Since 2006, cannabis use in older adults has increased more than any other age group in the United States. Yet there remains little research on its effects in older adults. Healthcare providers are often undereducated about cannabis and the function of the endocannabinoid system, where cannabis exerts its effects. This article discusses the prevalence of the use of medicinal and recreational cannabis in older adults, the mechanism of action of cannabis in the ECS, the risk of adverse drug reactions associated with cannabis use in older adults. Also included are guidelines for safe medication administration, knowledge about cannabis for safe nursing care and discussion of legal implications related to the administration of cannabis in clinical practice.
Collaboration is an effective means for nurses to establish professional relationships with organizations, and especially communities. When nurses collaborate on community-based research, they strengthen the ability to identify community level healthcare needs, social systems, local services and resources, and infrastructure for independence. There is limited investigation about collaboration among nurses, community providers, and healthcare leaders, especially from the perspective of the nurses. The objective of this report was to describe two nurses' perspectives about their collaboration with a research team in a community-based study. The research intervention included end-of-life conversations among members of underserved communities residing in a rural area in the western United States. The two nurses served as hosts/event planners for the intervention at a local community and senior center. Recruitment was conducted through social media, flyers, networking with local organizations, and word-of-mouth. Fourteen participants from underserved communities participated in the Hello game, which stimulated end-of-life conversations. The nurses reported collaboration challenges related to communication, consistency, and transparency. This report discusses these challenges from their perspective and offers salient points about their collaborative experience as a foundation for future successful collaboration with the potential to improve healthcare for underserved communities.
Many people in the United States suffer from one or more major chronic diseases. With the rise of individuals living with chronic and serious illnesses, effective advance care planning (ACP) is essential to ensure all patients receive care that is congruent with their preferences. Advance care planning (ACP) is a proactive, patient-centered process in which individuals delineate their preferences about medical care before losing their decision-making capacity. This process is ongoing and should be re-visited regularly to ensure it remains relevant and reflective of an individual's current wishes. In this article, we provide an overview of ACP, components of ACP, benefits and barriers of ACP, resources available for nurses/healthcare professionals, patients, and families. We also discuss the role of nurses in facilitating ACP, and additional policy considerations.
Medical Aid in Dying (MAID) is the practice in which terminally ill, mentally capable adults can voluntarily request prescribed medication to be self-administered in order to end their life in a peaceful manner. The MAID process involves a multidisciplinary team of healthcare professionals who provide ongoing clinical care, assessment, and support over the several weeks to months during which a patient goes through the process to obtain and potentially self-administer MAID medications. MAID has been authorized in the United States for nearly 30 years, since the enactment of the Death with Dignity Act in 1997 in Oregon. As more states authorize MAID, remove residency restrictions, and expand prescribing authority to APRNs, it is imperative that all nurses have current knowledge about laws and clinical practice guidelines for patients seeking MAID. This article offers an overview of the history and process of MAID in the United States, a discussion of attitudes and ethical code and position statements from several professional healthcare organizations, and considerations for nurses who are employed in states with and without legislation to support MAID.
Chronic disease and multimorbidity are leading drivers of adverse outcomes, mortality, and healthcare utilization in the United States, yet opportunities to align treatment with patient goals and preferences are often missed. Advance care planning (ACP) offers a structured, longitudinal process to elicit and document values, preferences, and priorities for future medical care. Advanced practice registered nurses (APRNs) are uniquely positioned to lead ACP efforts given their holistic approach, emphasis on patient advocacy, and longitudinal relationships with patients. In 2016, the Centers for Medicare & Medicaid Services introduced time-based Current Procedural Terminology (CPT) codes to reimburse clinicians, including APRNs, for ACP discussions. Despite this opportunity, ACP billing codes remain underutilized. While billing supports sustainability and recognition of APRN contributions, the primary concern is ensuring that patients receive high-quality ACP services. This article explores the role of APRNs in integrating ACP into practice, identifies barriers to ACP billing, and proposes strategies to enhance education, workflow design, and policy. The authors include a fictional case study that illustrates how a nurse practitioner might initiate an ACP discussion with an older adult with multiple comorbidities following hospitalization for heart failure and successfully bill for ACP services.
Approaching the topic of Advance Care Planning (ACP) with patients and families is often difficult, overwhelming, uncomfortable, and, unfortunately, too late. Over the past 30 years, numerous organizations have been established to identify and find solutions that bridge the knowledge gap between healthcare professionals and patients, while honoring a patient’s values, goals, and wishes. This gap created the need for ACP. Strategies and tools to guide healthcare professionals and patients can facilitate less difficult, more effective, and timely conversations among patients, families, and providers. In this article, we present numerous strategies and tools used in ACP by examining a fictional case study exemplar about an individual who is fairly advanced along the continuum of advance care planning. The complexities of the case study further accentuate the need for strategies and tools in ACP conversations and discusses those that we have used in practice. Included also are supplemental materials that offer definitions, and outline strategies and tools that can be helpful for healthcare professionals, patients and families, or anyone interested in addressing ACP.
Advance directives (ADs), sometimes known as advance healthcare directives (ACHDs), are legal documents that allow individuals to communicate and document their choices regarding medical care and treatment in the event they are unable to communicate their decisions. Nurses are often the most consistent point of contact for patients, positioning them to initiate and sustain meaningful conversations about ADs. This close access enables nurses to assess individual values, cultural beliefs, and psychosocial factors that influence patient decision-making. In addition, it is the nurse’s ethical duty to advocate for patients’ ADs when they lack their own decision making capacity. This article first briefly reviews current research regarding nursing students’ knowledge of ADs. We discuss evidence-based strategies for nurse educators, such as experiential learning via simulation or community partnerships, to incorporate content about ADs and the impact of nurse faculty initiatives on student experiences with ADs. Finally, we consider potential benefits and barriers of the End-of-Life Nursing Education Consortium (ELNEC) modules as one option to address required palliative care competencies and further prepare students to address advance care planning in both generalist and graduate nurse roles.
Obesity represents a major public health challenge among adults in the United States and globally, significantly contributing to the development of chronic diseases such as cardiovascular disease, type 2 diabetes, certain cancers, osteoarthritis, and psychological disorders. Notably, the Centers for Disease Control and Prevention has reported a disproportionately high prevalence of obesity among Hispanic and African American adults compared to other racial groups. This review focuses on the role of epigenetic mechanisms, specifically DNA methylation patterns, in mediating the observed racial disparities in obesity. Epigenetic regulation, influenced by diet and activity, impacts gene expression and disease risk. Unlike genetic variation, which remains stable throughout life, epigenetic modifications are plastic and tissue-specific, making them potential biomarkers for obesity and related diseases. Nurses play an important role in understanding and addressing health disparities. By studying racial disparities in obesity epigenetics, nurses can gain insights into how genetic and environmental factors contribute to obesity among different racial groups. Understanding epigenetic factors that contribute to these disparities can help nurses develop more effective, culturally sensitive interventions to address obesity and the associated health risks.
Advance care planning (ACP) is a shared decision-making process that promotes self-reflection, discussion, and documentation of future healthcare preferences for clients, families, and clinicians, including nurses. However, members of the lowest socioeconomic status (SES) communities are 33% less likely to use ACP compared to those with the highest SES, which is why our research has focused on understanding barriers and facilitators to ACP for these low SES populations. In this article, we have summarized and synthesized barriers and facilitators to ACP across four publications that have reported our previous qualitative studies. We discuss five emerging themes from this synthesis: 1. Healthcare, Health Insurance, and Health, 2. Structural Factors, 3. Interpersonal Factors, 4. Religious Beliefs, and 5. Personal Factors. Our discussion considers the five themes in the context of the nurses’ role to provide ACP for clients with the lowest socioeconomic status. These considerations include understanding the roots of historical mistrust in healthcare institutions, and connections between nurses and clients to initiate ACP topics while validating reasons for healthcare mistrust. Nurses can also use a holistic approach to address structural barriers to ACP by using their inherent skills to assess social needs and make interdisciplinary referrals. Finally, we discuss considerations for integrating families into ACP conversations, addressing religious beliefs for or against ACP, and using trauma-informed approaches.
A mixed-methods study investigated the diffusion and implementation of the American Nurses Association Nursing Scope and Standards of Practice (NSSP) among registered nurses (RNs) in the United States. Using Rogers’ diffusion of innovation model as a framework, a national survey was administered with open-ended questions to identify barriers, strategies, outcomes, and general perceptions related to adopting the NSSP. This article reports on the qualitative component of the study. Participants (n = 1,679) provided insights through comments about challenges such as awareness and usability, and suggested strategies including enhanced communication and educational initiatives. Analysis of the comments revealed themes that emphasize the complexity of integrating the NSSP into diverse nursing contexts, such as cultural resistance and practical challenges. Findings underscore the need for ongoing refinement and dissemination efforts to enhance the impact of the document on nursing education, practice, and research. Future investigations could explore comparative approaches to NSSP adoption and incorporation of technological interventions as well as the roles of leaders to integrate nursing standards in practice.
In Spring 2020, some nurses in the United States experienced financial hardship associated with the COVID-19 pandemic. Nurses House, Inc. responded and provided $2,734,500 in emergency grants to the 2,484 nurses who applied and met the eligibility criteria. The question arose, How long did this experience continue to impact the financial well-being of these nurses? Studies have been reported about the long-term physical, psychological, social, and workforce impact of the COVID-19 pandemic on nurses, but little was found about its long-term financial impact. An electronic survey was conducted to explore the endurance of the COVID-19 related financial hardship the grant recipient nurses had experienced and to determine if the financial crisis was more enduring for some nurses than others. The survey consisted of five categories of variables presented in 38 statements, along with 9 items eliciting demographic information. Specific categories measured included Current Personal Physical Health, Personal Emotional Health, Family Health and Well Being, Economic Well Being, and Support Systems. Aggregated data about demographic characteristics, along with statistically significant correlations and factor analyses, offered information about which nurses may be more vulnerable in times of financial crisis. The survey findings can inform proactive planning and advocacy for a safety net for nurses whose financial well-being may be threatened in times of an unanticipated crisis, such as a pandemic.
Shared governance is the structure through which nurses at all levels in an organization seek collaborative decision making. Recently the emergence and transition from shared governance to professional governance has become prevalent in literature. With this transition, nurses go beyond participation in their practice to ownership, accountability, and authority. The evaluation of established shared governance structures, membership, and activities using the Council Health Survey was an initial step to determine the current state of governance at a quaternary medical center within the Midwest United States. Clinical nurse shared governance site council chairs led a pre-post project that assessed the effectiveness of the current structure of shared governance and implementation of a standardized orientation for new or interested members. Results demonstrated a stable shared governance process with future opportunities to build upon strengths with transition to professional governance.
Nursing work stoppages are a significant concern within healthcare organizations, deeply affecting business operations, staff dynamics, and organizational stability. Using data triangulation, this qualitative study investigated the complex factors contributing to nursing work stoppages among unionized nurses in Southern California, aiming to uncover nuanced perceptions and identify effective resolution strategies. Using semi-structured interviews with 15 participants and a focus group session, this study analyzed in-depth qualitative data to comprehensively understand the motivations behind these collective actions. Thematic analysis revealed several key findings about factors that drive nursing work stoppages, included a lack of administrative support, inadequate staffing, and limited clinical decision-making autonomy. Emotional stress and frustration over poor leadership engagement and insufficient feedback mechanisms exacerbated nurses’ feelings of disempowerment and dissatisfaction. These key findings confirmed that psycho-social and job-related factors significantly influence the decision to participate in strikes. The study findings suggest several strategies for healthcare administrators to mitigate the impact of nursing work stoppages, such as improving communication and feedback channels, providing more robust administrative and emotional support, and addressing the chronic staffing shortages contributing to nurse burnout. Additionally, fostering greater autonomy and decision-making power for nurses can enhance job satisfaction and reduce the frequency of strikes.
Individuals with intellectual and developmental disabilities (IDD) are more likely than the general population to experience health inequities. While a number of factors contribute to these health inequities, a major modifiable factor is inadequate healthcare provider knowledge and comfort in caring for individuals with IDD. Education has been effective to improve patient outcomes, yet no regulatory or licensing bodies require IDD training for nurses. Educational content must be delivered voluntarily by educational institutions and healthcare employers. Change leadership can be useful to support the voluntary addition of IDD education. This article shares an example of creating change in a health system, guided by Kotter’s model, by adding IDD education to institutional library offerings. Topics within the newly developed education module included IDD awareness, patient rights, caregiver empathy, health inequities, communication skills, and de-escalation techniques. Using a pre- and post-survey design, improvements were noted by those completing the education model, specifically in the areas of comfort and perceived knowledge levels related to care for individuals with IDD. In the article, we also discuss implications for nurse clinicians, educators, researchers, and administrators.
As efforts to dismantle Diversity, Equity, and Inclusion (DEI) frameworks intensify across political and institutional landscapes, the nursing profession is uniquely positioned to respond, not with retreat, but with reinvention. This article introduces the C.A.R.E. Framework: Capacity, Allyship, Resilience, and Equity, as a strategic and values-driven evolution of DEI, rooted in the ethical, holistic, and human-centered philosophy of nursing. Drawing on Jean Watson’s Caring Science and Theory of Human Caring, the paper reaffirms nursing’s longstanding commitment to justice, advocacy, and healing beyond the bedside. Through the lens of Caring Science, nurses are positioned as caregivers and as moral agents capable of confronting systemic inequities with compassion and clarity. This article explores the role of popular culture, specifically the moral philosophy of the Star Wars Jedi Order, as a narrative bridge to make DEI values more accessible and culturally resonant. By anchoring DEI within the language and practice of care, this work presents C.A.R.E. as a transformative framework that empowers nurses to lead with intention in polarized times, uphold the principles of social justice, and sustain the profession’s legacy of inclusive advocacy. In a moment of ideological division, C.A.R.E. offers a cohesive, courageous path forward that affirms a shared humanitarian vision.
Safe anesthesia is vital for enhancing healthcare access and patient safety. The shortage of anesthesia providers in Guyana limits the availability of safe anesthesia services. Training more nurses and future nurse anesthesia providers will provide more Guyanese citizens with essential access to safe anesthesia. This project aims to develop and share information about the importance of the nursing profession, educational requirements, and steps to becoming a nurse in Guyana. A thorough literature review was performed using selected keywords. Articles, organizational, and government site information from this search contributed to creating an original nursing recruitment brochure. The brochure highlights the opportunities and benefits of a nursing career and addresses factors contributing to the nursing shortage. It was distributed in person and electronically to a small group of Guyanese nurses and key stakeholders, then anonymously evaluated through a Likert-scale survey and open-ended questions to assess its design and how well it reflects changes in Guyana's healthcare system. Feedback indicated that the brochure was well received, with respondents praising its clarity, readability, accurate presentation, and representation of the nursing profession. Challenges noted in the open-ended section included limited career counseling, language barriers, a lack of public awareness about nursing, and a need for more nursing schools in Guyana. Future collaboration between the Georgetown School of Nursing and the Middle Tennessee School of Anesthesia is recommended to evaluate its effectiveness in fostering interest in nursing in Guyana.
The COVID-19 pandemic highlighted and exacerbated pre-existing disparities in global and U.S. societies. The inequities laid bare during the COVID-19 pandemic warrant a joint movement among nurses and the other frontline workers who maintained the functions of society throughout the crisis. Increasing the voice of the nursing workforce through collaborative leadership and advocacy could ameliorate many of the struggles facing the profession today while empowering frontline workers to address the needs facing their patient populations and communities. This article analyzes four key multidisciplinary conceptual frameworks that could bolster a collaborative movement toward equity while exploring example initiatives, current efforts, and the barriers between frontline workers and the equitable distribution of their services. The multidisciplinary frameworks analyzed in this article include Social Determinants of Health (SDOH), Health in All Policies (HiAP), Street-level Bureaucrats, and accumulation by dispossession. Recommendations for nursing, advocacy, and leadership practice include seeking interdisciplinary collaboration among frontline workers, developing interdisciplinary leadership groups, fostering cooperation between unions representing frontline fields, and supporting areas of nursing that function in multidisciplinary spaces. Nurses can impact equity by applying the SDOH lens and HiAP approach to the delivery of care, advocacy, and the development of policy, as well as continuing research regarding the role of nursing in interdisciplinary leadership, health equity, policy-making, and advocacy.
Most healthcare providers graduate with a healthy understanding of the importance of listening to patients. Even though we cannot overstate the need to listen to patients, listening requires skills that can sometimes be neglected or forgotten. Healthcare providers often find that there are myriad obstacles in utilizing this precious tool in our skill set. Active listening means paying attention to sound, hearing with thoughtful attention, and giving consideration to mitigating factors. Listening requires us to receive the speaker’s words, understand the information presented, and process it appropriately. The purpose of this article is to explore the skill of active listening, which is critical to the provider-patient relationship. This article will accomplish this purpose by answering the following questions: What does it mean to listen well? Why do we need to listen well? How do we listen better, and who benefits when we become good listeners? This article is intended for healthcare providers who utilize listening skills for diagnosis, management of common conditions, and formation of critical therapeutic relationships in delivering care to patients throughout the lifespan.
