Kristin F. Lutz

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 4: Parent–Child Relationships at Risk

PURPOSE The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-childs chronic condition or occurrence within a risky context. CONCLUSIONS Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified. PRACTICE IMPLICATIONS Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

Abuse experiences, perceptions, and associated decisions during the childbearing cycle.

The study purpose was to generate a theoretical understanding of women’s experiences and perceptions of intimate partner abuse during the childbearing cycle. Dimensional analysis, a grounded theory method, was used. Twenty-one interviews were conducted with 12 women who were (a) currently in an abusive relationship with an intimate male partner and pregnant or postpartum (n = 5) or who had (b) experienced abuse by an intimate male partner during a past pregnancy or postpartum (n = 7). Disparities between the two concurrent phenomena of abuse and pregnancy led women to feel as though they were living two separate lives. Pregnancy provided the impetus for reinvesting in the partnered relationship and constructing a family. Leaving an abusive relationship was not considered unless the partner ended the relationship first or the woman perceived an increased risk of danger. Postpartum up to 2 years after birth was a critical transitional time for women.

Expanding the Praxis Debate: Contributions to Clinical Inquiry

Nursing science continues to debate the adequacy of various philosophic paradigms for their ability to forward the discipline. Nursing must embrace multiple paradigms, methodologies, and their philosophic assumptions to adequately address the complex and multifaceted human phenomena that is the focus of clinical inquiry in nursing. This article examines the differences in interpretive and critical approaches to clinical inquiry relative to praxis, expanding how praxis can be used to inform nursing practice. Differences in the nature of knowledge, goals of inquiry, and claims to praxis between the interpretive and critical traditions are discussed. Praxis, realized through clinical inquiry in both the interpretive and the critical paradigms, may contribute important pieces of the puzzle to improve the human condition. Expanding the praxis debate challenges nurses to consider the emancipatory possibilities of clinical inquiry within both interpretive and clinical paradigms.

Findings from Focus Groups Indicating what Chinese American Immigrant Women Think about Breast Cancer and Breast Cancer Screening

OBJECTIVES To explore beliefs of Chinese American, immigrant women related to breast cancer and mammography. DESIGN Qualitative description with semistructured focus groups. SETTING Metropolitan Portland, Oregon. PARTICIPANTS Thirty eight foreign-born Chinese women, age 40 and older, in five focus groups. METHODS Focus group discussions in Chinese were audiotaped, transcribed, and translated into English. Using a process of directed content analysis, group transcripts were coded for themes based on the discussion guide. RESULTS Three main themes emerged from the analysis: knowledge and beliefs; support, communication, and educational needs; and access to care. Subthemes included beliefs such as barriers and facilitators to screening and perceptions about personal breast cancer risk. Several women were profoundly affected by the negative breast cancer-related experiences of relatives and friends. Some common myths remain about causes and treatment of breast cancer. CONCLUSIONS Although Chinese American immigrant women share beliefs with other minority women in the United States, some culturally related barriers such as alienation due to cultural reasons for not sharing diagnosis with anyone and beliefs about the efficacy of Eastern versus Western medicine may affect adherence to screening and treatment. Facilitators included being told to get the test and getting screened for the sake of the family, whereas erroneous information about the cause of breast cancer such as diet and stress remained. Primary care providers such as advanced practice nurses should take into account culturally driven motivations and barriers to mammography adherence among Chinese American immigrant women. Provider/client interactions should involve more discussion about womens breast cancer risks and screening harms and benefits. Such awareness could open a dialogue around breast cancer that is culturally sensitive and nonthreatening to the patient. Information may need to be tailored to women individually or targeted to subethnic groups rather than using generic messages for all Asian immigrant women.

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 3: Interaction and the Parent–Child Relationship—Assessment and Intervention Studies

PURPOSE This integrative review concerns nursing research on parent-child interaction and relationships published from 1980 through 2008 and includes assessment and intervention studies in clinically important settings (e.g., feeding, teaching, play). CONCLUSIONS Directions for research include development of theoretical frameworks, valid observational systems, and multivariate and longitudinal data analytic strategies. PRACTICE IMPLICATIONS Observation of social-emotional as well as task-related interaction qualities in the context of assessing parent-child relationships could generate new questions for nursing research and for family-centered nursing practice.

The experiences of underrepresented minority faculty in schools of medicine

Introduction Faculty of color in schools of medicine play an essential role in addressing health disparities, increasing diversity in healthcare, and improving health professions education. Yet inadequate progress has been made in increasing the numbers of faculty of color in medical schools. The reasons for this gap, and ways to address it, are poorly understood. Methods We conducted a grounded theory study of 25 of faculty from groups historically underrepresented in academic medicine at 17 schools in the United States. Faculty were interviewed in person (n=4, 16%) and by telephone (n=21, 84%). Results We identified two processes that contribute to a greater understanding of the experiences of faculty of color: patterns of exclusion and control, and surviving and thriving. We also identified one outcome – faculty of color having influence. Conclusions Strong support from leaders, mentors, and peers to nurture and protect faculty of color in schools of medicine is needed to counteract the negative effects of racism and to promote the positive effects this group has on diversity and excellence in medical education. Specific strategies for survival and success are described.Introduction Faculty of color in schools of medicine play an essential role in addressing health disparities, increasing diversity in healthcare, and improving health professions education. Yet inadequate progress has been made in increasing the numbers of faculty of color in medical schools. The reasons for this gap, and ways to address it, are poorly understood. Methods We conducted a grounded theory study of 25 of faculty from groups historically underrepresented in academic medicine at 17 schools in the United States. Faculty were interviewed in person (n=4, 16%) and by telephone (n=21, 84%). Results We identified two processes that contribute to a greater understanding of the experiences of faculty of color: patterns of exclusion and control, and surviving and thriving. We also identified one outcome - faculty of color having influence. Conclusions Strong support from leaders, mentors, and peers to nurture and protect faculty of color in schools of medicine is needed to counteract the negative effects of racism and to promote the positive effects this group has on diversity and excellence in medical education. Specific strategies for survival and success are described.

Furthering the Understanding of Parent–Child Relationships: A Nursing Scholarship Review Series. Part 1: Introduction

PURPOSE Understanding the parent-child relationship is fundamental to nursing of children and families. The purpose of this integrative review is to explore nursing scholarship published from 1980-2008 concerning parent-child relationships. Study approaches are examined, critiqued, and future directions for research identified. CONCLUSIONS A historical review of nursing research is presented and methods described as an introduction to a review series of the parent-child relationship. IMPLICATIONS Definition and explication of the parent-child relationship is a first-step in understanding factors amenable to nursing intervention. A clear definition of the concept of parent-child relationship will support further study using appropriate theoretical frameworks, and enable development and testing of supportive nursing interventions.

Having influence: Faculty of color having influence in schools of nursing

Faculty of color (FOC) play an important role in mentoring students and other FOC in schools of nursing. However, the unique nature of mentoring that FOC provide, which includes transmission of expert knowledge of the operations of racism in nursing academe, is not well understood. Furthermore, the influence FOC have on school cultures has not been well documented. To address this gap in knowledge we conducted a critical grounded theory study with 23 FOC in predominately Euro-American schools of nursing. Findings indicate that FOC Having Influence is a key process that explicates the influence FOC wield, exposing their work, which is often taken for granted, hidden, and, unacknowledged. FOC Having Influence occurred in two areas: 1) the survival and success of students and FOC and 2) shaping practices in schools of nursing and impacting health in communities. Implications for educational practice and future research are presented, based on study findings.

Becoming a nurse: role formation among accelerated baccalaureate students.

To understand nursing role formation for students enrolled in an accelerated baccalaureate nursing program, end-of-term narrative reflections from 34 students were analyzed over the course of the 15-month program. Using thematic analysis, 4 major themes were identified: evolving role perception, extending nursing student-patient interaction, engaging with health care team and systems of care, and expanding clinical thinking.

Data-based considerations for electronic family health history applications

Family health history contains important information about the genetic and environmental factors that contribute to patterns of health and illness in families. Applications for collecting, managing, and analyzing family health history could be improved if their design were informed by an understanding of how consumers think about and report family health history. This article presents a descriptive analysis of themes from family health history interviews that have implications for development, selection, and use of family health history tools. Important themes included ways in which family is defined, including nonbiological family members and pets; ideas about health and disease, including degree of exposure and individual perceptions; and barriers to reporting family health history, including large biological families and uncertainty. Some themes identified (eg, uncertainty) have been recognized previously and continue to be important considerations. Other themes identified, such as perceptions about severity of illness or conditions and causal relationships, are newly recognized and may have implications for nurses and other providers designing, selecting, and using family health history applications.