Nursing Science

Letter to the Editor No abstract available

Letter to the Editor No abstract available

Reconceptualizing the Electronic Health Record for a New Decade: A Caring Technology? Since the 2009 publication by Petrovskaya et al on, “Dilemmas, Tetralemmas, Reimagining the Electronic Health Record,” and passage of the Health Information Technology for Economic Clinical Health (HITECH) Act, 96% of hospitals and 78% of providers have implemented the electronic health record. While many positive outcomes such as guidelines-based clinical decision support and patient portals have been realized, we explore recent issues in addition to those continuing problems identified by Petrovskaya et al that threaten patient safety and integrity of the profession. To address these challenges, we integrate polarity thinking with the tetralemma model discussed by Petrovskaya et al and propose application of a virtue ethics framework focused on cultivation of technomoral wisdom. Correspondence: Catherine Robichaux, PhD, RN, 2541 Gramercy Park Dr, Flower Mound, TX 75028 (robichaux@uthscsa.edu). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Clinical Information Needs: A Concept Analysis Health care organizations have invested resources to implement and upgrade information systems capable of collecting large quantities of data. Recent technology developments have created a renewed interest in studying clinician information needs. However, a common definition and analysis of the concept clinical information needs have not been provided. Walker and Avant's method was used to perform a concept analysis. Following a review of relevant literature, a clinical information need was defined as a conscious expression, which can be verbal or nonverbal, of a desire for knowledge to answer clinical questions in the course of decision making to deliver patient care. Correspondence: Cara S. Schlegel, MS, RN, The University of Texas at Austin, School of Nursing, 1710 Red River St, Austin, TX 78701 (cara.schlegel@utexas.edu). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Reducing 30-Day Readmissions Through Nursing Science: An Application of Transitions Theory With Best Practice Guidelines The Transition Management Model was developed by and for nurse care coordinators at an Independent Health Network to reduce Medicare and Medicaid 30-day readmission rates. Preimplementation assessment revealed the need for a nursing science framework to effectively reduce 30-day readmissions. The model was developed through thoughtful integration of transitions theory with best practice guidelines set forth by Project BOOST. Initial results of the Transition Management Model produced a decline in readmission rates by 11%. The Transition Management Model initiative can serve as an exemplar for the integration of transitions theory to best practice guidelines to effectively reduce 30-day readmissions. Correspondence: Bridget Stixrood, MSN, RN, CNL, 220 Tacoma Ave S, Apt 402, Tacoma, WA 98402 (bridgetstixrood@gmail.com). The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Analyzing Patients' Complaints: Awakening of the Ethic of Belonging Nursing ethics are fundamental principles to nursing practice. The purpose of this study is to analyze patients' complaints filed against nurses from a nursing ethics perspective. This is a qualitative study. The data source is the patients' complaints filed in a university-affiliated hospital in China. The complaints are categorized into 4 themes: uncompassionate attitudes, unprofessional communication, disrespect of patient rights, and unsatisfactory quality of nursing care. The ethic of belonging reflects nurse-patient relations. Patients expect to be treated with dignity. This study sends out a call for nurse leaders and educators to reevaluate the practice and education of the nursing professional identity. Correspondence: Holly Wei, PhD, RN, Graduate Nurse Leadership, College of Nursing, East Carolina University, Greenville, NC 27834 (weih16@ecu.edu). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. We would like to acknowledge the reviewers for their constructive feedback to improve the quality of this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Toward a System Theory of Stress, Resilience, and Reintegration Military to civilian reintegration is a complex, multidimensional phenomenon warranting holistic perspectives. Complex phenomena require theory to understand and interpret relationships among concepts. Despite the need for theory-driven research, recent nursing reports often lack a theoretical structure. We extracted relevant concepts from the Neuman's Systems Model (stressors, environment, and person) and the Transactional Model of Stress and Coping (primary and secondary appraisal, coping, and adaptation) to form a Conceptual-Theoretical-Empirical model. Exemplar empirical instruments are presented, along with their conceptual and theoretical dimensions. An integrated System Theory of Stress, Resilience, and Reintegration is presented with its utility demonstrated through a research application. Correspondence: Anna G. Etchin, PhD, RN, Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, 150 S Huntington Ave (182 JP), Jamaica Plain, MA 02130 (Anna.Etchin@va.gov). The first author sincerely thanks Dr Clifford for the Clifford Scholarship in the name of his late wife, Joyce Clifford. Dr Etchin was supported by a Veterans Affairs OAA Polytrauma fellowship, Jonas Veterans Healthcare Scholar grant 2016-2018, and Sigma grant 2018. This material is the result of work supported with resources and the use of facilities at the VA Boston Healthcare System. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs of the United States government. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Intersectionality and Critical Realism: A Philosophical Framework for Advancing Nursing Leadership This article presents intersectionality theory with critical realism as a philosophical framework for studying nursing leadership. In response to gaps in the current leadership literature, the aim is to develop an approach that addresses how the multiple social positions nurses hold can create an intersecting matrix of oppression that impacts on their opportunities to develop as leaders. The result is a theoretical foundation, which can inform the methodological framework of future studies. Providing evidence by which a reader can judge the merits of a chosen methodology, it sets the case for integrating intersectionality with critical realism for studying nursing leadership. Correspondence: Cathleen Aspinall, MSc, RN, School of Nursing, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand (c.aspinall@auckland.ac.nz). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Analysis and Evaluation of Conceptual Model for Health-Related Quality of Life Employing Fawcett and DeSanto-Madeya's Critique Framework Health-related quality of life is increasingly used as a predictor in nursing research and practice because its multidimensional constructs encompass the holistic spectrum of care. This article comprehensively analyzes and evaluates the conceptual model of health-related quality of life of Ferrans and colleagues using Fawcett and Desanto-Madeya's 2013 framework. The model encompasses all relevant concepts and propositions in its theoretical foundation while maintaining consistency with the nursing metaparadigm. Also, the model has comprehensive content, appropriate context, and social and theoretical significance. To maximize the model's empirical and pragmatic adequacy, researchers should carefully define the variables associated with each concept. Correspondence: Min Kyeong Jang, PhD, KOAPN, RN, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave, MC 802, Chicago, IL 60612 (mjang21@uic.edu). The authors are grateful to Dr Carol Ferrans of the University of Illinois at Chicago for making herself available to answer questions about her Conceptual Model for Health-Related Quality of Life. This study was funded in part by the National Institute of Nursing Research of the National Institutes of Health (K24NR015340), the Sigma Alpha Lambda Chapter, and the PhD Research Award from the University of Illinois at Chicago, College of Nursing. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Factors That Influence Health-Promoting Self-care in Registered Nurses: Barriers and Facilitators Nurses are instrumental in the battle against lifestyle-related diseases, yet nurses may not be participating in their own health-promoting self-care. This study used qualitative content analysis of survey responses to explore nurses' perceptions regarding barriers and facilitators to health-promoting behaviors such as exercise, healthy eating, and participation in stress reduction activities. Seven themes emerged: lack of time/overwork, lack of resources/facilities, fatigue, outside commitments, “unhealthy” food culture, supportive versus unsupportive individuals, and positive versus negative role models. Institutional, interpersonal, and intrapersonal changes are needed to adequately address barriers to nurses' participation in health-promoting behaviors. Correspondence: Alyson Ross, PhD, RN, National Institutes of Health Clinical Center, Bethesda, MD 20892 (alyson.ross@nih.gov). This research was supported by the Intramural Research Program of the NIH Clinical Center. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.