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The Dangers of Loneliness: Findings from a Study among Appalachian Elders

By Sylvia Foley, AJN senior editor

Arrow and mountains by taberandrew, via Flickr Arrow and mountains by taberandrew, via Flickr

Writing for AJN in 1955, Hildegard Peplau described the complexities of loneliness, observing that “often loneliness is not felt; instead the person has a feeling of unexplained dread, of desperation, or extreme restlessness.”  Fast-forward to 2009: nurse researchers Laurie Theeke and Jennifer Mallow wanted to better understand the health implications of loneliness, and decided to conduct a study. This month’s original research CE, “Loneliness and Quality of Life in Chronically Ill Rural Older Adults,” reports on a data analysis of their findings.

One of the most striking findings was that 97% of the sample reported significant loneliness, an extremely high prevalence rate. Here’s a quick overview of the study:

Background: Loneliness is a contributing factor to various health problems in older adults, including complex chronic illness, functional decline, and increased risk of mortality.

Objectives: A pilot study was conducted to learn more about the prevalence of loneliness in rural older adults with chronic illness and how it affects their quality of life. The purposes of the data analysis reported here were twofold: to describe loneliness, chronic illness diagnoses, chronic illness control measures, prescription medication use, […]

2017-07-27T14:50:14-04:00September 4th, 2013|nursing research|2 Comments
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The Heart of a Nurse

By Diane Stonecipher, BSN, RN. The author lives in Texas. Her forthcoming Viewpoint essay in the October issue of AJN, “The Old Becomes New,” will consider aspects of nursing that may be obscured or lost due to overreliance on technology.

Heartstudy by James P. Wells, via Flickr Heartstudy by James P. Wells, via Flickr

I am somewhat embarrassed to admit that my initial interest in nursing came as a 10-year-old Yankees baseball fan. I could not get enough of The Mick, Elston Howard, or Mel Stottlemyre on my transistor radio, during televised games, or in my baseball card collection. I decided that I could be the team nurse—take their vital signs, set their broken bones, assess their injuries, and best of all, travel with the team.

This rather irrational desire was solidified when my aunt had a face lift. I was 14 at the time, and she recovered at our house, specifically in my room. She was swollen like a prize fighter, with bloody bandages that needed changing, pain medication to be dispensed, meals to be fed—I was hooked. I am not sure I even knew what a nurse really did, but my heart was stirred.

I sailed through high school, graduated with honors, and left for one of the […]

2018-03-28T10:30:20-04:00August 14th, 2013|career, nursing perspective|17 Comments
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Trailblazing: The Value of Positive Deviance in Nursing

Illustration by Janet Hamlin. Illustration by Janet Hamlin.

By Sylvia Foley, AJN senior editor

The word deviant tends to have a negative connotation, suggesting something aberrant or harmful. But deviance simply means a departure from the expected or usual way of doing things—and there are times when being able and willing to do so is crucial. Indeed, some have called this trailblazing.

In “Exploring the Concept and Use of Positive Deviance in Nursing,” an August CE, author Jodie Gary points out that “the clinical setting contains an infinite assortment of situations” in which applicable pro­fessional standards might be unavailable or unrealistic; at such times, “nurses might have to react creatively” in order to provide optimal patient care. This article provides an in-depth, evidence-based look at positive deviance in nursing.

Overview: Positive deviance involves an intentional act of breaking the rules in order to serve the greater good. For nurses, the rightness or wrongness of such actions will be judged by other people who are in charge of rules enforcement; but the decision to engage in positive deviance lies solely with the nurse. There is no uniform or consistent definition of positive deviance. This article uses the Walker and Avant method of concept analysis to explore and identify the essence of the term positive deviance in the nursing practice environment, provide a better understanding of the concept, and clarify its meaning for the nursing pro­fession. In turn this led to an operational definition: positive […]

2017-07-27T14:50:36-04:00August 1st, 2013|nursing perspective|6 Comments
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When Loved Ones and Patients Don’t Choose Life

By Karen Roush, AJN clinical managing editor

Photo by the author Photo by the author

This isn’t the blog post I started out to write. That was a more personal story about someone close to me, let’s call this person Jess, who died after years of chronic illness worsened by self-neglect—after years of being that person Olsen talks about in this month’s article (free until August 15) on helping patients who don’t help themselves (and in his related blog post from last week).

But as I wrote, I realized that it wasn’t fair, that I was leaving out the complex story behind their persistent unhealthy behaviors, behaviors that eventually led to a lingering, awful death.

And without that background knowledge, it was too easy to be judgmental—as it is sometimes too easy for us as nurses to be judgmental of patients who don’t help themselves, who even seem to be willfully destroying their own health: the obese person who keeps drinking those giant sodas, the smoker who lights up another cigarette. As a nurse it can be very frustrating to care for a patient who ignores health recommendations, to their own detriment. As a family member or friend, it can be heartbreaking and infuriating.

There are limits to what we can do. We cannot force patients to eat well, take necessary medications, quit smoking, modify their alcohol intake, wear their seatbelts . . . the list goes on and on. Yes, we […]

2016-11-21T13:07:02-05:00July 15th, 2013|nursing perspective|4 Comments
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Obesity as Disease and the Health Care Culture’s Take on Personal Responsibility and Suffering

Doug OlsenBy Doug Olsen, PhD, RN, associate professor, Michigan State University College of Nursing, and AJN contributing editor. Olsen regularly addresses topics related to nursing ethics. His most recent article for AJN was “Helping Patients Who Don’t Help Themselves” (July issue; free until August 15).

Why does the American Medical Association’s recognition of obesity as a disease (AMA, 2013) stir strong feelings? People are just as heavy as before, their health is suffering as much, and the therapies for obesity remain the same. The main difference is that the label may give clinicians a better rationale to seek reimbursement for obesity-related services, which might help increase treatment rates. No one yet knows if the new label will really have an effect on treatment rates; in any case, this is not what people are concerned about.

The issue is what labeling a health problem with a behavioral component as a “disease” implies about personal responsibility—or what people think it means. How does personal responsibility relate to individual suffering?

The relationship between decision making, suffering, and personal responsibility is at the heart of bioethics as it is practiced in the United States. But bioethics didn’t invent our cultural tendency to connect personal responsibility and sympathetic regard for suffering, and our current approach to the issue was developed through […]

2017-04-03T12:12:36-04:00July 11th, 2013|Ethics, patient engagement, Public health|0 Comments
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