Practice Arena Research Articles

“It’s a Burden You Carry”: Describing Moral Distress in Emergency Nursing

IntroductionMoral distress in nursing has been studied in many settings, but there is a paucity of research on moral distress as it manifests in the emergency department. One study suggests a correlation between moral distress and aspects of burnout, and other researchers report that nurses have considered leaving their position or even their profession because of moral distress. Further exploration of these issues may provide insight into their effects on ED patient care and the emergency nursing profession. The purpose of this study was to explore the nature of moral distress as it is experienced and described by emergency nurses. MethodsA qualitative, exploratory design was employed using semi-structured focus groups for data collection. Using an iterative process, transcripts were analyzed for emerging themes by the research team. Six researchers analyzed the transcripts using a thematic analysis approach. ResultsThemes from the data included dysfunctional practice arena, being overwhelmed, and adaptive/maladaptive coping. Participants described, overall, a profound feeling of not being able to provide patient care as they wanted to. DiscussionCauses of moral distress in emergency nurses are environment driven, not incident driven, as is described in other settings, and include a high-acuity, high-demand, technical environment with insufficient resources. Interventions should be targeted to improve environmental factors that contribute to the moral distress of emergency nurses. Future research should focus on the development and validation of an instrument to measure moral distress in this setting.

Exploring Minority Youths’ Police Encounters: A Qualitative Interpretive Meta-synthesis

Recent deaths by police of unarmed minority youth have raised important questions about the nature and outcomes of involuntary minority youth-police encounters. Youth are the most surveilled group of Americans and minority youth frequently live in neighborhoods disproportionately targeted for proactive policing (i.e., using broad police discretion to “target” those most likely to be engaged in criminal activity before criminal acts become apparent). Understanding the experiences of minority youth who encounter police officers is of critical concern for social workers in many practice and research areas. Social workers must examine how a minority person’s perceptions are formed through repeated, frequent, involuntary encounters with the police. The purpose of this qualitative interpretive meta-synthesis was to capture these experiences through the voices of minority youth in recounting their contacts with the police. Four themes were identified: dangerous, controlling, prejudiced, and ineffective. Further reduction of these themes resulted in an overarching theme that captures the essences of these youth’s experiences: dehumanization. These results enhance understanding of minority youth experience with police officers and, thus, inform social work advocacy efforts around this issue in both practice and research arenas.

Introduction: Beijing+20 - Where now for Gender Equality?

The Beijing Declaration and Platform for Action (BPfA) is 20 years old. This introduction revisits the promises of the Beijing conference and reflects on how these have materialised amidst broader changes in the political economy of development. Most significant is the shift in the role of the state, with the entry of new development actors into the development policy and practice arena and growing private sector engagement. One consequence of this is that in the enthusiasm of corporate campaigns promoting women and girls as self-actualising individuals who can lift their communities out of poverty, effective implementation of progressive policies is getting lost. An important legacy of Beijing is the buzz it created within women's organising and the opportunities offered for the creation of transnational and local alliances. In conclusion we underline the hugely important part the energy of women's organisations continues to play in achieving positive and sustainable change.

Alternate Routes: Interpretive Trails, Resistance, and the View from East Jerusalem

Interpretive trails organize knowledge and power in ways quite unlike museums and discrete archaeological sites. While other heritage places tend to privilege sight, trails are designed to be ‘read’ through multiple senses, allowing for the trail narrative to be embodied as the visitor moves through it. This paper explores the potentially harmful consequences of this process when developed without community consent, and considers possible ‘alternate routes’ employed by community activists. The paper is organized around a case study of the interpretive trail at the City of David archaeological park, managed by an Israeli settler group, which winds through the Palestinian village of Silwan in East Jerusalem. The interpretive strategies of the official trail are compared to those used by an activist group that leads alternative tours through the park and provides its own guidebook with modified routes. The comparison illustrates an effective model for community resistance using the discursive space of cultural heritage as an arena for transformative practice.

Genome Medicine in Cancer: What's in a Name?

This is an exciting time to be in cancer medicine. New technologies, such as next-generation sequencing (NGS), have increased our understanding of the molecular aberrations that define cancer. This, in turn, has led to the identification of cancer-specific molecular targets and potential drugs to confront these targets. As these new technologies move toward clinical application, a new vocabulary of "genome medicine" has been introduced to the field of oncology. Unfortunately, unclear or incorrect use of the new terminology has led to semantic misunderstandings that impair communication between the basic research and clinical practice arenas. These misunderstandings have led to assumptions regarding the clinical application of NGS and other technologies that may or may not be true. For example, some organizations that perform NGS testing on clinical samples have endorsed use of the results of such tests to direct specific therapies based on laboratory hypotheses, but without clinical testing of the hypotheses to show utility for these potential predictive claims. Here, we review some simple, and hopefully universally acceptable, definitions, concepts, and trial designs so that laboratory researchers and clinicians can move closer toward speaking the same language.

From Heroic Victims to Competent Comrades

This research synthesis analyzed qualitative depictions of adult literacy learners and identified five ways in which they are typically characterized: the Heroic Victim, the Needy (Problem) Child, the Broken (but Repairable) Cog, the Pawn of Destiny, and the Capable Comrade. These types do not capture the diversity or complexity of all adult literacy learners, and we do not argue that they are comprehensive. Rather they are representative of the ways in which adult literacy learners are portrayed in the research literature. We argue that each type, like characters in a narrative, drive the “action” in research, policy, and practice arena. The ways in which they populate research may have very real consequences for how adult literacy learning opportunities are provided and the outcomes that can be expected.

Linda Burnes Bolton, DrPH, RN, FAAN

Dr. Linda Burnes Bolton is an extraordinary nurse leader: visionary, purposeful, committed to mentoring and sponsoring nurses in multiple roles and locations, including advanced practice nurses. An accomplished author, speaker and educator, Linda truly exemplifies "servant leadership." A long-tenured senior nurse executive at Cedars-Sinai Health System, Linda balances local community leadership with her national and international nursing leadership activities. A special view into Linda's success begins with following her "true north" or guiding light, centered on human caring.

The illusion of client-centred practice

Aim: A critical analysis of occupational therapy practice in the corporate health care culture in a free market economy was undertaken to demonstrate incongruence with the profession’s philosophical basis and espoused commitment to client-centred practice. Findings: The current practice of occupational therapy in the reimbursement-driven practice arena in the United States is incongruent with the profession’s espoused philosophy and values of client-centred practice. Occupational therapy differentiates itself from medicine’s expert model aimed at curing disease and remediating impairment, by its claim to client-centred practice focused on restoring health through occupational enablement. Practice focused on impairment and function is at odds with the profession’s core tenet, occupation, and minimizes the lasting impact of interventions on health and well-being. The profession cannot unleash the therapeutic power of human occupation in settings where body systems and body functions are not occupation-ready at the requisite levels for occupational participation. Conclusion: Client-centred practice is best embodied by occupation-focused interventions in the natural environment of everyday living. Providing services that are impairment-focused in unfamiliar settings is not a good fit for client-centred practice, which is the unique, authentic, and sustainable orientation for the profession.

An Introduction from the New Co-Editors: Building the Child and Adolescent Social Work Journal

As the new Co-Editors for the Child and Adolescent Social Work Journal (CASWJ) we would like to take this opportunity to introduce ourselves to the journal’s readership and outline some of the directions we hope the journal will take. Initially, however, we would like to gratefully acknowledge the distinguished contributions of Dr. Thomas Kennemore, the journal’s previous editor, and Dr. Kimberly Mann, the journal’s previous Associate Editor, who served in these roles for many years and provided such a stable foundation for us to transition into. In early 2014, the journal’s owner and publisher, Springer Publications, issued a call for nominations for someone to assume the Editorship of the CASWJ. We expressed our interest, submitted our resumes, and were invited to prepare a vision statement for the journal. This we did and after some back and forth communications came to an agreement with the staff at Springer, signed a contract, and began jointly taking over the editorial responsibilities in the fall of 2014. We in turn issued a call via various listservs for volunteers to serve on the journal’s editorial board, as well as inviting existed board members to retain their roles if they so wished. The result is the Editorial Board roster available on the journal’s masthead each issue, and also on its website. We are most grateful for these exceptional scholars and practitioners for their service as the primary blind reviewers of each submission. Our Editorial Board reflects a wide array of practice, research and methodological interests, and individuals from across North America and a number of international social workers as well. Frankly, it is exciting to be a part of such a marvelous group of fellow professionals concerned with children and adolescents. For ourselves, Dr. Schelbe’s background with children and adolescents is based in her practice experience in domestic violence agencies and a supervised visitation center. Her primary research interest is child welfare, specifically youth ‘aging out’ of the child welfare system, and prevention of child maltreatment. She was in the inaugural cohort of Doris Duke Fellowships for the Promotion of Child Well-being, and remains committed to the fellowship’s mission of seeking innovations to prevent child abuse and neglect. Lisa is an Assistant Professor at the Florida State University College of Social Work and a Faculty Affiliate at the Florida Institute for Child Welfare. Dr. Thyer is a Professor and former Dean with the College of Social Work at Florida State University. He founded and continues to edit the journal Research on Social Work Practice and brings to the CASWJ his experiences as an editor for that journal, and considerable work on the editorial boards of other journals. He is the proud parent of four children, currently aged 21, 19, 17 and 15, three sons and a daughter, respectively, so he has some experience in raising kids and all the joy, drama and sometimes trauma which accompanied the role of Dad. Bruce is a Licensed Clinical Social Worker in Georgia and Florida, and a Board-Certified Behavior Analyst, and he brings his past and current experience as a practitioner to this journal as well as his research background. He has published a large number of journal articles, chapters and books in the fields of social work, psychology, behavior analysis and psychiatry, and his professional interests lay in the arenas of evidence-based practice, clinical and program L. Schelbe (&) B. A. Thyer College of Social Work Florida State University, Tallahassee, USA e-mail: Lschelbe@fsu.edu

Identifying what matters: Science education, science communication, and democracy

Identifying what matters: Science education, science communication, and democracy

The scholarship of application: recognizing and promoting nurses' contribution to knowledge development.

The generation of knowledge is fundamental to the practice of nursing and occurs through various forms of scholarship. Boyer recognized this and described knowledge production through research, integration, teaching, and application. The focus of this article is on the scholarship of application and its role in the development of nursing knowledge. Examples of achievement in the scholarship of application are provided with outcomes of work between community and education partners and innovative clinical practice changes. The scholarship of application is of particular importance to nursing as it bridges research, practice, and education, and documents and disseminates nursing knowledge to enable peer critique. Approaches for developing a climate of scholarship are discussed, including differentiating scholarly practice from clinical scholarship and how the scholarship of application is situated in practice arenas. The role of clinical scholars and clinical leaders and the continuing development of future scholars are proposed.

Voice and meaning: the wisdom of Family Support veterans

AbstractAlthough a widely accepted term in child welfare discourses, there remains a vagueness as to what Family Support as a named orientation in children and family services actually entails. This lack of clarity is, at times, used to detract from its usefulness within the policy and practice arena. Using the accumulated wisdom of a select group of accomplished managers, academics and policy makers in social work and social care, this paper retrospectively reviews the evolution of Family Support within the Irish context and distils the core characteristics of Family Support practice and service delivery. An unstructured narrative inducing interview was conducted with 14 veterans of Family Support and child welfare. Participants who are based in the USA, the UK and Ireland each had between 30 and 60 years' experience working in this field. Salient factors were identified by participants as having contributed to the growth of Family Support. Specific and distinct characteristics of Family Support practice and services were also categorized by these veterans, providing voice and meaning to Family Support as a specific approach. This paper addresses the debate on Family Support with its place as an accepted and valued orientation within the child welfare arena acknowledged.

JABS at 50

A sampling of fifty years of articles published in the Journal of Applied Behavioral Sciences highlights the integration of theory and practice from JABS’ founding years to the mid-1980s, then a steady shift toward scholarship on “change knowing” and away from “change doing”. This review anchors JABS in the development of the applied behavioral sciences and organization development (OD) and reports on the author’s personal experiences as a budding practical scholar. JABS turn away from application is traced to the normalization of scientific progress in this arena and routinization of practice as change management. The paper then takes up the long-debated question “Is OD dead?” and considers how “something more”—concepts extending beyond conventional behavioral science—has led to revolutionary advances in the practice of change these past two decades. It then highlights how ideas from the arts, spirituality, and chaos-and-complexity sciences have added new dimensions to scholarly practice for the field (and for me) and today beckon sharper theorizing. JABS has of late stretched into these subjects but could do more so. The paper concludes with a call for more artsy, spiritual, and/or off-the-wall publications in JABS’ next fifty years.

The art of democracy: constitutive power and the limits of dissensus

This article engages critically with the normative framing of socially engaged/collaborative art as a consensual/dissensual dichotomy, whereby consensual practices are equated with political abdication. This way of framing such practices gives rise to three significant problems: one concerns the passive positioning of viewers/participants relative to the authorial autonomy of the artwork; the second concerns an inadequate understanding of power; and the third is an apparent inability to think consensus and dissensus together as features of the same arena of practice. The article argues for a more open approach to studying the relationship between politics and aesthetics, thereby avoiding the trap of using artistic practices as illustrative cases in support of conclusions that have been reached before the analysis has even commenced.

Telehealth Opportunities in the Digital Age

Telehealth Opportunities in the Digital Age

Indicators: from Counting to Communicating

The use of indicators for analysing quality of life conditions and differential access to resources and opportunities has gained attention in both academia as well as the planning practice and policy arena. However, teaching methods and usage of indicators is a challenge since it requires the practice of going through all the steps of developing indicators in a short period of time. These steps range from counting, construction, and operationalisation of the indicators to more policy and learning related steps that require a critical and reflective process. This gradient (from the traditional and mechanistic to the critical) is also reflected in the evolution of the indicators movement. To analyse and illustrate this development, we documented the education, fieldwork and research on indicators carried out at our faculty in the past 20 years. Our experience suggests that indicators have a great potential to bring the worlds of academics (research and education) and of planning and policy making closer together. However, we believe that in the education process it is of utmost importance to emphasise the shift in the role of indicators from one of traditional counting and description towards a more critical and communicative role. We present a framework to show the existing dichotomies and how to incorporate this shift in indicator development.

Pre‐Pregnancy Obesity and Weight Gain During Pregnancy: Relationship to the Development of Gestational Diabetes Mellitus and the Birth of a Large for Gestational Age Neonate

Poster Presentation Objective To compare the prevalence of gestational diabetes mellitus (GDM) and large for gestational age (LGA) neonates in pregnant obese women who gain less than, within, and greater than the 2009 recommended weight gain guidelines of the Institute of Medicine (IOM). Design A retrospective cohort study. Setting Data from the University of North Carolina (UNC) Perinatal Database. Sample Women with singleton pregnancies and body mass indices (BMI kg/m2) ≥ 30 delivering between January 2012 and December 2012 who underwent routine screening for GDM at UNC Women's Hospital. Methods We measured the association between early weight gain (EWG) and diagnosis of GDM and the association between total gestational weight gain (TWG) and LGA neonate. To determine EWG and TWG, respectively, we subtracted prepregnancy weight from weight at GDM screening or weight at last prenatal visit >37 weeks. We calculated and classified EWG as less than, greater than, and within based on IOM guidelines for first trimester (1.1 pounds) and second trimester weekly weight gain (0.4‐0.6 pounds; 0.6 = above). Women were separately classified as gaining less than ( 20 pounds) IOM guidelines for TWG. We compared maternal demographics and medical history data using Pearson chi‐square and t test. We reported unadjusted and adjusted risk ratios (RR, aRR) with 95% confidence intervals (95%CI) for GDM and LGA with women gaining less than IOM guidelines as reference. Final adjusted models included prepregnancy BMI, EWG within guidelines, and gestational age at 1‐hour screening. Results Among 778 obese women, 67% (524/778) had full data for EWG analysis; 33% (171/524) gained less than, 17% (90/524) within, and 50% (263/524) greater than IOM recommendations. EWG adherence was not associated with a GDM diagnosis (p = .9). Seventy‐one percent (549/778) had full data for TWG analysis; 24% (130/549) gained less than, 20% (108/549) within, 55% (304/549) greater than IOM guidelines. Compared with women gaining less than, those gaining within IOM guidelines were more likely to have an LGA neonate (RR = 2.88, 95% CI 1.05‐7.95; aRR=3.36, 95% CI 1.10‐10.31). Compared with women gaining less than, those gaining greater than IOM recommendations were more likely to have an LGA neonate (RR = 3.25, 95% CI 1.30‐8.08; aRR=3.54, 95% CI 1.10‐11.79). Conclusion/Implications for Nursing Practice Among obese women, EGW adherence to IOM guidelines did not affect GDM diagnosis in our data. Total gestational weight gain within and greater than the IOM recommendations was associated with birth of LGA neonate. Using arenas of practice, health policy, and education nurses can assist in decreasing the incidence of LGA and GDM.

En ny praksismodell i sykepleierutdanningen for fremtidens behov?

Aim:To explore the informants' experience of a new alternative model for clinical studies and its impact on learning outcomes.Background:Changes in the patient population and future lack of nurses have led to amended requirements for nursing student guidance. These conditions have triggered a need for alternative guidance models for nursing students in clinical studies. Therefore a project was conducted with the intention to increase the number of students in the practice arena and simultaneously frame tools that would improve the quality of clinical studies.Method:A Q-methodological study was conducted including 21 nursing students and tutors from the supervisor teams and head preceptor.Findings:Two opinion clusters, called factors, were prominent. Factor 1 experienced learning in pairs and guidance of a well-functioning supervisor team as positive for learning outcomes. Factor 2 experienced inadequate supervision of the supervisor team and preferred one-to-one tutoring. Head preceptor's role was importa...

Creating the Youth Justice Board: Policy and policy making in English and Welsh youth justice

Despite continuing interest in English and Welsh youth justice policy there has been little critical engagement with the nature of policy itself. Instead, analyses share a common methodological position whereby ‘policy’ is equated with policy ‘products’ (such as legislation or ministerial speeches). This article argues that to understand youth justice policy a wider view is required of what constitutes policy, and where and by whom it is made. It explores how policy is produced in the complex arena of social practice which, following the establishment of the Youth Justice Board for England and Wales (YJB), now constitutes the central operation of the system. Through the creation of the YJB the central youth justice system became essentially undefined. This not only gave YJB officials significant influence in shaping the direction of the youth justice system, but a broad and flexible arena in which to act. Moreover it enabled them to do so according to values and objectives potentially unconnected to ministerial outcomes. Drawing on an ethnographic study of the operation of the YJB, this article explores the policy-making work of YJB officials through the transformation of the role and activities of the YJB itself, comparing the initial parameters of its operation to the way it was defined in action. The article discusses the implications for understanding New Labour’s English and Welsh youth justice policy, and the nature of ‘policy’ itself.

Textual practices in the new media digital landscape: messing with digital literacies

This paper offers a working conversation between the authors about the uneasy relationship between literacy studies and learning technologies. We come from the field of literacy studies but from contrasting perspectives: from academic literacies and work on literacies and technologies in higher education; from an interest in media theory and the implications of digital mediation for the contemporary university; from everyday literacies in informal settings and a concern for the gaps between policy and practice. We illustrate our perspectives through reference to post-compulsory education, especially higher education, but intend our arguments to be of broader value to all sectors of education and learning. We argue that it is probably inevitable that terms such as literacy/digital/network will be taken up by different arenas of scholarship and practice to mean different things, but what is important is finding spaces to make visible the embedded and implicit understandings, assumptions and ideological positions that are carried by these terms. In the paper, we attempt to lay bare some of the tendencies in the different approaches and argue the case for building on these differences in our work rather than seeing them as paradigm contests. We suggest that it would be more generative to the field to acknowledge the richness and diversity of these different traditions, rather than attempting the impossible task of forcing them into a superficial reconciliation.Keywords: literacies; digital; textual practices; learning landscapes; ethnographic(Published: 31 January 2014)Citation: Research in Learning Technology 2014, 21: 21438 - http://dx.doi.org/10.3402/rlt.v21.21438