A short reply to both writings

Patients’ experiences of alcohol screening and advice in primary care: a qualitative study

This study, informed by the Normalization Process Theory, conducted interviews to explore the primary healthcare patient perspective on alcohol screening and advice. Normalization Process Theory was chosen to design, analyze and interpret the study because the theory’s four core constructs provide structure to implementing healthcare practice change. These constructs are coherence, cognitive participation, collective action, and reflexive monitoring; the article and study further broke down the mechanisms as sense-making, relational, operational and appraisal, respectively. The study was able to conclude generally positive attitudes toward alcohol screening in the primary setting, though the alcohol advice needs more individualization to gain the confidence of patients. Normalization Process Theory has been innovated for use in technology and healthcare with a focus on breaking up the processes that guide change into everyday use. In my opinion, this theory’s constructs are similar to aspects of EBP models we have studied so it is easy to make sense of its application to nursing practice. My biggest takeaway regarding the theory and the study was that integration of a new process requires conscious, continual action, knowledge collection and evaluation.

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May, C., Rapley, T., Mair, F.S., Treweek, S., Murray, E., Ballini, L., Macfarlane, A., Girling, M. and Finch, T.L. (2015) Normalization Process Theory On-line Users’ Manual, Toolkit and NoMAD Instrument. http://www.normalizationprocess.org

O’Donnell, Amy, et al. “Patients’ Experiences of Alcohol Screening and Advice in Primary Care: a Qualitative Study.” BMC Family Practice, vol. 21, no. 1, 2020, doi:10.1186/s12875-020-01142-9.

Changing Attitudes Toward Euthanasia and Suicide for Terminally Ill Persons, 1977 to 2016: An Age-Period-Cohort Analysis

This cohort anaylsis used life course sociological theory discernment to evaluate the broadened acceptance of euthanasia and suicide for terminally ill patients that has been shown through previous longitudinal studies. The analysis includes a specific section dedicated to an explanation of life course perspective and its appropriate application in this case, “for examining social change over time” (Atell, 2017). Three temporal parameters—age, cohort and period effects—are identified interdependent drivers of social change over time that the researcher sought to untwine from one another in the data to advance understanding on why attitudes toward euthanasia and suicide in terminally ill patients have relaxed. In this case, the researcher was able to determine that age effects had the greatest impact on the attitude shift. In this specific case, the findings are applicable to nursing in that laws have changed in the past, and thus may in the future, regarding death with dignity. In a broader scope, the life course theory is important to integrate into practice as it may help us understand our patients and co-worker’s opinions and decisions better. In a way, to me, it is like a theory application of worldview and can even better help us understand our own attitudes towards social changes.

Attell, Brandon K. “Changing Attitudes Toward Euthanasia and Suicide for Terminally Ill Persons, 1977 to 2016.” OMEGA – Journal of Death and Dying, vol. 80, no. 3, 2017, pp. 355–379., doi:10.1177/0030222817729612

Social Exchange as a Framework for Client‐Nurse Interaction During Public Health Nursing Maternal‐Child Home Visits

Social exchange theories are rooted in the philosophical perspective of utilitarianism, greatest good for the greatest number. Social exchange relationships are noted that individuals are purposive and motivates to maximize material benefits from exchanges with others in a free and competitive marketplace, as agents of a free market individuals have access to all information needed to weigh alternatives and calculate cost for each alternative, and based on their own calculations individuals are able to rationally choose the activities that will maximize their profits. (Mckewn & Wills 2019)

In an exchange relationship individual are sharing information they see as mutually beneficial to each other. Byrd states, “The voluntary transfer of resources from one person to another in return for resources is social exchange.” (Byrd 2006) Social exchange theory can be utilized analyzing nurse-patient relationships. In Byrd’s study “Social Exchange as a Framework for Client‐Nurse Interaction During Public Health Nursing Maternal‐Child Home Visits” she examines this social exchange during nurse home visits. Nurse patient relationships during home visits using exchange perspective focuses on the public health goals of health promotion, and disease and injury prevention. The concern of exchange theory in these interactions is what resources should be exchanged. Through the study Byrd examined child focused home visits with three categories single, short, and long term. In the single visits the nurse did not need to make a return visit based on positive predictive judgement due to the caregivers parenting skills. Short term visits were planned when the nurse was concerned about caregiving abilities. In long term visits the nurse saw the caregivers as competent and admired the interactions. Through the relationships the exchanged information was divided in three parts status, services, and goods. Status is the nurse validating and admiring the patient. Service is the nurse providing assessments, exams, and weights. Goods is the nurse exchanging formula, clothes, household items.

The Health Needs of Young Women: Applying a feminist philosophical lens to nursing science and practice

There is a wide range of feminist theory with varied perspectives on women’s role within society. McEwen and Wills describe feminist theory as “an analysis of women’s subordinations for the purpose of figuring out how to change it.” (Mckewn & Wills 2019) Feminist theory as it applies to nursing has been discussed for many years. Florence Nightingales wrote of gender roles in the 19th century in her efforts for women’s right to education, self-development, and careers.

Burton examines feminist theory in her study “The Health Needs of Young Women: Applying a feminist philosophical lens to nursing science and practice.” Feminist theoretical perspective could provide a useful lens in which to understand young women’s healthcare needs. Great potential for success comes with patient buy in. To successfully care for patients their individual perspectives, experience and goals should be considered in care development. Burton states, “Such efforts are often the specific province of nursing, which has been described as the art of combining empirical knowledge of physical processes with intuitive and acquired knowledge of the individual client.” (Burton 2016) Young women have often not been used in studies as they have been determined as too emotional or difficult to work with. As preventative medicine becomes an important arena of healthcare practice incorporating young women into their healthcare can set them up for success with positive health outcomes as they age. While it can be complex to study young women to due to having broad, divergent cognitive, developmental and physical health needs it is still worth examining these areas. Burton states, “Nonetheless, it has been shown that young women do engage in behaviors to enhance and improve their health and wellbeing. This evidence of self-caring suggests that like nurses, young women may know more about themselves and their needs than they readily verbalize.” (Burton 2016) While there is not extensive literature on applying feminist theory to young female healthcare there is a common theme amongst the literature of the importance of empowerment and validation of personal experience.

Burton C. W. (2016). The Health Needs of Young Women: Applying a Feminist Philosophical Lens to Nursing Science and Practice. ANS. Advances in nursing science, 39(2), 108–118. https://doi.org/10.1097/ANS.0000000000000119

Byrd, M. (2006). Social Exchange as a Framework for Client‐Nurse Interaction During Public Health Nursing Maternal‐Child Home Visits. Public Health Nursing, 23(3), 271-276.

McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing. Philadelphia: Wolters Kluwer. McEwen, M., & Wills, E. M. (2018). Theoretical basis for nursing. Philadelphia: Wolters Kluwer

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