Original Article

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Health-care professionals' documentation of wellbeing in patients following open heart surgery: a content analysis of medical records

1. Ann-Kristin Karlsson PhD Medical Social Worker^1,*, 
2. Evy Lidell PhD Associate Professor Member^2,3, 
3. Mats Johansson PhD Cardiologist⁴

Article first published online: 8 OCT 2012

DOI: 10.1111/j.1365-2834.2012.01458.x

© 2012 Blackwell Publishing Ltd

Issue

Journal of Nursing Management

Special Issue: This issue: Promoting excellence - Evidence-based Practice at the Bedside and Beyond Issue editors: Kristiina Hyrkas and James P. Rhudy Jr

Volume 21, Issue 1, pages 112–120, January 2013

Keywords:

• documentation;
• healthcare professionals;
• open heart surgery;
• wellbeing

Aim

To explore health-care professionals' documentation of patient wellbeing in the first five months after open heart surgery.

Background

Open heart surgery (coronary artery bypass grafting or heart valve replacement) is an intervention aimed at relief of symptoms and increased wellbeing. It is a complex procedure with deep experiences encompassing physiological, psychological and social aspects. Health-care professionals' documentation of expressions of decreased wellbeing related to open heart surgery is an important basis for decisions and for the understanding of patients' overall health situation.

Method

Eighty medical records were examined by means of qualitative and quantitative methods in order to explore documentation of patient wellbeing at four points in time. The analysis was performed by content analysis and descriptive statistics.

Results

Documentation of physical wellbeing was dominant on all occasions, while psychological wellbeing was moderately well documented and social aspects of wellbeing were rarely documented.

Conclusion

The medical records did not adequately reflect the complexity of undergoing open heart surgery. Hence the holistic approach was not confirmed in health-care professionals' documentation.

Implications for nursing management

Managers need to support and work for a patient-centred approach in cardiac care, resulting in patient documentation that reflects patient wellbeing as a whole.

LINK TO onlinelibrary.wiley.com/full

An Update of Childhood Genetic Disorders

1. Cynthia A. Prows MSN, CNS, FAAN¹,
2. Robert J. Hopkin MD², 
3. Sivia Barnoy PhD, RN³, 
4. Marcia Van Riper PhD, RN, FAAN⁴

Article first published online: 7 JAN 2013

DOI: 10.1111/jnu.12003

© 2013 Sigma Theta Tau International

Issue

Journal of Nursing Scholarship

Volume 45, Issue 1, pages 34–42, March 2013

Keywords:

• Child health/pediatrics;
• genetics/heredity;
• evidence-based practice;
• neonatal/infant

Abstract

Purpose: Thousands of single gene, mitochondrial, and chromosomal disorders have been described in children. The purpose of this article is twofold. The first is to increase nurses’ awareness of new developments in genetic disorders that are commonly seen in practice and taught in schools of nursing. The second is to illustrate important genetic concepts of relevance to nurses who care for infants, children, or adolescents.

Organizing Construct: This article is organized into four sections: one that describes new developments in a well-known disorder, a second that discusses the process and potential outcomes of diagnosing a very rare disorder, and the third and fourth sections that describe select conditions caused by single gene mutations.

Methods: Clinical expertise was paired with literature review to present evidence-based current information. Implications for nursing practice are highlighted throughout the article. Citations of publicly available evidence-based online resources are used so nurses can continue to use these in their practices.

Findings: Diagnosis and treatment strategies for children with genetic disorders are rapidly changing. While it is impossible to stay current in all disorders, resources are available to help nurses provide evidence-based care to children with genetic disorders.

Clinical Relevance: Nurses have an important role in the early identification of children with genetic disorders and in facilitating their access to appropriate services and resources. Nurses can also help families understand why genetic testing may be necessary and assure families are informed throughout the process.

LINK TO onlinelibrary.wiley.com/full

Implications of Newborn Screening for Nurses

1. Jane DeLuca PhD, RN, CPNP, APNG¹,
2. Karen L. Zanni MSN, ARNP-BC, RN-C²,
3. Natasha Bonhomme BA³, 
4. Alex R. Kemper MD, MPH, MS⁴

Article first published online: 31 JAN 2013

DOI: 10.1111/jnu.12005

© 2013 Sigma Theta Tau International

Issue

Journal of Nursing Scholarship

Volume 45, Issue 1, pages 25–33, March 2013

Keywords:

• Neonatal screening;
• ethics;
• genome;
• nursing practice

Abstract

Purpose: Newborn screening has dramatically decreased the morbidity and mortality associated with a wide range of heritable conditions. Continuing advances in screening technology and improvements in the effectiveness of treatment are driving the rapid expansion of newborn screening programs. In this article, we review issues in newborn screening care and opportunities for nurses and nursing faculty to provide education and conduct research to improve the impact of newborn screening.

Organizing Construct: This article provides (a) an overview of current newborn screening activities, including how conditions are added to newborn screening panels and how implementation occurs at state and national levels; (b) a description of current controversies and ethical considerations; (c) a description of the roles of nurses in the newborn screening process; (d) suggestions for nursing education and research; and (e) a summary of expected future developments in newborn screening, including genome sequencing.

Conclusions: Nurses are uniquely well suited to address the educational needs and future research in newborn screening because of the role that nurses play in the provision of direct clinical care and in population-based healthcare delivery.

Clinical Relevance: Newborn screening is a public health approach to the identification of rare but treatable conditions in early infancy. In the United States, as in other industrialized countries, newborn screening is rapidly expanding. Nurses, nurse educators, and nurse researchers are positioned to contribute to the field of newborn screening by assuring programs are implemented safely and effectively, by facilitating education of the nursing work force, and by developing and contributing to research programs in newborn screening.

LINK TO onlinelibrary.wiley.com/full

Ethical, Legal, and Social Issues in the Translation of Genomics Into Health Care

1. Laurie Badzek LLM, JD, MS, RN, FAAN¹,
2. Mark Henaghan LLB², 
3. Martha Turner PhD, RN³, 
4. Rita Monsen DSN, MPH, RN, FAAN⁴

Article first published online: 31 JAN 2013

DOI: 10.1111/jnu.12000

© 2013 Sigma Theta Tau International

Issue

Journal of Nursing Scholarship

Volume 45, Issue 1, pages 15–24, March 2013

Abstract

Purpose: The rapid continuous feed of new information from scientific discoveries related to the human genome makes translation and incorporation of information into the clinical setting difficult and creates ethical, legal, and social challenges for providers. This article overviews some of the legal and ethical foundations that guide our response to current complex issues in health care associated with the impact of scientific discoveries related to the human genome.

Organizing Construct: Overlapping ethical, legal, and social implications impact nurses and other healthcare professionals as they seek to identify and translate into practice important information related to new genomic scientific knowledge.

Methods: Ethical and legal foundations such as professional codes, human dignity, and human rights provide the framework for understanding highly complex genomic issues. Ethical, legal, and social concerns of the health provider in the translation of genomic knowledge into practice including minimizing harms, maximizing benefits, transparency, confidentiality, and informed consent are described. Additionally, nursing professional competencies related to ethical, legal, and social issues in the translation of genomics into health care are discussed.

Conclusions: Ethical, legal, and social considerations in new genomic discovery necessitate that healthcare professionals have knowledge and competence to respond to complex genomic issues and provide appropriate information and care to patients, families, and communities.

Clinical Relevance: Understanding the ethical, legal, and social issues in the translation of genomic information into practice is essential to provide patients, families, and communities with competent, safe, effective health care.

Ethical and legal foundations provide a framework for understanding the appropriate incorporation of genomic information and its translation into healthcare practice. A description of the ethical, legal, and social concerns as they relate to healthcare provider obligations, legal and ethical concepts, including confidentiality, informed consent, the duty to warn, access, and genetic testing, are topics presented. Healthcare providers, including nurses, have a social and professional responsibility to ensure fairness and equity to patients, families, and communities amid rapidly developing technology.

The need for health provider education and competency has been established. Competencies related to ethical, legal, and social issues have been developed in the United States, United Kingdom, and other countries worldwide (Jenkins & Calzone, 2007; Kirk, Calzone, Arimori, & Tonkin, 2011). Despite accepted and approved competencies, education and resources are still in their development and are challenged by the continuous stream of new genomic information, some of which is not yet fully applicable to clinical practice (Tonkin, Calzone, Jenkins, Lea, & Prows, 2011).

LINK TO onlinelibrary.wiley.com/full

Current and Emerging Technology Approaches in Genomics

1. Yvette P. Conley PhD¹, 
2. Leslie G. Biesecker MD², 
3. Stephen Gonsalves MSN³, 
4. Carrie J. Merkle RN, PhD⁴, 
5. Maggie Kirk PhD, BSc(Hons), DipN, RGN⁵, 
6. Bradley E. Aouizerat PhD⁶

Article first published online: 7 JAN 2013

DOI: 10.1111/jnu.12001

No claim to original US government works

Issue

Journal of Nursing Scholarship

Volume 45, Issue 1, pages 5–14, March 2013

Abstract

Purpose: To introduce current and emerging approaches that are being utilized in the field of genomics so the reader can conceptually evaluate the literature and appreciate how these approaches are advancing our understanding of health-related issues.

Organizing Construct: Each approach is described and includes information related to how it is advancing research, its potential clinical utility, exemplars of current uses, challenges related to technologies used for these approaches, and when appropriate information related to understanding the evidence base for clinical utilization of each approach is provided. Web-based resources are included for the reader who would like more in-depth information and to provide opportunity to stay up to date with these approaches and their utility.

Conclusions: The chosen approaches—genome sequencing, genome-wide association studies, epigenomics, and gene expression—are extremely valuable approaches for collecting research data to help us better understand the pathophysiology of a variety of health-related conditions, but they are also gaining in utility for clinical assessment and testing purposes.

Clinical Relevance: Our increased understanding of the molecular underpinnings of disease will assist with better development of screening tests, diagnostic tests, tests that allow us to prognosticate, tests that allow for individualized treatments, and tests to facilitate post-treatment surveillance.

Improvements in genomic data collection technologies have been an important driving force behind the increased accuracy and rapidity in which we can currently collect genomic data. Improved accuracy and rapidity of data collection are also very important aspects of moving genomic findings into the clinical arena for translation to patient care. This article focuses on four approaches: genome sequencing (Biesecker, 2012; Rizzo & Buck, 2012), genome-wide association studies (GWAS; Marian, 2012), gene expression profiling (GEP; Arao, Matsumoto, Maegawa, & Nishio, 2011), and epigenomics (Emes & Farrell, 2012). Genome sequencing and GWAS both interrogate DNA directly, with the former generating information about the order of DNA nucleotide bases and the latter generating data about genotypes at specific places in the DNA. GEP interrogates messenger RNA (mRNA) that is generated when a gene is “active” and transcribed and therefore gives us information about gene regulation. Epigenomics interrogates the DNA, but unlike genome sequencing and GWAS it generates data related to chemical modifications and structure of the DNA, which impact gene regulation, and not the sequence or genotype information held in the DNA. Each of these approaches has utility and challenges, but all are contributing to our better understanding of important health-related issues and are gaining momentum for clinical value.

Our goal with this article is to introduce the reader to these approaches; discuss their application to current research, their current and potential clinical applications, and challenges related to using the technologies for data collection and interpreting data generated by these technologies; and, if appropriate, provide data related to evidence base for clinical application. This article incorporates a thorough literature review but is not intended to provide an exhaustive coverage of these approaches; however, additional online resources (see Clinical Resources) are provided for the reader who would like to gain more understanding of these approaches and associated technologies and the large-scale projects that are currently using them. We, as the authors, acknowledge that the information about these technologies, particularly in reference to current research findings and clinical applicability, changes rapidly. We hope that the online resources will also allow the reader to stay up to date with these technologies and their application to health care.

LINK TO onlinelibrary.wiley.com/full