Creative Nursing

The concept of transforming power over to power with, the theme of this issue of Creative Nursing, comes from Riane Eisler's cultural transformation theory describing a continuum of domination and partnership along which cultures orient themselves. Hierarchies are important organizing principles in many systems; it is not their presence that is inhumane, but how they function. Domination systems display authoritarian rule in both the family and the state or tribe, with strict hierarchies of domination, and narratives that normalize domination and present the violence that maintains it as inevitable. Partnership systems are characterized by egalitarian structures in both the family and state or tribe, with hierarchies of actualization in which power is used to empower others rather than disempower, low levels of sanctioned violence (since it is not needed to maintain power), and narratives depicting mutual respect, accountability, and benefit as natural. All the articles in this issue of Creative Nursing depict empowerment: of patients, parents and other family members, foster parents, children from preschool age to near adulthood, providers of direct patient care at many levels in many areas, nurses seeking to publish their knowledge, and all people who seek to use language that demonstrates respect and value for all people while acknowledging the diverse cultures in which we abide.

Design labs are one of the most exciting multidimensional communication and disruption strategies available to health-care teams today. A design lab can be as simple as a gathering of people who use the framework of design thinking to iterate solutions and innovations to problems in their environment. Design labs support teams in exploring solutions for current health-care challenges, in a safe, creative space. They are a place where nurses can explore their own practice and iterate organizational policies and processes.

Patient experience and team engagement are key performance indicators in organizational strategic planning. Health-care organizations have a seldom-used resource within acute care settings that expands the ability to improve patients’ experiences of their care as well as their own team engagement. Environmental services (ES) staff, the second largest health-care workforce, spend an average of 10 min per patient day interacting with patients and families. Few studies highlight how nursing theory may influence patient experience outside of the nursing role. This paper explores how ES staff at a non-profit rural 974-bed academic medical center impacted patient experience using nursing theory to promote a caring environment. Applying Watson's Theory of Human Caring and Caritas Processes^© with ES team members beginning at leadership levels increased team engagement and improved patient experience. ES team members benefited from a professional nursing framework and from being integrated as a valued partner in advancing human caring.

Research shows how vital sleep is to total health, with poor sleep having a strong correlation with morbidity and mortality, yet fewer than half of top hospitals have sleep-friendly practices. This article describes a project motivated by the lived experiences of a nurse manager and a hospitalist who partnered to improve the sleep environments on two inpatient units. They used design thinking, empathizing with the patients’ experiences with the sleep environment, to design interventions to promote quality sleep. Results showed improvements in patient experience on the Hospital Consumer Assessment of Healthcare Providers & Systems question, “During your hospital stay how often was the area around your room quiet at night?” Patient measures on how well the hospital created conditions for sleep on the unit also showed improvements, as well as the patients’ perception of how well they slept. Care teams can use design thinking to replicate this project and listen to their patients to build and deploy interventions on their units to improve sleep environments.

Objective: In an exam-based education system, it is of utmost importance to identify levels of test anxiety and educational stress that directly affect success, and to reduce anxiety. A study was conducted to examine the effects of laughter yoga on test anxiety and educational stress in 8th grade students in Turkey. Methods: A cluster sampling, parallel-group randomized controlled trial with pre-test/post-test design studied 64 students (32 in the intervention group and 32 in the control group). The intervention group received laughter yoga sessions twice a week for 6 weeks. The control group received no intervention. Data were collected by a demographic questionnaire, the Westside Test Anxiety Scale, and the Educational Stress Scale. Results: After laughter yoga, the intervention group showed a significant decrease in test anxiety (d = 0.859; p < 0.005) and educational stress scores (d = 0.52875; p < 0.001) compared to the control group. Conclusion: Laughter yoga was associated with decreased test anxiety and educational stress. Laughter yoga activities in schools are recommended to decrease educational stress and test anxiety of students.

Purpose: This study explored barriers and facilitators to utilizing health-care services for foster youth, from the perspective of foster parents. Background: There are nearly 437,283 youths in the United States foster care system. Youths living in locations that are different from their familial home situations have a significantly higher occurrence of physical and mental health illnesses than children who remain in their familial homes, increasing risk for homelessness, substance use and abuse, chronic long-term illnesses, and incarceration, thus placing additional burden on the health-care system. Design and Methods: This study utilized a qualitative descriptive design with purposive sampling, with video focus groups to explore 15 foster parents’ experiences in accessing health-care services for foster youth. Results: Barriers and facilitators to accessing health care and care coordination were identified, including logistics, transportation, electronic health record access, location of health care, and the impact of the social worker. Practice Implications: Nurses are well-positioned to aid in closing gaps in care for foster youth. Conclusions: These experiences provide important insights and implications for health-care providers and for future research and policy development.

This paper offers a critical discussion of the evolution and impact of an international nursing writing group, developed to support nursing faculty and academics globally. Amid the challenges posed by the COVID-19 pandemic, the writing group adapted and thrived online with a flattened power structure, and shared influence and acknowledgment of mutual capacity and contribution. The writing group attracted participants from various countries, with international members enriching collaboration, and fostering a global network of nursing scholars. By embracing diverse perspectives and promoting nonpatriarchal approaches to scholarly writing, the International Writing Group became a unique and valuable platform for academic growth and cross-cultural exchange in nursing.

Inclusive language has become a theoretical approach in attempts to ensure that language is not only clear but void of cultural nuances. Depending on the source or the discipline, the definition may vary, but the essence is similar. Inclusive language demonstrates a sense of respect and value for all people while simultaneously acknowledging the diverse culture in which we abide. Incorporating inclusive language should be a deliberate effort to avoid words and phrases that are synonymous with stereotypes and biases about any individual or group. Attention to inclusive language demonstrates that one is sensitive to and respectful of individual differences. Words send intentional or unintentional messages, either of which may have a powerful impact. Thus, it is paramount that the language we use is void of words or expressions that further exclude or denigrate individuals or groups of people based on their defining characteristics.

The Centers for Disease Control and Prevention estimates that 34.8% of adults in the United States experience non-restorative sleep. The restorative theory of sleep is based on sleep as a means for the restoration of cellular function that is needed for activities when awake. Non-restorative sleep leads to awakening feeling unrefreshed and not ready for the activities of the day three or more times weekly. Aims: The aim of this quality improvement project was to increase restorative sleep by increasing the average amount of sleep over units of 24 h, decreasing perceived insufficient sleep, and decreasing episodes of unintended daytime sleep among patients with depressive symptoms ages 18 to 80 years in an outpatient mental health clinic. Methods: Ten patients with depressive symptoms and reporting non-restorative sleep volunteered to participate in the project. Participants kept a sleep diary and followed principles of healthy sleep such as limiting time in bed and going to bed at the same time nightly. The change in and the average amount of sleep over 24 h and daytime sleepiness were evaluated using the Behavioral Risk Factor Surveillance System. Results: All participants achieved at least one more day of restorative sleep, with nine increasing restorative sleep by at least 30 min per day, and nine having no episodes of unintentionally falling asleep.

Background: Musculoskeletal disorders (MSDs) occur as a result of long-term exposure to inappropriate working postures and repetitive use of body postures, leading to harmful consequences for patients, employees, and employers. Evaluating distinct working postures can contribute to effective interventions. Purpose: The aim of this study was to determine ergonomic risks of MSDs during repeated blood pressure measurement processes and to evaluate the effectiveness of a training on this topic. Methods: A pretest/posttest quasi-experimental design studied 64 nurses in a training and research hospital in Turkey. Participants were evaluated for the prevalence and risk of MSDs using the Nordic Musculoskeletal Questionnaire Extended Version and the Rapid Entire Body Assessment (REBA) Checklist, and by photographing them performing the procedure. Nurses with high risk for MSDs received an ergonomics training program and were followed up twice in 3 months. Results: Reduction in prevalence of MSDs in neck, shoulder, and hip/thigh areas, and in mean REBA scores after the training were statistically significant. Conclusion: Nurses should be trained about correct posture for specific high-risk activities that may cause MSDs, and offered exercise programs that support the musculoskeletal system.

The transition from hospital to home after surgery is a vulnerable time for all cardiac surgical patients, particularly older adults. This postoperative phase presents multiple physical, physiological, emotional, and socioeconomic challenges, not only for patients but also for their families and informal caregivers, who often describe this period as stressful and overwhelming. Health-care professionals, particularly nurses, play an integral role in a patient's discharge process; the challenges can be ameliorated through timely discharge planning and effective discharge education. The context-sensitive solutions shared in this paper propose enhancing nurses’ discharge practices to provide individualized care and to facilitate the hospital-to-home transition.

Nurses are at the forefront of providing health education for the general public and are leaders in developing health education programs for all ages. Research has shown that the pediatric population often experience anxiety surrounding common medical procedures. However, evidence-based health education has been shown to enhance self-management, increase knowledge, and decrease anxiety in the pediatric population. One such successful evidence-based health education approach designed for the pediatric population is the Teddy Bear Clinic. The purpose of this article is to report on the efficacy of a nursing student-led Teddy Bear Clinic designed to increase the awareness of common medical equipment and procedures in the pre-school pediatric population. This quality improvement project used a program evaluation design to assess the children's knowledge of common medical procedures and equipment. Participants were a convenience sample of 16 children aged 3–5 years old, attending one daycare center in a large city in Atlantic Canada. Findings showed that after participation in the clinic, the pre-schoolers reported a high level of knowledge of common medical equipment and procedures. This project shows that a Teddy Bear Clinic run by senior nursing students can promote community partnerships and enhance health knowledge in pre-school children.

The bright vision presented by this book provides an invigorating push to bring out the inner anarchist hidden in even the most complacent of health professionals. This book renews the ongoing discussion of how theory-driven change can be used to ground and promote the integration of love and human caring into system innovation. Each chapter of this book provides concrete and realistic application strategies to front-line practice and gives intensive guidance on how to linguistically and intellectually challenge the barriers within an organization that can undermine a vision of holistic caring. For leaders of teams, this book provides invaluable tools to build a culture of caring and maintain a team that perceives caring from both leadership and the organization as a whole. For team members, this book is a reminder that an expectation of workplace culture that is positive, supportive, and fosters growth is not out of reach; it simply has yet to be implemented within their system.