Essential in Our Practice and in Our Lives

International Partnerships

Our Guest Editors are both mentors to international authors, aligning closely with this journal's mission. Dr. Abbott-Anderson and her colleagues in the U.S. (Cy Schweiss, Sonja Meiers, Sandra Eggenberger, and Julie Ponto) partnered with Maiara Rodrigues dos Santos and Regina Szylit of the School of Nursing at the University of São Paulo in Brazil to study the experiences of nurses in their two countries during the COVID-19 pandemic. They found similarities in the ways nurses engaged with community members, family members, and friends while positioned between dire hospital situations and community disbelief about the seriousness of the pandemic, often along political lines. In both countries, nurses were initially depicted as heroes, but “as the pandemic continued and rhetoric around COVID-19 escalated, violence toward nurses and other health-care providers escalated.” As they struggled to reconcile the extremity of their caregiving with the misinformation and denial in their communities and families, “nurses were confronted with risks in all aspects of their lives … There was no place of respite for them.” In both countries, heightened visibility of the role of nurses in the health-care system was one positive impact.

Dr. de Ruiter and U.S. colleagues Luke Gietzen, Sarah Ogilvie, and Rebecca Houston partnered with Emilie Steerling and Jens Nygren of the School of Health and Welfare at Halmstad University in Sweden to review the current state of literature about the potential unintended consequences and ethical dilemmas arising from new health technologies. The actual impact of a new technology may not be fully understood until years after implementation; few researchers preemptively consider the ethical implications. Of the more than 24 million articles about common health technologies identified in the search, only 0.07% referred to potential ethical implications. These authors urge researchers to think like nurses during the development phase, “critically analyzing and strategically considering the potential outcomes of actions.”

Integrative Care

The newest edition of the American Nurses Association's Scope and Standards of Practice makes frequent reference to whole-person care and invites nurses to reflect on how they can incorporate mindfulness and other integrative therapies into their self-care and professional practice. Integrative Nursing is aligned with the Scope and Standards and provides a useful framework for practice that expands the reach of nursing across clinical and community settings and patient populations. Mary Jo Kreitzer, Director of the Earl E. Bakken Center for Spirituality & Healing at the University of Minnesota, and colleagues Mary Koithan, Shanna Sullivan, Molly Nunez, and Megan Voss highlight how Integrative Nursing is being implemented in clinical settings and nursing education programs: Across a clinical enterprise at The University of California, Irvine Health; in a mentorship model for new-to-practice nurses in academic medical centers and specialty hospitals in Boston, Massachusetts; as a specialty emphasis within a baccalaureate nursing program at the University of Arizona; and as an advanced practice specialty program at the University of Minnesota School of Nursing. “Using an integrative toolbox, nurses can shape the healing environment, enhance care and outcomes for patients, and experience joy and resilience in our professional practice.”

Shanna Sullivan is also co-author with Paula Koppel (both at the Dana Farber Cancer Institute in Boston) of “Thinking Like a Nurse: A Professional Practice Model for Nursing Innovation.” This article introduces a model that integrates the nursing process with Design Thinking and Theory U change management processes, facilitating practice improvements and leveraging skills, strengths, and values that are integral to nursing. Human-centered design emphasizes gathering data with a focus on empathy for the end user, openness to considering all ideas, and the use of collaborative interdisciplinary design teams. “The nursing process enables nurses to solve problems and make decisions that are patient-centered, personalized, and grounded in mind, body, and spirit, rather than quick, reactive, and formulaic.”

An experience that contains integrative characteristics is hygge, a Nordic practice of creating warmth and comfort from within to improve wellness. To explore hygge as a health-care intervention, Sigrid Ladores, nursing professor at the University of Alabama at Birmingham, and colleagues Rebecca Billings and Morgan Polen used a semi-structured interview guide and the Middle Range Theory of Self-Care of Chronic Illness to explore the experiences of a woman with cystic fibrosis (CF) who uses hygge to cope with the daily challenges of her illness. She incorporates its basic tenets into her daily life and also shares the practice with the online support group she founded and facilitates for 600+ mothers with CF. They embrace hygge principles as a framework for how they interact with each other and conduct their individual lives.

A VALUABLE LENS

The Family and Society lens is valuable in many nursing arenas. Karla Padrón, professor of Gender Studies at Northern Illinois University, and Coralie Pederson, nurse practitioner in the campus health service at the University of Minnesota, believe that traditional Person-Centered Care (PCC) has not adequately honored the rights and humanity of transgender and non-binary patients, whose rights, including the right to gender-affirming medical care, are in jeopardy from “heteronormative and cisnormative standards that protect and normalize Eurocentric notions of health and deservingness.” Intersectionality is a paradigm that illustrates the relationship between individuals and the institutions that grant and deny life chances; interweaving PCC with intersectionality promotes social justice for transgender and non-binary patients.

“Performed at the right time and with the necessary communication, nursing actions can prevent disease onset and promote healthy lifestyles among patients, their families, and entire communities.” Marta Otero Ceballos, a professor in the National School of Public Health in Havana, Cuba, and colleagues Niurka Tamarit Calderin, Julia Maricela Torres Esperón, Rogelio Pérez Reyes, and Roymar Perez Otero, report on a three-stage methodological study that led to the design of a practical guide for nursing personnel who care for the primary caregivers of patients with dementia in the Havana municipality of Marianao. Five of the human needs described by nursing theoretician Virginia Henderson were contextualized and linked to health promotion and mental health actions in a primary health-care setting. In addition to the actual caregiver guide that was the product of the study, the delineation of its methodology will be useful “for similar situations and needs, and contribute to improved nursing protocols that consider the various contexts in which nursing personnel carry out their work.”

The Healing Role of Music

Two articles describe and celebrate the role of music in caring for those we serve. In “Finding Joy and Purpose Through Singing: Giving Voice to Persons Living with Dementia,” Giving Voice Chorus board member Barbara Greene, co-founder Marge Ostroushko, and Jodi Melius, RN Study Coordinator of the Alzheimer's Disease Research Center at the Mayo Clinic, explore how the chorus and similar groups “help meet cultural, social, geographic, and community needs for people who are determined to continue vibrant, creative lives with memory loss.” The article recounts how these choruses developed, and depicts the creative lifeline they provide for individuals and families in diverse communities. Within a choral model, there is space for flexibility and adaptation, especially to honor heritage and culture. For health-care professionals and others seeking resources and referral networks, Giving Voice Chorus is a beacon of light, establishing new supportive networks with hope and affirmation.

Jorgie Contreras, clinical nursing professor at the University of Texas Health Science Center at San Antonio, provides a definition of the concept of music as medicine: The use of music as a non-pharmacological strategy for coping and healing. Musical interventions are used in many areas of health care and medical sciences to meet the physical, psychological, social, and emotional needs of individuals. Music as medicine can promote self-care, enhance moods, promote well-being, and increase relaxation; in one salient finding, listening to music reduced mechanically ventilated patients’ respiratory rate and systolic blood pressure, possibly reducing the need for sedatives and analgesics. The calming effect of music can have a positive impact on mood and quality of work; an increase in perceived level of relaxation may help students focus on academic performance and help nurses focus on patient care.

Learning about Crisis Situations through Simulation

The pedagogy of simulation allows learners to practice in safe environments where mistakes create opportunities, not harm. Two articles address the challenge of teaching nursing students how to respond readily and appropriately in extremely stressful situations of care. For Jürgen Magerman, a lecturer and researcher at HOGENT University of Applied Sciences and Arts in Ghent, Belgium, and colleagues Dennis Demedts, Stefaan De Smet, and Maaike Fobelets, the simulated situation is a conversation with a client who is expressing suicidal ideation. “Many students are not used to dealing with the inability to cure; talking about existential topics such as death and end-of-life tends to be difficult for younger students and caregivers.” These authors report on an interdisciplinary simulation that comprised online learning modules about detection of suicidal ideations and possible interventions; a video dramatizing a conversation between a caregiver and a client expressing suicidal thoughts, that modeled building a therapeutic relationship; simulation scenarios in which students took the role of client, caregiver, or observers; and a debriefing that included viewing and discussing video recordings of the role-played scenarios.

For Sabrina Ehmke, Assistant Professor in the School of Nursing at Minnesota State University Mankato, and colleagues Stacey Van Gelderen, Marilyn Swan, and Laura Bourdeanu, the simulated situation was responding to the patient's acute needs in an obstetric emergency while also addressing the family's needs for information, reassurance, and support. Historically, nurses have been taught to care for the patient, viewing the family as the “background of care;” when the patient is the sole focus of the nurse's care, the family's needs may not be included in care planning. In this study, participants cared for simulated obstetric patients experiencing decline; their provision of Family-Focused Care (FFC) was evaluated using a rubric comprising 12 family-care constructs. Two demographic variables that influenced the rubric scores were nursing specialty certification and having received continuing education in FFC. “Health-care organizations seeking to improve patient outcomes must provide nurses with educational opportunities that advance their knowledge of family-focused care and create practice environments that give nurses time to provide it.”

Helping Nursing Students Thrive

Nursing students are part of society too; for them, the COVID-19 pandemic has exerted academic as well as personal stress. Today's virtual learning environments require faculty to find creative ways to help students thrive; “social interventions such as sharing self-affirmations are useful in helping people develop positive narratives regarding difficult situations.” Professors Sarah Lewandowski, Nitha Mathew Joseph, Florence Schaefer, and Faith Strunk at Cizik School of Nursing at UTHealth Houston in Houston, Texas, helped nurses transition into the first semester of an online RN-to-BSN program using affirmations shared on an online discussion board. Analysis of students’ responses revealed themes that aligned with holistic nursing practice and nursing role development.

For Creative Nursing 2023 our editorial board has chosen the overarching theme of Redesigning Health Care. Our four issues are: #1—Inspiring, Recruiting, and Retaining the Health-Care Workforce; #2—Questioning Long-held Assumptions; #3—Revealing the Structures that Determine Health and Wellbeing; and #4—Exposing the Human and Financial Costs of Marginalization. Please join us in envisioning a better, healthier world for ourselves, our colleagues, and those we serve.