Encyclopedia of Nursing Research

E N C Y C L O P E D I A O F Kazer

NURSING RESEARCH Fitzpatrick





T H I R D E D I T I O N E N C Y C L O P E D I A O F

Joyce J. Fitzpatrick,
PhD, MBA, RN, FAAN, FNAP
Meredith Wallace Kazer, NURSING
PhD, APRN, CNL, A/GNP-BC, FAAN E

Editors N
RESEARCH

Second Edition named a “Choice Outstanding Academic Title” C
award for 2007 and an “ANJ Book of the Year” Y



C
he award-winning Encyclopedia of Nursing Research, now in its third edition, is the L
Tcomprehensive resource for tracking developments in the fi eld. With over 20 new O T H I R D E D I T I O N
areas of research, and meticulous updates of existing entries, the encyclopedia presents NURSING RESEARCH
key terms and concepts and their application to practice. Pithy entries provide the most P
relevant and current research perspectives, and will be a starting point for future content
and references. Nurse researchers, educators, students—and those in all clinical special- E
ties—will fi nd the encyclopedia an important introduction to the breadth of nursing D
research today and to come. I

New topics include NIH-funded research areas, a comprehensive survey of major nursing A
research journals, addictions care, palliative care, translational science, simulation, trau-
ma care, family-centered care, mild cognitive impairment, active surveillance for cancer
care, workplace and empowerment research, nurse engagement, nurse-physician col- O
laboration, CAM and empowerment research, spirituality, synthesis and action research, Editors
mixed-methods research, systematic review, ethnopharmacology, and more. F
Key Features:

• Includes NIH-funded research topics Joyce J. Fitzpatrick
• Provides a comprehensive survey of major nursing research journals
• Adds over 20 new areas of research and updates existing entries THIRD
• Contributions from over 200 nursing research experts EDITION Meredith Wallace Kazer
• Organized alphabetically for easy access to information

ISBN 978-0-8261-0750-3






11 W. 42nd Street
New York, NY 10036-8002 9 780826 107503
www.springerpub.com

Encyclopedia of

Nursing Research




Third Edition

Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, FNAP, is the Elizabeth Brooks
Ford Professor of Nursing at the Frances Payne Bolton School of Nursing,
Case Western Reserve University (CWRU) in Cleveland, Ohio, where she
was the dean from 1982 through 1997. She holds an adjunct position as a
professor in the Department of Geriatrics, Mount Sinai School of Medicine,
New York, New York. She earned a BSN at Georgetown University, an MS
in Psychiatric-Mental Health Nursing at Ohio State University, a PhD in
Nursing at New York University, and an MBA from CWRU in 1992. In May
1990, Dr. Fitzpatrick received an honorary doctorate, Doctor of Humane
Letters, from her alma mater, Georgetown University. She has received
numerous honors and awards; she was elected a fellow in the American
Academy of Nursing in 1981 and a fellow in the National Academies of
Practice in 1996. She has received an American Journal of Nursing Book of
the Year Award 18 times. In 2002, Dr. Fitzpatrick received the American
Nurses Foundation Distinguished Contribution to Nursing Science Award for her sustained commitment and
contributions to the development of the discipline. She received the STTI Lucie Kelly Mentor Award in 2003
and the STTI Founders Award for Leadership in 2005. For 2007 to 2008, she served as a Fulbright Scholar at
University College Cork, Cork, Ireland.
Dr. Fitzpatrick is widely published in nursing and health care literature having more than 300 publica-
tions. She served as coeditor of the Annual Review of Nursing Research series, volumes 1 through 26; she currently
edits the journals Applied Nursing Research, Archives in Psychiatric Nursing, and Nursing Education Perspectives, the
official journal of the National League for Nursing. Dr. Fitzpatrick edited two editions of the classic Encyclopedia
of Nursing Research and a series of nursing research digests. In 2008, she edited The Doctor of Nursing Practice
and Clinical Nurse Leader, published by Springer Publishing. Her recent books published by Springer Publishing
include Giving through Teaching: How Nurse Educators Are Changing the World, published in June 2010, and Problem
Solving for Better Health: A Global Perspective, published in October 2010.
Dr. Fitzpatrick founded and led the Bolton School’s World Health Organization Collaborating Center for
Nursing; she has provided consultation on nursing education and research throughout the world, including
universities and health ministries in Africa, Asia, Australia, Europe, Latin America, and the Middle East. She
served as a project director for a Nursing Care Quality Initiative, a multisystem, 10-hospital project focused on
improving the care for hospitalized elders and their families funded by the New York Health Alliance and the
Brookdale Foundation. In summer 2008, she was appointed the first Spratt Center for Nursing Education and
Research Visiting Scholar at Danbury Hospital in Connecticut. She has served as the chair of the Global Advisory
Committee for the Center for Nursing Research and Education at the Mount Sinai School of Medicine.




Meredith Wallace Kazer, PhD, APRN, CNL, A/GNP-BC, FAAN, com-
pleted her BSN degree magna cum laude at Boston University in 1988. She
earned an MSN in medical-surgical nursing with a specialty in geriat-
rics at Yale University and a PhD in nursing research and theory devel-
opment at New York University. While at New York University, she was
awarded a predoctoral fellowship at the Hartford Institute for Geriatric
Nursing. In this capacity, she became the original author and editor of Try
This: Best Practices in Geriatric Nursing series. In 2001, she won the Springer
Publishing Company Award for Applied Nursing Research. She was the
managing editor of the Journal of Applied Nursing Research and is currently
the research brief editor for the journal.
Dr. Kazer is the author of numerous journal articles and book chap-
ters. She published Prostate Cancer: Nursing Assessment Management and
Care in April 2002, which won an American Journal of Nursing Book of the
Year Award. Preceding this, she was the associate editor of The Geriatric Nursing Research Digest in 2002 and the
associate editor of the second edition of the Encyclopedia of Nursing Research published in 2006, both of which also
won the American Journal of Nursing Book of the Year Awards. She is a recent recipient of the Eastern Nursing
Research Society/John A. Hartford Foundation junior investigator award. She is an adult nurse practitioner and
currently maintains a practice in primary care with a focus on chronic illness in the elderly. She is currently an
associate professor at Fairfield University School of Nursing, Fairfield, Connecticut and was recently inducted
into the American Academy of Nursing.

Encyclopedia of


Nursing Research



Third Edition






Editors


Joyce J. Fitzpatrick, PhD, MBA, RN,
FAAN, FNAP


Meredith Wallace Kazer, PhD, APRN,

CNL, A/GNP-BC, FAAN

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Contents











Preface vii

Contributors ix

List of Entries xxvii

Entries A–Z 1–556

References 557

Index 679

Preface










This third edition of the Encyclopedia of content and references and a timely source
Nursing Research (ENR) is a comprehensive, of the most relevant and recent research. The
authoritative, yet concise guide to current alphabetical ordering of entries is provided
nursing research literature. The first edition to assist the reader in easily locating a topic.
of ENR grew out of the commitment of Dr. Every effort has been made to be inclusive of
Ursula Springer to nursing research and my all relevant terms in nursing research, which
commitment to nurse scholars globally. were selected on the basis of the review of
The first edition of ENR followed 15 previous editions and the extant nursing
volumes of the Annual Review of Nursing research literature.
Research (ARNR) journal. The second edition This work would not have been possible
was published incorporating terms from the without the dedication of a number of indi-
first 22 volumes of ARNR. This third edition viduals. First, we would like to acknowl-
of ENR not only incorporates topics from edge the nurse researchers whose scientific
the first two editions but also adds content work and resultant publications led to the
through the 30 volumes of ARNR that have inception of an encyclopedia. Second, we
been published to date. In preparing and in thank all of the contributors from the three
organizing the content we were cognizant editions for their careful review of the liter-
of the current depth of nursing research in ature and their synopses of the research. We
some areas, for example, geriatric nursing, also thank the staff of Springer Publishing
in which there has been a major investment Company, led by our publisher, Allan
of resources and thus substantive science Graubard, for their thoughtful review and
development. editing of this volume. Collectively, we have
Nurses at all levels of preparation and all contributed to another important work,
in all clinical specialties will find this an one that we should proudly exclaim as the
important introduction to the extent of nurs- culmination of more than four decades of
ing research. Previous editions have been nursing research.
most helpful to basic and graduate students.
The summary entries provide the reader Joyce J. Fitzpatrick
with an important starting point for future Editor

This page intentionally left blank

Contributors










Lauren S. Aaronson, PhD, RN, FAAN Cecilia D. Alvarez, DNP, RN
Professor, University of Kansas School of Nurse Manager, Coronary Care Unit, Central
Nursing, Deputy Director, Heartland Institute Telemetry, and Rapid Response Team,
for Clinical and Translational Research, Hackensack University Medical Center,
University of Kansas Medical Center, Hackensack, New Jersey, Assistant Professor,
Kansas City, Kansas Fairleigh Dickinson University, Teaneck,
Data Analysis, Fatigue, Grantsmanship, New Jersey
Sampling Patient Satisfaction
Faye G. Abdellah, EdD, ScD, RN, FAAN Gene Cranston Anderson, PhD, RN, FAAN
Professor Emeritus, Graduate School of Nursing, Edward J. and Louise Mellen Professor Emerita
Uniformed Services University of the Health of Nursing, Frances Payne Bolton School of
Sciences, Bethesda, Maryland Nursing, Case Western Reserve University,
History of Nursing Research Cleveland, Ohio, Professor Emeritus and
Courtesy Faculty, College of Nursing,
Ivo Abraham, PhD, RN University of Florida, Gainesville, Florida
Professor and Director, Center for Health Kangaroo Care (Skin-to-Skin Contact)
Outcomes and Practice Effectiveness, College
of Pharmacy, University of Arizona, Tucson, Ida Androwich, PhD, RNC, FAAN
Arizona, Chief Scientist, Matrix45, Earlysville, Professor, School of Nursing, Loyola University
Virginia Medical, Center Maywood, Illinois
Applied Research, Comparative Effectiveness Nursing Information Systems
Research, Experimental Research,
Quasi-Experimental Research Karen J. Aroian, PhD, CNAA-BC
Katharine Faville Professor of Nursing Research,
Raeda Fawzi AbuAlRub, RN, PhD College of Nursing, Wayne State University,
Associate Professor, Vice Dean, Faculty of Detroit, Michigan
Nursing, College of Nursing, Jordan Immigrant Women
University of Science and Technology,
Irbid, Jordan Carol A. Ashton, PhD, RN
Social Support Director of Nursing, Research LDS, Cottonwood,
and Alta View Hospitals, Salt Lake City, Utah
Ivy M. Alexander, PhD, APRN, Research Utilization
ANP-BC, FAAN
Professor and Director, Adult, Family, Joan K. Austin, PhD, RN, FAAN
Gerontological, and Women’s Health and Distinguished Professor Emerita, School of
Primary Care Specialty, School of Nursing, Nursing, Indiana University, Indianapolis,
Yale University, New Haven, Connecticut Indiana
Women’s Health Epilepsy

x n CONTRIBUTORS



Kay C. Avant, PhD, RN, FAAN Cheryl Tatano Beck, DNSc, CNM, FAAN
Professor/Roger L. and Laura D. Zeller Professor, University of Connecticut School of
Charitable Foundation Professorship, School Nursing, Storrs, Connecticut
of Nursing, University of Texas Health Science Meta-Analysis, Phenomenology, Replication
Center, San Antonio, Texas Studies
Concept Analysis
Abir K. Bekhet, PhD, RN, HSMI
Cynthia G. Ayres, PhD, RN Assistant Professor, College of Nursing,
Assistant Professor, Rutgers College of Nursing, Marquette University, Milwaukee,
Rutgers, The State University of New Jersey, Wisconsin
Newark, New Jersey Depression in Older Adults
Clinical Preventive Services
Sandra C. Garmon Bibb, DNSc, RN
Terry A. Badger, PhD, PMHCNS-BC, RN, FAAN Associate Professor, Chair, Department of Health
Professor and Director, Community and Systems Systems, Risk, and Contingency Management,
Health Science Division, College of Nursing, Graduate School of Nursing, Uniformed
University of Arizona, Tucson, Arizona Services University of the Health Sciences,
Depression in Families Bethesda, Maryland
Leininger’s Theory of Culture Care Diversity
Marianne Baernholdt, PhD, MPH, RN and Universality, Population Health
Assistant Professor, Department of Public Health
Sciences, School of Nursing, University of Alyson Blanck, MSN, RN, NEA-BC
Virginia, Charlottesville, Virginia Director of Nursing Practice, Danbury Hospital,
Rural Health Danbury, Connecticut
Patient Education
Donald E. Bailey, PhD, RN
Associate Professor, Senior Fellow, Center for Meg Bourbonniere, PhD, RN
the Study of Aging and Human Development, Vice President for Nursing Research, Thomas
Claire M. Fagin Fellow, John A. Hartford Jefferson University Hospital, Philadelphia,
Foundation, School of Nursing, Duke Pennsylvania
University, Durham, North Carolina Physical Restraints
Active Surveillance for Prostate Cancer
Diane K. Boyle, PhD, RN
Carolyn Baird, DNP, MBA, RN-BC, University of Kansas, School of Nursing, Kansas
CARN-AP, ICCDPD City, Kansas
Adjunct Faculty, Waynesburg University, Job Satisfaction
McMurray, Pennsylvania
Addiction Care Geraldine A. Britton, PhD, RN
Assistant Research Professor, Decker School of
Tamilyn Bakas, PhD, RN, FAHA, FAAN Nursing, Binghamton University, Binghamton,
Professor, School of Nursing, Indiana University, New York
Indianapolis, Indiana Osteoporosis
Stroke
Dorothy Brooten, PhD, FAAN
Suzanne Bakken, RN, DNSc, FAAN, FACMI
Alumni Professor of Nursing and Professor of Professor, School of Nursing, Florida
Biomedical Informatics, Director, Center for International University, Miami, Florida
Evidence-based Practice in the Underserved, Clinical Trials
Director, Reducing Health Disparities through Helen Kogan Budzynski, PhD, FAAN
Informatics Pre- and Postdoctoral Training Faculty Emeritus, School of Nursing, University
Program, Columbia University, New York, of Washington, Seattle, Washington
New York Biofeedback
Active Surveillance for Prostate Cancer, Formal
Nursing Languages, SNOMED Clinical Terms

CONTRIBUTORS n xi



Christopher J. Burant, PhD, RN Inge B. Corless, RN, PHD, FAAN
Assistant Professor, Frances Payne Bolton School Amelia Peabody Professor of Nursing Research,
of Nursing, Case Western Reserve University, Institute of Health Professions, Massachusetts
Cleveland, Ohio General Hospital, Boston, Massachusetts
Factor Analysis Hospice, Terminal Illness

Sara L. Campbell, PhD, RN, NEA-BC Sile A. Creedon
Professor, School of Nursing, Illinois State Catherine McAuley School of Nursing and
University, Normal, Illinois Midwifery, Brookfield Health Sciences
Feminist Research Methodology Complex, University College Cork, Cork,
Ireland
Suzanne Hetzel Campbell, PhD, Infection Control, Nosocomial Infections
WHNP-BC, IBCLC
Associate Dean for Academic Programs, Sabina De Geest, PhD, RN
Associate Professor and Graduate Program Professor and Director, Institute of Nursing
Director, Fairfield University School of Science, University of Basel, Basel,
Nursing, Project Director, Robin Kanarek Switzerland
Learning Resource Center, Fairfield, Applied Research
Connecticut
Breastfeeding, Simulation Alice S. Demi, PhD, RN, FAAN
Professor, Byrdine F. Lewis School of Nursing,
Jeeyae Choi, RN, DNSc Georgia State University, Atlanta, Georgia
Clinical Informatician, Spaulding Rehabilitation Delphi Technique
Hospital, Boston, Massachusetts
Formal Nursing Languages Mary Jo Devereaux
Hospital Librarian, Community Medical Center,
Sean P. Clarke, RN, PhD, FAAN Scranton, Pennsylvania
RBC Chair in Cardiovascular Nursing Research, Orem’s Self-Care Theory
Lawrence S. Bloomberg Faculty of Nursing,
University of Toronto, Peter Munk Cardiac Rose Ann DiMaria-Ghalili, PhD, RN
Centre, University Health Network, Toronto, Associate Professor, Doctoral Nursing
Ontario, Canada Department, John A. Hartford Foundation
Nurse Staffing, Organizational Culture, Claire M. Fagin Fellow, College of Nursing
Organizational Design and Health Professions, Drexel University,
Philadelphia, Pennsylvania
Amy Coenen, PhD, RN, FAAN Nutrition in the Elderly
International Council of Nurses, College of
Nursing, University of Wisconsin–Milwaukee, Kristy Dixon, MS, RN, NEA-BC
Milwaukee, Wisconsin Director of Patient Care–Critical Care,
International Classification for Nursing Practice Cardiology, Emergency, Trauma, Danbury
Hospital, Danbury, Connecticut
Marlene Zichi Cohen, PhD, RN, FAAN Advance Directives
Professor and Kenneth E. Morehead Endowed
Chair in Nursing, Associate Dean for Research, Moreen Donahue, DNP, RN, NEA-BC
College of Nursing, University of Nebraska Senior Vice President, Patient Care Services and
Medical Center, Omaha, Nebraska Chief Nurse Executive, Danbury Hospital,
Descriptive Research, Nursing Assessment Danbury, Connecticut
Clinical Judgment
Rosemary Collier, MSN, RN
PhD Student, Decker School of Nursing,
Binghamton University, Binghamton,
New York
Osteoporosis

xii n CONTRIBUTORS



Sue K. Donaldson, PhD, RN, FAAN Veronica F. Engle, PhD, FGSA, FAAN
Dean and Professor, School of Nursing, Johns Professor, College of Nursing and College of
Hopkins University, Baltimore, Maryland Medicine, University of Tennessee Health
Basic Research Science Center, Memphis, Tennessee
Newman’s Theory of Health
Dianna Hutto Douglas, DNS APRN-CNS
Professor, Health Science Center, School of Carol Diane Epstein, PhD, RN, FCCM
Nursing, Louisiana State University, Associate Professor, Director, Combined Degree
New Orleans, Louisiana Program, Pleasantville Lienhard School of
Empathy Nursing, Pace University, Pleasantville,
New York
Evelyn G. Duffy, DNP, G/ANP-BC, FAANP Critical Care Nursing Research
Assistant Professor, Director of the Adult-
Gerontological Nurse Practitioner Program, W. Scott Erdley, DNS, RN
Associate Director of the University Center Special Projects Simulation Educational
on Aging and Health, Frances Payne Bolton Specialist, Behling Simulation Center,
School of Nursing, Case Western Reserve University at Buffalo Academic
University, Cleveland, Ohio Health Sciences Center, Buffalo, New York
Osteoporosis Electronic Network
Jacqueline Dunbar-Jacob, PhD, RN, FAAN Lois K. Evans, PhD, RN, FAAN
Professor, Nursing, Psychology, Epidemiology, Van Ameringen Professor in Nursing Excellence,
and Occupational Therapy, Dean, School of School of Nursing, University of Pennsylvania,
Nursing, University of Pittsburgh, Pittsburgh, Philadelphia, Pennsylvania
Pennsylvania Physical Restraints
Adherence/Compliance, Behavioral Research
Deborah B. Fahs, MSN, APRN, CPNP
Patricia C. Dykes, RN, DNSc Lecturer, School of Nursing, Yale University,
Corporate Manager Nursing Informatics New Haven, Connecticut
and Research, Partners HealthCare, Wellesley, Eating Disorders
Massachusetts
Clinical Judgment, Nursing Information Systems Melissa Spezia Faulkner, DSN, RN, FAAN
Gladys E. Sorensen Endowed Professor,
Emerson E. Ea, DNP, APRN, BC, CEN Diabetes Research, College of Nursing,
Clinical Assistant Professor, College of University of Arizona, Tucson, Arizona
Nursing, New York University, New York, Diabetes Research
New York
Acculturation Jacqueline Fawcett, PhD, FAAN
Professor and Nursing Department Chairperson,
Shelly Eisbach, PhD, RN College of Nursing and Health Sciences,
Morton and Jane Blaustein Postdoctoral Fellow University of Massachusetts, Boston,
in Mental Health and Psychiatric Nursing, Massachusetts
School of Nursing, Johns Hopkins University, Johnson’s Behavioral System Model
Baltimore, Maryland
Mother–Infant/Toddler Relationships Suzanne Feetham, PhD, RN, FAAN
Visiting Professor, University of Wisconsin,
Marsha L. Ellett, PhD, RN Milwaukee, Wisconsin, Nursing Research
Professor, School of Nursing, Indiana University, Consultant, Children’s National Medical
Indianapolis, Indiana Center, Washington, DC
Enteral Tube Placement Family Health

CONTRIBUTORS n xiii



Kathleen Fentress, BS Sara T. Fry, PhD, RN, FAAN
Graduate Student, School of Nursing, Yale Henry R. Luce Professor of Nursing Ethics School
University, New Haven, Connecticut of Nursing, Boston College, Chestnut Hill,
Schizophrenia Massachusetts
Rights of Human Subjects
Donna M. Fick, PhD, GCNS-BC,
FGSA, FAAN Terry Fulmer, PhD, RN, FAAN
School of Nursing, Pennsylvania State University, The Erline Perkins McGriff Professor and Dean,
University Park, Pennsylvania College of Nursing, New York University,
Ageism New York, New York
Acute Care of the Elderly, Elder Mistreatment
Ellen Fineout-Overholt, PhD, RN,
FNAP, FAAN Carol D. Gaskamp, PhD, RN, CNE
Director, Center for Advancement of Evidence- Assistant Professor of Clinical Nursing, Division
based Practice, Arizona State University Chair, Family, Public Health Nursing, and
College of Nursing and Health Innovation, Nursing Administration Division, School of
Phoenix, Arizona Nursing, University of Texas at Austin,
Evidence-Based Practice Austin, Texas
Spirituality
Mary L. Fisher, PhD, RN, CNAA, BC
Associate Professor, School of Nursing, Indiana Marion Good, PhD, RN, FAAN
University, Indianapolis, Indiana Professor Emerita, Frances Payne Bolton School
Cost Analysis of Nursing Care of Nursing, Case Western Reserve University,
Cleveland, Ohio
Jane Flanagan, PhD, ANP-BC Music Therapy, Pain
Assistant Professor, William F. Connell School
of Nursing, Boston College, Chestnut Hill, Patricia A. Grady, PhD, RN, FAAN
Massachusetts, Nurse Scientist, Yvonne Director, National Institute of Nursing Research,
L. Munn Center for Nursing Research, National Institutes of Health, Bethesda,
Massachusetts General Hospital, Boston, Maryland
Massachusetts Acute Care of the Elderly, National Institute of
Functional Health Patterns, Nursing Practice Nursing Research
Models
Judith R. Graves, PhD, RN, FAAN
Marquis D. Foreman, PhD, RN, FAAN Professor, College of Nursing, University of Utah,
Professor Emeritus, College of Nursing, Salt Lake City, Utah
University of Chicago at Illinois, Chicago, Secondary Data Analysis
Illinois
Delirium Bobbe Ann Gray, PhD, RNC-OB, CNS-BC
Associate Professor, Director, Doctor of Nursing
Emily Fox-Hill, PhD, RN Practice Program, College of Nursing and
Assistant Professor, College of Nursing, Health, Wright State University, Dayton, Ohio
University of Tennessee Health Science Center, Childbirth Education
Memphis, Tennessee
Newman’s Theory of Health Mary T. Quinn Griffin, PhD, RN
Assistant Professor of Nursing, Frances Payne
Maureen A. Frey, PhD, RN Bolton School of Nursing, Case Western
Director of Research and Advanced Practice Reserve University, Cleveland, Ohio
Children’s Hospital of Michigan, Detroit, Health Conceptualization, Institutional
Michigan Review Board and Informed Consent, Parse’s
King’s Conceptual System and Theory of Humanbecoming School of Thought, Roy
Goal Attainment Adaptation Model

xiv n CONTRIBUTORS



Hurdis M. Griffith, PhD, RN, FAAN Laura L. Hayman, PhD, RN, FAAN
Professor and Dean Emeritus, College of Associate Dean for Research, Professor of
Nursing, Rutgers University, Newark, Nursing, College of Nursing and Health
New Jersey Sciences, University of Massachusetts Boston,
Current Procedural Terminology–Coded Services Director of Research, GoKids Boston, Boston,
Massachusetts
Deborah Gross, DNSc, RN, FAAN Cardiovascular Risk Factors: Cholesterol, Nutrition
Leonard and Helen Stulman Professor in in Infancy and Childhood
Mental Health and Psychiatric Nursing,
School of Nursing and School of Medicine, Josephine Hegarty, PhD, MSc, RNT, BSc, RGN
Department of Psychiatry and Behavioral Associate Professor, Director of Undergraduate
Sciences, Johns Hopkins University, Baltimore, Education, Catherine McAuley School of
Maryland Nursing and Midwifery, Brookfield Health
Mother–Infant/Toddler Relationships Sciences Complex, University College Cork,
Cork, Ireland
Sarah H. Gueldner Cochrane Review
Frances Payne Bolton School of Nursing, Case
Western Reserve University, Cleveland, Ohio Patricia A. Higgins, RN, PhD
Osteoporosis Associate Professor, Case Western Reserve
University, Researcher, Cleveland VAMC
Barbara J. Guthrie, PhD, RN, FAAN Geriatric Research Education and Clinical
Associate Professor, Associate Dean for Center, Cleveland, Ohio
Academic Affairs, School of Nursing, Yale Failure to Thrive (Adult)
University, New Haven, Connecticut
Eating Disorders Martha N. Hill, RN, PhD
Department of Health Systems and Outcomes,
Barbara K. Haight, RNC, DRPH, FAAN School of Nursing, Johns Hopkins University,
Professor Emeritus, College of Nursing, Medical Baltimore, Maryland
University of South Carolina, Charleston, Hypertension
South Carolina
Reminiscence Mary Angelique Hill, DNP, RN, CPN
Professor of Nursing, Florida Gateway College,
Lake City, Florida
Kimberly B. Hall, MSN, RN, NE-BC
Assistant Professor, Department of Nursing, Boykin and Schoenhofer: The Theory of
Jefferson College of Health Sciences, Roanoke, Nursing as Caring
Virginia Cheryl R. Dennison Himmelfarb, RN, ANP, PhD
Stress, Stress Management
Associate Professor, Department of Health
Systems and Outcomes, School of Nursing,
Edward J. Halloran, PhD, RN, FAAN Division of Health Sciences Informatics,
Associate Professor, School of Nursing, School of Medicine, Johns Hopkins University,
University of North Carolina–Chapel Hill, Baltimore, Maryland
Chapel Hill, North Carolina Hypertension
Henderson’s Model
Marilyn Hockenberry, PhD, RN-CS, PNP, FAAN
Emily J. Hauenstein, PhD, LCP, MSN, RN Professor of Pediatrics, Department of
Thomas A. Saunders III, Family Professor and Hematology-Oncology, Baylor College of
Director, Southeastern Rural Mental Health Medicine, Nurse Scientist, Director, Center for
Research Center, School of Nursing, University Nursing Research, Texas Children’s Hospital,
of Virginia, Charlottesville, Virginia Houston, Texas
Depression in Women Cancer in Children

CONTRIBUTORS n xv



Diane Holditch-Davis, PhD, RN, FAAN Kathleen Huttlinger, PhD
Marcus Hobbs Distinguished Professor of Professor, Associate Director for Graduate
Nursing, Associate Dean for Research Affairs, Programs, School of Nursing, College of
School of Nursing, Duke University, Durham, Health and Social Services, New Mexico State
North Carolina University, Las Cruces, New Mexico
Neurobehavioral Development, Parenting Research Content Analysis, Exploratory Studies,
in Nursing Participant Observation
Cheryl Holly, EdD, RN Gail L. Ingersoll, EdD, RN, FAAN
Associate Professor and Chair, Capacity Building Professor and Associate Dean for Research,
Systems, Director, DNP Program, Co-Director, University of Rochester School of Nursing
New Jersey Center for Evidence Based Practice, Rochester, New York
Joanna Briggs Institute Collaborating Center, Evaluation
School of Nursing, University of Medicine and
Dentistry of New Jersey, Newark, New Jersey Pamela M. Ironside, PhD, RN, FAAN, ANEF
Systematic Review Associate Professor, Director of the Center
for Research in Nursing Education, School of
Barbara J. Holtzclaw, PhD, RN, FAAN Nursing, Indiana University, Indianapolis,
Nurse Scientist, Professor, Associate Director, Indiana
Geriatric Nursing Translational Research Hermeneutics
Training, Donald W. Reynolds Center of
Geriatric Nursing Excellence, College of Sharol F. Jacobson, PhD, RN, FAAN
Nursing and Graduate College, University of Associate Dean for Research and Practice,
Oklahoma Health Sciences Center, Oklahoma Professor, University of Alabama School of
City, Oklahoma, Professor Emeritus, School of Nursing, Tuscaloosa, AL
Nursing, University of Texas Health Science Cultural/Transcultural Focus
Center at San Antonio, San Antonio Texas
Fever/Febrile Response, Shivering, Connie A. Jastremski, RN, MS, MBA, FCCM
Thermal Balance Chief Nursing Officer and VP Patient Care
Services, Bassett Healthcare, Cooperstown,
June Andrews Horowitz, RN, PhD, FAAN New York
Professor, William F. Connell School of Patient Care Delivery Models
Nursing, Boston College, Chestnut Hill,
Massachusetts Amy R. Johnson, MAT, MA, LLPC,
Postpartum Depression TLS, CPDT-KA
Special Projects Coordinator, School of Nursing,
Ann C. Hurley, RN, DNSc, FAANA Oakland University, Rochester, Michigan
Senior Nurse Scientist Emerita, Center for Pet Therapy
Nursing Excellence, Brigham and Women’s
Hospital, Boston, Massachusetts Kathy A. Johnson, RN, MSN, PhD Student
Mental Status Measurement: Mini-Mental School of Nursing, University of Wisconsin,
State Examination Madison, Wisconsin
Widows and Widowers
Sally A. Hutchinson, PhD, RN, FAAN
Professor, University of Florida College of Joyce Johnston MBA, RN
Nursing Jacksonville, Florida Practice Manager, Hospitalist Department,
Grounded Theory, Research Interviews Carilion Clinic, Roanoke, Virginia
(Qualitative) Wellness

xvi n CONTRIBUTORS



Dorothy A. Jones, EdD, RN, FAAN Mary E. Kerr, PhD, RN
Professor, William F. Connell School of Nursing, Deputy Director, National Institute of Nursing
Boston College, Chestnut Hill, Massachusetts, Research, National Institutes of Health,
Director, Yvonne L. Munn Center for Nursing Bethesda Maryland
Research, Massachusetts General Hospital, Cerebral Ischemia
Boston, Massachusetts
Functional Health Patterns, Nursing Practice Shaké Ketefian, EdD, RN, FAAN
Models Professor Emerita, Office of International Affairs,
School of Nursing, University of Michigan,
Jeffrey Schwab Jones, DNP, PMHCNS-BC, LNC Ann Arbor, Michigan
Board Certified-Psychiatric Clinical Nurse Research in Nursing Ethics
Specialist, Legal Nurse Consultant, Pinnacle Hesook Suzie Kim, RN, PhD
Mental Health Associates, Inc, Mansfield, Ohio Professor Emerita, College of Nursing, University
Interpersonal Communication: Nurse–Patient
of Rhode Island, Kingston, Rhode Island
Josette Jones, RN, PhD Action Science, Discourse Analysis, Narrative
Assistant Professor, School of Informatics–School Analysis
of Nursing, Indiana University, Indianapolis, Tae Youn Kim, PhD, RN
Indiana Assistant Professor, College of Nursing,
Telehealth, Telenursing/Telepractice, Telepresence University of Wisconsin–Milwaukee,
Milwaukee, Wisconsin
Alyson Karakouzian, BSNc International Classification for Nursing Practice
Student, College of Nursing and Health Sciences,
University of Massachusetts Boston, Boston, Kenn M. Kirksey, RN, MSN, PhD, ACNS-BC
Massachusetts Director, The Center for Nursing Research,
Nutrition in Infancy and Childhood SETON Family of Hospitals, Austin, Texas
HIV Symptom Management and Quality of Life
Maureen Keckeisen, RN, MN, CCRN
Clinical Nurse Specialist, Liver Transplant/ Chiemi Kochinda, PhD, RN
Surgical Specialties ICU, University of Assistant Professor, School of Nursing,
Los Angeles Health System, Los Angeles, University of Kansas, Kansas City, Kansas
California Instrument Translation
Hemodynamic Monitoring
Katharine Kolcaba, RN, PhD
Lisa Skemp Kelley Associate Professor (Emeritus), The University of
Associate Professor, College of Nursing, Akron, Akron, Ohio, Owner/Consultant, The
University of Iowa, Iowa City, Iowa Comfort Line, Chagrin Falls, Ohio
Qualitative Research
Comfort Theory
Susan J. Kelley, PhD Heidi V. Krowchuk, RN, PhD, FAAN
Dean and Professor, College of Health and Associate Professor, School of Nursing, The
Human Sciences, Georgia State University, University of North Carolina at Greensboro,
Atlanta, Georgia Greensboro, North Carolina
Grandparents Raising Grandchildren
Child–Lead Exposure Effects, Failure to
Alice Kempe, PhD, CS Thrive (Child)
Associate Professor, Ursuline College, Pepper Marjorie Thomas Lawson, PhD, APRN, BC, FNP
Pike, Ohio Associate Professor and Graduate Coordinator,
Family Caregiving and the Seriously Mentally Ill
Maine College of Nursing and Health
Vicki Keough, PhD, RN, ACNP Professions, University of Southern, Portland,
Dean, School of Nursing, Loyola University Maine
Chicago, Chicago, Illinois Interpersonal Communication: Nurse–Patient
Emergency Nursing

CONTRIBUTORS n xvii



Mark Lazenby, PhD, RN Patricia Liehr, PhD, RN
Lecturer, School of Nursing, Yale University, Christine F. Lynn College of Nursing, Florida
New Haven, Connecticut Atlantic University, Boca Raton, Florida
Chronic Illness Middle-Range Theories, Story Theory
Regina Placzek Lederman, RN, BSN, Deborah F. Lindell, ND, APRN, BC
MNEd, MA, PhD Assistant Professor of Nursing, Case Western
Professor, Division of Sociomedical Sciences, Reserve University, Frances Payne Bolton,
Department of Preventive Medicine and School of Nursing, Cleveland, Ohio
Community Health, University of Texas at Grounded Theory
Galveston, School of Nursing, Galveston, Texas
Maternal Anxiety and Psychosocial Adaptation Adrianne D. Linton, PhD, RN, FAAN
During Normal and High-Risk Pregnancy Chair and Professor, Department of Family
and Community Health Systems, School of
Yi-Hui Lee, PhD, RN Nursing, University of Texas Health Science
Assistant Professor, College of Nursing and Center at San Antonio, San Antonio, Texas
Health, Wright State University, Dayton, Ohio Wandering
Depression and Cardiovascular Diseases,
HIV Risk Behavior Terri H. Lipman, PhD, CRNP, FAAN
Miriam Stirl Endowed Term Professor of
Elizabeth R. Lenz, PhD, RN, FAAN Nutrition, Professor of Nursing of Children,
Dean and Professor, College of Nursing, Ohio School of Nursing, University of Pennsylvania,
State University, Columbus, Ohio Philadelphia, Pennsylvania
Doctoral Education Clinical Decision Making
Eugene Levine, PhD Jane Lipscomb, PhD, RN, FAAN
Professor Emeritus Uniformed Services, Professor and Director, Work and Health
Graduate School of Nursing, University of the Research Center, School of Nursing, University
Health Sciences, Bethesda, Maryland of Maryland, Baltimore, Maryland
Quantitative Research Workplace Violence
Wendy Lewandowski, PhD, PMHCNS-BC Robert Lucero, PhD, MPH, RN
Associate Professor, Director, PMHN Graduate Assistant Professor of Nursing, Center for Health
Program, College of Nursing, Kent State Policy, School of Nursing, Columbia University,
University, Kent, Ohio New York, New York
Community Mental Health Patient Safety
Irene Daniels Lewis, DNS, APN, FAAN Stacie Salsbury Lyons, PhD, RN
Professor, College of Applied Sciences and Arts, Palmer Center for Chiropractic Research,
San Jose State University, School of Nursing, Davenport, Iowa
San Jose, California Ethnography
Ethnogeriatrics
Karen MacDonald, PhD, RN
Judith A. Lewis, PhD, RN, WHNP-BC, FAAN Chief Executive, Matrix45, Earlysville, Virginia
Professor Emerita, School of Nursing, Virginia Applied Research, Experimental Research,
Commonwealth University, Richmond, Quasi-Experimental Research
Virginia
Genetics Ellen K. Mahoney, RN, DNS, FGSA
Associate Professor and Department Chair,
Suling Li, PhD, RN William F. Connell School of Nursing, Boston
Director, Institute for Emergency Nursing College, Chestnut Hill, Massachusetts
Research, Emergency Nurses Association, Burr Mental Status Measurement: Mini-Mental
Ride, Illinois State Examination
Emergency Nursing

xviii n CONTRIBUTORS



Judith A. Maloni, PhD, RN Geraldine McCarthy, PhD, MSN, MEd,
Professor, Frances Payne Bolton School of DNS, RGN, RNT
Nursing, Case Western Reserve University, Dean and Professor, Catherine McCauley School
Cleveland, Ohio of Nursing and Midwifery, University College
Prevention of Preterm Birth, Preterm Labor, Cork, Cork, Ireland
and Low Birth Weight Mild Cognitive Impairment
Linda Manfrin-Ledet, DNS, APRN, BC Ruth McCorkle, PhD, FAAN
Associate Professor of Nursing, Nicholls State Florence Wald Prof Nursing and Epidemiology
University, Thibodaux, Louisiana and Public Health, School of Nursing, Yale
Violence University, New Haven, Connecticut
Chronic Illness
Marie Manthey, MNA, (h) PhD
President Emeritus, Creative Healthcare Susan H. McCrone, PhD, RN, PMHCHS-BC
Management, Minneapolis, Minnesota Professor and Chair, Health Promotion/Risk
Primary Nursing Reduction Department, School of Nursing,
West Virginia University, Morgantown,
Patricia A. Martin, PhD, RN West Virginia
Dean and Professor, College of Nursing and Coronary Artery Bypass Graft Surgery
Health, Wright State University,
Dayton, Ohio Graham J. McDougall Jr., RN, PhD,
Research Dissemination FAAN, FGSA
Professor, School of Nursing, University of Texas
Marianne Matzo, PhD, GNP-BC, at Austin, Austin, Texas
FPCN, FAAN Alzheimer’s Disease
Professor and Frances E. and A. Earl Ziegler
Chair in Palliative Care Nursing, Sooner Gayle McGlory, PhD, RN-BC
Palliative Care Institute: Dedicated to Clinical Nursing Educator II, Medical Surgical
Excellence in Palliative Care Education, and Critical Care Services, Harris County
Research, and Practice, Adjunct Professor, Hospital District, Lyndon B. Johnson General
Department of Geriatric Medicine, College of Hospital, Houston, Texas
Nursing, University of Oklahoma, Oklahoma HIV Symptom Management and Quality of Life
City, Oklahoma Gretchen A. McNally, PhD, ANP-BC
Palliative Care Nurse Practitioner–Hematology, Dr. John Byrd
and Dr. Joseph Flynn, Arthur G. James Cancer
Linda J. Mayberry, RN, PhD, FAAN Hospital, Ohio State University, Columbus, Ohio
Associate Adjunct Professor, New York Smoking Cessation
University, New York City, New York
Postpartum Depression Mary J. McNamee, PhD, RN
Director, Office of Student Equity and
Angela Barron McBride, PhD, RN, FAAN Multicultural Affairs, Assistant Vice
Distinguished Professor and University Dean Chancellor for Academic Affairs, University of
Emerita, School of Nursing, Indiana University, Nebraska Medical Center, Omaha, Nebraska
Indianapolis, Indiana Homeless Health
Women’s Health
Barbara Medoff-Cooper, PhD, RN, FAAN
Melen R. McBride, PhD, RN, FGSA Ruth M. Colket Professor of Pediatric Nursing,
Associate Director, Stanford Geriatric Education Director, Biobehavioral Research Center,
Center, School of Nursing, Stanford University, School of Nursing, University of Pennsylvania,
Manhattan Beach, California Philadelphia, Pennsylvania
Ethnogeriatrics Neurobehavioral Development

CONTRIBUTORS n xix



Paula M. Meek, PhD, RN, FAAN Raquel M. Meyer, PhD, RN
Professor, Senior Scholar, Division Chair Adult Assistant Professor (CLTA), Lawrence S.
and Senior Health, Health Science Center, Bloomberg, Faculty of Nursing, University of
College of Nursing, University of Colorado Toronto, Toronto, Ontario, Canada
Denver, Aurora, Colorado Nurse Staffing, Organizational Culture,
Instrumentation, Reliability, Validity Organizational Design
Janet C. Meininger, PhD, FAAN Margaret Shandor Miles, PhD, RN, FAAN
Lee and Joseph D. Jamail Distinguished Professor, School of Nursing, University of North
Professor, School of Nursing, Professor, School Carolina, Chapel Hill, North Carolina
of Public Health, University of Texas Health Parenting Research in Nursing
Science Center at Houston, Houston, Texas
Observational Research Design Nancy Houston Miller, RN, BSN
Associate Director, Stanford Cardiac
Afaf Ibrahim Meleis Rehabilitation Program, Palo Alto, California
Margaret Bon Simon Dean of Nursing, School Smoking/Tobacco as a Cardiovascular Risk Factor
of Nursing, University of Pennsylvania,
Philadelphia, Pennsylvania Peggy A. Miller, RN, PhD
Immigrant Women, International Nursing Research Assistant Professor, University of
Research, Transitions and Health Kansas Medical Center, Kansas City, Kansas
Job Satisfaction
Bernadette Melnyk, PhD, RN, CPNP/PMHNP,
FNAP, FAAN Susan M. Miovech, PhD, RNC-OB
Dean and Distinguished Foundation Professor Associate Professor (Retired), Holy Family
in Nursing, College of Nursing and Health University, Philadelphia, Pennsylvania
Innovation, Arizona State University, Phoenix, Fetal Monitoring
Arizona
Evidence-Based Practice Merle H. Mishel, PhD, FAAN
Kenan Professor of Nursing and Director,
Victoria Menzies, PhD, RN Doctoral and Postdoctoral Programs, School of
Center for the Study of Complementary and Nursing, University of North Carolina, Chapel
Alternative Therapies, School of Nursing, Hill, North Carolina
University of Virginia, Charlottesville, Virginia Uncertainty in Illness
Complementary and Alternative Practices and
Products Ethel L. Mitty, EdD, RN
Adjunct Clinical Professor of Nursing, College
Martha G. Meraviglia RN, CNS, PhD of Nursing, New York University, New York,
Associate Professor of Clinical Nursing, School of New York
Nursing, University of Texas at Austin, Austin, End-of-Life Planning and Choices, Unlicensed
Texas Assistive Personnel
Spirituality
Mary Moller, DNP, ARNP, APRN,
DeAnne K. Hilfinger Messias, PhD, RN, FAAN PMHCNS-BC, CPRP, FAAN
College of Nursing and Women’s and Gender Associate Professor, Specialty Director–
Studies, School of Nursing, University of South Psychiatric Mental Health Nursing, School
Carolina, Columbia, South Carolina of Nursing, Yale University, New Haven,
Immigrant Women Connecticut
Schizophrenia
Bonnie L. Metzger, PhD, RN, FAAN
Professor Emerita, School of Nursing, University
of Michigan, Ann Arbor, Michigan
Time Series Analysis

xx n CONTRIBUTORS



Kristen S. Montgomery, PhD, RN Alvita Nathaniel, PhD, FNP-BC, FAANP
Assistant Professor, University of North Carolina Associate Professor, Coordinator Family Nurse
at Charlotte, Charlotte, North Carolina Practitioner Track, School of Nursing, West
Fitzpatrick’s Rhythm Model, Pregnancy, Watson’s Virginia University, Charleston, West Virginia
Theory of Human Caring Moral Distress, Moral Reckoning

Shirley M. Moore, PhD, RN, FAAN Mary D. Naylor, PhD, RN, FAAN
Professor and Associate Dean for Research, Director, New Courtland Center for Transitions
Frances Payne Bolton School of Nursing, Case and Health, School of Nursing, University of
Western Reserve University, Cleveland, Ohio Pennsylvania, Philadelphia, Pennsylvania
Theoretical Framework Transitional Care

Sue Moorhead, PhD, RN Leslie Neal-Boylan, PhD, CRRN,
Associate Professor and Director for the Center APRN-BC, FNP
for Nursing Classification and Clinical Professor, Graduate Program Director, School
Effectiveness, College of Nursing, The of Nursing, Southern Connecticut State
University of Iowa, Iowa City, Iowa University, New Haven, Connecticut
Nursing Diagnoses, Interventions, and Home Health Systems
Outcomes: NANDA-I, Nursing Interventions
Classification, and Nursing Outcomes M. Janice Nelson, PhD, RN
Classification Retired Dean and Professor Emeritus, Upstate
Medical University, College of Nursing,
Diana Lynn Morris, PhD, RN, FAAN Syracuse, New York
Associate Professor Case Western Reserve, Patient Care Delivery Models
School of Nursing, University Frances Payne
Bolton, Cleveland, Ohio Kathleen M. Nokes, PhD, RN, FAAN
Watson’s Theory of Human Caring Professor and Director of the Graduate Nursing
Program, Hunter-Bellevue School of Nursing,
Barbara Munro, PhD, RN, FAAN Hunter College, City University of New York,
Professor, School of Nursing, Boston College, Stone Ridge, New York
Chestnut Hill, Massachusetts HIV/AIDS Care and Treatment
Data Management, Statistical Techniques
Jeanne Marie Novotny, PhD, RN, FAAN
Carol M. Musil, PhD, RN Dean and Professor, School of Nursing, Fairfield
Professor Case Western Reserve, School of University, Fairfield, Connecticut
Nursing, University Frances Payne Bolton, Nursing Education
Cleveland, Ohio
Cohort Design, Pilot Study Adey Nyamathi, ANP, PhD, FAAN
Professor and Associate Dean for International
Madeline A. Naegle, APRN, BC, PhD, FAAN Research and Scholarly Activities, Acting
Professor and Coordinator, Advanced Practice Associate Dean for Research, Audrienne H.
Nursing: Psychiatric-mental Health, Director, Moseley Endowed Chair in Community Health
College of Nursing, New York University, Research, Director of the NINR-funded Ruth,
International Programs Director, WHO School of Nursing, University of California,
Collaborating Center for Geriatric Nursing Los Angeles, California
Education, New York University, New York Health Disparities: Theoretical and
City, New York Methodological Approaches
Substance Use Disorders in Registered Nurses

CONTRIBUTORS n xxi



Cassandra Okechukwu, ScD, MSN Sue A. Popkess-Vawter, PhD, RN
Assistant Professor of Society, Human Professor, University of Kansas, School of
Development and Health, Harvard School of Nursing, Kansas City, Kansas
Public Health, Boston, Massachusetts Weight Management
Workplace Violence
Demetrius J. Porche, DNS, PhD,
Patti Hart O’Regan, DNP, ARNP, ANP-C, APRN-FNP, FAANP, FAAN
PMHNP-BC, LMHC Dean and Professor, Health Sciences Center,
Board Certified Nurse Practitioner, Adult School of Nursing, Louisiana State University,
Primary Care and Psychiatry, President and New Orleans, Louisiana
CEO, Village Health LLC, Port Richey, Florida Violence
Quality of Care
Eileen J. Porter, PhD, RN, FGSA
Beth Palmer, DNP, ACNS-BC, ANP-BC Professor, School of Nursing, University of
Nurse Practitioner, VA San Diego Healthcare Wisconsin–Madison, Madison, Wisconsin
System, San Diego, California Widows and Widowers
Nurse Engagement
Diane Shea Pravikoff, RN, PhD, FAAN
Sarah Pernikoff, BA Director of Research/Professional Liaison,
Undergraduate Nursing Student, College of CINAHL Information Systems, Glendale,
Nursing, New York University, New York, California
®
New York CINAHL Database
Acute Care of the Elderly, Elder Mistreatment
Tara C. Prescott, DNP, RN
John Phillips, PhD, RN Quality Division, Exeter Hospital, Exeter,
Professor Emeritus, School of Education, New New Hampshire
York University, New York, New York Nurse and Physician Interdisciplinary
Rogers’ Science of Unitary Persons Collaboration
Linda R. Phillips, PhD, RN, FAAN Jana L. Pressler, PhD, RN
Professor and Audrienne H. Moseley Endowed Professor and PhD Program Director and DNP
Chair in Nursing, University of California, Los Project Director, University of Oklahoma
Angeles, California Health Sciences Center, Oklahoma City,
Clinical Nursing Research Oklahoma
Fitzpatrick’s Rhythm Model
Sally Phillips RN, PhD
Director Public Health Emergency Preparedness Pamela G. Reed, PhD, RN, FAAN
Program, Agency for Health Care Research Professor, College of Nursing, University of
and Quality, Rockville, Maryland Arizona, Tucson, Arizona
Caring, Nursing Process Peplau’s Theoretical Model
Ubolrat Piamjariyakul, PhD, RN K. M. Reeder, PhD, RN
Research Associate Professor, School of Nursing, Senior Research Associate, School of Nursing,
University of Kansas, Kansas City, Kansas University of Kansas, Kansas City, Kansas
Caregiver, Nurse-Led Group Clinic Visits Quality of Life

Denise F. Polit, FAAN Sally Reel, PhD, RN
Professor, School of Nursing, Griffith University, Clinical Professor and Associate Dean for
Gold Coast, Australia, President, Humanalysis, Practice, College of Nursing, University of
Inc., Saratoga Springs, New York Arizona, Tucson, Arizona
Data Collection Methods Comparative Effectiveness Research

xxii n CONTRIBUTORS



Barbara Resnick, PhD, CRNP, FAAN, FAANP Carol A. Romano, PhD, RN, BC, NEA,
Professor and Chairperson, University of FAAN, FACMI
Maryland, School of Nursing, Baltimore, Associate Dean for Academic Affairs and
Maryland Professor, Graduate School of Nursing,
Continuing Care Retirement Communities, Uniformed Services University of the Health
Self-Efficacy Sciences, Bethesda, Maryland
Data Stewardship
Brandon N. Respress, PhD, RN, MSN,
MPH, CPNP Eileen Virginia Romeo, MSN, RN
Research Fellow, Health Promotion/Risk Doctoral Student, Case Western Reserve, School
Reduction Interventions with Vulnerable of Nursing, University Frances Payne Bolton,
Populations, School of Nursing, University of Cleveland, Ohio
Michigan, Ann Arbor, Michigan Orem’s Self-Care Theory
Health Disparities in Racial and Ethnic Minorities
Linda Rose, RN, PhD
Jimmy Reyes, DNP, MSN, RN Associate Professor, School of Nursing, Johns
Project Director, College of Nursing, University Hopkins University, Baltimore, Maryland
of Iowa, Iowa City, Iowa Serious Mental Illness
Ethnography
Virginia K. Saba, EdD, RN, FAAN, FACMI
Virginia Richardson, PhD, RN, CPNP, FAANP Distinguished Scholar, Adjunct, Georgetown
Associate Professor, School of Nursing, Indiana University, Washington, DC, CEO and
University, Indianapolis, Indiana President, SabaCare Inc., Arlington, Virginia
Pediatric Primary Care Clinical Care Classification System, Nursing
Information Systems
Beverly L. Roberts, PhD, FAAN, FGSA
Annabel Davis Jenks Professor of Nursing, Ali Salman, PhD, RN
School of Nursing, University of Florida, Visiting Assistant Professor, School of Nursing,
Gainesville, Florida Oakland University, Rochester, Michigan
Falls Depression and Cardiovascular Diseases,
HIV Risk Behavior
Karen R. Robinson, PhD, RN, FAAN
Associate Director for Clinical Operations, Laura J. Samuel, FNP, MSN
Department of Veterans Affairs Medical Center School of Nursing, Johns Hopkins University,
Fargo, North Dakota Baltimore, Maryland
Current Procedural Terminology–Coded Services Hypertension
Cheryl Rodgers, PhD, CPNP, CPON Eileen Savage, PhD, MEd, BNS, RCN, RGN
Clinical Instructor, Department of Pediatrics, Professor of Nursing, School of Nursing and
Baylor College of Medicine, Pediatric Nurse Midwifery, University College Cork, Cork,
Practitioner, Texas Children’s Cancer Center, Ireland
Houston, Texas Cochrane Review
Cancer in Children
Elizabeth A. Schlenk, PhD, RN
Bonnie Rogers, DrPH, COHN-S, LNCC Assistant Professor, School of Nursing,
Director, NC Occupational Safety and Health University of Pittsburgh, Pittsburgh,
and Education and Research Center and OHN Pennsylvania
Program, School of Public Health, University of Patient Contracting
North Carolina, Chapel Hill, North Carolina
Nursing Occupational Injury and Stress

CONTRIBUTORS n xxiii



Karen L. Schumacher, RN, PhD Carol E. Smith, PhD, RN
Associate Professor, College of Nursing, Professor School of Nursing and Professor of
University of Nebraska, Omaha, Nebraska Preventive Medicine and Public Health, School
Transitions and Health of Nursing, University of Kansas Medical
Center, Kansas City, Kansas
Joan L. Shaver, PhD, RN, FAAN Caregiver, Home Care Technologies, Nurse-Led
Professor and Dean, College of Nursing, Group Clinic Visits, Virtual Nurse Caring
University of Arizona, Tucson, Arizona
Sleep Science Marlaine C. Smith, RN, PhD, AHN-BC, FAAN
Associate Dean and Helen K. Persson Eminent
Nelma B. C. Shearer, PhD, RN Scholar, Christine E. Lynn College of Nursing,
Associate Professor and Codirector, Hartford Florida Atlantic University, Boca Raton, Florida
Center of Geriatric Nursing Excellence, College Caring
of Nursing and Health Innovation, Arizona
State University, Phoenix, Arizona Mary Jane Smith, PhD, RN
Peplau’s Theoretical Model Professor and Associate Dean for Graduate
Academic Affairs, School of Nursing, West
Caryn A. Sheehan, DNP, APRN-BC Virginia University, Morganstown,
Associate Professor, School of Nursing, Saint West Virginia
Anselm College, Manchester, New Hampshire Drinking and Driving Among Adolescents, Middle-
Pender’s Health Promotion Model Range Theories, Story Theory

Deborah Shelton, PhD, RN, NE-BC, Sandra Sojka, PhD, RN
CCHP, FAAN Assistant Professor, Health Systems, Leadership
Professor, School of Nursing/Department of and Policy, Marcella Niehoff School of Nursing,
Medicine, Director, Research and Evaluation– Loyola University Chicago, Maywood, Illinois
Correctional Managed Health Care, University Home Health Classification Systems
of Connecticut, Storrs, Connecticut
Child Delinquents Bernard Sorofman, PhD
Professor and Chair, Department of Pharmacy
Elaine K. Shimono, MA, RN Practice and Science, Executive Associate
Clinical Director Psychiatry Care Center, Mount Dean, College of Pharmacy, University of Iowa,
Sinai Medical Center, New York, New York Iowa City, Iowa
Rogers’ Science of Unitary Persons Ethnography
Mary Cipriano Silva, PhD, RN, FAAN Susan M. Sparks, PhD, RN, FAAN
Professor Emeritus, College of Nursing and Retired Project Officer, National Library of
Health Science, George Mason University, Medicine, Bethesda, Maryland
Fairfax, Virginia Electronic Network
Ethics of Research, Philosophy of Nursing
Ann M. Stalter, PhD, RN
Michael Simon, RN, BSN, MSN Assistant Professor, College of Nursing and
Research Assistant Professor, Manager, Research Health, Wright State University,
and Development, National Database of Dayton, Ohio
Nursing Quality Indicators (NDNQI), School Vulnerable Populations
of Nursing, University of Kansas, Kansas City,
Kansas Theresa Standing, PhD, RN
Outcome Measures Assistant Professor Case Western Reserve, School
of Nursing, University Frances Payne Bolton,
Arlene Smaldone, DNSc, CPNP, CDE Cleveland, Ohio
Assistant Professor of Nursing, Center for Health Triangulation
Policy, School of Nursing, Columbia University,
New York, New York
Patient Safety

xxiv n CONTRIBUTORS



Patricia W. Stone, PhD, FAAN Debera Jane Thomas, DNS, RN, FNP/ANP
Professor of Nursing, Director of the Center for Dean and Professor, School of Nursing, Northern
Health Policy, School of Nursing, Columbia Arizona University, Flagstaff, Arizona
University, New York, New York Case Study as a Method of Research
Patient Safety
Agnes Tiwari, PhD, RN, FAAN
Ora Lea Strickland, PhD, RN, Associate Professor and Director of Graduate
DSc(Hon.), FAAN Programs, Assistant Dean (Education), Li Ka
Professor, Nell Hodgson Woodruff School of Shing Faculty of Medicine, School of Nursing,
Nursing, Senior Editor, Journal of Nursing University of Hong Kong, Hong Kong, China
Measurement, Emory University, Atlanta, Domestic Violence
Georgia
Measurement and Scales Toni Tripp-Reimer, DNP, MSN, RN
College of Nursing, The University of Iowa, Iowa
Neville E. Strumpf, PhD, RN, FAAN City, Iowa
Professor, School of Nursing, University of Ethnography, Qualitative Research
Pennsylvania, Philadelphia, Pennsylvania
Physical Restraints Susan Tullai-McGuinness, PhD, RN
Associate Professor, Frances Payne Bolton School
Sheri Stucke, PhD, RN of Nursing, Case Western Reserve University,
Las Vegas Medical Center, Las Vegas, Nevada Cleveland, Ohio
Osteoporosis Health Policy and Health Service Delivery, Health
Services Research
Hsin-Yi Jean Tang, PhD, ARNP-BC
Assistant Professor, College of Nursing, Seattle Mark P. Tyrrell, MEd, BNS, RGN, RPN, RNT
University, Seattle, Washington Lecturer, Catherine McCauley School of Nursing
Biofeedback and Midwifery, University College Cork, Cork,
Ireland
Anita J. Tarzian, PhD, RN Mild Cognitive Impairment
Associate Professor, Family and Community
Health, School of Nursing, University of Barbara Valanis, PhD, FAAN
Maryland, Program Coordinator, Maryland Adjunct Faculty, School of Nursing, Oregon
Health Care Ethics Committee Network; Law Health and Science University, Portland,
and Health Care Program, School of Law, Oregon
University of Maryland, Baltimore, Maryland Consortial Research
Descriptive Research, Nursing Assessment
Janet H. Van Cleave, MSN, PhD
Ann Gill Taylor, RN, MS, EdD, FAAN NRSA Postdoctoral Research Fellow,
Betty Norman Norris Professor of Nursing Individualized Care for At-Risk Older Adults,
and Director, Center for the Study of National Institute of Nursing Research,
Complementary and Alternative Therapies Bethesda, Maryland
(CSCAT), University of Virginia School of Transitional Care
Nursing, Charlottesville, Virginia
Complementary and Alternative Practices and Connie Vance, RN, EdD, FAAN
Products Professor, School of Nursing, The College of New
Rochelle, New Rochelle, New York
Diana Taylor, RNP, PhD, FAAN Mentoring
Professor Emerita, UCSF School of Nursing,
Director, Research and Evaluation, UCSF Patricia E. H. Vermeersch, PhD, GNP-BC
Primary Care Initiative, Advancing New Associate Professor, College of Nursing and
Standards in Reproductive Health Program Health, Wright State University, Dayton, Ohio
(ANSIRH), UCSF Bixby Center for Global Delirium
Reproductive Health, Oakland, California
Menopause

CONTRIBUTORS n xxv



Joyce A. Verran, PhD, RN, FAAN Carolyn A. Williams, RN, PhD, FAAN
Research Professor, College of Nursing, Professor, College of Nursing, University of
University of Arizona, Tucson, Arizona Kentucky, Lexington, Kentucky
Instrumentation, Reliability, Validity Populations and Aggregates
Antonia M. Villarruel, PhD, FAAN Danny G. Willis, DNS, PMHCNS-BC
Associate Dean for Research and Global Affairs, Assistant Professor, William F. Connell School
Professor and Nola J. Pender Collegiate Chair, of Nursing, Boston College, Chestnut Hill,
School of Nursing, University of Michigan, Massachusetts
Ann Arbor, Michigan Violence
Health Disparities in Racial and Ethnic Minorities
Celia E. Wills, PhD, RN
Anna L. D. Villena, PhD, RN, FNP, BC Grayce M. Sills Professor in Interdisciplinary
Assistant Professor of Clinical Nursing, College Behavioral Health Nursing, Associate
of Nursing, The Ohio State University, Professor, College of Nursing, The Ohio State
Columbus, Ohio University, Columbus, Ohio
Mental Health in Public Sector Primary Care, Mental Health in Public Sector Primary Care,
Mental Health Services Research Mental Health Services Research
Ladislav Volicer, MD, PhD Teresa Wills, MSc, PDipTLHEd,
Courtesy Full Professor, School of Aging Studies, BNS, RM, RGN
University of South Florida, Tampa, Florida College Lecturer, School of Nursing and
Mental Status Measurement: Mini-Mental Midwifery, Brookfield Health Sciences
State Examination Complex, University College Cork, Cork,
Ireland
Patricia Hinton Walker, PhD, RN, FAAN Obesity
Vice president for Nursing Policy and Professor,
Graduate School of Nursing, University of the Holly Skodol Wilson, PhD, RN, FAAN
Health Sciences, Bethesda, Maryland Professor Emeritus, School of Nursing,
Neuman Systems Model University of California, San Francisco, San
Francisco, California
Joanne Warner, PhD, RN Grounded Theory, Research Interviews
Dean and Professor, University of Portland, (Qualitative)
Portland, Oregon
Collaborative Research Kaye Wilson-Anderson, RN, DNSc
Associate Professor, University of Portland,
Marilyn Wegehaupt, MSN, RN School of Nursing, Portland, Oregon
Homeless Shelter Nurse, Visiting Nurses Collaborative Research
Association, Omaha, Nebraska
Homeless Health Chris Winkelman, RN, PhD, CCRN, ACNP
Associate Professor, Frances Payne Bolton School
Mary Ellen Wewers, PhD, MPH, RN, FAAN of Nursing, Case Western Reserve University,
Professor, College of Public Health, The Ohio Cleveland, Ohio
State University, Columbus, Ohio Physiology
Smoking Cessation
Nancy Fugate Woods, PhD, RN, FAAN
Kathleen M. White, PhD, RN, NEA-BC, FAAN Professor, Biobehavioral Nursing, and Dean
Associate Professor, School of Nursing, Johns Emeritus, School of Nursing, University of
Hopkins University, Baltimore, Maryland Washington, Seattle, Washington
Translational Research Menopause

xxvi n CONTRIBUTORS



Staci S. Wuchner, RN, BSN, CCRN JoAnne M. Youngblut, PhD, RN, FAAN
Graduate Student, School of Nursing, Indiana Professor, School of Nursing, Florida
University, Indianapolis, Indiana International University, Miami, Florida
Stroke Causal Modeling, Structural Equation Modeling
May L. Wykle, PhD, RN, FAAN, FGSA Jaclene A. Zauszniewski, PhD, RNC, FAAN
Marvin and Ruth Durr Denekas Professor, Dean Kate Hanna Harvey Professor in Community
of Nursing, Frances Payne Bolton School of Health Nursing, Associate Dean for Doctoral
Nursing, Case Western Reserve University, Education, Case Western Reserve University,
Cleveland, Ohio Cleveland, Ohio
Depression in Older Adults Depression in Older Adults, Factor Analysis,
Resourcefulness
Andrea M. Yevchak, GCNS-BC, RN
Doctoral Candidate, John A. Hartford Foundation Tamara L. Zurakowski, PhD, CRNP
BAGNC Predoctoral Scholar, School of Practice Associate Professor of Nursing, School
Nursing, Pennsylvania State University, of Nursing, University of Pennsylvania,
University Park, Pennsylvania Philadelphia, Pennsylvania
Ageism Nightingale, Florence

List of Entries











Acculturation Emerson E. Ea Chronic Illness Ruth McCorkle and Mark Lazenby
®
Action Science Hesook Suzie Kim CINAHL Database Diane Shea Pravikoff
Active Surveillance for Prostate Cancer Clinical Care Classification System
Donald E. Bailey Virginia K. Saba
Acute Care of the Elderly Terry Fulmer and Clinical Decision Making Terri H. Lipman
Sarah Pernikoff Clinical Judgment Patricia C. Dykes and
Addiction Care Carolyn Baird Moreen Donahue
Adherence/Compliance Jacqueline Dunbar-Jacob Clinical Nursing Research Linda R. Phillips
Advance Directives Kristy Dixon Clinical Preventive Services Cynthia G. Ayres
Ageism Andrea M. Yevchak and Donna M. Fick Clinical Trials Dorothy Brooten
Alzheimer’s Disease Graham J. McDougall Jr. Cochrane Review Josephine Hegarty and
Applied Research Ivo Abraham, Sabina De Geest, Eileen Savage
and Karen MacDonald Cohort Design Carol M. Musil
Basic Research Sue K. Donaldson Collaborative Research Kaye Wilson-Anderson
Behavioral Research Jacqueline Dunbar-Jacob and Joanne Warner
Biofeedback Helen Kogan Budzynski and Comfort Theory Katharine Kolcaba
Hsin-Yi (Jean) Tang Community Mental Health Wendy Lewandowski
Boykin and Schoenhofer: The Theory of Nursing Comparative Effectiveness Research
as Caring Mary Angelique Hill Ivo Abraham and Sally Reel
Breastfeeding Suzanne Hetzel Campbell Complementary and Alternative Practices and
Cancer in Children Marilyn Hockenberry and Products Ann Gill Taylor and Victoria Menzies
Cheryl Rodgers Concept Analysis Kay C. Avant
Cardiovascular Risk Factors: Cholesterol Conceptual Model (Framework)
Laura L. Hayman Joyce J. Fitzpatrick
Caregiver Ubolrat Piamjariyakul and Consortial Research Barbara Valanis
Carol E. Smith Content Analysis Kathleen Huttlinger
Caring Marlaine C. Smith and Sally Phillips Continuing Care Retirement
Case Study as a Method of Research Communities Barbara Resnick
Debera Jane Thomas Coronary Artery Bypass Graft Surgery
Causal Modeling JoAnne M. Youngblut Susan H. McCrone
Cerebral Ischemia Mary E. Kerr Cost Analysis of Nursing Care Mary L. Fisher
Child Delinquents Deborah Shelton Critical Care Nursing Research
Child–Lead Exposure Effects Heidi V. Krowchuk Carol Diane Epstein
Childbirth Education Bobbe Ann Gray Cultural/Transcultural Focus Sharol F. Jacobson

xxviii n LIST OF ENTRIES



Current Procedural Terminology-Coded Factor Analysis Christopher J. Burant and
Services Karen R. Robinson and Jaclene A. Zauszniewski
Hurdis M. Griffith Failure to Thrive (Adult) Patricia A. Higgins
Data Analysis Lauren S. Aaronson Failure to Thrive (Child) Heidi V. Krowchuk
Data Collection Methods Denise F. Polit Falls Beverly L. Roberts
Data Management Barbara Munro Family Caregiving and the Seriously
Data Stewardship Carol A. Romano Mentally Ill Alice Kempe
Delirium Marquis D. Foreman and Family Health Suzanne Feetham
Patricia E. H. Vermeersch Fatigue Lauren S. Aaronson
Delphi Technique Alice S. Demi Feminist Research Methodology
Depression and Cardiovascular Diseases Sara L. Campbell
Ali Salman and Yi-Hui Lee Fetal Monitoring Susan M. Miovech
Depression in Families Terry A. Badger Fever/Febrile Response Barbara J. Holtzclaw
Depression in Older Adults Jaclene A. Fitzpatrick’s Rhythm Model Jana L. Pressler
Zauszniewski, Abir K. Bekhet, and May L. Wykle and Kristen S. Montgomery
Depression in Women Emily J. Hauenstein Formal Nursing Languages Suzanne Bakken
Descriptive Research Anita J. Tarzian and and Jeeyae Choi
Marlene Zichi Cohen Functional Health Patterns Dorothy A. Jones
Diabetes Research Melissa Spezia Faulkner and Jane Flanagan
Discourse Analysis Hesook Suzie Kim Genetics Judith A. Lewis
Doctoral Education Elizabeth R. Lenz Grandparents Raising Grandchildren
Domestic Violence Agnes Tiwari Susan J. Kelley
Drinking and Driving Among Grantsmanship Lauren S. Aaronson
Adolescents Mary Jane Smith Grounded Theory Holly Skodol Wilson,
Eating Disorders Deborah B. Fahs and Sally A. Hutchinson, and Deborah F. Lindell
Barbara J. Guthrie Health Conceptualization Mary T. Quinn Griffin
Elder Mistreatment Terry Fulmer and Health Disparities in Racial and Ethnic
Sarah Pernikoff Minorities Antonia M. Villarruel and
Electronic Network W. Scott Erdley and Brandon N. Respress
Susan M. Sparks Health Disparities: Theoretical and
Emergency Nursing Suling Li and Vicki Keough Methodological Approaches Adey Nyamathi
Empathy Dianna Hutto Douglas Health Policy and Health Service
End-of-Life Planning and Choices Ethel L. Mitty Delivery Susan Tullai-McGuinness
Enteral Tube Placement Marsha L. Ellett Health Services Research
Susan Tullai-McGuinness
Epilepsy Joan K. Austin
Ethics of Research Mary Cipriano Silva Hemodynamic Monitoring Maureen Keckeisen
Henderson’s Model Edward J. Halloran
Ethnogeriatrics Melen R. McBride and
Irene Daniels Lewis Hermeneutics Pamela M. Ironside
Ethnography Toni Tripp-Reimer, Stacie Salsbury History of Nursing Research Faye G. Abdellah
Lyons, Bernard Sorofman, and Jimmy Reyes HIV/AIDS Care and Treatment
Evaluation Gail L. Ingersoll Kathleen M. Nokes
Evidence-Based Practice Bernadette Mazurek HIV Risk Behavior Yi-Hui Lee and Ali Salman
Melnyk and Ellen Fineout-Overholt HIV Symptom Management and
Experimental Research Ivo Abraham and Quality of Life Kenn M. Kirksey and
Karen MacDonald Gayle McGlory
Exploratory Studies Kathleen Huttlinger Home Care Technologies Carol E. Smith

LIST OF ENTRIES n xxix



Home Health Classification Systems Meta-Analysis Cheryl Tatano Beck
Sandra Sojka Middle-Range Theories Patricia Liehr and
Home Health Systems Leslie Neal-Boylan Mary Jane Smith
Homeless Health Mary J. McNamee and Mild Cognitive Impairment Mark P. Tyrrell and
Marilyn Wegehaupt Geraldine McCarthy
Hospice Inge B. Corless Moral Distress Alvita Nathaniel
Hypertension Cheryl R. Dennison Himmelfarb, Moral Reckoning Alvita Nathaniel
Laura J. Samuel, and Martha N. Hill Mother–Infant/Toddler Relationships
Immigrant Women Afaf Ibrahim Meleis, DeAnne Deborah Gross and Shelly Eisbach
K. Hilfinger Messias, and Karen J. Aroian Music Therapy Marion Good
Infection Control Sile A. Creedon Narrative Analysis Hesook Suzie Kim
Institutional Review Board and Informed National Institute of Nursing Research
Consent Mary T. Quinn Griffin Patricia A. Grady
Instrument Translation Chiemi Kochinda Neuman Systems Model Patricia Hinton Walker
Instrumentation Joyce A. Verran and Neurobehavioral Development
Paula M. Meek Barbara Medoff-Cooper and Diane Holditch-Davis
International Classification for Nursing Newman’s Theory of Health Emily J. Fox-Hill
Practice Tae Youn Kim and Amy Coenen and Veronica F. Engle
International Nursing Research Nightingale, Florence Tamara L. Zurakowski
Afaf Ibrahim Meleis Nosocomial Infections Sile A. Creedon
Interpersonal Communication: Nurse–
Patient Marjorie Thomas Lawson and Nurse Engagement Beth Palmer
Jeffrey Schwab Jones Nurse-Led Group Clinic Visits
Job Satisfaction Peggy A. Miller and Ubolrat Piamjariyakul and Carol Smith
Diane K. Boyle Nurse and Physician Interdisciplinary
Johnson’s Behavioral System Model Collaboration Tara C. Prescott
Jacqueline Fawcett Nurse Staffing Sean P. Clarke and
Kangaroo Care (Skin-to-Skin Contact) Raquel M. Meyer
Gene Cranston Anderson Nursing Assessment Marlene Zichi Cohen and
King’s Conceptual System and Theory of Goal Anita J. Tarzian
Attainment Maureen A. Frey Nursing Diagnosis, Interventions, and
Leininger’s Theory of Culture Care Diversity and Outcomes: NANDA-I, Nursing Interventions
Universality Sandra C. Garmon Bibb Classification, and Nursing Outcomes
Maternal Anxiety and Psychosocial Classification Sue Moorhead
Adaptation During Normal and High-Risk Nursing Education Jeanne Marie Novotny
Pregnancy Regina Placzek Lederman Nursing Information Systems Patricia C. Dykes,
Measurement and Scales Ora Lea Strickland Ida Androwich, and Virginia K. Saba
Menopause Diana Taylor and Nursing Occupational Injury and
Nancy Fugate Woods Stress Bonnie Rogers
Mental Health in Public Sector Primary Nursing Practice Models Dorothy A. Jones and
Care Celia E. Wills and Anna L.D. Villena Jane Flanagan
Mental Health Services Research Celia E. Wills
and Anna L.D. Villena Nursing Process Sally Phillips
Mental Status Measurement: Mini-Mental State Nutrition in Infancy and Childhood Laura L.
Examination Ann C. Hurley, Ladislov Volicer, Hayman and Alyson Karakouzian
and Ellen K. Mahoney Nutrition in the Elderly Rose Ann DiMaria-Ghalili
Mentoring Connie Vance Obesity Teresa Wills

xxx n LIST OF ENTRIES



Observational Research Design Qualitative Research Toni Tripp-Reimer and
Janet C. Meininger Lisa Skemp Kelley
Orem’s Self-Care Theory Eileen Virginia Romeo Quality of Care Patti Hart O’Regan
and Mary Jo Devereaux Quality of Life K. M. Reeder
Organizational Culture Sean P. Clarke and Quantitative Research Eugene Levine
Raquel M. Meyer Quasi-Experimental Research Ivo Abraham and
Organizational Design Sean P. Clarke and Karen MacDonald
Raquel M. Meyer Reliability Paula M. Meek and Joyce A. Verran
Osteoporosis Evelyn Duffy, Geraldine A. Britton, Reminiscence Barbara K. Haight
Sheri Stucke, Rosemary Collier, and
Sarah H. Gueldner Replication Studies Cheryl Tatano Beck
Outcome Measures Michael Simon Research Dissemination Patricia A. Martin
Pain Marion Good Research in Nursing Ethics Shaké Ketefian
Palliative Care Marianne Matzo Research Interviews (Qualitative)
Sally A. Hutchinson and Holly Skodol Wilson
Parenting Research in Nursing
Diane Holditch-Davis and Margaret Shandor Miles Research Utilization Carol A. Ashton
Parse’s Humanbecoming School of Resourcefulness Jaclene A. Zauszniewski
Thought Mary T. Quinn Griffin Rights of Human Subjects Sara T. Fry
Participant Observation Kathleen Huttlinger Rogers’ Science of Unitary Persons John Phillips
Patient Care Delivery Models M. Janice Nelson and Elaine K. Shimono
and Connie A. Jastremski Roy Adaptation Model Mary T. Quinn Griffin
Patient Contracting Elizabeth A. Schlenk Rural Health Marianne Baernholdt
Patient Education Alyson Blanck Sampling Lauren S. Aaronson
Patient Safety Patricia W. Stone, Arlene Smaldone, Schizophrenia Mary Moller and Kathleen Fentress
and Robert Lucero Secondary Data Analysis Judith R. Graves
Patient Satisfaction Cecilia D. Alvarez Self-Efficacy Barbara Resnick
Pediatric Primary Care Virginia Richardson Serious Mental Illness Linda Rose
Pender’s Health Promotion Model Shivering Barbara J. Holtzclaw
Caryn A. Sheehan Simulation Suzanne Hetzel Campbell
Peplau’s Theoretical Model Pamela G. Reed and Sleep Science Joan L. Shaver
Nelma B. C. Shearer Smoking Cessation Gretchen A. McNally and
Pet Therapy Amy R. Johnson Mary Ellen Wewers
Phenomenology Cheryl Tatano Beck Smoking/Tobacco as a Cardiovascular Risk
Philosophy of Nursing Mary Cipriano Silva Factor Nancy Houston Miller
Physical Restraints Lois K. Evans, SNOMED Clinical Terms Suzanne Bakken
Meg Bourbonniere, and Neville E. Strumpf Social Support Raeda Fawzi AbuAlRub
Physiology Chris Winkelman Spirituality Carol D. Gaskamp and
Pilot Study Carol M. Musil Martha G. Meraviglia
Population Health Sandra C. Garmon Bibb Statistical Techniques Barbara Munro
Populations and Aggregates Carolyn A. Williams Story Theory Mary Jane Smith and
Postpartum Depression Linda J. Mayberry and Patricia Liehr
June Andrews Horowitz Stress Kimberly B. Hall
Pregnancy Kristen S. Montgomery Stress Management Kimberly B. Hall
Prevention of Preterm Birth, Preterm Labor, and Stroke Tamilyn Bakas and Staci S. Wuchner
Low Birth Weight Judith A. Maloni Structural Equation Modeling JoAnne M.
Primary Nursing Marie Manthey Youngblut

LIST OF ENTRIES n xxxi



Substance Use Disorders in Registered Unlicensed Assistive Personnel Ethel L. Mitty
Nurses Madeline A. Naegle Validity Joyce A. Verran and Paula M. Meek
Systematic Review Cheryl Holly Violence Linda Manfrin-Ledet, Danny G. Willis,
Telehealth Josette Jones and Demetrius J. Porche
Telenursing/Telepractice Josette Jones Virtual Nurse Caring Carol E. Smith
Telepresence Josette Jones Vulnerable Populations Ann M. Stalter
Terminal Illness Inge B. Corless Wandering Adrianne D. Linton
Theoretical Framework Shirley M. Moore Watson’s Theory of Human Caring
Thermal Balance Barbara J. Holtzclaw Diana Lynn Morris and Kristen S. Montgomery
Time Series Analysis Bonnie L. Metzger Weight Management Sue A. Popkess-Vawter
Transitional Care Janet H. Van Cleave and Wellness Joyce Johnston
Mary D. Naylor Widows and Widowers Eileen J. Porter and
Transitions and Health Afaf Ibrahim Meleis and Kathy A. Johnson
Karen L. Schumacher Women’s Health Ivy M. Alexander and
Translational Research Kathleen M. White Angela Barron McBride
Triangulation Theresa Standing Workplace Violence Jane Lipscomb and
Uncertainty in Illness Merle H. Mishel Cassandra Okechukwu

Encyclopedia of

Nursing Research




Third Edition

A














rejection of both the host and heritage cul-
AcculturAtion tures (Berry, 2003). These categories suggest
that acculturation is influenced by individual
and societal factors, particularly those inher-
We are in the midst of an unparalleled rate of ent in host countries (Berry, 2003).
international migration particularly in North The factors that influence global migra-
America and Europe, which are experienc- tion are multifactorial. They are commonly
ing an unprecedented influx of immigrants described in the literature as push and pull
coming from Latin America, Asia, Africa, the factors (Kingma, 2001). Pull factors are those
Middle East, and the Caribbean (Schwartz, conditions found in receiving countries that
Unger, Zamboanga, & Szapocznik, 2010). attract migrants to relocate, whereas push
This phenomenon is shaping history and factors are those intrinsic and extrinsic con-
has resulted in significant multidisciplinary ditions that drive individuals to leave their
scholarships. There is extensive literature homeland (Kingma, 2001).
that investigates and explores how this phe- The global nursing shortage has been
nomenon impacts the person, the society, a catalyst for the international mobility of
and the global community as a whole. nursing professionals. However, interna-
The transformational experience of an tional nurse migration is predominantly uni-
individual when moving from a familiar cul- directional that has significantly impacted
ture or place of birth to a different culture, the health care delivery systems of both
country, or region is referred to as accul- the host and donor countries (Ea, Quinn
turation (Berry, 2003; Schwartz et al., 2010). Griffin, L’Eplattenier, & Fitzpatrick, 2008).
This process is multidimensional, individ- Economically advantaged countries such
ualized, dynamic, and interrelated (Berry, as the United States, the United Kingdom,
2003; Schwartz et al., 2010). Many scholars and some countries in the Middle East have
cite Berry’s (2003) conceptualization of accul- become magnet destinations for registered
turation, which he described to have several nurses coming from economically disad-
interacting phases that include an initial vantaged countries in Asia, Africa, and the
contact, a conflict resolution phase and an Caribbean (Ea et al., 2008). Examples of push
adaptation phase. Berry (2003) further cate- and pull factors that influence the migration
gorized adaptation to include assimilation, of nurses include improved employment
separation, integration, and marginalization. opportunities and increased professional
Assimilation refers to the adoption of the opportunities overseas, a search for a better
receiving country’s culture and relinquishing quality of life, an inherent personal desire
of one’s original culture, integration suggests to experience other cultures, and the need
biculturalism where an individual adopts to seek a safe working and living conditions
some behaviors and traits of the receiving (Kingma, 2001).
country while retaining one’s cultural heri- There are many instruments found in
tage, separation indicates retaining the her- the literature that attempt to measure accul-
itage culture and rejecting the host culture’s turation. Scholars on acculturation recom-
practices, and marginalization suggests mend that instruments that take into account

2 n ACTioN SCiENCE



the many domains and factors associated Global migration has profound effects
with acculturation be used to capture this on the individual, on the community, and
A complex phenomenon instead of using sin- to the host and donor countries. As global-
gle-item proxy measures, such as length of ization intensifies, there is a critical need to
residency to the receiving county or age at continue to understand this complex experi-
immigration or those instruments that con- ence and to develop valid and reliable instru-
ceptualize acculturation as a unidirectional ments that capture the essence of this elusive
process (Cabassa, 2003; Schwartz et al., 2010). concept. There is a particular need to con-
The process of acculturation is also asso- tinue to explore the impact of acculturation
ciated with periods of stress that has been on the overall health and well-being of the
shown to profoundly impact physical and immigrant. As the global nursing shortage
mental health among immigrants (Alegria continues to deepen, there is also a need to
et al. 2008; Allen et al., 2008; Choi, Rankin, further investigate the impact of accultura-
Stewart, & oka, 2008; Lasseter & Callister, tion to the immigrant nurse using a multim-
2009; Steffen, Smith, Larson, & Butler, 2006; ethod approach and how this impacts one’s
Zemore, 2007). Results of these studies show physical and mental health and work-related
that higher level of acculturation has been and other personal-related factors.
associated with poor health outcomes, also
called the immigrant paradox, which include Emerson E. Ea
increased risk for hypertension, obesity,
depression, increased use of alcohol, and
smoking (Alegria et al., 2008; Allen et al., 2008;
Choi et al., 2008; Lasseter & Callister, 2009; Action Science
Steffen et al., 2006; Zemore, 2007). However, a
major critique of most of these studies is their
reliance on the use of single-proxy measures Action science is an approach for inquiry ini-
or instruments that conceptualizes accultura- tially developed by Chris Argyris and Donald
tion as unidimensional (Schwartz et al., 2010). Schön (1974) and expanded by Argyris,
it is not clear if these outcomes were the result Putnam, and Smith (1985), aimed at generat-
of adopting the receiving country’s cultural ing knowledge for and improving individual
norms or relinquishing the original culture’s and organizational learning. Action science
practices or both (Schwartz et al., 2010). has been applied in the field of management,
There is a growing literature that exam- specifically for organizational learning, and
ines how immigrant nurses adjust to the in various professional practice fields such
host country’s culture. Most of these stud- as education, nursing, social work, and med-
ies are conducted in host countries such as icine for individual learning in practice. it
the United States and the United Kingdom. is an approach to generate knowledge for
Similar to Berry’s conceptualization, the practice and to transform practice by engag-
process of acculturation among immigrant ing practitioners in the process of inquiry
nurses could also be characterized by sev- through reflection on their own behavioral
eral phases of adjustment that are dynamic worlds of practice (Argyris et al., 1985; Schön,
and individualized (Magnusdottir, 2005; Xu, 1983). Action science has been further devel-
2007). Findings of several nursing studies oped by Torbert (1991) as “action inquiry,”
show that those who have adopted some of which is used interchangeably in the liter-
the host culture’s traits, behaviors, and atti- ature. Although action science and action
tudes have increased overall levels of job research, participatory action research in
and life satisfaction (DiCicco-Bloom, 2004; Ea particular, are viewed by many to be in the
et al., 2008; Magnusdottir, 2005; Xu, 2007). same inquiry family within social sciences

ACTioN SCiENCE n 3



sharing the notion that the inquiry is oriented of practice, whereas theories in use refers to
to change and in solving practical problems theories that are actually used in practice.
through participation of involved people, Theories in use are only inferable from the A
action science differs from participatory actions themselves, and practitioners usually
action research by focusing on the learning are not aware of or not able to articulate their
models that are at the base for human actions theories in use except through careful reflec-
as the locus for producing changes (Argyris & tion and self-dialogue.
Schön, 1989). in action science, changes in Argyris and Schön (1974) and Argyris
human actions are sought by examining and et al. (1985) identified Model 1 theories in
correcting the fundamental mechanisms and use as a type that seals practitioners from
reasons for adhering to certain repertoires of learning and produces routinization and
behaviors that result from a closed-up mode ineffective practice. Humans act in general
of learning. to satisfy the governing variables (to be in
Putnam (1999) suggested that action sci- control, to strive to win, to suppress nega-
ence is based on three philosophical prem- tive feelings, and to act rationally), repre-
ises: (a) human practice involves meaning senting Model 1 theory in use, which often
making, intentionality in action, and norma- result in defensiveness, misunderstanding,
tivity from the perspective of human agency; and self- fulfilling and self-sealing processes
(b) human practice goes on in an interdepen- (Argyris, 1982; Argyris et al., 1985; Argyris &
dent milieu of behavioral norms and insti- Schön, 1996). on the other hand, Model 2
tutional politics; and (c) the epistemology theory in use encompasses principles of
of practice calls for the engagement of prac- valid information, free and informed choice
titioners in generating knowledge. Action in action, and internal commitment. Model
science thus is a method and philosophy for 1 theory in use represents single-loop learn-
improving practice and generating knowl- ing, whereas Model 2 theory in use aligns
edge. Argyris (1980) further suggested that with double-loop learning. Thus, action sci-
action science is an interventionist approach ence aims to change people from single-loop
in which three prerequisites must be estab- learning of Model 1 to double-loop learning
lished for the research to ensue: (a) a creation of Model 2 through the processes of reflec-
of normative models of rare universes that tion and learning engaging both practitio-
are free of defensive routines, (b) a theory ners and researchers for the transformation
of intervention that can move practitioners (Argyris, 1993, 2002; Argyris et al., 1985;
and organizations from the present to a new Argyris & Schön, 1996). Single-loop learning
desirable universe, and (c) a theory of instruc- results in change in actions without revising
tion that can be used to teach new skills and the governing variables, whereas double-
create new culture. loop learning begins with changing the gov-
Action science holds that actions in erning variables, followed by change in the
professional practice are based on practitio- actions.
ners’ theories of action. Theories of action Knowledge of practitioners’ theories
are learned and organized as repertoires of in use and espoused theories provides a
concepts, schemata, and propositions and descriptive understanding about the pat-
are the basis on which practitioners’ behav- terns of inconsistencies between theories in
ioral worlds are created in specific situations use and espoused theories recalled in actual
of practice. Argyris et al. (1985) identified practice. Through action science, practitio-
espoused theories and theories in use as two ners engaged in Model 2 theories in use pro-
types of theories of action. Espoused theories duce practice knowledge that informs their
of action are the rationale expressed by practi- approach to practice without routinization
tioners as guiding their actions in a situation or the self-sealing mode. in addition, action

4 n ACTivE SURvEiLLANCE FoR PRoSTATE CANCER



science generates knowledge regarding the may be entrenched with routinization or fro-
process involved in self-awareness and the zen within Model 1 theories in use.
A learning of new theories in use through The general aim of action science for
reflective practice and practice design. nursing is then to improve nursing practice
Research process in action science calls by freeing nurses from self-sealing practices
for the cooperative participation of practi- and by engaging them in the process of learn-
tioner and researcher through the phases of ing and participatory research. An extended
description, discovery of theories in use, and model of inquiry based on action science
intervention. The core process in this inquiry such as critical reflective inquiry (Kim, 1999)
is the cooperative offline reflection (Rudolph, can be applied to develop knowledge for
Taylor, & Foldy, 2001). Transcriptions of actual improving nursing practice.
practice by the researcher or narratives of
actual practice by the practitioner are ana- Hesook Suzie Kim
lyzed together to describe and inform reflec-
tively the nature of practice and theories in
use. Action Design (1996) suggested the use
of the ladder of inference as a tool to discover Active SurveillAnce for
practitioners’ modes of thinking and action
as revealed in transcripts or narratives. The ProStAte cAncer
research process is not oriented to the anal-
ysis of action transcripts or narratives by a
researcher independent of the practitioner. Active surveillance for early stage pros-
it involves a postpractice face-to-face discus- tate cancer is defined as a period of intense
sion (interview) between the researcher and monitoring for the purpose of delaying
the practitioner. Such sessions are used to traditional therapy within a timeframe
get at the reconstructed reasoning of prac- that allows for cure if disease progression
titioners regarding critical moments of the is detected. This approach can be offered
practice and to provide opportunities for to men with low or very low risk cancers
reflection on the thinking and doing that and may reduce overtreatment of clinically
were involved in the practice. Through such insignificant disease and the subsequent
sessions, the researcher also acts as an inter- side effects that include urinary incon-
ventionist by engaging the practitioner to tinence and impotence. Men who select
move toward new learning. active surveillance are usually monitored
Nursing practice is a human-to-human every 3 to 6 months by their health care pro-
service that occurs in the context of health vider. Monitoring may include digital rec-
care. Nursing practice occurs within online tal examination, repeat biopsy to evaluate
conditions that are complex not only with Gleason score, estimate of tumor volume,
respect to clients’ problems but also in terms and prostate-specific antigen (PSA) testing
of organizational elements of the health care to include PSA density (Dall’Era & Kane,
environment. Nursing practice is not based 2008). PSA levels provide the most useful
simply on linear translations of relevant the- information for monitoring disease progres-
oretical knowledge that governs the situation sion. However, evidence-based selection cri-
of practice but has to be derived and designed teria, monitoring schedules, and confirmed
from the nurse’s knowledge of and responses methods to monitor disease activity have
to the competing and complex demands of not been established and at this time; there-
the situation (Kim, 2010). in addition, as the fore, active surveillance protocols remain
action scientists suggest, nursing practice in institution and practitioner specific. Given
general as well as particular nursing actions the lack of an established approach for

ACTivE SURvEiLLANCE FoR PRoSTATE CANCER n 5



active surveillance, this management strat- of 150 Dutch men during their first 9 months
egy remains underutilized by men in the of active surveillance. However, Bailey et al.
United States as fewer than 10% of poten- (2009) reported that men between 5 and 8 A
tially appropriate patients select this option months of active surveillance experienced
(Large & Eggener, 2009). moderate levels of illness uncertainty. in
Active surveillance has evolved from the a previous study, men with higher levels
concept of watchful waiting, a strategy of of illness uncertainty had lower levels of
periodic monitoring followed by active treat- quality of life (Hegarty, Wallace, & Comber,
ment if and when disease progression leads 2008). Quality of life may also be affected by
to troublesome symptoms (Adolfsson, 1995). the cost of care associated with a diagno-
Historically, watchful waiting was viewed as sis of prostate cancer (Gomella, Johannes, &
a strategy for men in their seventies, with con- Trabulsi, 2009). However, this relationship
comitant illnesses that prohibited traditional has not been confirmed.
therapy. However, many patients and health in contemporary practice, patient selec-
care providers viewed this as a do-nothing tion remains a significant challenge because
approach, and few considered it a reasonable we still do not have the ability to accu-
strategy for disease management resulting in rately determine at the time of diagnosis
low rate of adoption (approximately 5%) by which patients’ disease will remain indo-
men in the United States; this may contrib- lent. However, several clinicians and can-
ute to the low numbers of men currently in cer centers have proposed selection criteria.
active surveillance. in addition, health care Warlick, Allaf, and Carter (2006) has refined
providers may be reluctant to offer this strat- the identification process to include men who
egy because they are uncertain about how to are 65 years and older with T1c stage disease,
appropriately manage patients, fear of legal PSA density less than 0.15 ng/ml/cm , and
3
backlash in the event a patient’s disease pro- a Gleason grade of 6 or less after adequate
gresses to an advanced stage or dies, and a biopsy as the safest candidates for active
strongly held belief that cancer should be surveillance followed by active treatment.
fought with the best treatments available. Clinicians at the University of California, San
From an economic perspective, the adop- Francisco, have established criteria for men
tion of active surveillance for early stage pros- with low-risk prostate cancer as the best can-
tate cancer has the potential to reduce costs, didates for active surveillance. These criteria
to impact psychosocial outcomes, and to include Gleason sum of 6 (no tumor grade
affect quality of life. in an evaluation of cost pattern of 4 or 5), PSA at diagnosis of 10 ng/ml
associated with the diagnosis of prostate can- or less and stable, 33% or less positive cores,
cer, Crawford, Blac, Eaddy, and Kruep (2010) and 50% or less single-needle core involved
determined that the total cost of monitoring with cancer from biopsy, stable repeat PSA,
a man’s disease to be $24,809 compared with and organ-confined disease determined by
$59,286 for treatment that mostly included ultrasound. This center has enrolled more
surgical intervention to remove the prostate than 500 men into an active surveillance
cancer. The direct cost of treating prostate protocol. To date, approximately one in five
cancer with any type of traditional therapy of those men have undergone treatment for
was five times higher than a course of careful their disease an average of two to three years
monitoring (Crawford et al., 2010). The find- after diagnosis (Dall’Era et al., 2008).
ings are mixed with regard to the impact a The National Comprehensive Cancer
course of active surveillance has on psycho- Network (2010) has recently updated their
social outcomes and quality of life. van den guidelines to recommend only active surveil-
Bergh et al. (2010) reported favorably low lance for men diagnosed with low-risk pros-
levels of anxiety and depression in a sample tate cancer who have a life expectancy of less

6 n ACTivE SURvEiLLANCE FoR PRoSTATE CANCER



than ten years. in addition, they have also The primary outcome, disease-specific sur-
defined a group at very low risk and recom- vival, will not be available until 2025. Lastly,
A mend that these men with a life expectancy of the Prostate Cancer Research international:
less than 20 years only receive active surveil- Active Surveillance study, a Web-based
lance. These guidelines use life expectancy trial, will provide important information
as an important variable in the active surveil- on changes in PSA values and kinetics (van
lance decision-making discussion. However, den Bergh et al., 2007). These studies have
for younger men, the question of appropri- the potential to address important questions
ateness remains open and will require addi- related to the selection of active surveillance.
tional data. The hope is to improve selection Because these answers are at least 10 years in
criteria to include younger men who wish to the future, men will continue to make their
preserve their quality of life. decision to elect a course of active surveil-
Although men undergoing active sur- lance with limited evidence.
veillance may eventually need traditional The urologic medical community and
therapy, the delayed time to treatment nurse scientists investigating the effects of
leaves quality of life intact and may result in active surveillance continue to advocate for
improved treatment in the future. in a recent research that will help men make informed
report, Duffield, Lee, Miyamoto, Carter, and treatment decisions and then offer theoreti-
Epstein (2009) found that the 48 men of 470 cally based interventions to help them man-
who opted for treatment within an average age the psychological aftermath inherent in
timeframe of 2.5 years (range = 1–6 years), 31 a course of close monitoring for early stage
(66%) had organ-confined disease, 17 (35%) prostate cancer (Kazer, Bailey, Colberg, Kelly,
and 3 (6%) had extraprostatic extension and & Carroll, 2011). This concern occurs within
seminal vesicle involvement, respectively, the ongoing debate regarding PSA testing and
and 7 (15%) had positive margins at the time which treatment really is better for men with
of surgery. However, up to 50% of men may early stage disease. Although the selection
opt for care in the absence of disease progres- of active surveillance by men in the United
sion (Klotz, 2005). States continues to decline (Moul, Mouraviev,
There are four large randomized clin- Sun, Schroeck, & Polascik, 2009), urologists
ical trials that are attempting to determine and cancer centers will offer patient selection
the benefits of active surveillance for local- guidelines on the basis of current but incom-
ized prostate cancer. The Prostate Testing plete evidence. Eggener et al. (2009) found that
for Cancer and Treatment trial has enrolled only 1 of 262 patients who initiated a course
approximately 109,750 as of 2008 from the of active surveillance developed bone metas-
United Kingdom to determine which of tases at 38 months. Forty-three additional
three treatments, active surveillance, pros- patients initiated traditional therapy during
tatectomy, or conformal radiotherapy, is the the follow-up period of 29 months. Being able
best. This study will follow men for 10 to to adequately predict a man’s disease risk
15 years (Bastian et al., 2009). The Canary would improve the likelihood that increasing
Prostate Active Surveillance Study is a mul- numbers of men would view active surveil-
ticenter study that seeks to determine the lance in a favorable light (Klotz, 2009). Until
aggressive prostate cancers that progress on we have the evidence to accurately identify
active surveillance from those cancers that the most appropriate men for active surveil-
will remain indolent (Newcomb et al., 2010). lance, the selection of this treatment strategy
The Surveillance Therapy Against Radical will remain underutilized, and the overtreat-
Treatment, a multicenter Phase 3 trial, will ment of prostate cancer will persist.
enroll 2,130 men into either active surveillance
or aggressive treatment (surgery or radiation). Donald E. Bailey

ACUTE CARE oF THE ELDERLy n 7



baseline dependencies at admission had devel-
Acute cAre of the elderly oped one or more limitations within 2 months
(Hart, Birkas, Lachmann, & Saunders, 2002). A
individuals older than 65 years are more likely
older people have a greater prevalence of to be admitted to acute care from the emer-
chronic diseases and disorders that lead to gency department than other age groups. The
hospitalization. on average, people older than hospitalized elderly are at an increased risk
65 years are hospitalized more than three for poor outcomes such as increased length
times as often as younger individuals, and of stay, readmissions, functional decline,
the length of their stay is estimated to be and iatrogenic complications, as compared
50% longer than that of younger individuals. with other age groups. There is a significant
Nursing research that defines the evidence for and serious readmission rate for older adults,
practice interventions is needed for patients of ranging from 18% to 33% within 1 to 3 months
all ages, and especially for the elderly (Capezuti and complications such as acute confusion
et al., 2008). Nursing research that provides and nosocomial infections, which are com-
the basis for best practice for hospitalized mon among the elderly, resulting in increased
elders is often embedded in interdi sciplinary morbidity and mortality (Lindenauer et al.,
studies. Several studies have recently docu- 2010). Fifty-eight percent of patients who are
mented the essential nature of continuity of hospitalized will experience at least one iatro-
care across settings for optimal acute care out- genic complication (Hart et al., 2002).
comes (Boyd et al., 2010; Counsell, Callahan, The composition of hospital staff has been
Tu, Stump, & Arling, 2009). increasingly, criti- shown to make a difference in patient out-
cal care of older adults has received attention, comes (Aiken, Clarke, Silber, & Sloane, 2003;
given the demographic shifts nationally and Estabrooks, Midodzi, Cummings, Ricker, &
the advancing age of those in intensive care Giovannetti, 2005; Tourangeau et al., 2007).
units, emergency rooms, and other critical Nurse accountability and models of patients
care areas (Foreman et al., 2010). and nursing administration also have been
Acute care of the elderly (ACE) units, examined (Baggs, 2007; Baggs, Ryan, Phelps,
which developed in the early 1990s, have Richeson, & Johnson, 1992; Piquette, Reeves, &
shown improved outcomes among older Leblanc, 2009; Scherb, Rapp, Johnson, & Maas,
patients who have been hospitalized. These 1998). These studies provide some informa-
units focus on precise and ongoing assess- tion regarding outcomes for the elderly, but
ment of older adults, especially related to intensive effort needs to be focused on under-
functional capacity and decline and follow the standing the differences between outcomes
evidence to create individualized care plans for younger individuals versus older indi-
(Malone et al., 2010). A classic study conducted viduals in the case of hospital care. For exam-
by Landefeld, Palmer, Kresevic, Fortinsky, ple, do older adults have difference cardiac
and Kowal (1995) demonstrated that patients output after coronary artery bypass surgery
admitted to an ACE unit were more likely to than younger individuals when other vari-
improve in activities of daily living and were ables are held constant, such as premorbid
less likely to be institutionalized. Asplund conditions? Such parameters are needed for
et al. (2000) also demonstrated that ACE units the improvement of care for the elderly. The
reduce the institutionalization rate of the hos- Cochrane Collaboration published a review
pitalized elders. The overarching framework on interprofessional education (2009) that
for care on ACE units is interdisciplinary examined the effects on professional practice
teaming (Siegler, Glick, & Lee, 2002). in a pro- and healthcare outcomes and reported that
spective study of 804 patients 80 years of age data from six studies produced positive out-
or older, 42% of the elderly patients with no comes in satisfaction, collaboration, reduction

8 n ADDiCTioN CARE



of clinical error, and management of care altering substances and behaviors. over
for selected patient groups (Zwarenstein, time, the structure and the function of the
A Goldman, & Reeves, 2009). Although not spe- brain are changed (American Psychiatric
cific to geriatrics only, the data are promising Association, 2000; Angres & Bettinadi-
for improving care for hospitalized elderly Angres, 2008; Kleber et al., 2006; National
given the majority of patients in hospitals are institute on Drug Abuse [NiDA], 2010). The
older adults. individual may begin to display physical,
Historically, elders were not considered to cognitive, and behavioral symptoms. The
be “suitable candidates” for surgeries and treat- course of the disease is marked by periods of
ments that today are considered routine. in the use and abstinence with symptoms of with-
early 1970s, individuals older than 65 years drawal and the development of tolerance.
were excluded from surgical intensive care Frequently, physical and/or additional psy-
units, as it was felt that the cost benefit was not chological disorders are also present.
going to be in favor of the older patient. Today, Historically, substance abuse and sub-
individuals in their 80s and 90s undergo open stance dependence have been classified
heart surgery and require appropriate postop- as psychological disorders. Treatment has
erative care that only a surgical intensive care been typically provided in a psychiatric set-
unit can provide (Silverstein, 2010). ting, but individuals experience a variety of
Ethical issues abound regarding elders symptoms and enter care through many dif-
during a hospitalization. For example, if ferent portals. Nurses are usually the direct
there is an insufficient number of beds in an care provider at all points of entry. This
intensive care unit, should older individu- would suggest that all nurses should have at
als be sent out to the floor before younger least a basic understanding of the disease of
individuals? Are scarce resources allocated addiction. Even so, nursing has seen addic-
to younger individuals before they are used tion care as a specialty on its own or under
to care for the elderly? Further, elder abuse, mental health. There are professional nurs-
a serious and potentially fatal syndrome, is ing organizations dedicated to the specialties
frequently overlooked when elders come into of addictions and psychiatric nursing. The
the hospital with severe symptoms, such as international Nurses Society on Addictions
bilateral bruising, histories incompatible was established in 1975. Addictions nurs-
with injuries, and overt fear of caregivers. ing certifications were offered through the
These issues are a part of ACE and need to Addictions Nursing Certification Board at
be addressed with rigorous research studies. the generalist level (Certified Addictions
Studies involving younger individuals need Registered Nurse) starting in 1989 and at the
to be replicated among older adults to dis- advanced practice level (Certified Addictions
cern differences between the age cohorts. Registered Nurse–Advanced Practice) in
2000. The American Psychiatric Nurses
Terry Fulmer Association has been in existence since 1986.
Sarah Pernikoff in the past few years other nursing
specialty organizations, for example, the
Association of Nurses in AiDs Care and
the American Society of Pain Management
Addiction cAre Nurses, have been adding a focus on sub-
stance abuse disorders because of the comor-
bidity of their disorder with addiction. other
Addiction is usually defined as a chronic, specialty nursing organizations focus on
relapsing brain disease. it is characterized addiction because of the risk for substance
by the compulsive nature of the use of mood abuse or dependence that their members

ADDiCTioN CARE n 9



experience. Statistics support that all health The Center for Substance Abuse Treatment,
care provider groups have a 10% prevalence a part of the Substance Abuse Mental Health
for substance use, abuse, or neglect. in each Services Administration, the NiDA, and A
group, from 6% to 8% of the providers may the National institute on Alcohol Abuse
use to the extent that their practice is nega- and Alcoholism are the main resources for
tively affected. State Boards of Nursing dis- funding of research and information about
cipline approximately 6,000 nurses each year substance abuse and dependence. Many edu-
because of substance abuse or dependency. cational documents have been made avail-
Taking into consideration the numbers of able through publications available on their
individuals and professionals affected each Web sites.
year by the disease of addiction, the American According to the 2008 National Survey
Association of Colleges of Nursing (1998) on Drug Use and Health (NSDUH) for
introduced a position statement that outlined Americans 12 years and older, an estimated
the importance of including substance abuse 20.1 million Americans (8%) currently used
education in all curriculums in all schools of illicit drugs and 129 million (51.6%) were
nursing. To date, most nursing schools have current users of alcohol. More than 100,000
not responded to the recommendations of Americans die, and more than half a tril-
this position statement. lion dollars is spent each year as a result of
in the early thirties, alcoholism was the impact of substance abuse and addic-
explained by attributing it to an allergy tion (NiDA, 2010). Using the Diagnostic and
(Angres & Bettinadi-Angres, 2008). one of the Statistical Manual of Mental Disorders, fourth
best-known figures in the study of addiction, edition, an estimated 22.2 million persons
Bill Wilson, was inspired to start Alcoholics (8.9% of the population 12 years or older) met
Anonymous after experiencing treatment the criteria for substance dependence or abuse
under that theory. Hospitals in Minnesota in the prior year. Some 3.1 million Americans
attempted to partner with Alcoholics met the criteria for dependence or abuse of
Anonymous, giving rise to an altered con- both alcohol and drugs, 3.9 million for depen-
cept of substance abuse called the Minnesota dence or abuse of just illicit drugs, and 15.2
Model. This was the beginning of a disease million for abuse or dependence of just alco-
concept for addiction. Twenty years later, hol (Substance Abuse and Mental Health
E. Morton Jellinek would conduct research Services Administration, 2009). in 2008, 23.1
with male alcoholics and develop the Jellinek million individuals (9.2% of those 12 or older)
Curve (http://www.in.gov/judiciary/ijlap/ were in need of substance abuse treatment,
docs/jellinek.pdf) that became the basis for but only 2.3 million (0.9%) received it.
his Disease Concept of Alcoholism. Every segment of the population is
Then as now, diagnosis of this disease equally susceptible to this disease. Adole-
depends on the evaluation of presenting signs scence seems to be the period of time where
and symptoms reported by the affected indi- use is the highest. Educational programming
vidual, which are then fitted into a defined set has been directed toward prevention in an
of elements or criteria (Doweiko, 2006). Many attempt to decrease the initial experimenta-
health care professionals continue to work tion, but untreated use and abuse becomes
on a theory of addiction that will be accepted dependence. More effort needs to be directed
regardless of the specialty area or expertise toward educating parents, teachers, other
of the practitioners. This work continues to adults in authority, and health care providers
be difficult because definitions and termi- about recognizing the signs and symptoms
nology can vary from area to area, and many of use and abuse to increase the referrals to
individuals continue to believe that addic- treatment. Efforts have been made to inte-
tion is a choice or due to a lack of willpower. grate systems of service, that is, mental

10 n ADDiCTioN CARE



health, substance abuse, and primary care. an evidence base to provide guidance in set-
Consideration is being given to understand- ting and achieving specific outcomes from
A ing the dynamics of different populations treatment approaches in all practice settings
in the development of treatment approaches has given nursing the opportunity to be rep-
and guidelines. resented in interdisciplinary networks in any
Just as the theoretical understanding of practice setting that nurses choose for their
addiction as a disease process shaped the specialty. That has led to nursing represen-
field’s understanding of addiction, so has the tation on the National Quality Forum Task
theoretical approach to treatment changed in Forces, panels established by the Agency for
an effort to increase credibility and meet the Healthcare Research and Quality (2006) and
demands of the current climate. With increas- the Center for Substance Abuse Treatment,
ing health care costs and declining quality, researchers for organizations, agencies,
the institute of Medicine (ioM) produced facilities, and government programs, and
Crossing the Quality Chasm (ioM, 2001) and as authors for educational and professional
Improving the Quality of Health Care for Mental publications.
and Substance-Use Disorders (ioM, 2006). The goals of nursing and addiction care
These two documents recommend develop- research are closely aligned because they
ing a health care system that is safe, effective, are based on clinically relevant research and
patient-centered, timely, efficient, and equita- clinical expertise guided by the unique pref-
ble and serve as the framework for a redesign erences of the patient (ioM, 2001; McCarty,
of the health care system on the basis of six 2010). According to the National Quality
goals: (1) adapting care delivery to the new Forum (2007), research to this point has
process; (2) effective use of information tech- focused on four general areas: identifying
nology; (3) workforce adaptation and man- substance use conditions, approaches for
agement; (4) effective teaming of providers initiating and engaging participation, ther-
and coordinating care according to patient apeutic interventions, and coordination of
conditions, services, and settings; (5) measur- care. Some of the changes are integrated
ing quality; and (6) quality-based payment screening; protocols for addressing posi-
(ioM, 2001; Pincus et al., 2007). one of the tive screens, brief interventions, and refer-
changes that has risen from these recommen- rals; treatments and pharmacotherapy based
dations has been evidence-based research for on empirical data; and established perfor-
evidence-based practice. Although other def- mance and outcomes measurements (Baird
initions exist, the most widely accepted nurs- & Fornili, 2008; McCarty, 2010). Federal proj-
ing definition of evidence-based practice is ects are addressing integrated treatment for
that of Porter-o’Grady. Evidence-based prac- comorbid mental health and substance abuse
tice includes the integration of best research disorders; Screening, Brief intervention and
evidence with clinical expertise and patient Referral to Treatment for primary care pro-
values (Boswell & Cannon, 2009; Malloch & viders; clinical nursing guidelines for the use
Porter-o’Grady, 2006; McCarty, 2010). of suboxone; clinical guidelines for opioid
The social changes after World War ii addiction treatment; and issues with addic-
identified the need for nursing research in the tion and criminal justice.
1950s. Priorities began to be set, and master’s The evidence-based research and the
and doctoral programs for nurses became use of evidence-based practice are in their
available. Research focused on clinical prac- infancies for nursing and the addiction
tice, quality improvement, and establishment field. Resistance comes from concerns that
of evidence-based guidelines and standards approaches are simplistic and manualized.
of care (LoBiondo-Wood & Haber, 2006). Empirically based treatment needs to be
Now in the twenty-first century, the call for able to address all issues associated with

ADHERENCE/CoMPLiANCE n 11



addiction comprehensively. Research that literature was published in Nursing Research
links theory, education, and practice will be in 1970 by Marston. Since that time, there has
needed that focuses on diverse populations, been a profusion of research from a variety of A
directs the development of curriculums, disciplines. The majority of the research has
establishes priorities for workforce develop- been focused on patient adherence, although
ment, and influences the direction of policy there is a smaller body of literature on the
decisions. All nurses regardless of specialty adherence of research staff to clinical proto-
can participate by reading and sharing cols and a growing body of literature on pro-
applicable research within their own spe- vider adherence to treatment guidelines.
cialty area that increases their own exper- Studies on adherence have focused pri-
tise and improves patient care (Kronenfeld marily at the stage of maintaining a pre-
et al., 2007; LoBiondo-Wood & Haber, 2006; scribed and adopted treatment regimen.
McCarty, 2010). Nurses practicing in the spe- Adherence, however, is important from the
cialty areas of addiction and mental health time of regimen advice to the acquisition of
can participate in, conduct, or collect data the medication, food, exercise equipment,
for a variety of research improving quality and so forth, required to carry out that
of addiction care and increasing knowledge advice for the initiation of care, design and
about the disease. accurate management of the regimen, and
contribution over the short and long term.
Carolyn Baird These preceding stages have not been well
studied.
one of the issues that continue to arise
in discussions of patient adherence is patient
autonomy. is nonadherence a patient right or
Adherence/comPliAnce is adherence a patient responsibility? This
argument presumes that the patient is aware
of his or her own behavior and has con-
Adherence is defined as the degree to which sciously decided not to follow a treatment
behavior corresponds to a recommended regimen. The literature suggests that less
therapeutic regimen (Haynes, Taylor, & than 20% of patients with medication regi-
Sackett, 1979). Numerous terms have been mens consciously decide not to engage in a
used to describe this behavior, including treatment program. Those patients who have
compliance, therapeutic alliance, and patient decided to follow the regimen but do not
cooperation. Although the literature is filled carry it out are unaware of episodic lapses in
with discussion of the acceptability of these behavior or have difficulty in integration of
terms and the differences between them, the health care regimen into their lives. The
most investigators view the terms as synon- most common reasons given by patients for
ymous and independent of the decision to lapses in adherence are forgetting and being
engage in a particular therapeutic regimen. too busy. This group comprises on average
The most complete literature can be obtained 40% to 50% or more of patients in a treatment
from structured databases with the term regimen.
patient compliance. The problem of nonadherence is costly
Adherence to health care regimens has in terms of dollars and lives. The national
been discussed in the literature since the pharmacy council estimates that nonad-
days of Plato. However, little systematic herence to pharmacological therapies costs
attention was given to this phenomenon until $100 to $300 billion annually. Although the
the 1970s, when there was a proliferation cost of nonadherence to nonpharmacologi-
of research. one of the first reviews of the cal therapies has not been estimated, the

12 n ADvANCE DiRECTivES



contribution to morbidity and mortality is information, such as electronic monitors,
high. Failures to quit smoking, to lose and PDAs, and other technologies.
A maintain weight, to exercise regularly, to Future research on adherence should
engage in safe sex practices, to avoid excess address strategies by which nurses can
alcohol, and to use seat belts contribute sig- improve adherence to treatment regimens
nificantly to declines in functional ability with attention directed toward various age
as well as to early mortality. Further data groups, clinical populations, and regimen
suggest that nonadherence to pharmacolog- behaviors across the range from decision to
ical as well as nonpharmacological thera- adopt to long-term maintenance. The research
pies contribute to excess hospitalization and would benefit from theoretical approaches
complication rates. to the problem of patient adherence and the
Poor adherence then is a significant design of intervention strategies. Effective
problem of direct relevance to nursing. strategies delivered by nurses have consider-
Nurse practitioners may prescribe or recom- able promise of a favorable impact on health
mend therapies. Home health and commu- outcomes and costs.
nity nurses provide education and assistance
in carrying out health care advice. Hospital, This paper was supported in part by the National
clinic, and office nurses provide education institute of Nursing Research (grant no. 5 P30
regarding treatment plans. There is a need NR03924) and the National Heart, Lung, and
for intervention studies that will guide prac- Blood institute (grant no. 1 Uo1HL48992).
tice as nurses prepare and support patients Jacqueline Dunbar-Jacob
in the conduct of treatment regimens.
Research on adherence has been focused
heavily on the determination of the extent of
the problem and on predictors or contribut-
ing factors. The 2010 report on medication AdvAnce directiveS
adherence by the Cochrane Collaboration
suggested that just 70 randomized con-
trolled studies have evaluated interventions Despite the advances in medicine and tech-
to improve medication adherence and exam- nology that have occurred over the past cen-
ine both adherence and clinical indicators tury, it remains imperative for all individuals
as outcomes. Thirty-six reported improve- to consider and plan end-of-life care. Since
ment in adherence, 25 in outcome. Most of the late 1960s, individuals have been encour-
these used general educational or behavioral aged to obtain greater control in the decisions
counseling interventions. improving con- that affect their future medical treatment
venience system-wide interventions have and assure advance directives are in place.
shown modest improvements with the use of Advance directives are legal documents that
case managers. Fewer studies have examined allow a patient to express their choice about
adherence to lifestyle behaviors. medical care or name another individual to
one problem in evaluating interventions make decisions regarding medical treatment
and identifying relevant predictors is that in the event that they are unable to make deci-
of measurement. Most clinical studies have sions themselves. As many more Americans
relied on self-report of adherence. There is with chronic medical conditions and poor
a growing body of evidence indicating that medical prognoses experience the suffering
individuals do not report accurately, and and costs associated with end-of-life care, the
those reports are biased toward an over- need for adults to maintain their autonomy
estimate of performance. Thus, alternative and their dignity at end of life has prompted
strategies are being used to obtain better health care providers and lawmakers to

ADvANCE DiRECTivES n 13



encourage the development and implemen- desire on the basis of past discussions and the
tation of advance directives. individual’s moral, spiritual, and personal
There are two forms of advance direc- beliefs. The health care proxy has the same A
tives: the development of a living will and the rights to accept, to refuse, or to request medi-
designation of health care powers of attor- cal treatment that the individual would have
ney. in 1967, Luis Kutner, an attorney from if he or she has capable of making and com-
illinois, proposed that individuals needed to municating decisions. Because of this, some
have a way to speak to how they envisioned states statutes combine a power of attorney
their health care management when they and a living will into one document.
would not be able to verbally express their Should a patient not execute a health
wishes. This document is a written state- care proxy or living will, many states will
ment that states under what specific condi- designate a surrogate decision maker. Some
tions and individual would want to accept states will only do so under certain condi-
or reject life sustaining medical treatment. tions such as an individual having a terminal
Because the individual is alive, yet not able illness who is permanently unconscious or
to make decisions, this document is titled for specific types of treatment such as cardio-
a “living will.” The living will is only to be pulmonary resuscitation. in an emergency
used if the individual is unable to provided setting, outside of a hospital or medical facil-
informed consent or is medically incapaci- ity, advance directives may not apply. Some
tated. The living will includes specific infor- states may or may not allow emergency med-
mation regarding an individual’s desire for ical service personnel to resuscitate patients
medical interventions such as the use of life who have a bracelet designating themselves
support equipment such as ventilators, life as a “do not resuscitate” patient.
saving procedures such as cardiopulmonary The topic of advance directives is an
resuscitation, organ and tissue donation and extremely controversial subject that has
medical management such as the use of feed- created much debate regarding the right to
ing tubes, analgesia, and administration of stop medical treatments that could prolong
hydration. in 1976, California became the a patient’s life and allow natural death to
first state in the United States to legally sanc- occur. The debate and discussion became
tion living wills. Within a year, 7 states had widely known to the public in 1976 dur-
passed bills and 43 states had considered the ing the first “right to die” case surrounding
living will legislation, which subsequently Karen Ann Quinlan and again in 1990 dur-
progressed on a state-by-state basis. By 1992, ing the case of Cruzan v. Director Missouri
all 50 states had passed legislation to legalize Department of Health. Both cases involved
some form of advance directives. the desire of the patient’s families to dis-
A health care power of attorney, also continue feedings that were prolonging the
known as a durable power of attorney or a lives of two young individuals who did not
health care proxy, appoints a key individual have any clear verbal or written instruc-
to function as the formal decision maker and tions regarding their end-of-life treatment
make all decisions regarding the medical care desires. it was not until 1990 and the case
and treatment of an individual should that of Cruzan v. Director Missouri Department of
individual lose their decision making abil- Health that the U.S. Supreme Court agreed
ity. The designation of a health care power of to review a case regarding advance direc-
attorney is broader than the development of tives. Until that time, the Supreme Court
a living will because it includes all medical held the belief that legislation surrounding
decisions besides those pertaining to life sus- advance directives should be determined
taining treatment. The appointed designee at the state rather than the federal level.
must determine what the individual would in 1990, the U.S. Supreme Court upheld

14 n ADvANCE DiRECTivES



the Missouri Supreme Court standard that care issues with their health care provider at
required clear and convincing evidence of their office visit during a time that they are
A the patient’s wishes before permitting the less anxious. Literature on end-of-life care
family of Cruzan to discontinue the tube reveals that patients and health care profes-
feedings that were sustaining her life. sionals, including physicians, nurses, and
The U.S. government through the social workers, tend to avoid discussing
Congress and Supreme Court has demon- decisions about preparing for end-of-life care
strated interest in assuring the public is (Rizzo et al., 2010). The Study to Understand
aware of the benefits of advance directives. the Prognoses and Preferences for outcomes
in 1991, the U.S. House of Representatives and Risks of Treatment (SUPPoRT Principle
enacted the Patient Self Determination Act. investigators, 1995) involved 4,805 patients
This federal legislation validates the exis- in five teaching hospitals who were at an
tence of advance directives in each state and advance stage of illness. The study found
stipulates that all hospitals who received that physicians often ignored advance direc-
Medicare or Medicaid reimbursement must tives regardless of efforts made to improved
assure that patients have or would like to physician to patient communication regard-
have advance directives. Hospitals must ing end-of-life decisions.
offer assistance to patients in completing a There are limited studies that focus on
directive upon patient request. the effect and knowledge that nurses have
Although an individual may have regarding advance directives. Crego and
advance directives, there are situations in Lipp (1998) found that more than 50% of the
which they may not be complied with. Many nurses of the 339 nurses that were surveyed in
times, advance directives are not available a 600-bed acute hospital did not have a good
when they are needed because of the patient understanding of advance directives. Sixty-
not letting their loved ones know of the exis- seven percent thought that the nurse was the
tence of such a document or a hospital may most likely health care provider to assess the
fail to include a copy of the patients specific need for advance health care planning. Wood
advance directives in his or her medical and DelPapa (1996) conducted a small survey
chart. The interpretation of the terms within of hospital nurses (n = 112) and found that
an advance directive document can cause 76% of nurses had a low level of knowledge
debate, and a clearly written document may on questions related to advance directives.
also not represent a patient’s wishes as the A study by Scherer, Jezewski, Graves, Wu,
reality of their own death becomes immi- and Bu (2006) assessed 210 certified critical
nent. Health care proxies can have a difficult care nurses regarding their knowledge and
time following making decisions regarding experience regarding advance directives.
life-sustaining interventions because of their Results demonstrated that 94.8% of the crit-
own feelings and beliefs about death and ical care nurses felt that the nurse’s primary
their connection and relationship with the responsibility was to ensure that the patient’s
patient. decisions were met, 42.5% agreed that the
Further studies have demonstrated that a information available on advance directives
lack of advance care planning leads to issues, was sufficient to direct treatment, and 6%
questions, and concerns regarding end- had low knowledge scores on questions sur-
of-life care (Lawrence, 2010). Adults should be rounding advance directives.
encouraged to complete their advance direc- The role that advance directives play in
tives when discussing medical decisions with end-of-life care decision making will con-
their health care providers. Stetler, Elliott, tinue to be a topic of ongoing discussion and
and Bruno (1992) found that 60% to 80% of debate. This controversial discussion will
patients would like to discuss end-of-life continue to have an emotional impact on all

AGEiSM n 15



those involved. Further research is required How to delineate aging and the aging
to explore the role health care providers play process is a controversial and complex topic.
in assuring that patients and their families Prejudice, stereotyping, and labeling may A
understand the importance of advance direc- lead to policies for rationing health care: the
tives and that when in place, they are imple- withholding treatment based on age alone, a
mented and followed. lack of qualified personnel to care for older
adults, the underrepresentation of older
Kristy Dixon adults in clinical trials, and the underrecog-
nition of geriatric problems and syndromes
(Butler, 2008; Wallace, Greiner, Grossman,
Lange, & Lippman, 2006; Wilson, 2010).
Ageism can be seen on personal levels in
AgeiSm the daily care of older patients in a hospital
and on a population level when older adults
are excluded from disease screening or pri-
on July 7, 2010, Robert Butler died at the mary prevention programs (ory, Hoffman,
age of 83 years. He was the first to use the Hawkins, Sanner, & Mockenhaupt, 2003). As
term “ageism” and fought against stereotyp- technology continues to advance, the ability
ing and prejudice of older adults through to extend life becomes possible. This exten-
research and public policy. Butler himself sion of number of years often comes at the
was a living argument against ageism, work- price of chronic disease and a decreased qual-
ing until 3 days before his death, demonstrat- ity of life. As the number of elders continues
ing through his life and writings that older to grow at a rapid rate, the need to preserve
adults can maintain productive, optimistic, quality of life while maintaining autonomy
and engaged lives (Martin, 2010). for older adults is imperative.
Ageism is a negative attitude or bias Nursing research in ageism focuses
toward older people that can lead to a belief on several areas. Ageism research could
that older people cannot or should not partic- encompass studies that address how to best
ipate in certain activities or be given the same educate health professionals aging, exami-
opportunity as younger persons (Holohan- nation of student and practicing nurse’s atti-
Bell & Brummel-Smith, 1999). Elders repre- tudes, sociopolitical issues impacting older
sent 50% of hospital days, 70% of home adults, clinical care problems, and biological
health services, and 90% of residents in nurs- issues. Some of the current research impact-
ing facilities (Mezey et al., 2008). Almost all ing ageism involves the use of technology
health care personnel will find themselves at in multiple care settings (Tak, Benefield, &
one time or another caring for the elderly. in Mahoney, 2010), enhancing clinical care of
fact, the majority of nurses will spend most of elders through established programs (Allen
their career caring for older adults in a vari- & Close, 2010; Boltz et al., 2008), bolstering
ety of settings and will face a personal expe- geriatric education in baccalaureate programs
rience with aging in a family member or with through additional coursework and educa-
their won development. As these challenges tor training (Berman et al., 2005; Krichbaum,
are met, it is necessary to continually exam- Kaas, Mueller, & Wyman, 2010; Miller, van
ine the development of attitudes and roles in Son, Cartwright, & Allen, 2010; Wilson, 2010),
the prevention of ageism. older persons may and measuring the impact of gerontolog-
be discriminated against because of the way ical research in schools of nursing (Maas,
they look, speak, or function in a society that Buckwalter, Conn, & Tripp-Reimer, 2010).
values productivity, economic wealth, speed, The older population that is at the
youth, and beauty. greatest risk of prejudice, stereotyping, and

16 n AGEiSM



ageism, however, are persons with mental Ageism will continue to be important
illness, dementia, and mental retardation. in almost every area of geriatric nursing
A The diagnosis of dementia often stigma- research. Ageism will influence both the type
tizes both the patient and the family. As of research that is done and the public dissem-
new technologies and diagnostic techniques ination of research. Researchers must describe
become available, labels such as mild cogni- the relationship of ageism with qualitative
tive impairment also have the potential to and quantitative research in the areas of eth-
stigmatize patients and families (Garand, ics, workplace studies, decision making and
Lingler, Conner, & Dew, 2009). Research informed consent research, genetics, health
has demonstrated links between cognitive promotion and prevention screening, cancer,
impairment, cardiovascular disease, diabe- presentations of disease, symptoms research,
tes, and depression. This has highlighted the biomarkers of aging, quality of life, barriers
potential widespread impact of preventative to treatment, nursing home care and organi-
measures and health maintenance in older zational studies, resource utilization in health
adults. Further research on cognitive reserve care, dementia care, mental health, care of the
in dementia and delirium has advanced disabled older adult, and care of the diverse
the understanding of persons with multi- older adult population. The increasing role of
ple types of cognitive impairment and has technology in mitigating stereotypes of aging
exposed myths often held about this popula- will also be of great importance, as will the
tion, such as the inability to learn new infor- use of new technologies to allow older adults
mation or to change behaviors (Jones et al., to live independently. At the same time,
2010; Kolanowski, Fick, Clare, Therrien, & technology must not replace the human-to-
Gill, 2010; ory et al., 2003; Stern, 2009). human interaction (Harmon, 2010; Tak et al.,
This research is important as it forces the 2010), which is the foundation of nursing.
reexamination of stereotypes held about Nurses must also be aware of the role of
older persons and influences both care and popular media in socializing nursing edu-
treatment. cation, practice, and research. The popular
in addition to new diagnoses or labels, media socializes multiple age groups to ste-
certain conditions or circumstances that were reotypes. Nurses have the power to negate
relegated to old age are becoming issues in these typical roles, where older adults are
younger phases of life, such as hearing loss. seen as powerless. The media also portrays an
The resulting ageism and stigma (Wallhagen, “antiaging” campaign, where “70 is the new
2010) that occurs with such conditions may 60.” Practicing nurses, student nurses, educa-
be tempered by this shift. tors, and nurse scientists have the ability to
The economic impact of ageism is and show that older adults maintain productivity
will continue to be significant to gerontolog- and purpose in life, and in their daily work
ical nursing. Robert Butler, in his book The they must go beyond the media stereotypes
Longevity Revolution, argues that we should when examining aging and quality of life.
continue to work beyond the age of 65 years Researchers have agreed that past and
because early retirement can be equated to present experience with the elderly, faculty
wasted productive capacity (Butler, 2008). He role models, and continuing education pos-
maintains that this will help to combat ageist itively affects attitudes on aging (Burbank,
stereotypes. Beyond workforce issues, nurses Dowling-Castronovo, Crowther, & Capezuti,
will have a vital role in shaping the health care 2006; Wallace et al., 2006). Several government
system at local and national levels as it con- and privately funded programs are promot-
tinues to be reformed to meet the needs of our ing positive attitudes toward older adults by
aging population (Beverly, Burger, Maas, & showcasing geriatric nursing as a challeng-
Specht, 2010). ing and attractive specialty for practicing

ALZHEiMER’S DiSEASE n 17



nurses, bringing national attention to nurs- plaques and tangles. in addition, these physi-
ing care of the elderly, reaching out to hospi- ological deficits create a systemic effect on the
tal, home care, and nursing home nurses, and macrolevel function and affect an individual’s A
illustrating the need for more advance prac- ability to work or function in everyday life.
tice nurses and for basic gerontology content in nursing home residents, 61% were
in baccalaureate nursing programs to care cognitively impaired; however, only 12 had
for one of the most vulnerable populations a diagnosis in their records indicating cog-
(Berman et al., 2005; Boltz et al., 2008; Davis, nitive disturbance, and 43% were depressed
Beel-Bates, & Jensen, 2008; Maas et al., 2010; (McDougall, 1998). A study of the prevalence
Mezey et al., 2008; Rieder, 2006). of dementia among Black and White resi-
Nursing has a vital role in combating dents being admitted to nursing homes found
ageism and continues to be in a key position rates 50% higher among Blacks than Whites.
to minimize ageist attitudes in the future. in other studies, the prevalence of dementia
Nurses must be involved in future studies in Maryland nursing homes was estimated
to investigate these important and relevant between 49% and 54% (Magaziner et al., 2000;
areas of research and in dissemination of Weintraub et al., 2000). With the increase in
these findings through best practice initia- the number of assisted living facilities and
tives. in addition, nurses must be prominent continuing care retirement communities,
in other relevant arenas (intergenerational projections are following the same patterns
linkages, global attitudes on aging, and work- as nursing homes. For example in Maryland,
force) that challenge stereotypes of aging and the prevalence of dementia and other psychi-
promote appropriate views and care of older atric disorders was 68% from a random sam-
adults. Perhaps the most lasting and power- ple of 22 facilities. Differences were notable
ful way to combat ageism is through mentor- between large (63%) and small facilities (81%).
ing of practicing nurses, nurses in training, These findings support earlier findings that
and young adults by encouraging active dia- differentiate the facilities on the basis of the
logue and interaction with older adults. number of residents (Rosenblatt et al., 2004).
The number of new cases of AD, par-
Andrea M. Yevchak ticularly for minority elders, is expected to
Donna M. Fick increase threefold to 13.2 million by 2050
(Hebert, Scherr, Bienias, Bennett, & Evans,
2003). The health disparity between these
groups of older adults and mainstream groups
Alzheimer’S diSeASe is illustrated by the disproportionate preva-
lence of cognitive impairments and demen-
tia in this population. African Americans
Alzheimer’s disease (AD) is a psychiatric are projected to increase more than 31% and
diagnosis that affects the lives and families of Hispanics more than 86% compared with a
some 5 million individuals who are diagnosed 15% increase in Anglos. Nationwide, by 2025,
(Alzheimer’s Association, 2010). The Diagnostic 10% of the population will be older than 65
and Statistical Manual of Mental Disorders out- years, a trend that is reflected in the popu-
lines a detailed set of criteria for the diagnosis lations of many countries around the world.
of AD, specifically multiple cognitive deficits, How cognitive function is determined also
including memory impairment, and neurolog- plays a major role in recognition of an impair-
ical symptoms, including one of either agno- ment in minority populations (Parker &
sia, aphasia, apraxia, and impaired executive Philp, 2004; Wilder et al., 1995).
function. Microcellular damages are nota- With the increase in minority elders pro-
ble because of the formation of beta-amyloid jected, for example, Hispanic to increase 86%