Leading-Following Interpretations: Living Quality and Working, the Musical

It is important to explore the ways that the working lives of persons provides meaning in personal, professional, and organizational ways. In this paper, the author utilized the processes of Parse's (2021a) humanbecoming hermeneutic sciencing (discoursing with penetrating engaging, interpreting with quiescent beholding, and understanding with inspiring envisaging) and the leading-following model to further understanding of the meaning of "working" through Stephen Schwarz's Broadway show, Working, the Musical (Browning & Schwartz, 1982/2002). Although not a formal sciencing project, this interpretive reflection provided a way to "see" how work is "lived out" uniquely.

Policy Crafting: Humanbecoming and the Rainbow PRISM Model

It is important that nurses guide practice with crafted policies based in nursing knowledge that is distinctive and specific to the values and beliefs of all persons, such as humanbecoming. As policy crafters in nursing, a nursing theory or model must serve as the foundation in service to others. In this article, the author explores crafting policy with the Rainbow PRISM model (Cody, 2003; Ortiz, 2018), in light of Parse's (2021a) humanbecoming paradigm, the humanbecoming community change concepts (Parse, 2003, 2021a), and Parse's (1987, 2021a) principles of inquiry construction.

Leading-Following and Community Change Concepts: A Humanbecoming Perspective

Nurses in various settings are called upon to lead new projects and initiatives that further the mission of healthcare organizations or communities. It is important that there is a nursing theoretical framework to serve as a leadership foundation. This foundation grounds the direction of projects and initiatives, so that the path toward success is clear. The purpose of this paper is to explore leading-following within the humanbecoming community change concepts.

Health Policy: Nursing Theory as Inspiration for Policy Development

The theoretical knowledge base of nurse policy-makers enhances their thoughts with inspiring opportunities with communities and healthcare agencies. Nursing theory and frameworks can serve as a motivating, inspirational force for nurses to be imaginative and view situations in innovative ways. In this paper, the author explores some ways in which health and nursing policy-makers may be inspired by unique nursing knowledge to craft policies that are consistent with nursing's theories and models.

Leading-Following and Living Quality: A Reflection

There are many moments within all collaborative leading-following relationships that form each constituent over time. In collaborative leading-following, it is important that there is a nursing theoretical framework that guides the professional relationship with a knowledge base that is distinctive and shared by all involved. In this paper, the author reflects on the humanbecoming core knowings of living quality in light of the essences of leading-following (Parse, 2021a, 2021b).

Health and Nursing Policies: Word Choice and Crafting Policies With Unique Nursing Knowledge

Discipline specific policies that utilize nursing's unique knowledge base provide nurses with ways of seeing and comprehending policies in light of nursing theoretical concepts. Humanbecoming has been used to guide the development of health policies in a variety of settings. In this paper, the author explores the importance of words in crafting health and nursing policies grounded in discipline-specific knowledge, such as the humanbecoming paradigm.

Leading-Following: Living Quality and Spending Time

The purpose of this article is to explore the ways in which living quality shapes the ways nurses and leaders spend their time with ever-changing value priorities.

Power, Policy, and Community Change: Humanbecoming Reflections

Nursing is filled with many innovative leaders who strive to work at the "cutting edge" of possibilities. This edge is tenuous and must be attended to with care through how nurse leaders and policymakers are present with people, situations, and ideas. Nurse leaders and policymakers must be guided by unique nursing theoretical perspectives as they are "present" with others navigating power and change. The purpose of this paper is to explore humanbecoming and the way it contributes to understanding power, health policy, and community change concepts.

Envy and Originality: van Kaam-Parse Connections and Reflections

Originality and envy arise with humanbecoming and leading-following situations. Originality in leadership is significant because there is always pushing-resisting to cocreate something new and carve-out paths that differ from what already is. Envy and originality are lived out in unique patterns by all persons, in some way. How these patterns are lived depends on the choices persons make about how they live their unique originality among infinite possibilities. In this exploration, the author utilized ideas about originality and envy from existentialist psychologist and formative spiritualist, Adrian van Kaam, and nurse theorist, Rosemarie Rizzo Parse.

Health Policy and Community Change Concepts as Metaphors

Policy development, implementation, and maintenance are central to the "carrying-out" of healthcare within organizations and communities. Nurses play an important role in not only developing meaningful policies with constituents but in also providing explanations that "make sense" to all persons involved. This "sense making" may be facilitated by the use of metaphors. In this paper, the author explores Parse's (2021) community change concepts as metaphors that may enhance policy development and understanding.

Leading-Following and Mentoring: Making Connections

There are many meaning-making moments within the leader-leader protégé relationship that shapes each person moment-to-moment over time. It is important that there is a nursing theoretical framework to serve as the foundation to build a professional relationship with a knowledge base that is unique and shared by the leader-leader protégé. It is essential to think about the ways in which leading and mentoring may be connected, so that mentoring may arise within leadership. The purpose of this paper is to explore the essences of Parse's (2021) leading-following model in light of mentoring.

Community Change Concepts and Health Policy Implications

Nursing knowledge is housed in its paradigms, philosophies, models, and theories. This knowledge must be utilized to demark nursing's unique contributions within healthcare, regardless of the setting. The purpose of this paper is to explore the ways in which Parse's community model may serve as a way to think about health policies and the unique ways policies may connect to nursing knowledge. Within this paper, there is a discussion about health policy, Parse's humanbecoming paradigm, and policy development reflected upon with change concepts within the humanbecoming community model. This exploration is important because "disciplinary knowledge is the foundation for transforming health policy and health care delivery systems" (American Academy of Nursing, 2020, para. 1).

Best Practices in Patient-Centered Care: Nursing Theory Reflections

The utilization of nursing theories should serve as the foundation of policies that guide care for patients and those they love. The author of this paper explores linking conceptual elements within nursing theories to high-quality patient-centered care examples and policies. These linkages make clear how nursing knowledge may be utilized within healthcare systems that value patient-centered care. These patient-centered care policies need to be explicit about the contributions of nurses to healthcare, regardless of setting.

Leading-Following: Nurse-Led Care Center Exemplars

There are many ways to lead across all healthcare settings. It is important for nurses to find a way of leading that is grounded in unique nursing knowledge that is consistent with their values and beliefs. These values and beliefs are "lived out" in chosen projects. The purpose of this paper is to explore Parse's leading-following model. This exploration is focused on nurse-led care centers or clinics exemplars, since the centers serve as "chosen" projects of nurse leaders.

The Patient-Centered Health Neighborhood

The creation, implementation, and ongoing maintenance of a patient-centered health neighborhood are central to care in the 21st century. This neighborhood must adhere to the principles of patient-centered care and rest on the foundation of nursing theory that honors what is important to people and the mission and vision of healthcare clinics and systems. It is important that there is strong leadership to develop, implement, and maintain a patient-centered health neighborhood. In this paper, there is an exploration of the patient-centered health neighborhood and the ways it connects to Parse's unique nursing paradigm, humanbecoming.

Patient Engagement, Nursing Theory, and Policy Possibilities

It is important to continually carve out ways to connect with persons in practice and ensure that polices and processes directing practice are aligned with the values and beliefs of nurses and those they serve. In this paper, patient engagement is discussed in light of nursing theoretical principles and concepts, specifically Parse's (2014) humanbecoming paradigm. In addition, policy connections will be outlined to show how nurses may participate in patient engagement in unique ways.

Cocreating Nursing’s Future: A Leading-Following View

The Institute of Medicine’s (IOM, 2011) Future of Nursing report is an important study of the healthcare system that reflects significant ways nurses may drive transformational change. In this paper, the author explores the Key Elements from the IOM’s (2011) Future of Nursing report in light of Parse’s (2008) leading-following model and community change concepts (Parse, 2003, 2012). This exploration is logical in that to implement the IOM’s Key Elements, community change and leadership are necessary.

Patient-Centered Medical (Health) Home: Nursing Theory-Guided Policy Perspectives

Nurses have provided care to individuals, families, and communities, since its “official” founding by Nightingale. Over time, nurses have carved out their unique contributions to serving others by articulating the knowledge needed to practice in a variety of settings so that the “work” of nurses is differentiated from other healthcare professionals. One broad area of practice where nurses serve diverse populations is the Patient-Centered Medical or health Home. The purpose of this paper is to examine patient-centered health (medical) homes (PCHH) and the ways in which nursing theory may guide the principles and policies of PCCHs.

Patient-Centered Care: Nursing Knowledge and Policy

There has been much written about the importance of care that is centered on persons and their loved ones. Patient-centered care has been central to nursing practice and unique nursing knowledge. This central focus provides an opportunity for nurses to develop policies that may affect practice so that practice is consistent with a distinctive knowledge base. The purpose of this paper is to discuss patient-centered care and nursing theory.

Leading-Following Challenges to Living Dignity

There are many moments when the values and beliefs of leaders are "shown" to others, especially as those in formal leadership positions are faced with opportunities and challenges. While guiding others, it is important to be grounded in dignity that places others as priority. Dignity is always present and serves as the basis for the ethos of humanbecoming: shaping the enduring tradition of honoring people and the lives they live.

Transitional Care: Nursing Knowledge and Policy Implications

It is important to develop and implement policies that are unique to nursing practice situations. To do so, nurses must participate in policy development that connects disciplinary knowledge with policy formulation. The purpose of this paper is to explore connections between nursing knowledge and transitional care. This is done with a discussion of transitional care definitions and models, along with connections to concepts and principles within extant nursing theories and models.

Thinking of Being or Becoming a Leader: Lessons and Quotes

The "actions" of the nurse theorists have shaped nursing as a discipline by providing distinct knowledge that serves as a guide for research, practice, education, and leadership. With these "actions," the theorists have "inspired" generations of nurses dedicated to excellence in nursing; the theorists were and are some of the original leaders in nursing. The purpose of this paper is to reflect on a personal leading-following path guided by Parse's humanbecoming paradigm, specifically her leading-following model.

Leading-Following: Guiding Care in the Community

There are many ways nurses may be leaders and serve others in the community by utilizing a unique knowledge base that is grounded in the extant nursing theories and models. Leading and serving others with nursing knowledge demarks the contributions nurses make in all situations. The purpose of this paper is to illuminate how Parse's leading-following model and the Rainbow PRISM model (RPM) guide healthcare services in academic nursing health and wellness centers that serve the needs of all persons living in the community. Also, concepts within the RPM are discussed to align with Parse's current refinements of the humanbecoming paradigm.

Latino Nursing Leadership: A Leading-Following Perspective

Nurse leaders have many demands that must be attended to in a manner that is focused, so that organizational, professional, and personal visions are moved forward. The focus emerges from the values and beliefs of the nurse leaders. These values and beliefs embrace nursing models and theories that are the foundation from which they lead others.

“Oh, the Places” Nurses “Go!”

It is interesting to imagine the many diverse places and settings that nurses “go” to serve individuals, families, and communities with their unique knowledge base. Nurses working in rural areas have many challenges and opportunities, since they work in isolated areas “in the wide open air” where there is limited access to healthcare.

Professional Practice Models: A Way to Guide the Leading-Following Process

In the following article, Dr. Kimberly Glassman describes leading-following through the development and implementation of a nursing professional practice model within a large healthcare system that was grounded in different nursing concepts, professional values, and Magnet recognition elements.

Collaborative Partnerships

In the following article, Dr. Linda Everett, a veteran nurse executive, describes the ebb and flow of leading-following within a nursing academic-nursing practice partnership that was grounded in respectful collaboration.

Respiratory sinus arrhythmia in growth restricted fetuses with normal Doppler hemodynamic indices

BACKGROUND

The autonomic behavior of growth-restricted fetuses at different evolving hemodynamic stages has not been fully elicited.

AIM

To analyze the respiratory sinus arrhythmia (RSA) of growth-restricted fetuses that despite this severe condition show normal Doppler hemodynamics.

SUBJECTS

10 growth-restricted fetuses (FGR group) with normal arterial pulsatility indices (umbilical, uterine, middle cerebral, ductus venosus and aortic isthmus), and 10 healthy fetuses (Control group), 32-37weeks of gestation.

METHOD

B-mode ultrasound images for visualizing fetal breathing movements (FBM) or breathing akinesis (FBA), and the simultaneous RR-interval time series from maternal abdominal ECG recordings were obtained. The root-mean-square of successive differences of RR-intervals (RMSSD) was considered as a RSA-related parameter among the instantaneous amplitude of the high-frequency component (AMPHF) and its corresponding instantaneous frequency (IFHF), both computed by using empirical mode decomposition. Mean fetal heart-periods and RSA-related parameters were assessed during episodes of FBM and FBA in 30s length windows.

RESULTS

FGR and Control groups presented RSA-related fluctuations during FBM and FBA. Also, both groups showed significant higher (p<0.001) values for the mean heart-period, RMSSD and AMPHF during FBM. No-significant differences (p>0.05) were found for the IFHF regardless of breathing activity (FBM vs. FBA).

CONCLUSION

Growth-restricted fetuses without evident hemodynamic compromise exhibit a preserved autonomic cardiovascular regulation, characterized by higher values of RSA and mean heart-period in the presence of FBM. This physiological response reflects a compensatory strategy that may contribute to preserve blood flow redistribution to vital organs.

Developing Leaders from “Seeming Opposites”

The development of nurse leaders arises out of nursing and knowledge from other disciplines. In this column, Dr. McBride shares her experiences as a nurse leader and takes a view of leadership that makes the “tensions” of apparent “opposites” explicit to provide clarity within leading-following situations.

Nursing Science Leaders

This introduces the guest author’s column on perspectives on the development of leaders in science. The need for leadership in science is discussed and a model for the development of science leaders in nursing is outlined.

Everything is different, nothing is changed

Sciencing and living the art of humanbecoming are a commitment to a specific ontology housed in the humanbecoming paradigm. This article is a reflection on Parse's unique humanbecoming paradigm and its postulates: illimitability, paradox, freedom, and mystery. It is important to interpret these postulates in ways that are personally unique, as all persons live humanbecoming in the emerging now in the endless sea of nows.

Recommendations of a group of experts for the pathological assessment of tumour regression of liver metastases of colorectal cancer and damage of non-tumour liver tissue after neoadjuvant therapy

Colorectal cancer (CRC) incidence has increased during the past decades in Spain, being the first malignant tumour in incidence. Observed mortality for CRC is mainly due to liver and lung metastases. The only curative treatment is surgery; new surgical techniques and neoadjuvant treatments have increased the number of surgery candidate patients. Patients should be managed with a multidisciplinary approach that includes imaging techniques, chemotherapy, surgery and pathological assessment. As an answer to this approach, a group of pathology experts interested on CRC liver metastases aimed to review the diagnosis and prognosis of liver mestastases and developed practical recommendations for its assessment. The expert group revised the current literature and prepared questions to be discussed based on available evidence and on their clinical practise. As a result, recommendations for the assessment of tumour regression of liver metastases are proposed, which could be implemented in oncology centres allowing assessment standardisation for these patients. Prospective multi-center studies to evaluate these recommendations validity will further contribute to improve the standard care of CRC liver metastases patients.

Effects of fetal respiratory movements on the short-term fractal properties of heart rate variability

We evaluated the effect of fetal respiratory movements (RM) on the heart rate (HR) fractal dynamics.Abdominal ECG recordings were collected from low-middle-risk pregnant woman at rest. Mean gestational age was 34.8 ± 3.7 weeks. Ultrasound images were simultaneously acquired determining if RM were exhibited by fetuses. 13 pairs of HR series were compared. Each pair included 5 min of data from the same fetus either during the manifestation of RM or when there was no persistent indication of them. Detrended fluctuation analysis was applied to these series for obtaining the scaling exponent α1. HR series were also assessed using the conventional parameters RMSSD and HF power.The main findings of this contribution were the lack of significant changes in the scaling exponent α1 of fetal HR fluctuations as a result of RM. By contrast, HF power and RMSSD did show significant changes associated with the manifestation of fetal RM (p < 0.001 and p < 0.05, respectively). Yet the scaling exponent was the only parameter showing a significant relationship with the particular frequency of fetal RM (r s  = 0.6, p < 0.03). Given the invariability of α1 regarding the manifestation of fetal RM, we consider that the HR short-term fractal properties are convenient for assessing the cardiovascular prenatal regulation.

Short-term heart rate dynamics of women during labor

We studied 10 minutes segments of heartbeat interval fluctuations from 18 young women in labor with normal outcome of pregnancy. Data of each studied case were classified into two distinct groups. One group involving segments where the uterine activity was observable (three or more contractions in ten minutes), and the other group of reference having segments with fewer uterine activity or not presenting contractions at all. For comparison, we also included segments collected during the last trimester of gestation prior to labor from a third group of women. Corresponding RR interval series were analyzed to estimate RR(mean), RMSSD, α(1), α(1(MAG)) and α(1(SIGN)) parameters. No significant differences among groups were identified in RMSSD, α(1) and α(1(MAG)) Nevertheless, α(1(SIGN)) did present significant differences in comparison with the last trimester results (p<0.007), revealing a subtle change in the temporal organization of maternal RR series during labor. Results of these parameters then suggest that during labor, despite preserving a concomitant non-linear influence, the maternal short-term autonomic cardiac regulation behaves with less antagonism.

Short-term heart rate dynamics of pregnant women

Aiming to detect the stage of gestation where dynamical changes of the RR fluctuations may occur, we assessed short-term fluctuations of low risk pregnant women. Ninety six, 10min ECG recordings were collected along gestation (7 to 39 weeks). Corresponding RR fluctuations series were analysed to obtain the RMSSD, α(1), α(1(mag)) and α(1(sign)) parameters. Four groups covering first, second and last trimesters of gestation were conformed. No significant changes in α(1), which was close to unit, and α(1(sign)) among gestational groups were identified. But, in accordance with previous findings, we did find a significant reduction of RMSSD along gestation, and significant short-term changes that indicate a higher degree of nonlinearity after about 26 weeks of gestation (α(1(mag))>0.5)). These results suggest that the short-term heart rate dynamics of low risk pregnant women do not become compromised during gestation, despite the increased haemodynamic demands and other ongoing adaptations. Yet the complexity of the mechanisms involved in the cardiac regulation of pregnant women does seem to increase from mid-pregnancy, possibly owing to new short-term control influences or to modifications regardless the strength of the regulatory interactions.

HIV, AIDS, and sexuality

The purpose of this article is to outline information about people who live with HIV and AIDS and provide nurses with information on how to provide high-quality care for these patients related to sexuality and intimacy. This care is provided through a discussion of relationships, sexuality and sexual health, gender perceptions about sexuality, sexual needs and difficulties, and nursing assessment and intervention strategies.

Prenatal RR fluctuations dynamics: detecting fetal short-range fractal correlations

OBJECTIVE

Several studies have suggested that the analysis of heart rate variability (HRV) during gestation provides indications of the development or maturation of fetal cardiovascular regulatory mechanisms. In this study, we evaluate the existence of short-range fractal-like correlations in fetal RR fluctuations data from the second half of human gestation.

METHODS

Fifty-six short-term abdominal ECG recordings were obtained from low-middle-risk pregnant women. Gestational age varied from estimated 21 weeks to term. For comparison, RR-interval data of 51 healthy adults were also analysed.

RESULTS

Principal findings along the gestational period explored were the existence of fractal RR dynamics in prenatal fetal data as revealed by the short-range scaling exponent alpha(1). No significant differences of alpha(1) (p = 0.4770) were found between fetal (median 1.2879) and adult data (median 1.3214), either between the fetal cases before or after 24 weeks (p = 0.6116) despite observing more variation at early stages. However, fetal RR data did involve lower magnitude in comparison with adults as we found significant differences in pNN20 and SDNN values.

CONCLUSION

The fetal short-range fractal behaviour of RR data could then be linked to the functional development of the parasympathetic activity, which appears to become manifested before 21 weeks of gestation.

Population-based incidence and survival of gastrointestinal stromal tumours (GIST) in Girona, Spain

BACKGROUND

Gastrointestinal stromal tumours (GIST) are rare malignancies characterised by their association with KIT oncogene mutations. Until now, population-based reports of the incidence or survival of kit-confirmed GIST have been rare, and none have originated in Southern Europe.

MATERIALS AND METHODS

We used the Girona Cancer Registry to identify malignant mesenchymal tumours of the digestive tract between 1994 and 2001, and performed c-kit testing in the tumour samples. Age-adjusted incidence rates and survival rates were calculated, and they were also analysed by sex and NIH risk categories.

RESULTS

Forty-six cases were categorised as GIST. Fifty percent were localised in the stomach, 43.5% in small intestine, 4.3% in the omentum, and 2.2% in colon. Thirty-seven percent were classified as high risk of an aggressive behaviour, 30.4% as intermediate risk and 32.6% as low or very low risk. Only one patient received treatment with imatinib mesilate. The annual incidence by 100,000 inhabitants in crude rate, European age-standardised rate and world age-standardised rate was, respectively, 1.09, 0.90 and 0.65 cases. The relative 5-year survival rate was 74.7% for the entire cohort, and it was markedly lower in the high-risk cases (20.3%).

CONCLUSIONS

We report the first population-based study of GIST incidence and survival in Southern Europe. The incidence rate is low and comparable with that of cancer registries from Northern Europe. Survival was favourable in our pre-imatinib population although it was low in high risk cases. Prognostic discrimination of the cases with intermediate, low, or very low risk is inadequate, and these categories should be considered jointly in the future. Our results will help researchers in establishing baseline values against which they can compare, in the future, the impact of imatinib and other Kit tyrosine inhibitors on survival.

Comparison of RR-interval scaling exponents derived from long and short segments at different wake periods

Heartbeat fluctuations show fractal-like correlations that are associated with highly adaptive cardiovascular regulatory systems. Moreover, the short-range fractal or scaling exponent alpha(1) extracted from these correlations has been found to be a predictor of mortality for subjects with an impaired left ventricular function. In general, the RR-interval data required for this analysis are derived from long-term ECG recordings during free-running conditions. Yet short-term recordings are more likely to be obtained in some practical circumstances, so becoming relevant to assess the possibility of obtaining representative alpha(1) exponents from these recordings. Here, we compare the alpha(1) exponents extracted from the RR-interval series (9:00 AM-6:00 PM) of 51 healthy adults in normal sinus rhythm and the alpha(1) calculated from three shorted segments of only 700 beats obtained from the same series at 9:00 AM, 1:30 PM and 5:00 PM. We found no significant differences between the scaling exponents derived from the whole 9 h series and the short segments at 9:00 AM and 5:00 PM, but did find significant differences when comparing the whole series with the short segment at 1:30 PM. Thus, only if the time of day is taken into consideration can short segments of heartbeat fluctuation data be used to obtain representative alpha(1) exponents.

Lingering presence: a study using the human becoming hermeneutic method

The purpose of this human becoming hermeneutic research was to explore the meaning of lingering presence. The emergent meanings were: (a) A lingering presence surfaces in the cherished remembered which changes moment to moment as new experiences arise in the now and shed different light on the was and will be; (b) a lingering presence is lived in private ways, yet with others in a different alone-togetherness; and (c) a lingering presence is living with the familiar-unfamiliar in the now moment, while moving beyond with different possibles. The findings are discussed in relation to how they contribute to nursing knowledge development.

Fatal right spontaneous haemothorax in Von Recklinghausen's disease

Spontaneous massive haemothorax is uncommon and usually occurs as a result of pulmonary infarction, arteriovenous fistula, neoplasm, ruptured aortic aneurysm, rupture of pleural adhesions or pleural endometriosis. Massive haemothorax in Von Recklinghausen's disease occurs rarely but with potentially fatal results in spite of surgery. We present a case of a spontaneous massive exsanguinating haemothorax in a patient with neurofibromatosis type 1 caused by rupture of a branch of the right subclavian artery. Bleeding was probably due to neurofibromatous invasion of the arterial wall.