Jane Flanagan

Aims: Despite advancements in diabetes care, up to one in four Americans report rationing insulin due to cost concerns; emerging adults are especially susceptible to cost worries as they transition away from family support. Financial toxicity may help elucidate how emerging adults with type 1 diabetes (T1D) experience emotional burden. This study aimed to understand how emerging adults with T1D describe subjective financial distress, objective financial burden and difficulties navigating health insurance coverage. Methods: A qualitative descriptive design using semi‐structured interviews. Analysis was completed using standard qualitative content analysis procedures. Results: Participants included 8 men and 7 women, 80% identified as White with a median age of 24 years and diabetes duration of 12 years. Sixty percent were on their parents' health insurance and 100% used diabetes technology. Four themes emerged: (1) diabetes distress is substantial and embedded within the developmental stage of emerging adulthood; (2) diabetes distress includes the new responsibility of affording diabetes care independently, which participants experience as an emotional burden, both in the present and when contemplating the future; (3) financial costs of diabetes are exacerbated by insurance barriers, leading to inadequate access to management resources; and (4) emerging adults endorse cost coping strategies, both in the present and when planning for the future. Conclusions: Emerging adults with T1D experience financial toxicity as a source of diabetes distress, leading to cost coping strategies, which are embedded in the larger context of the demands of this developmental stage.

This paper examines misconceptions surrounding the use of theory in qualitative research. To advance nursing knowledge, nurse researchers using qualitative approaches must describe if and how their work is informed by the concepts and theoretical lenses of the nursing perspective. Nursing research is informed by a philosophical view consistent with the discipline’s focus on caring, creating opportunities for mutual dialogue, and facilitating humanization – a connection that is particularly evident in qualitative approaches. In this paper, we discuss the importance of integrating nursing knowledge to guide study design and the interpretation of findings to develop, extend, or refute nursing theory.

There is a lack of evidence describing the lived experience of the early healing period (72 hours to 6 weeks post-transplant) and its meaning to people undergoing liver transplant surgery. To address this gap, a qualitative hermeneutic phenomenological approach guided by Newman’s Theory of Health as Expanding Consciousness was used to describe and interpret the meaning of the early stage of healing post liver transplantation. We conducted 2 semistructured interviews with 9 participants (8 men, 1 woman; ages 31-70 years). Six themes were identified: Waiting to die while preparing to live; Desire to help others as a way of supporting themselves; Misaligned expectations that complicate the healing process; Nonjudgmental, nonstigmatizing healing; Financial and employment difficulties as a barrier to healing; and History of adverse childhood experiences as a barrier to healing. The overarching conceptualization of the study was the awareness of the need to address past traumas as central to whole-person healing. Findings highlight the many educational, psychosocial, financial, and interpersonal challenges faced by this population that should be considered to improve the healing process.

Purpose: The purpose of this study was to describe the extent to which nursing assessment data was present in the electronic health record and linked to NANDA-I, NIC, and NOC. Methods: This retrospective review used a descriptive approach to examine documentation in the electronic health records (EHR) of 10 hospitalized patients requiring cardiac surgery. A team of experts applied a Delphi consensus-building process to identify the supports and barriers for nursing documentation. Findings: Collection of the health history was organized using Gordon's Functional Health Pattern (FHP) Framework. Seventy-five fields were noted for the entry of nursing assessment data of which 65 focused on health history data and 30 documented physical findings and observations. There were no references to the defining characteristics or etiologies with any of the diagnostic labels used. Care plans included the nursing diagnoses, goals of care, and interventions, although there was a lack of clear alignment between the assessment, NANDA-I, NIC, and NOC and the care plan. Progress note documentation addressed significant events in the patient's clinical course; however, these were not nursing problem or diagnosis focused. Four expert reviewers arrived at consensus regarding the supports and challenges impacting nurses’ ability to document data depicting nursing's contribution to care using a FHP and standardized nursing language in the EHR. Conclusions: The EHR provides an opportunity to reflect nursing clinical judgment and make nursing care visible. These findings suggest there are challenges to capturing nurse focused data elements in the EHR. Implications for nursing practice: This work has important implications for clinicians, educators, and administrators alike. EHR systems must accurately capture nurses’ contribution to patient care to plan for resource allocation and quality care delivery. Ultimately, the development of standardized data sources reflecting the outcomes of nursing care will expand the opportunities to advance nursing knowledge.

The Nursing Theory-Guided Practice Expert Panel (NTGP-EP), one of the 14 Expert Panels, is officially designated to advance the mission and strategic goals of the American Academy of Nursing. The NTGP-EP has created a forum for dialogue among nurse scholars interested in advancing nursing theory to promote health and wellbecoming. The purpose of this paper is to share the important work of the NTGP-EP and its history, contributions, and accomplishments, and to propose a member-driven agenda to re-envision our preferred future and the impact of the use of nursing theory to guide nursing education, research, practice, and policy.

Purpose: Nurses are on the forefront of delivering care to patients hospitalized with COVID-19. Nurses’ impact on patient care can be discerned through assessment and documentation strategies, including structured and unstructured narratives, clinical pathways, flowsheets, and problem-based approaches. To date, there are no published reports regarding nursing assessment and documentation during the COVID-19 pandemic using an assessment framework to capture clinical decision making, nursing diagnoses, and key social determinant of health (SDoH) data. Hence, the purpose of this investigation was to conduct an exploratory nursing documentation audit of patients hospitalized with COVID-19 during the first surge to identify types and frequency of nurse-sensitive indicators, including SDoH. Method: This pilot study utilized a retrospective chart review design at a single academic medical center, utilizing Gordon's Eleven Functional Health Patterns (FHP) framework to extract clinical, social, and nursing assessment data for patients hospitalized with COVID-19. Descriptive statistics were computed for continuous variables and counts/percentages for categorical variables. Findings: Data from 94 patient records were analyzed. Most patients were male (59.6%), with a mean age of 58 years. Nearly 15% of patients were Black and 12.8% were Hispanic, most residing in four geographic areas. Nine of the 11 FHPs were reflected in nurse-sensitive indicators documented in the electronic health record. SDoH data were inconsistently documented, including race, education, history of neglect/abuse, and occupation. Conclusion: The FHP framework captured many nurse-sensitive indicators during the first COVID-19 surge, although screening for and documenting SDoH data were limited. Implications for nursing practice: Findings can influence the development of nursing assessment and documentation during crisis care delivery that are inclusive of distinct sociodemographic factors, in addition to clinical factors, to provide comprehensive, culturally sensitive care. Such documentation will enhance the use of nursing knowledge guided by a nursing framework to make visible the essential contributions of nurses to healthcare delivery.

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