Nurse-parent dialogue: illuminating the evolving pattern of families with children who are medically fragile

Life Patterns of Family Caregivers of Patients With Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a terminal disease that greatly affects patients and the family caregivers who provide most of their care. Despite the psychological, physical, and financial strain placed on ALS caregivers, few research efforts have been directed to this caregiving phenomenon. The purpose of this research study, utilizing Newman's health as expanding consciousness as the theoretical framework and research method, was to advance understanding of the experience of ALS family caregivers for the advancement of nursing science. Nine patterns of the whole across all family caregivers emerged from the data, showing important implications for nursing research and practice.

Using Margaret Newman's Health as Expanding Consciousness to Explore Pediatric Nurses' Pattern Recognition Process

BACKGROUND AND PURPOSE

This study explored pattern recognition practices of experienced pediatric nurses caring for children with chronic, complex healthcare needs and their families. Nurses worked in the inpatient settings of two different freestanding pediatric hospitals.

METHODS

Margaret Newman's theory of Health as Expanding Consciousness (1999) was used to explore the pediatric nurses' experiences. During interviews, participants (n = 8) related their stories in caring for these children and their families. Individual interview data were blended to examine themes.

RESULTS

Participants described people and events in practice that allowed them to use pattern recognition in the care of children with chronic, complex healthcare needs. Pattern recognition developed in acknowledgement of their past experiences in nursing, as well as with each individual patient and family.

IMPLICATIONS FOR PRACTICE

Participants had the opportunity to reflect on relationships between their day-to-day practice and their experiences building knowledge and understanding in practice. They considered their abilities to move from skills and tasks to appreciating what each patient and family has taught them about their practice of pattern recognition.

Integrative Review on the Use of Newman Praxis Relationship in Chronic Illness

Over the past 20 years, many Newman scholars across the globe have investigated health as expanding consciousness with persons living with chronic illness. This integrative review examines the use of the concept, relationship, and its seven dimensions-health, caring, consciousness, mutual process, patterning, presence, and meaning with persons with chronic illness when engaged in health as expanding consciousness praxis. A regular and sustained pattern of publication of studies that included the seven dimensions was found. Relationships among the dimensions of a Newman praxis relationship, chronic illness, and health as expanding consciousness are discussed.

Defining technology dependence in children and adolescents

The purpose of this review was to identify current terms and definitions used to identify and describe children and adolescents who require technology. A total of 400 articles published from January 2000 through May 2012 were reviewed; 26 articles met the inclusion criteria. The review included only primary research studies that focused on a child and adolescent sample (birth to 18 years old) who required technology. Current terms and definitions used to describe children and adolescents who require technology include technology and complex care. Technology is a constant in both terminology and definitions, and it differentiates this population from the general population of children with chronic illness and special health care needs. This review highlights the need for better, more detailed descriptions of the population of children and adolescents who require technology in their daily lives.

Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded expert consultation and theory development

AIM

To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home.

BACKGROUND

Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking.

DESIGN

Novel mixed-method integrative review informed by health systems theory. DATA 

SOURCES

CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. REVIEW 

METHODS

Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development.

RESULTS

Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge.

CONCLUSION

The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models.

A longitudinal study of families with technology-dependent children

Few researchers have longitudinally examined families caring for technology-dependent children at home. We tested a theoretically and empirically based conceptual model by examining family functioning and normalization in 82 mothers (female primary caregivers) twice over 12 months. Time 1 and Time 2 cross-sectional findings were consistent; the only predictor of family functioning was mothers' depressive symptoms. Contrary to the proposed model, normalization, caregiving duration, and home nursing hours were not directly related to family functioning. Baseline family functioning significantly predicted future family functioning. Also, mothers whose children were no longer technology-dependent at Time 2 reported significant improvements in family functioning and normalization. An intervention to address high levels of depressive symptoms of these mothers is essential to optimizing family functioning.

Integrative Review of Research Related to Margaret Newman’s Theory of Health as Expanding Consciousness

Since 1978 when Margaret Newman first introduced her theory of health as expanding consciousness, the theory has been widely expanded upon by Newman and nursing scholars around the world. This manuscript provides an integrative review of research related to the theory of health as expanding consciousness and analyzes strengths, limitations, and directions for the future. A consistent method of praxis within a unitary, participatory worldview was found. Health as expanding consciousness praxis provides a lens for guiding and interpreting meaning and has cross-cultural appeal and utility.

Identifying Patterns in Partnership With Students Who Want to Quit Smoking

Students who wanted to quit smoking were invited to partner with teachers/support persons to identify the meaningful patterns of their lives. The theoretical framework guiding the study was Newman’s theory of health as expanding consciousness from the perspective of the unitary-transformative paradigm in nursing science. Student participants shared the meaningful relationships and events of their lives with their supportive partners, and together they reflected on the patterns of the students’ lives. Two similarities among the individual patterns were found: a difficult experience in interpersonal relationships at some point in their lives and the initiation of smoking in their search for connectedness with friends. In the dialectic process, students experienced insight regarding their evolving patterns and made transformative changes in their lives, reflecting varying levels of tobacco control.

Having a child diagnosed with cancer: an assessment of values from the mother's viewpoint

The purpose of this qualitative study was to explore the mother's experience of having a child diagnosed with cancer. Semistructured interview questions, focused specifically on values, provided the foundation for the study. Each of the 9 participants was a mother of a child diagnosed with cancer 30 days prior to participation. Subsequent data were collected from each participant 6 months after the original interview. Using a phenomenological approach for data collection and analyses, themes were uncovered from each interview data set. The initial interviews identified 3 themes: (1) problems accessing the health care system, (2) challenges of family dynamics, and (3) support structures. Each theme persisted in the second interview, with an additional theme, (4) future plans, uncovered. Data from this study may provide guidance for health care professionals who provide care to these children and their families. The importance of maintaining communication and keeping promises cannot be overstated.

Partnering of Researcher and Practicing Nurses for Transformative Nursing

The purpose of this praxis research was to address the process of a researcher’s partnering with practicing nurses to incorporate Newman’s theory of health as expanding consciousness as a guide for nursing practice. Initially the nurses were bound by their commitment to help clients within a philosophy of cure, but as they began to engage in a caring relationship of pattern recognition with clients, they experienced the clients’ transformations in a way that was transformative for them and that pervaded the total realm of their nursing practice. The process illustrates the immediate applicability of Newman’s theory.

The relational core of nursing practice as partnership

BACKGROUND

Consideration of the relational core of nursing has gained significance in today's health systems, where the work of nurses is dominated by technologically-driven, prescriptive, and outcome-oriented approaches. This has led to disregard for individual experiences of living life with diverse health conditions.

AIM

The aim of this paper is to articulate the relational core of nursing practice as partnership.

DISCUSSION

The relational core of nursing practice is explicated as a process of professional partnership, focusing on the evolving dialogue between nurse and patient. In partnership, the dialogue is open, caring, mutually responsive and non-directive. The nurse attends to that which is of concern to patients in relation to their health predicaments and the meaning in the health experience unfolds. Nurse and patient reach insight that represents more useful ways of comprehending and acting on their health predicaments.

CONCLUSIONS

Partnership represents theoretically-driven practice that invites nurses to meet patients where they are in understanding their health predicaments and what can be done about them. As such, partnership strengthens the resolve of nurses to resist the pressures of contemporary health service delivery to provide a technical form of practice and it protects the relational core of a fully professional practice.

Designing the neonatal intensive care unit for optimal family involvement

The design of a new neonatal intensive care unit provides an opportunity to ensure that the new facility best meets the needs of the infants and families whom the unit serves. In design planning,administrators, staff, family members, and the architect must work together in a self-education process that entails examining current design standards, exploring exemplary facilities at other institutions,defining the priorities and needs of infants, families, and staff, and deciding how to respond to them. The involvement of family members in this important work can help ensure that the facility is responsive to families and supports the family as the primary caregiver and decision maker for the infant. Such an environment will lead to improved health and developmental outcomes for infants and greater family and staff satisfaction.

Nursing praxis within Margaret Newman's theory of health as expanding consciousness

Nursing praxis was explored from the perspective of one Newman scholar. She shared her evolving perspectives on research as a doctoral candidate and as a member of a hospital-based praxis team she went on to develop with colleagues focusing on women with cancer. Using Newman's research method, the team interviewed families regarding meaningful persons and events in their lives. They then conducted another study in the form of action research. The praxis team found that Newman's theory resonated throughout nursing practice. Newman nursing praxis integrates theory, practice, and research.