What about public health?

Please consider this post in light of a preventive perspective targeting multiple etiologies and not correlations. This is not meant to disrespect all the great work public heath has been and is currently providing* 
The major causes of disease and death (DaD) in the 21st century have never been scientifically proven although outcomes have been correlated and mistakenly identified as causes. This is one of the greatest mistakes in public health and medicine today (Taubes, 2012). It can be speculated that major causes of DaD are the standard American diet (SAD), iatrogenic comorbidity (Starfield, 2000), and toxic environmental factors (Walsh, 2010). Perhaps the greatest influence is our biological mismatch (Kruse, 2012). Our lives no longer synchronize with the Earth’s cyclical rotations affecting great influence on our collective behavior. Hormone, immunity, and metabolic functional alterations can result from mismatches with natural circadian rhythms (O’Connor, 2012), food availability cycles (Kruse, 2012), and seasonal sunlight temperature fluctuations all correlating with DaD (Hastings Maywood & Reddy, 2003).
Public heath has made great strides reducing pathogenic morbidity. Unfortunately, the factors mentioned above are not considered when attempting to moderate major diseases resulting from these influences. As a result, cardiovascular disease, cancer, and respiratory infections are free to develop and reveal themselves as top killers in our country (Leading Causes of Death, 2012). Public health and modern healthcare can provide invaluable service to their constituents by targeting pathways that optimize immunity, increase longevity, and improve health status by replacing methods that facilitate further disruption of our physiologic mechanisms. The disturbing effects on our homeostatic ability (MacDonald & Monteleione, 2005) in addition to perpetuating a dysfunctional healthcare system (Starfield, 2000) needs serious consideration.
One public health strategy used to reduce pathogenic disease is to regulate food production and distribution. Preventive practice in this area has fallen through the cracks. Animals and plants mass produced for consumption are now adulterated with pesticides, hormones, antibiotics, and genetic modifications. These are all factors influencing our epigenetic predisposition. Autism is now found in 1 of 54 boys and 1 of 252 girls (CDC, 2012). Genetics can only take so much responsibility. Environmental influences that predispose us to disease and death should be a major consideration for public interest.  How public health choses to move forward must include looking backward. What we consider causes are often merely symptoms.

CDC (2012). Autism Spectrum Disorders (ASDs). Retrieved March 31, 2012 from http://www.cdc.gov/ncbddd/autism/index.html

Hastings, M., Maywood, E., and Reddy, A. (2003). A clockwork web: circadian timing in brain and periphery, in health and disease. [Abstract]. Nature Reviews Neuroscience. 4:649-661. Retrieved March 31, 2012 from http://www.nature.com/nrn/journal/v4/n8/abs/nrn1177.html
Kruse, J. (2012). Why perspective Matters? Cellular theory of relativity. Living an Optimized Life. Retrieved March 31, 2012 from http://jackkruse.com/why-perspective-matters/
Leading Causes of Death, (2012). Centers for Disease Control and Prevention. Retrieved March 31, 2012 from http://www.cdc.gov/nchs/fastats/lcod.htm
MacDonald, T. and Monteleione, G. (2005). Immunity, inflammation, and allergy in the gut. [Abstract]. Science. 25(307) pp.1920-1925. DOI: 10.1126/science.1106442
O’Connor, A. (2012). Really? The Claim: Your Body Clock Can Determine When You Get Sick. New York Times. Retrieved March 31, 2012 from well.blogs.nytimes.com/2012/02/27/really-the-claim-your-body-clock-can-determine-when-you-get-sick/
Starfield, B. (2000). Is US Health Really the Best in the World? The Journal of American Medical Association. 284(4):483-485. doi: 10.1001/jama.284.4.483
Taubes, G. (2012). Science, Pseudoscience, Nutritional Epidemiology, and Meat. Retrieved March 31, 2012 from http://garytaubes.com/2012/03/science-pseudoscience-nutritional-epidemiology-and-meat/
Walsh, B. (2010). Environmental Toxins. Time Magazine. Retrieved March 31, 2012 from http://www.time.com/time/specials/packages/article/0,28804,1976909_1976908,00.html

Qualitative vs. Quantitative Research

Qualitative research (QlR) and quantitative research (QnR) each have their own strengths and weaknesses. When it comes to the rubber meeting the road, both types of research are immensely important. Some researchers have argued that neither is genuinely independent of each other while others go as far as proclaiming, “There is no such thing as qualitative data” (Writing@CSU, 2012). I personally believe that both are so intricately linked, one without the other is generally inadequate for effective evidenced-based treatment outcomes. Both types should be considered in order to address behavior and clinical issues. Now on to my brief and limited perspective about some of the shortcomings . . .
If you are a strict researcher interested in facts substantiated by definitive measurements, then qualitative research is not your thing. Qualitative research focuses on holistic processes through a narrative and subjective analysis (Polit & Beck, 2012). Since people’s perspectives are the receptacle of inquiry, numerical data, questionnaires, and other inventories are generally unnecessary. The researcher often works with the subjects in the field to learn about the interested phenomena. The results can often reflect the researchers’ original bias or the subjects’ worldview. It may be difficult to determine exact mechanisms of underlying principles since the researcher is striving to find out the how or why phenomena occur in the absence of scientific experimentation (Polit & Beck, 2012). It is generally observational in nature and as a result is challenged when determining causal factors.
Quantitative research seeks to understand variables and causal pathways with quantifiable data and controls (Answers Research, 2011). What QnR often fails to do is see the 30,000-foot picture since it is focusing on specific variables. Since the bigger picture is usually missed, additional or alternative causal factorsn, and confounding variables are overlooked. Even though this type of inquiry’s lens is limited, some of the things touted as strengths are statistical power and large amounts of data. This can be expensive and complicated. As a result, financial interests can creep into bias, reported, data, and outcomes (Freedman, 2011). QnR also tends to be shorter in duration not allowing for deeper, long-term statistical intervention analysis. In addition, misuse of data, simple errors, and research bias can reduce the validity and accuracy of the underlying hypothesis (Freedman, 2011).

Answers Research, (2011). Articles: Quantitative vs. qualitative. Retrieved February 6, 2012 from www.answersresearch.com/article9.php
Freedman, D. (2011). Lies, Lies, Damned Lies, and Medical Science. The Atlantic Monthly. Retrieved February 6, 2012 from http://www.theatlantic.com/magazine/ archive/2010/11/lies-damned-lies-and-medical-science/8269
Polit, D. and Beck, C. (2012). Nursing research: Generating and assessing evidence for nursing practice [9th ed.]. Philadelphia, PA: Lippincott Williams & Wilkins.
Writing@CSU, (2012). The qualitative vs. quantitative research debate. Colorado State University. Retrieved February 6, 2012 from http//:writing.colostate.edu/guides/research/ gentrans/pop2f.cfm

A Tidbit on Nursing and Theories

Nursing theory is invaluable to application of practice. What theory a nurse adheres to is not as important as thoughtful consideration of practice and incorporation of the theory. The benefits of theory application are observed in treatment outcomes and thinking processes (McEwen & Wills, 2011). Theories use principles of reasoning that define our practice through structured models, systematic explanation, and evidenced-based research.
Currently, I am incorporating scientific research rarely defined by nursing theory into my understanding of health and wellness. I do not prescribe to any specific theory and pull from most theories to some extent. As a nurse seeking to understand how to improve my health and reduce all risk factors associated with morbidity and mortality, the general systems theory, adaptation theory, and developmental theory (Nursing Theories, 2011) all play into my understanding of the complex mechanisms of homeostasis, intra/intercellular communication, and the external influences that direct health outcomes.
The general systems theory seeks to define the whole person into compartmentalized parts and then explain how these parts interact and influence the whole person (Nursing Theories, 2011). One area I am currently studying is cardiovascular disease. This theory is critical in understanding how specific parts of the whole like cholesterol and cytokines are influenced by bodily responses to intake and how these responses impact systemic immunity, cardiovascular disease, and cancer.
Adaptation theory explains how we adapt and our body evolves and changes through hormesis or becomes damaged by mutagenic forces. It also describes how we interact and respond psychologically both socially and personally to external and internal influences (Nursing Theories, 2011).
Developmental theory seeks to explain how we as people go through stages physically, mentally, socially, and emotionally and how these factors influence our quality of life, decisions, and perspectives (Nursing Theories, 2011).
Finding how a theory or theories fit into our professional practice is a natural outcome of personal exploration by seeking to understand ourselves, our profession, and the world around us. Applying scientific theory that explains the influences of our behaviors, health, and values will help us to continue to grow as professional and people while we contribute to the world around us.
McEwen, M. and Wills, E. (2011). Theoretical Basis for Nursing. [3rd ed.]. Philadelphia, PA: Wolters, Kluwer/Lippincott, William, and Wilkins
Nursing Theories: An Overview, (2011). Retrieved December 9, 2011 from http://currentnursing.com/nursing_theory/nursing_theories_overview.html

Gender Bias In Nursing Education

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Summary of Article
            The article, Warming the nursing education climate for traditional-age learners who are male, (Bell-Scriber, 2008) describes some of the various mechanisms that contribute to an environment resulting in higher attrition among traditional-age (18-23) males. It highlights the limited amount of research and programs designed to understand the problem and facilitate retention. Surprisingly, some of the factors attributed to hold the most significance impairing male students exist within the environment designed to educate and train nurses for readiness in the profession. One barrier to success includes the paucity of available male mentors. This is underscored by the core influencing hindering factor: nurse instructors’ attitudes and behaviors that have been demonstrated to be characteristically unsupportive (Bell-Scriber, 2008). Bell-Scriber also notes that nurse instructors, overwhelmingly female, are frequently unaware of the needs and triggers that stimulate frustration and stress in the male student. Males have also expressed perceived discrimination in the clinical setting although this is generally bias influenced by perceived role identity within settings such as labor and delivery and pediatrics.
            The belief that a woman and a man are equal in skills and outcomes reveal a direct contrast when both sexes develop opposing experiences and perspectives about the learning environment and process associated information differently. Apparently, the number of years an instructor teaches does not play a role when perceiving influences that affect learning. Many factors play into this and more research underpinning educators’ influence regarding students’ ability to learn is clearly indicated.
Themes Influencing Climate
            There were five themes generated from the study: 1) Nurse educators’ behaviors and characteristics; Micro-inequalities inherent in instruction delivery. Subtleties such as conversive terseness, body language, gestures, tone, inferring a diminutive attitude toward male learners feelings and thoughts, and absence of interaction all relay an atmosphere that erodes the learning climate. It was noted that nurse educators often fail to understand male students and perceive their behaviors as lazy. Female learners on the other hand were perceived as more nurturing and caring endearing stronger support from their instructors. 2) Meaningful experiences; all male learners described meaningful experiences occurred away from their instructors with their patients while most females described experiences occurring with their instructor as meaningful. 3) Peers’ behaviors and characteristics; Male learners experienced support from their peers as a prospective nurse while some of their instructors questioned their motivations. 4) Education environmental factors; Classroom size inhibited interaction due to males fearing being focused on when asking questions. Textbooks showed a strong disparity using females as examples while omitting males. The use of the terms her and she where noted as universal in some textbooks and handouts. In addition to these influences, male learners noticed their continued diminishing population, which enhanced other negative climate variables. 5) External environmental factors; Men often experienced inadequate social support from their peer group, family, and friends. They were sometimes teased or their intentions questioned. This was known to have a stifling effect (Bell-Scriber, 2008). 
Application to Practice
According to the National League for Nursing (Adams et. al, 2005), a core competency of nurse educators should be the ability to develop an environment that is conducive to learning for all students regardless of cultural variable including age, sex, and minority status. Traditional-age males are no exception. Nontraditional-age males do not experience the same difficulties as their life experience and coping abilities have evolved better equipping them to overcome perceived challenges noted by traditional-age male learners (Bell-Scriber, 2008). There are many strategies to consider in addressing this educational challenge. Nurse educators can be encouraged to allow for outside observers or culturally aware colleagues to evaluate their educational delivery methods via direct observation, video, or audio recording. Other strategies could include incorporating assessment rubrics for prospective nurse educators as a part of the hiring process. A continuous plan of action could also be incorporated in the workplace raising awareness of bias and climate indicators that inhibit success for all minority classes. Cohort relationships can also carry strong importance though the student learner process. Developing methods to encourage healthy male-female relationships within student populations can foster friendships, socialization, and camaraderie that may extend far beyond nursing school. This socialization process has been shown to help diminish stress affiliated with male learners (Bell-Scriber, 2008). Addressing these issues proactively can help reduce the projected nursing shortage expected to grow in the next 20 years both in the in field and education institutions (Barker, 2009).
Understanding the circumstances unique to the male learner is critical to nursing education. How nursing instructors construct their message, encourage interaction, foster relationships is dependent upon identification of the needs of their learners. The nurse educator holds the experience of their students’ learning in their hands. Creating a climate that meets the needs of the male learner can further encourage altruistic purpose and enhance the understanding of nursing in the minds of men. It is true; men are traditionally considering ways to increase income through the field of nursing. By igniting awareness in the delivery process, educators can contribute significant depth and width to male learners understanding. The efforts nurse educators make in delivering meaningful and rewarding education should be more readily understood and appreciated by male learners. In doing so, educators can help develop traits in male learners that may foster an increased interest in delivering those same learned rewards to other prospective nurses.
AACN, (2011). Financial Aid. American Association of Colleges of Nursing. Retrieved December 6, 2011 from http://www.aacn.nche.edu/students/financial-aid
Barker, A. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession. Sudburry, Ma: Jones and Bartlett.
Bell-Scriber, M. (2008). Nursing Education Research: Warming the nursing climate for traditional-age learners who are male. Nursing Education Perspective. 29(3), May/June:143-150. Retrieved December 6, 2011 from http://ovidsp.tx.ovid.com.library.gcu.edu
Adams, C., Aucoin, J., Lindell, D., Connolly, M., Devaney, S., Love, A., Ortelli, T., Sharts-Hopko, N., Timmons, M., Zhan, L. (2005). The Scope of Practice for Academic Nurse Educators. National League for Nursing. Retrieved December 7, 2011 from http://www.nln.org/publications/scope/index.htm

The AACN, an Umbrella Organization

As I have mentioned before, I am getting an advanced education in nursing right now so some of my posts will be directly related to my studies and things I am learning. Most of the nursing posts over the next two years will be written from this perspective. So, here is one about a professional nursing organization that may end up being critical to the development of nursing as a profession. 
To my surprise, there are at least 113 national nursing organizations and 140 state nursing organizations. There are also international nursing organizations such as Nurses of Emergency and International Society of Psychiatric Mental Health. When I had to select one to write about, needless to say I was overwhelmed. A cursory review of these organizations (NP Central, 2003) reveal an absence of my interest spectrum, which emphasizes beneficent outcomes related to treatment modalities central to nutritional intake through gut-brain axis mechanisms. Perhaps another professional organization is in order. Until that happens, I decided to look more closely at the American Association of Colleges of Nursing (AACN). Many of the organizations listed on NP Central’s website hold goals that fall under the umbrella of the AANC’s purview. The AACN has a national goal of synthesizing nursing professional structure and development as a whole.
The AACN is special in the sense that its vision for the future, specifically by 2020 is to develop consistently educated and trained professional nurses across the country trained to lead improved healthcare delivery methods. By establishing collaborative relationships and alliances with educational institutions nationally, the AACN hopes to influence member school’s processes associated with education, research, and clinical practice (AACN, 2011). In doing so, the AACN can function as a nationally accepted primary source of advanced nursing education through policy, initiatives, and programs designed to propel nursing professionals to the forefront of healthcare and in their profession (AACN, 2011). 
The AACN describes organizational values that are open and responsive the interest of their stakeholders (AACN, 2011). Their priorities and goals may contribute dramatically to the final emergence of nursing as a profession. Their comprehensive grasp of nursing’s strengths, weaknesses, and potential contributions to society should benefit all practicing nurses, especially the upcoming generation of advance-practice nurses. Understanding the goals and aspirations of the AACN, nurses can incorporate a similar philosophy within their practice connecting them literally to the evolution of nursing from an occupation to a profession. I am personally going to incorporate their perspective with my own goals and encourage fellow nurses to help advance their practice through education and learning. Only by continuing our interaction and taking advantage of learning opportunities such as those provided by nursing and non-nursing organizations can the advancement of nursing progress.
AACN, (2011). Mission and Values. American Association of Colleges of Nursing. Retrieved November 27, 2011 from http://www.aacn.nche.edu/about-aacn/mission-values
NP Central, (2003). Nursing Organization Links: National Nursing Organizations, State Nursing Organization, International Nursing Organizations. Retrieved November 27, 2011 from http://www.nurse.org/orgs.shtml

Advanced Practice Nursing

Recently starting my MSN Ed, I quickly realized there is a newer and larger definition of advanced practice nursing or advanced nursing practice. I’ll just call it APN. Historically, APN stood for advanced clinically trained nurses in direct patient care such as nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse-midwives.

The current trending definition of APN includes all master’s and doctorate level educated nurses. According to the (AACN, 2004),

Any form of nursing intervention that influences health care outcomes for individuals or populations, including direct care of individual patients, management of care for individuals and populations, administration of nursing and health care organizations, and the development and implementation of health policy.

This modern definition of APN includes nurse educators, public health nurses, nurse administrators, and nursing research. I was surprised to learn APNs are no longer limited to direct clinical care. As far as mandating doctorate level education to the definition of APN, direct clinical care (DNP) and nursing research (PhD) seem to be the only two defined terminal pathways.

The exceptions to the current proposed mandate of doctorate level educated nurses by 2015 appear to be limited to clinical nurse leaders and nurse educators. These two professional arenas are generally accepted at the master’s level due to the combination of didactic training and practical experience (Barker, 2009).


AACN, (2004). AACN Postion Statement on the Practice Doctorate in Nursing, October 2004. American College of Association of Nurses. Retrieved November 21, 2011 from http://www.aacn.nche.edu/publications/position/DNPpositionstatement.pdf

Barker, A. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession. Sudburry, Ma: Jones and Bartlett.