Journal of Nursing & Care

This article explores the use of Mezirow's Transformative Theory in nursing education. The author offers compelling evidence to broaden the use of this theory by nurse educators in designing curricula while incorporating national standards of practice and safety guidelines. Addressing the disorienting dilemmas facing nursing, letting go of out dated frames of reference can positively impact patient care.

Vital signs provide critical information about health and help form the baseline for clinical care. Twenty years ago, the Nutrition Screening Initiative posed nutrition screening as a vital sign for older Americans but this has still not occurred. Nursing is on the frontline for monitoring as well as working to improve nutrition intake in collaboration with dietitians and other healthcare professionals. This article describes the importance of malnutrition screening, key indicators of elder well-being, and how the older American population has changed in the last few decades. The article also chronicles the multidisciplinary Nutrition Screening Initiative, its accomplishments, challenges, and new developments including new screening data collection instruments and the frailty index. Other developments described are the Alliance to Advance Patient Nutrition's intervention framework and documentation of the economic value of nutrition intervention. Opportunities and next steps for nurses to help malnutrition screening become a vital sign are identified. These include the need to make malnutrition screening and intervention part of the core training for nurses. In the hospital setting, the Joint Commission requires that all patients be screened for malnutrition within 24 hours, however malnutrition interventions are often lacking. Thus another opportunity is for malnutrition measurement and documentation to be developed as a summative measure and included as part of the standardized nursing language, with a specific section in the Electronic Health Record. Becoming part of national health goals, such as the Healthy People 2020 objectives, is an additional important step for the evolution of malnutrition screening as a vital sign as is integrating malnutrition screening and intervention into healthcare incentives, including the Patient Protection and Affordable Care Act, transitions of care, and community intervention. Finally, committing funding for malnutrition screening, such as through reauthorization of the Older Americans Act, and gaining key learning from international experiences are important.

The prevalence of overweight and obesity has increased over the last decades. Parental obesity plays an important role in determining childhood obesity. We aimed to evaluate the relationship between parental and offspring’ weight status in a population of children from South of Italy, as no data have ever been published from this area. We recruited 636 children (5.7 ± 1.5 years old) and their parents. Seventy-three (11.5%) and sixteen (2.5%) children were overweight and obese, respectively. Offspring weight status was significantly associated with parents’ weight status. The linear regression analysis showed that offspring BMI was more affected by paternal than by maternal BMI. Our data confirmed that parents’ weight status plays an important role on children’s BMI. Interestingly, in our study, parents’ height and weight were measured and not reported as in most of the previous papers, strengthening our conclusions. We suggest that intensive nutritional education and preventive programs should be performed in children with overweight / obese parents rather than in children with normal weight parent. Furthermore, nutritional education should be performed also for overweight parents to modify preventable risk factor for pediatric obesity.

The prevalence of Type 2 diabetes mellitus has dramatically increased and patients may require insulin therapy to effectively manage their diabetes mellitus. Nurses and other health professionals can assist these individuals to be more confident as they initiate and continue insulin therapy. This article discusses barriers to initiating insulin, target glycemic goals, and common regimens used for initiating and titrating insulin in individuals with T2DM. Implications for health professionals are addressed. Literature was reviewed using key words for regimens used for initiating and titrating insulin in individuals with type 2 diabetes mellitus and limited to those published in English from January 2007 to December 2014, unless earlier data were cited in papers as a primary source. Many reviewed sources cited information derived from the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) and the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD). Common insulin regimens use basal insulin only and basal insulin plus a rapid-acting insulin to one or more meals. Health clinician, health system, and patient barriers influence initiating and titrating insulin therapy to achieve target goals consistent with a HbA1C of <7.0%, except in patients with multiple co-morbidities or severe hypoglycemia. Health professionals must work together to assess patient characteristics; determine target glucose goals; use strategies to address heath clinician, health system, and patient barriers; and initiate and titrate insulin therapy.

Background: Child and elder abuse and/or neglect have been a long standing healthcare topic. Family structure, socioeconomics, and developmental tasks often increase the burden for healthcare providers to identify abuse and neglect of the very young or elderly. These same factors often increase the risks for abuse or neglect. However, there are individual state laws requiring healthcare professionals report suspected abuse/neglect, else face legal ramifications. Abuse may appear in multiple forms according to Dong (2012). These include maltreatment in the form of psychological, physical, and sexual abuse, neglect and financial exploitation. Childhood abuse often leads to psychological issues that follow the individual into adulthood. It is important nurses learn to recognize signs and symptoms of abuse and/or neglect and report per local regulation requirements. Advocating for one's patient(s) and for one's self creates positive outcomes for all involved.

Purpose: The purpose of this manuscript is to encourage nurses across the United States to acquire education on abuse and/or neglect reporting requirements and to take action when appropriate, advocating for those that cannot self-advocate.

Conclusions: It is imperative nurses recognize the signs and symptoms of abuse and neglect, advocate for those that cannot do so and follow local state regulations/laws. Literature research reveals approximately 120 children are substantiated as experiencing abuse and/or neglect per hour. In the U.S. greater than 3.4 million children will live with a grandparent due to mother substance abuse disorder and the number of abused or neglected elderly is simply unknown.

Background: Diabetes Mellitus is a global public health concern for many nations in the 21st Century with approximately 246 million people worldwide living with diabetes. A large number of research studies have it that nurses’ knowledge on diabetes mellitus is poor and that there is the need to increase their knowledge level for effective management of patients with diabetes mellitus. In some cases, nurses’ knowledge was adequate but they lacked knowledge in certain aspects of diabetes mellitus care especially, diabetic complications and insulin advancements. Also, there was a general notion in Sub-Saharan Africa that health care workers were insufficiently trained in chronic disease management. Methods: With this in mind, there was the need to find out the knowledge level of nurses in the Central Region of Ghana, particularly the Central Regional Hospital, the District Hospital and the University Hospital. To arrive at that a modified version of The Michigan Diabetes Research and Training Centre’s Brief Diabetic Knowledge Test was administered. Results: Fourty- four 44 (32.4%) of the respondents’ knowledge was good.However, knowledge level in the area of diabetic complications was generally poor among majority (68.4%) of the respondents. Conclusions: It is recommended that nurses continue to upgrade their knowledge in the area of diabetes mellitus, particularly in the area of diabetes complications and insulin advancements.

Nurses represent the largest community in the health system. At the same time, they are the closest to the patients among all health care providers. Furthermore, nurses’ roles contain a lot of interaction with patients. This interaction hides huge potential possibilities for them to face moral situations. In addition, moral situations usually have a complex nature. For all that, nurses should be prepared with knowledge and critical thinking skills to be able to make sound moral decisions. This paper discusses the ethical dimensions of an incident. The incident presents the conflict nurses usually face during and after making a paternalistic intervention. The aim of this paper is to discuss the ethical issues related to the paternalistic interventions in the light of the suitable ethical theories in the literature.

Health care requires increasing the number and quality of registered nurses to the baccalaureate level to address part of the critical nurse shortage problem and need for highly qualified professionals. Two major national initiatives examining the nursing workforce issue in the United States recommend decreasing barriers, refining academic pathways and facilitating nurses return to school for higher levels of education by streamlining nursing education between community colleges and baccalaureate programs. Nurses prepared at higher levels have demonstrated stronger patient outcomes and ability to provide safe and effective care. This study sought to define barriers, priorities and enhancement/motivational factors, as identified by students, during transition from associate degree to baccalaureate nursing degree completion programs. Additionally, demographic data was compared to barriers and enhancement factors to determine if any associations between these exist. Students were provided with an electronic survey tool that allowed easy access and return. The outcome data from this pilot study provides nursing educators and professional practice leaders a better understanding the barrier factors, allowing leaders to design programs, delivery models, advising, and address needed areas of additional support or elimination to promote student success. At the same time, identified enhancement factors can be increased, streamlined for students.

Objective: The specific aims of the present study were to explore the parenting experiences of those with 11 to 15 year old children, and the experiences of professionals working with both adolescents and their parents, in order to assess the need for parent education programs.

Methods: This study used a qualitative descriptive design. Data were collected through individual and focus group interviews with parents of adolescents and mental health professionals that work with both adolescents and parents. Interviews were conducted at participants’ homes, workplaces, cafés, or local community meeting rooms. The interviews lasted for half an hour to 2 hours and were audio-taped. Qualitative content analysis was used for data analysis.

Results: A total of 27 parents (2 fathers, 25 mothers) and 9 mental health professionals (1 male, 8 female) participated in the study. As parents recognize their child’s developmental changes during adolescence, parents also go through a variety of feelings related to this transition. These were categorized into four main themes: “standing in the midst of numerous discrepancies,” “outside my child’s closed door,” “over-identifying myself with, yet distancing myself from, my child,” and “feeling ambivalent.” The present study also demonstrated parents’ need for structured, interactive, and accessible parent education programs that provide an opportunity for self-reflection on their parental experiences, and not just simply deliver knowledge and parenting skills.

Conclusion: The findings of the study revealed several challenges experienced by Korean parents with 11 to 15 year old children. Unsuccessful management of these challenges was found to result in the onset of negative emotions and thoughts, and the development of parent–child conflicts. In order to better promote the parent–child relationship and the mental health of children during their transition to adolescence, effective and accessible parent education programs that reflect the needs and expectations of parents are required.