It is unclear whether these biases also affect other outcomes, such as caesarean section rates or referrals for infertility treatment. The message may not be relevant to the recipient if it is not framed in an appropriate cultural context.
Access to Family Planning Services
Additionally, there is a mistrust of providers by some minority populations based on historical events such as the sterilization of poor black women, which may decrease adherence to physician recommendations.
Access to Postpartum Contraceptive Care
Increase Knowledge of Contraceptive Types and Use
Immigrant populations have also been noted to have low contraceptive knowledge of contraceptive methods available in the United States. Otherwise, few differences in contraceptive knowledge were noted between black women and white women of all ages, suggesting that differences in outcomes are likely attributable to factors other than contraceptive knowledge.
Better Contraception Counseling
Among men, black and Hispanic men had less knowledge about contraception than white men (Borrero et al., 2013). For example, black and Hispanic men were less likely than white men to know that birth control pills are ineffective if two to three pills in a pack of birth control pills are missed, and that fertility is not delayed after stopping birth control pills.
Pregnancy Intention
Guidelines
Increase Engagement in Childbirth Education
Recruiting a Diverse Nursing and Midwifery Workforce
Supporting and educating individuals and families provides families of color with specific tools and resources for empowerment. By understanding and supporting families of color, we can work together to reduce racial disparities.
CASE STUDY 3-1: CASES IN OBSTETRICS CARE
CASE STUDY 3-2: CASES IN FAMILY PLANNING
It's the skin you're in”: African-American women talk about their experiences with racism. This chapter explores how social justice was conceptualized in nursing literature between the years 2000-2018.
Social Justice in Nursing
The many methods of advancing a social justice agenda, from awareness-raising to re-inventing social policies, are also circumscribed. Develop a concise statement of how to incorporate awareness of social justice, improvement, and transformation into nursing research, education, or practice actions.
A Review of the Literature
These social justice and nursing publications included publications in academic journals (n = 450), journal publications (n = 57), dissertations (n = 10), continuing education units (n = 16), and books (n = 1 ). The chapter also provides examples of how social justice is articulated in articles focused on nursing education, research, and practice.
Defining Justice in Nursing
When ethics is defined in the foreground, the concept of social justice often recedes into the background and appears fleetingly in the concluding parts of articles. Only one article examined the theoretical connection between social justice and spirituality (Pesut, Fowler, Reimer-Kirkham, Taylor, & Sawatzky, 2009).
Social, Distributive, and Market Justice: Within and Beyond the Nursing Literature
Social justice is not a parallel model to market justice; rather, it is at odds with a market model (Beauchamp, 1986). Using a social justice framework, everyone in the United States would be entitled to health care when needed if health care were considered a right of citizenship.
Views of Justice in Nursing Education Articles
In one instance, the term social justice was used but never defined (Herman & Sassatelli, 2002). Even fewer authors advance discussions of how to integrate social justice into nursing education as a curricular feature.
Views of Justice in Nursing Research Articles
Boutain described curricular changes in nursing education to promote social justice learning, practice, and education. The contextualized model offers a way to work with nurses and consider the different ways of acquiring social justice knowledge.
Views of Justice in Nursing Practice Articles
Social justice theories are advocated in philosophy (Young, 1990), public health science (Beauchamp, 1986) and religious studies (Lebacqz, 1986). Irreconcilable contradictions: A critical review of the concept of social justice in three national nursing documents.
Health Literacy: Through the Lens of One Provider
The end of the chapter provides case studies that show how health literacy applies to the real world. Functional health literacy requires that people 56 Chapter 5 Health Literacy: Through the Lens of One Provider.
CASE STUDY 5-1: EDGAR AND LILLY
Lilly convinces him to go to the self-pay clinic an hour away in the next town over to be evaluated. The provider will call an ambulance and have Edgar immediately transferred to the hospital for treatment.
The Breakdown
The provider's staff assures them that the hospital will work out a payment plan and convinces them to go. He is transferred to the nearest emergency department where it is determined that he has suffered from a re-occlusion of his arteries and has experienced a stroke.
The Evolution of Vulnerable Populations When It Comes to Health Literacy
Lilly and Edgar are overwhelmed and very worried about how they will pay the hospital bill without insurance. He spends 8 days in the hospital and is released on five new medications, has three follow-up appointments with various doctors, can't drive for 6 weeks and can't work for 3 months.
CASE STUDY 5-2: AMELIA
The Intervention
Struggling to Understand
The use of a screening tool for health education would have demonstrated the necessity of intervention with both families. Link to CDC Health Education Training Module: https://cdc.train.org/DesktopModules/eLearning /CourseDetails/CourseDetailsForm.aspx?courseid=1057675.
Bullying
While bullying can occur in a variety of contexts, this chapter focuses on child bullying because when young children are bullied, they carry the stigma with them throughout their lives, and the long-term consequences have serious implications for their future behavior. This chapter is an overview of the current literature on bullying to define bullying and its key features, recognize the long-term consequences of bullying, and understand that policies alone do not fill the gap in intervention.
Victim
Understanding the predictors of bullying in the early years can be critical to breaking a cycle of bullying that can be perpetuated during adolescence (Fink & Wolpert, 2018).
Bully
Bully-Victims
Victims of bullying report the highest level of suicidal ideation at 24.8 percent versus 5.7 percent in young adult non-bullied students (Copeland et al., 2013). According to Copeland et al. 2013), bully victims report the highest levels of suicidality at 24.8 percent vs. 5.7 percent in young adult non-bullied students and the highest levels of depressive disorders (21.5 percent vs. 3.3 percent in non-bullied).
Areas of Agreement
The researchers proposed several theories about what changes occur over time as a result of bullying based on physiological changes, including altered hypothalamic-pituitary-adrenal axis (stress response), a biomarker for stress, and the shortening of telomere length due to stress. No direct correlation has been made between these physiological changes and the development of psychiatric illness, but there is evidence linking stress to psychiatric illness (Copeland et al., 2013).
Areas of Disagreement
The moderating effects of school climate on bullying prevention efforts was a program based on a 1-year elementary school bullying prevention trial of the Steps to Respect (STR) program. The marked contrast between main effects of climate versus intervention status suggests that preventing bullying is not a simple or quick fix, but rather multifactorial (Ryzin & Low, 2014).
Bullying Prevention: A Call for Collaborative Efforts Between the School Nurse and School Psychologists
Unfortunately, several recent meta-analyses have revealed that over the past decade, evaluations of bullying prevention in schools have shown negligible to non-significant results. Effective bullying prevention programs help teachers learn to intervene effectively, and victims are more likely to feel supported by the school (Juvonen et al., 2016).
Applying Middle-Range Concepts and Theories
Risjord (2010) argued that the development of nursing knowledge, which he termed the “nursing standpoint”, begins in “nurses' lives”. p. 74), or that problems and solutions in nursing are identified within the daily practice of nurses.
Family nursing students applied middle grade concepts and theories to practice in the course. In this chapter, we will discuss middle-class concepts or theories of self-efficacy, adherence, and change at the individual level.
Self-Efficacy
Intermediate theories are helpful in addressing the problems of nursing, especially among vulnerable populations. Mid-range concepts and theories selected for this chapter have been adapted to the content of a graduate-level general practitioner training on health care theory.
Self-Efficacy Sources
Early work by Bandura and colleagues with individuals who had a phobia of snakes provided the basis for self-efficacy theory (Bandura, Blanchard, & Ritter, 1969). Bandura (1977) argued that fear-motivated individuals avoid threatening situations that they believe are beyond their coping abilities, whereas individuals who believe they are capable will undoubtedly manage situations or problems.
Enactive Attainment
Self-efficacy expectations influence the amount of effort an individual puts into behavior change and how likely the individual is to persist in achieving the behavior change despite obstacles (Bandura, 1977). Bandura was careful to note that expectations alone do not produce behavioral change and that individuals may be capable of change but lack the incentive to engage in the process.
Vicarious Experience
Verbal Persuasion
Physiological Feedback
Application to Vulnerable Populations
Research Example
Practical Application
Adherence
Medication adherence was measured in two ways: patients self-reported pill counts for both psychiatric and non-psychiatric medications, and serum levels of antipsychotic drugs were determined at 6 months. When serum antipsychotic levels were determined, 54.7 percent of the experimental group that received the telephone intervention had therapeutic antipsychotic levels after 6 months compared to 32.7 percent of the control group.
Practice Application
Beebe and colleagues reported that after 6 months there were no significant differences in the number of psychiatric and non-psychiatric medication pills taken between the control group and the experimental group. Medication adherence remains suboptimal in psychiatrically stable individuals with schizophrenia spectrum disorders; however, the researchers provided preliminary evidence of improved outcomes using telephone support.
Change
Central Constructs of the TTM
Stages of Change
Processes of Change
Decision-Making Ability
Designing nursing interventions based on the patient's stage of change is important, especially if barriers to the change process are identified and managed in the treatment plan. The nurse plans to see Jeremiah in 2 weeks at the health center to assess where he is with the change process.
Social Support
Middle class social concepts and theories address the structure and interactions of social support systems within relationships. A nurse at a local shelter helps Chad identify sources of social support.
Health-Related Quality of Life
Amelia shares with the nurse at the outpatient chemotherapy center that colon cancer treatment has affected her quality of life in terms of overall life satisfaction and overall perception of her health. Amelia tells the nurse that she has limited physical function and continues to experience physical symptoms including, but not limited to, fatigue, hair loss, and loss of appetite.
Health Promotion
Behavior-specific cognitions include perception of benefits/barriers to action, perception of self-efficacy and movement (affects) to actively engage in health-promoting behaviors (Pender, 1996; Pender et al., 2010). The nurse understands that engagement in health promotion activities begins with understanding the families' past experience with physical activity, cultural values related to physical activity, perceived benefits and barriers to participating in the sessions, and commitment to a plan of action.
Resilience
The nurse plans a series of adolescent-only, parent-only, and family-only support groups/information sessions to encourage verbalization of fears and concerns within a supportive environment. Information sessions will also be used for teens and their parents to make plans on how to continue to ensure campus safety by utilizing resources within the community.
Chronic Care
Summary Table
A descriptive study of 441 cancer survivors in 5 countries; greater self-efficacy was reported after receiving a verbal explanation of follow-up care plans. A longitudinal study of 250 bereaved older adults; poor perceived emotional social support predicted depressive symptoms 48 months after bereavement.
Resilience in Health Care
Suggest ways family nurses can intervene with nurses with substance abuse disorders.
Registered Nurses with Substance Use Disorders
Next, we will discuss the concept of resilience, which refers to the presence of resilience as a factor influencing successful rehabilitation among nurses with substance abuse problems. A second wave of research focused on reaching a consensus on protective factors and exploring the dynamic process of resilience (Grafton et al., 2010).
Assumptions of the Concept of Resilience
A positive relationship between a nurse recovering from substance abuse disorder and the nurse practitioner can promote a resilient outcome. Finally, the nurse practitioner may be sensitive to nursing colleagues and patients they treat with complaints of pain who may be recovering from substance use disorders.
Afghan Women
Nurses may be among the first healthcare professionals refugees encounter when they resettle in the United States. Explore intersectionality feminism in relation to the Afghan refugee women in the United States.
Refugees: Application of Intersectionality
This chapter discusses a group of refugees (Afghan women) in the United States and uses feminist intersectionality theory to explore identifiers that may lead to the marginalization of this population. Juliene Lipson, a nurse-anthropologist, has conducted several studies with her colleagues focusing on the Afghan refugee women in California.
Feminist Theory
At the opposite end of the continuum, the United States remains the primary host country for refugees, asylees, and resettled refugees from all countries, including Afghanistan. The focus of my dissertation was a phenomenological study of Afghan women's lived refugee experience in the southeastern United States.
First Wave
Within the United States, Georgia is among the top ten states for refugee resettlement (Zong & Batalova, 2015) and among the seven states with the most Afghan refugees and asylum seekers. Given the complexity of the refugee experience of Afghan women, this theory seemed most appropriate for the study.
Second Wave
Miriam and Odessa held hands and sang along with the rest of the black citizens, in support of each other and in resistance to the dominant power of white men. One of the goals of Western feminists was to create a global sisterhood, but they had little or no understanding of the unique problems facing women in developing countries.
Third Wave
Instead, the intersection of race and gender multiplies oppression and discrimination against black women. Like Crenshaw, Collins recounted ways the oppression of black women in the United States continued—politically, academically, and socially.
Transnational Feminism
Orelus (2012) discussed this issue and pointed to ways in which students and educators have suffered oppression and been pushed to the margins of society. Further, these identifiers intersect to create a situation where oppression and marginalization are strong possibilities.
Refugee Status
The reason for choosing the feminist theory of intersectionality for the research population of Afghan refugee women in metropolitan Atlanta is because it corresponds to the situation in which these women now live. The following section discusses the identification features and how they affect the well-being of Afghan refugee women.
Financial Issues
They have multiple identifiers, each of which places them in a minority and marginalized category. Therefore, they have had to work two or three jobs to support their families.
Gender
In addition, having a job means reliable transportation, and the spouses don't have the income or credit to buy anything other than cheap vehicles, which may not be reliable.
Language
Religion
As with any religion, believers of Islam run the gamut from strict fundamentalists to more liberal-minded individuals. However, the strict fundamentalists are the ones who get the most media attention for their cruelty towards women and non-believers.
Country of Origin: Afghanistan
Related Research
It's All About the Benjamins: Economic Determinants of Third-Wave Feminism in the United States. Retrieved from http://www .migrationpolicy.org/article/refugees-and-asylees-united-states#Top%20Refugee-Receiving%20States.
A Holistic Approach
Criteria from Chinn and Kramer (2015) will determine the description and critical reflection of the theory. The Sultanate of Oman (hereafter referred to as Oman) is a country in Southwest Asia, on the southeast coast of the Arabian Peninsula.
In the 1970s, the government adopted a policy of gender equality in education that prepared women for all levels of the Omani workforce. The fundamental statute of the country declares equal rights and opportunities for all (Al-Lamky, 2007).
Theory Description
Although several studies (Al-Lamky, 2007; Alsawafi, 2016; Chavali, 2016; Kemp & Madsen, 2014; McElwee & Al-Riyami, 2003) have investigated the cultural change towards the inclusion of Omani women in the workforce, there is a gap in the literature scientific about why Omani women choose particular career paths. Because the nature of nursing work is contrary to traditional Arab gender ideology and feminine codes of conduct, the nursing profession in the Arab Gulf countries has a somewhat low status (Al Awaisi, Cooke, & Pryjmachuk, 2015; Kemp & Zhao , 2016; Maben, Al-Thowini, West, . & Rafferty, 2010).
Purpose
Assumptions
Structure
Concepts and Definitions
Women’s Employment
A woman's potential client/employer will pay for the product a woman provides based on that person's assessment of the desire to do so. If the overall desire to pay for the woman's product is higher than the desire not to, the potential (customer/ .employer) will choose to do so (Spierings, 2016, pp. 46–47).
Conceptual Levels
The three decisions summarize the relationship between the woman as agent and the context, consisting of structures and other agents.
The Individual Woman
The Household
The Community
The Country
The Globe
The strongest influence on a woman's likelihood to be employed is with contextual characteristics at the level closest to the individual woman (Spierings, 2016).
Relationships Among Levels
Conditions
According to Chinn and Kramer (2015), "Critical reflection contributes to understanding how well theory relates to practice, research, or educational activities" (p. 199). Their approach to theory evaluation deliberately does not involve normative criteria, because judgments about a theory's value depend on the purpose for which the theory is used.
Clarity
Semantic Clarity
Semantic Consistency
Structural Clarity
Structural Consistency
Simplicity
How General Is the Theory?
How Accessible Is the Theory?
How Important Is the Theory?
Retrieved from http://proxy.kennesaw.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db. Sisters making it for themselves in the Middle East: Emirati women navigating their career paths.
Research
The Boys on the Porch: Life Among
Joseph House of Hospitality (St. Joe's), a residence for formerly homeless men located in the Hill District of Pittsburgh. Joe's was on Bedford Avenue at the time of the series, I don't remember it being featured on the show.
The Boys on the Porch
Overlooking the Monongahela River as it enters the city of Pittsburgh, the Hill is a colorful old neighborhood that has been home to successive generations of immigrants. The setting of this prime-time TV series about urban community policing featured Pittsburgh's Hill District.
Life Among Previously Homeless Men
Newcomers and those who have lived there for many years start and end their days on the veranda, the entrance to Sv.
The Residents of St. Joe’s
The case manager and a few men on the porch decided to visit him. One of the men on the porch who works in the kitchen jokes about all the jobs he's lost in his life.
Validation of Fluid Intake Tracking System Designed
Heart failure (HF) is a chronic, progressive, and often fatal condition that affects people worldwide in epidemic proportions. According to the American Heart Association (AHA) Heart Disease and Stroke Statistics Update (2017a), the number of people diagnosed with HF is increasing and is projected to increase by 46 percent by 2030.
Age, Race, and Socioeconomic Factors
The New York Heart Association Criteria Committee (1994) developed a staging system for HF that has become an international standard based on the patient's activity tolerance (see BOX 12-1). A study by Desai (2015) notes that patients with HF are particularly vulnerable after hospital discharge, with approximately 30 percent of all readmissions occurring within the first 2 months after discharge for worsening HF.
The Burden of Self-Care
To address this problem, a fluid intake tracking system (FITS), an instrument that health care providers and patients can use to learn and monitor daily fluid intake, has been developed. A review of currently available fluid-restricted dietary education found a variety of methods and systems for limiting and tracking daily fluid intake.
Conceptualization
These resources included conversion tables for fluid measurements and general instructions for monitoring fluid intake; however, there was no consistency in the presentation of this information. No educational methods designed for bedside or ambulatory teaching were identified.
Theoretical Perspective
Instrument Design
This is especially true for government-owned hospitals and those in areas with lower median incomes. The same ease of reproducibility applies to doctor's offices, clinics and home care facilities.
Design Validity
The pen and paper fluid intake tracking sheet design is cost effective and readily available to all healthcare facilities. After reviewing the instrument, the experts unanimously concluded that the elements of the construct were represented in the design, and they believed that people would be able to use it.
Approval and Participants
Study Design and Procedures
Participants were instructed to complete and mail the user survey at the end of the instrument use period. The survey consisted of a six-item questionnaire on the learnability, ease of use and transferability of the instrument using Likert-type responses ranging from agree to disagree.
Data Collection and Analysis
To protect participants' confidentiality and maintain the integrity of the written instructions, no personal information was exchanged between participant and researcher and no follow-up was done. This result suggests that the tool has the ability to help HF patients enjoy more personal freedom than other available methods (ie, using a jar or large bottle to help them track their intake).
Limitations of the Study
A study by Ciere, Cartwright, and Newman (2012) showed that maintaining physical independence, spending time with loved ones, and having control over one's life were found to be among the top five quality of life goals for HF patients. More than half (67.44 percent) of respondents agreed that it was just as easy to use the tool to track their fluid intake when away from home.
Areas for Improvement
Implications for Research
Incorporating a valid instrument for tracking fluid intake could provide more robust data regarding the daily skills and handling of unique situations required for adequate self-care management. No study was found that incorporated a standardized method for participants to track their fluid intake.
Implications for Practice
Use of the instrument in the inpatient setting can significantly improve the accuracy of fluid intake measurement on the part of the nursing staff. The simplicity of the design makes developing the tool into a mobile app for tracking fluid intake an obvious next step.
CASE STUDY 12-1: AJ
Exercise: A Day in the Life of an HF Patient
A systematic review of the mediating role of knowledge, self-efficacy and self-care behavior in remote heart failure patients. A targeted intervention improves knowledge but not self-care or readmissions in heart failure patients with mild cognitive impairment.
A Systematic Review of Cardiomyopathy and
PPCM is a new form of heart failure that affects women during pregnancy or during the first 5 months after delivery (Fuster, Walsh, & Harrington, 2011; Hilfiker-Kleiner, Haghikia, Nonhoff, & Bauersachs, 2015). PPCM is not always fatal, but fatalities can occur months or years after this 5 month period.
Incidence
Sudden death from a cardiac event within five months of termination of pregnancy cannot be counted as maternal death, although it is related to the pregnancy. The etiology of PPCM is unknown and occurs in the absence of previous heart disease, although current research has identified several risk factors (Hilfiker-Kleiner et al., 2015).
Risk Factors
Cardiomyopathies of all types account for 11 percent of maternal deaths in the United States, and when combined with cardiovascular disease overall, account for 26.5 percent of all maternal deaths (Creanga, Syverson, Seed, & Callaghan, 2017).
Maternal Mortality in the United States
PPCM and African Americans Mothers
According to the CARDIA study, African American women and men are 20 times more likely to develop heart failure before age 50 compared to white women and men (Bibbins-Domingo et al., 2009). One of the shocking findings of the CARDIA study is that heart failure can be predicted and prevented 10–15 years before the average age of 39 years when African American women and men are diagnosed with heart failure (Bibbins-Domingo et al., 2009).
Genetic and Epigenetic Factors Affecting African American Mothers
Inequality with cardiovascular mortality does not only apply to fertility; it is also seen in the African American general population.
Other Possible Risk Factors
The Social Impact of PPCM
Screening
Treatment of Hypertension Disorders
Targeted Treatment by Race and Ethnicity
Racial Differences in Hypertension Management in Pregnancy
The Dilemma
Normal Heart Changes in Pregnancy
Diagnosing PPCM
The biggest factor in recovery is the degree of impact on cardiac ejection fraction (EF) (Carlin et al., 2017). She is at potential risk for further damage to her heart with subsequent pregnancies (Carlin et al., 2010).
Cardiac Transplant
The more severe the impact on the heart's EF, the less likely recovery is. While a woman with PPCM may live with symptoms at a NYHA Class I or II for many years, eventually symptoms will progress to a higher class and she will require intervention, such as a left ventricular assist device (LVAD), heart transplant, or palliative care (Carlin et al., 2017).
Left Ventricular Assist Device
The woman must always carry spare batteries and take long-term anticoagulation with the attendant risks (van Valen et al., 2017). The following case study exemplifies the difficulties associated with the management of PPCM and the impact on the woman, her family and the community.
CASE STUDY 13-1: NO SAFETY NET: A STORY OF DISPARITY AND VULNERABILITY
Why high blood pressure is a "silent killer." Retrieved from http://www.heart.org /HEARTORG/Conditions/HighBloodPressure/UnderstandSymptomsRisks/Why-High-Blood-Pressure-is-a-Silent -Killer_UCM_002053_Article.jsp#.Wa3pwj597I Another important term for this study was quadriplegia, which is an injury in the cervical spinal cord between the C1 and C8 segments, including the organs (Nas, Yazmalar, Sah, Aydin, & Ones, 2015).
Life Beyond Movement
The research question investigated was the process that adult male quadriplegics use to achieve success following a spinal cord injury (SCI). In this study, the conceptual definition of the term spinal cord injury was defined as an injury to the spinal cord that causes motor and/or sensory loss to the upper and/or lower limbs.
A Life History of a Male Quadriplegic
The literature review provided a detailed description of the process used by adult male quadriplegics to achieve success after spinal cord injury. Throughout the study by Monden et al. 2014), many SCI participants also found that their spirituality was a strong factor in achieving resilience.
Rehabilitation
Many participants explained that their traumatic experiences were made meaningful by their faith, which positively influenced their ability to adapt (Monden et al., 2014). Treatment and rehabilitation processes for SCI participants consisted of both acute care with early surgical interventions and long-term treatments throughout life (Nas et al., 2015).
Finances and Quality of Life
2015) agreed with this approach and discussed the same factors as Guzelkucuk et al. 2015) also provided an in-depth explanation of the complications of SCI in relation to rehabilitation goals. 2015) explained that rehabilitation processes for SCI participants were continuous, requiring years of therapy, with the aim of preventing physical, psychosocial and economic complications.
Areas of Agreement and Disagreement
2015) specifically examined the length of stay during rehabilitation related to the mechanism of SCI, the degree of SCI and the age of the participant.
Gap in the Literature
Treatment and rehabilitation processes for SCI participants consisted of acute care with early surgical intervention and long-term lifelong treatments (Nas et al did not mention any specific educational program that was developed or implemented, which was the pattern throughout the review of literature Throughout this qualitative study, this gap in the literature was not true according to one tetraplegic male participant interviewed.
State-of-the-Art Summary
2015) mentioned no specific training programs being developed or implemented, which was the pattern throughout the literature review.
Design and Sample
Setting
IRB Statement
Instrumentation
Rigor and Data Analysis
Procedures
The second month of the study, in July 2017, the researchers conducted and analyzed the first interview. Finally, during the sixth month, November 2017, the researchers submitted the final study report, which included changes made to the study.
Discussion of Sample
In the third month, in August 2017, the researchers conducted the second interview with the participant, as well as analyzed all the study data. During the fourth and fifth months, in September and October 2017, the researchers met approximately four times a week and discussed the results of the study.
Discussion of Results
Shut up Steven and get on with your life! Steven pointed out to the researchers during the interview that if his spinal cord injury were to occur half an inch higher in his fourth vertebra, he would be unable to have any function of his arms or hands. After analyzing the interviews, the researchers further divided rehabilitation into two more specific sub-concepts: physical therapy and counseling.
Physical Therapy
Steven stated that he still finds himself out in a restaurant with people staring at him. Steven got closer to this patient and saw that he could not move any part of his body below his neck.
Counseling
Spirituality
Steven said that if he hadn't gone to church that night, he doesn't think he would be the type of person who would be able to accept the challenges of being a quadriplegic.
Results Related to Theory
Conclusions
Implications
In addition, NPs help coordinate to ensure patients have access to the necessary medical equipment to optimize their functional status. If NPs are not adequately educated and trained in the specific care that patients with SCI require, then they will not be able to provide accurate education or treatment for the specific needs of these patients (Kosevich et al., 2014).
Recommendations
From a pediatric perspective, breastfeeding has been associated with reductions in chronic disease, acute disease, and childhood obesity (AAP, 2012). Nevertheless, breastfeeding initiation rates in the United States have increased significantly.
Overcoming Breastfeeding Challenges: A Case Study
Given the benefits of breastfeeding, public health experts and health professionals in the United States are increasing the promotion of breastfeeding. Despite the presence of these and other concerns, some mothers are able to overcome their obstacles and maintain breastfeeding despite the challenges.
Rationale
The research in this proposal will examine this situation with the following question: What challenges do breastfeeding mothers face in a community setting, and what resources do these mothers use to overcome these challenges and continue to breastfeed successfully. This question will be explored through a case study of a breastfeeding mother; specifically, a woman who experienced significant challenges while breastfeeding her infant but was able to adequately address these challenges to continue breastfeeding.
Importance to the Field of Study
Prior to the start of the study, a systematic review of the recent literature on the topic of breastfeeding problems was performed. Only research studies that addressed breastfeeding issues in some form of an outpatient, community setting and specifically addressed challenges of breastfeeding were included in the review.
Themes
The Rise of Digital or Online Forms of Support
The search was limited to full-text articles in peer-reviewed journals published between 2011 and 2016. After the research itself was completed, another search was conducted using the same criteria listed previously, but only for the dates between April 2016 and November 2016, to identify any articles published on this topic since the initial project proposal.
Influence of Healthcare Providers
The study revealed how much participants valued the support they received from social media and other electronic resources, both in terms of accessing accurate and individualized information about breastfeeding and in terms of encouraging their choice, especially if family or peers were not supportive.
Importance of Prenatal Exposure to Breastfeeding Education
The studies, overall, reported that common challenges leading to breastfeeding cessation were lack of social support from family or partners, poor or current milk supply, perceived infant preference for formula, breast or nipple pain, increased stress, difficulty returning. at work or school, lack of knowledge about breastfeeding and lack of support for health care (Brand et al., 2011;. While the factors that contributed to improving the rates and duration of breastfeeding were not studied as often as factors that contributed to breastfeeding cessation, authors agreed that factors that helped breastfeeding were improved family or social support and maternal self-efficacy (Chen et al., 2012; Dunn et al., 2015; Negin , Coffman, Vizintin, & Raynes-Greenow, 2016; Wambach et al., 2016.).
State of the Art in the Literature
One area of agreement in the literature was regarding the common barriers mothers encountered while breastfeeding. A variety of suggestions have been found in the literature, including interventions by lactation consultants (Bonuck et al., 2014), improving health care providers' self-education about breastfeeding (Chen et al., 2012), use of breastfeeding diaries (Pollard, 2011), increased use of forms of social media support (Asiodu et al., 2014; West et al., 2011) and delaying return to work until a normalized mother-child routine is established (Froehlich et al., 2015) .
Design
Sample
Instrument and Data
Sections of the transcript corresponding to the purpose of the study were underlined and coded. These final coded sections of the transcript were then reviewed and analyzed for emerging themes and subthemes.
Rigor
The digital recording of the interview was transcribed by the study's author to create a verbatim written record of the interview.
Procedure
Participant
The concepts that emerged from the interview fell into two broad categories: barriers to breastfeeding and factors that helped overcome these barriers.
Barriers to Breastfeeding
Physical Barriers
Lack of Breastfeeding Knowledge
Elizabeth's health care providers were also not fully prepared to respond to her physical breastfeeding challenges. When Elizabeth approached her providers with problems, they often did not respond aggressively or seriously to her concerns.
Social Stigma
Also, the class did not cover all the difficulties she eventually encountered—for example, Elizabeth. You need a little more addressing." As for her vasospasm, Elizabeth's providers had no idea what her condition was and were unable to properly diagnose it.
Education and Expert Advice
But it's a big deal when it's three in the morning and your baby wants to feed and you're in pain. It was only after Elizabeth conducted extensive research on her own and brought the research (including recommended treatment) to her healthcare provider that she received the care needed to resolve the issue.
Medical Interventions
She also enjoyed the antenatal and postnatal support from lactation consultants associated with her local hospital.
Community Support
2015) found that maternal confidence and knowledge of the importance of breastfeeding positively influence breastfeeding success, and these factors (particularly self-confidence) were strong in Elizabeth, leading her to believe she had control over her role as a nurse. - feeding mother. Breaking down her goal into smaller, manageable steps and realizing she was in control of starting and stopping breastfeeding as she chose helped overcome the barriers.
Theoretical Implications
Whether this took the form of her seeking to find the cause of her sore nipple, actively confronting people who glared at her or, in one case, even telling her to cover up while she was nursing in public, Elizabeth felt that she had the power and ability to overcome challenges to achieve her goal. Finally, she had the support of her peers—other mothers who were also breastfeeding their babies at the same time as her.
Recommendations for Future Research
The implication for APRNs in this regard has several parts: assessing the patient's social support for breastfeeding before birth, and helping the patient find ways to increase her support for breastfeeding (such as involving family members in breastfeeding education close, as advocated by Dunn et al. [2015]); help encourage the formation of breastfeeding support groups in the patient's local communities; exploring the creation and development of digital forms of breastfeeding support; and assess a patient's needs and successfully direct her to resources available to her in her community. This is a somewhat complicated task, but it is one way to encourage self-efficacy by emphasizing a mother's ability to control the potential pitfalls of breastfeeding and giving mothers a more explicit understanding of how breastfeeding works and what is normal. is and isn't.
