Moral distress in public health practice: Case studies from nursing education.

Moral distress in critical care nursing has been well studied; however, there is a gap in the literature related to moral distress among nurses and nursing students practicing in the community. This paper describes moral distress experienced during participation in the Interprofessional Care Access Network, a community-based nurse-led education and practice program providing longitudinal care coordination for underserved individuals and families in rural communities and urban neighborhoods. Two case studies represent client situations resulting in moral distress for nursing faculty and students.

"Having a Normal Life": A Qualitative Study on Client Goal-Setting Within a Health Care and Social Needs Navigation Program.

Client goals within healthcare and social needs navigation programs are neither well understood nor incorporated into ambulatory care practices. This study provides a qualitative analysis of client-established goals within the Interprofessional Care Access Network (I-CAN), a community-based health care and social needs navigation program. One hundred eleven client goal lists were analyzed using conventional content analysis.

The Interprofessional Care Access Network (I-CAN): achieving client health outcomes by addressing social determinants in the community.

Four health professions schools at an academic health science university and a partner state university collaborated to develop the (I-CAN), a model of healthcare delivery and interprofessional education that addresses the Triple Aims for vulnerable populations in three underserved neighborhoods. Program goals were achieved through community-based partnerships and the development of a health-care workforce prepared for competent practice in emerging models of care. In the first three years, almost 600 nursing, medicine, dentistry, and pharmacy students worked with clients referred from community partners, providing interprofessional care coordination addressing life instability and social determinants of health.

Advancing Health Equity Through Student Empowerment and Professional Success: A Statewide Approach.

Background: A lack of diversity in the nursing workforce nationally has been identified by Oregon state leaders as a factor contributing to health inequity.

Method: The goal of Advancing Health Equity Through Student Empowerment and Professional Success (HealthE STEPS) is to graduate nursing students from disadvantaged backgrounds to improve health equity within their communities. A comprehensive plan of evidence-based strategies was developed based on social determinants of health and addresses academic socialization, learning support, financial resources, networking, curriculum development, and campus culture.

The Meanings African American Caregivers Ascribe to Dementia-Related Changes: The Paradox of Hanging on to Loss.

Purpose Of The Study: Using an interpretive phenomenological approach, this study explored the meaning African American (AA) caregivers ascribed to the dementia-related changes in their care-recipients.

Design And Methods: Data were gathered in this qualitative study with 22 in-depth interviews. Eleven AA caregivers for persons with dementia, living in the Pacific Northwestern United States, were interviewed twice.

An academic-practice model to improve the health of underserved neighborhoods.

The Interprofessional Care Access Network is an innovative model for academic-practice partnership providing care coordination for vulnerable and underserved clients and populations in identified neighborhoods. Interprofessional student teams, including health professions students from nursing, medicine, pharmacy, and dentistry, collaborate with community service organizations and primary care clinics to address social determinants of health identified as barriers to achieving health care outcomes and Triple Aim goals. Teams are supervised by a nursing faculty in residence and address issues such as housing, health insurance, food security, and lack of primary care.

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.

Creating and sustaining a diverse student community in a school of nursing.

In response to national and state mandates to increase diversity in the nursing workforce, a small, liberal arts college in Oregon implemented a comprehensive program to recruit and retain students underrepresented in nursing, especially Hispanics. The goals of Ayudando Podemos were to increase enrollment of underrepresented and disadvantaged students, improve student retention and graduation rates, increase student participation in a mentorship program, improve cultural competence in the campus community, and increase the number of graduates working in medically underserved or health professional shortage areas (HPSAs). The program had four parts: institutional catalysts and commitment, relationship building and student connection, individualized academic coaching, and financial aid and scholarship coaching.

Comparing learning outcomes of international and local community partnerships for undergraduate nursing students.

International health care experiences offer undergraduate nursing students the opportunity for significant personal and professional growth. During a month-long travel course to Cameroon, West Africa, students improved their skills in clinical assessment, data management, intercultural communication, and collaboration based on an empowerment model of international partnership. Although it is not possible for all students to participate in providing health care in another country, it is possible to design a local course in which students are able to meet similar outcomes in a community health experience in partnership with an immigrant and refugee center.

Giving voice: incorporating the wisdom of Hispanic RNs into practice.

This study used Heideggerian phenomenology to: 1) explore professional practice values and ethical concerns of Hispanic nurses practicing in the Pacific Northwest; and 2) describe values conflicts experienced by Hispanic nurses in clinical practice. Twenty-seven Hispanic nurses were interviewed about nursing practice experiences. Themes included: obligation to serve the Hispanic community; correct cultural mistakes; teach about racism and discrimination; protect professional relationships; act as interpreter and cultural broker; balance additional workload; and represent all Hispanic nurses.

Concept mapping: a nursing model for care planning.

Concept mapping has many applications and has been used as an effective teaching strategy in nursing and other disciplines to evaluate both content knowledge and student thinking patterns. Previous applications related to nursing care planning usually organize client information around a medical diagnosis. The approach described is focused around the reason for nursing care and a holistic nursing view of the client, rather than a disease model.

Ethical concerns: comparison of values from two cultures.

The present study was a secondary analysis of data from two phenomenological studies of nurses in the USA and Japan. The study incorporated hermeneutics and feminist methodologies to answer the following questions. Are there common values and ethical concerns and values within the nursing cultures of Japan and the USA? What are some commonalities and differences between Japanese nurses' ethical concerns and those of American nurses? Findings indicated that nurses from the USA and Japan share common values and ethical concerns as professional nurses, including competence, respect for the patient as a person, responsibility, relationship and connection, importance of the family, caring, good death, comfort, truth-telling, understanding the patient/situation, and anticipatory care.