Rebekah L. Fox

A critical examination of the U.S. nursing shortage: contributing factors, public policy implications.

BACKGROUND. Despite short-lived periods of adequacy in nurse availability, the nursing shortage has endured. In order to better understand the myriad factors that influence the current shortage of nurses, as well as possible solutions, this project addresses the influence of social factors and government policy on nurse staffing inadequacy. When the government intervenes in a philosophically free-market economy, the assumption is that a problem, such as the current nursing shortage, could not be solved without such intervention. PURPOSE. Nursing care arguably falls into the realm of protecting the common good, and therefore requires government oversight. We provide a critical analysis of policy intervention efforts into the nursing shortage debate by examining the passage of legislation, the provision of educational assistance, and the establishment of minimum staffing requirements and minimum quality standards for reimbursement, which all impact nursing supply and demand. RESULTS. Arguments supporting and opposing policy intervention in general, and its impact on the overall provision of nursing care in the United States, were examined. Without policy incentive to place financial value on the quality of care provided by nurses, a simple increase in the number of available nurses is unlikely to solve the current problem. IMPLICATIONS. Important considerations that should be factored into policy creation include measurement and compensation for quality care, the nature of recruitment efforts of new nurses, and the complex nature of a nursing work.

Tanning, Skin Cancer Risk, and Prevention: A Content Analysis of Eight Popular Magazines That Target Female Readers, 1997–2006

The majority of tanning bed users in the U.S. are women. Previous health communication research frequently focused on the risk of skin cancer, but few studies assessed the mediated communication environment that may surround womens beliefs and behaviors relevant to tanning. A content analysis of articles in 8 magazines targeting girls, young women, older women, and women who are interested in fitness during the 10-year period of 1997–2006 was conducted. The amount of coverage of tanning bed use consequences was less than 50% of the coverage of tanning benefits. About 40% of the tanning benefits coverage touted looking healthy. The coverage of prevention methods focused on sunscreen use (55%), whereas the more important methods (e.g., protective clothing use) were rarely featured. Longitudinally, the coverage of the risk- and prevention-relevant issues increased between 1997 and 2006. The data indicate that the coverage of tanning benefits also increased during the same period.

Managing the unmet psychosocial and information needs of patients with cancer

In this article, we synthesize current literature regarding the unmet needs of cancer patients, with a specific focus on interventions that address psychosocial distress, social support, and information deficits. Research indicates many patients diagnosed with cancer express unmet needs in terms of emotional distress, decision-making support, and practical concerns such as childcare, transportation, and financial assistance. Four types of system-level barriers to the meeting of patient psychosocial and information-based needs emerge from the literature: unde- ridentification of needs due to inadequate assessment, time constraints on cancer care providers, lack of adequate reimbursement for psychosocial and information services, and barriers related to communication of disease-related information. There is also evidence that unmet need, especially unmet information need, is related to the level of patient health literacy. Patient empowerment through the resolution of unmet needs increases patient participation in care, and is especially crucial in regards to understanding risks and benefits of treatment. There is evidence that some interventions are effective for some patients, and that even relatively simple interventions can reduce psychosocial and information-based needs. The challenge is therefore to discover which intervention will be effective for each individual patient, and to attain the skills and resources necessary to intervene appropriately.

Improving the Implementation of Evidence-Based Practice and Information Systems in Healthcare: A Social Network Approach

In healthcare, evidence-based practice EBP integrates clinical expertise with the best available external evidence from systematic research. Yet even with the aid of technology, implementation of EBP in many settings remains a challenge due in part to the complexity of the healthcare system and the lack of a strong theoretical and analytical foundation to guide implementation efforts. This paper combines research from the fields of healthcare implementation science and social networks to present a theoretically based, integrated framework for the study of EBP implementation. This study explores the application of the framework to a complex healthcare collaborative, the MRSA infection control project, a project intended to foster the implementation of EBP to reduce the spread of MRSA infections. The authors consider how the framework can also be used to inform future research into EBP-related information system implementations and innovations.

Tensions of Praxis: A New Taxonomy for Social Movements

This essay introduces and illustrates tensions of praxis that humans involved in activism face so that thought–action translation can occur more reflexively. Because social movements face unique challenges in effecting social change (Simons, 1970; Stewart, Smith, & Denton, 2007) the tensions of praxis are especially important for this type of social change agency. Therefore, this essay situates itself within discussions of environmental social movements and begins with a brief introduction of praxis as a theoretical and practical concern. Then, in order to illuminate the tensions of praxis, the following tensions are identified, explained, and illustrated: (1) this world or that world; (2) activity or inactivity; and (3) means and ends. Throughout the essay, primary data from a 2009 interview with Julia Butterfly Hill are used to illustrate these tensions. The essay concludes with theoretical and practical significance of the tensions of praxis and suggests directions for future research.

Voices from the Field: Wildland Fire Managers and High-Reliability Organizing Mindfulness

Wildland fire management agencies manage wildland fires for resource benefit while protecting firefighter and public safety. Firefighting fatalities and property damaged by wildfires prompt reviews aimed at preventing similar accidents. The principles of high-reliability organizing (HRO) have been used to analyze such unexpected, high-consequence events. However, fire managers who agree to the value of an HRO framework often have difficulty applying and teaching it. Using data gathered from experienced fire managers, we identify salient examples that illustrate each HRO mindfulness behavior. We then focus on specific language choices encountered in these examples and suggest how these choices might add to the applicability for both HRO theorizing and practice.

Leveraging Social Network Analysis to Improve the Implementation of Evidence-Based Practices and Systems in Healthcare

In healthcare, evidence-based practice (EBP) integrates clinical expertise with the best available external evidence from systematic research. Yet even with the aid of technology, implementation of EBP in many settings remains a challenge. This paper combines research from the fields of healthcare implementation science and social networks to present an integrated framework for the study of EBP-related information systems. We explore the application of the framework to a complex healthcare collaborative, the MRSA infection control project, a project intended to foster the implementation of EBPs to reduce the spread of MRSA infections. We also consider how the framework can be used with other theories, to inform EBP-related information system implementations.

Reframing Corporations as Individuals: The “Persuasive Marvels” Unleashed by the Citizens United Ruling

In this essay we examine the sharply contested Supreme Court ruling in the case of Citizens United v. Federal Election Commission, which struck down restrictions against corporations, unions, and advocacy groups’ funding ads that support or oppose political candidates. We review the literature that examines the conceptual and critical issues involved with corporate personhood. Then we examine how public voices are framing related issues by examining newspaper editorial content.

Teaching free speech across the communication studies curriculum

ABSTRACT While we applaud the efforts of those instructors who teach classes in free speech, we recognize that as a discipline we are often missing important opportunities to teach students about free speech in a variety of other communication studies courses. Our discipline and our democracy rest on the tenets of free speech, and our classrooms should reflect its importance. In this essay, we outline how topics in free speech can be integrated into four different types of classes in the communication curriculum that do not focus solely on the First Amendment.

Cultivating a reluctance to simplify: exploring the radio communication context in wildland firefighting

Although communication is often cited as a contributor to organisational accidents, complexities of the communication context are still understudied. In training materials and some investigative reports, communication is often presented as an equipment issue or as a simple skill that can be picked up on the job. However, interviews with operational and managerial professionals in wildland firefighting reveal 10 simplifications in guidance about radio communication that do not match the complexities experienced by firefighters in the fire environment. Borrowing language from high-reliability organising theory, this study encourages the fire community to cultivate a ‘reluctance to simplify’ how communication is understood and taught, starting with introductory training. The study recommends a move away from the old information transfer model for communication and towards an ecology of meanings model for communication.