NewYork-Presbyterian Adult Emergency Department New York, NY
Audrey Graham-O’Gilvie, DNP, RN, ACNS-BC, CCRN-k Coreen Simmons, PhD(c), DNP, MSN, MPH, RN Assistant Professor Professional Nursing Practice Coordinator Touro College School of Health Sciences Teaneck, NJ Hawthorne, NY
Simon Paul P. Navarro, MA, BSN, RN, CCRN, TCRN
Clinical Nurse Bronx, NY
NewYork-Presbyterian / Columbia University Irving Medical Center New York, NY
The information, views, and opinions expressed in The Journal articles are those of the authors, and do not necessarily reflect the official policy or position of the New York State Nurses Association, its Board of Directors, or any of its employees. Neither the New York State Nurses Association, the authors, the editors, nor the publisher assumes any responsibility for any errors or omissions herein contained.
The Journal of the New York State Nurses Association is peer reviewed and published biannually by the New York State Nurses Association. ISSN# 0028-7644. Editorial and general offices are located at 131 West 33rd Street, 4th Floor, New York, NY, 10001; Telephone 212-785-0157; Fax 212-785-0429; email info@nysna.org. Annual subscription: no cost for NYSNA members; $17 for nonmembers
The Journal of the New York State Nurses Association is indexed in the Cumulative Index to Nursing, Allied Health Literature, and the International Nursing Index. It is searchable in CD-ROM and online versions of these databases available from a variety of vendors including SilverPlatter, BRS Information Services, DIALOG Services, and The National Library of Medicine’s MEDLINE system. It is available in microform from National Archive Publishing Company, Ann Arbor, Michigan.
Balancing Perspectives on the Multifaceted Roles of Nursing
Mother Teresa once said, “It is not how much you do, but how much love you put into doing it.” For nurses, it is hard to separate the “how much” from the “caring touch” of nursing. The two concepts go together—care for others motivates nurses to do all we can possibly do for our patients, ensuring the highest level of service. The loving care of nursing is evident throughout this issue of the Journal of the NYSNA in articles that examine nursing’s multiple roles from a variety of perspectives.
In “The Experience of Newly Unionized Nurses Undergoing Collective Bargaining: An Ethnography,” the authors explore the experiences of newly unionized nurses and some of the perceived professional and emotional conflicts they experience in their journey toward empowerment. The authors argue that involvement in union activity allows nurses to effect positive change for both themselves and their patients. Through “self-advocacy,” nurses can develop informal leadership behaviors that help them counteract workplace disempowerment.
In “Do Persons Age in the Same Manner Related to Their Date of Birth?” the authors examine the complex factors that influence individuals’ journeys in relation to their aging processes. The authors note that chronological age plays a part, but other factors such as health determinants, socialization, and self-perception also influence how people age. A multidimensional approach is recommended to better understand various factors that impact people’s ages and to tailor care to meet the unique needs of aging patients. As nurses and other healthcare providers come to understand attitudes toward healthy aging, they are better able to identify and implement interventions that improve the physical and psychological strengths of seniors.
In “Trauma-Informed Care in Nursing Education,” the authors demonstrate that some events or experiences may cause trauma that can happen to anyone and at any stage of life. Adverse childhood experiences (ACEs), which occur before adulthood, may cause trauma and can lead to future challenges. Nurses are expected to treat the “whole patient,” not just their acute illness. Introducing the concept of trauma-informed care to nursing students is a strategy to prepare the future workforce to incorporate universal trauma precautions as they deliver care to reduce the likelihood of causing retraumatization among this patient population.
The nurse must take the time to understand each patient’s unique needs before they can effectively care for or advocate for them. As Francis Peabody, an American physician, once said, “The secret of the care of the patient is in caring for the patient.” When nurses approach care with compassion and attention to individual circumstances, they not only improve patient outcomes, but also enhance their own job satisfaction and professional fulfillment.
Anne Bové, MSN, RN-BC, CCRN, ANP
Audrey Graham-O’Gilvie, DNP, RN, ACNS-BC, CCRN-k
Meredith King-Jensen, PhD, MSN, RN
Alsacia L. Sepulveda-Pacsi, PhD, DNS, RN, FNP, CCRN, CEN
Coreen Simmons, PhD(c), DNP, MSN, MPH, RN
The Experiences of Newly Unionized Nurses Undergoing Collective Bargaining: An Ethnography
Jacqueline Christianson, PhD, FNP-C, CNE
Jessica Leiberg, PhD, DNP, ACNP, RN
Cathleen Fox, RN
Norah Johnson, PhD, RN, CPNP-PC, FAAN
Kristin Haglund, PhD, RN, FNP, PNP, APRN
n Abstract
Background: Collective bargaining is a unique time when the relationships between employers and employees are legally and socially renegotiated.
Purpose: The purpose of this study was to understand and describe the cultural changes among newly unionized nurses undergoing collective bargaining for the first time.
Methods: This study utilized ethnography, a method of studying individual cultures.
Results: Three cultural values were identified during this study: community, disillusionment, and empowerment. Nurses in this study felt a renewed sense of community with their peers and patients. While they felt disillusioned with hospital administrators, nurses felt empowered to effect positive changes through their union activity.
Conclusions: Findings from this study highlight unionization as a method for self-advocacy that nurses engaged in despite disempowerment within the workplace. This study provides evidence that formation of community and workplace empowerment is not contingent upon formal leadership behaviors.
Nurses value their professional duty to champion patient care needs, yet often feel subject to constraints outside of their control that disempower them from elevating patient care standards (Dahlke & Hunter, 2020). Constraints and barriers that interfere with nurses’ ability to provide high-quality care are linked to moral distress, burnout, and intention to leave the nursing profession (Bevan & Emerson, 2020; Christianson, 2023). Conversely, promotion of nurse empowerment in the workplace is associated with a positive organizational culture (e.g., the shared interaction and goals between people within a business organization), which affects both nurse turnover and organizational outcomes (Aldhafeeri, 2024; Fragkos et al., 2020).
Labor unionization and collective bargaining may be viable alternatives to address both barriers to provision of high-quality patient care and nurse disempowerment in the workplace. Nationally, there has been renewed interest in unionization among healthcare employees as a strategy to compel healthcare administrators to engage in shared decision-making and address the needs of healthcare professionals (Burden et al., 2024; National Labor Relations Board, [NLRB] 2022b). Nursing labor unions impact the inextricably related goals of quality patient care, maintaining a healthy workforce, retaining experienced nurses, and promoting professional advocacy for both patient and workforce needs. However, there is a dearth of literature describing how collective bargaining changes the social and
Jacqueline Christianson, PhD, FNP-C, CNE, College of Nursing, Marquette University, Milwaukee, Wisconsin
Jessica Leiberg, PhD, DNP, ACNP, RN, ACNP, School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
Cathleen Fox, RN, Rochester Union of Nurses and Allied Professionals, Rochester, New York
Norah Johnson, PhD, RN, CPNP-PC, FAAN, College of Nursing, Marquette University, Milwaukee, Wisconsin
Kristin Haglund, PhD, RN, FNP, PNP, APRN, College of Nursing, Marquette University, Milwaukee, Wisconsin
cultural context of the nursing workplace. Therefore, the purpose of this ethnographic study was to understand and describe the cultural changes among newly unionized nurses undergoing collective bargaining.
Labor Unions in Nursing: A Contentious History
In the late 19th to the early 20th century in the United States, there was a push to recognize nursing as a profession. A profession is a group of individuals who were uniquely educated and skilled to perform a given occupation. Prior to professionalization efforts, nursing was largely undertaken by people in religious orders, family members, or hired caretakers. Nursing was often seen as dirty and undesirable work performed by people in low socioeconomic classes (Apesoa-Varano & Varano, 2004). Several notable nurses rose to prominence in the mid19th century, including Florence Nightingale during the Crimean War and Clara Barton during the American Civil War, who shifted public perceptions toward nursing as a noble “calling” that filled a social need rather than being a dirty job or a job performed by caretakers in religious orders (Apesoa-Varano & Varano, 2004; Emerson, 2017; Scott, 2018). Nightingale’s efforts to improve patient hygiene and overall outcomes and Barton’s advocacy for the needs of patients who could not self-advocate provided a foundation to justify the need for educated and trained nurses.
The professionalization of nursing led leaders to organize nursing labor unions to advocate for better working conditions and provide nurses a venue for patient advocacy. Within the discipline, there were supporters and detractors. Support for unionization included concern that nursing would be “de-skilled” by use of non-nurses to accomplish nursing tasks (Chaison & Bigelow, 2002). However, some nursing leaders felt that unionization could contribute to a public perception that nursing was a trade rather than a profession (Fowler, 2021). One reason for this was the perception that labor unions existed to advocate for types of labor that lacked a self-evident or explicitly defined body of professional knowledge (Apesoa-Varano & Varano, 2004). Unionization has also been described by some as unprofessional because collective bargaining is characterized by standardization of working conditions, roles, and compensation for labor. Such standardization may be construed as an intrusion into how individual professionals are valued (Higgins, 2016). Additionally, concerns for patient care stoppages during labor strikes were, and still are, a point of contention among nurses. The threat of labor stoppages is necessary to a credible strike threat, however [threatened and actual] patient care stoppages are perceived by some nurses as an unethical bargaining tool (Essex & Weldon, 2022; Jennings & Western, 1997).
The history of the American Nurses Association (ANA) as a labor union serves as an exemplar of the conflicting viewpoints regarding professionalization and unionization. The ANA once acted as both a labor union and an organization advocating nursing as a profession. While the ANA advocated for nurses through activities like media campaigns and informational picketing, they forbade labor strikes until the late 1960s due to concerns over the optics of a labor strike with regards to professionalism and ethics (Seidman, 1970). The ANA’s position with regards to labor disputes led to a schism between ANA and several state nursing associations that wanted to take a more labor-forward stance during collective bargaining including California, Massachusetts, Minnesota, and New York (Higgins, 2016). In 2009, these states formed
a new national coalition of nursing unions called National Nurses United, which is currently the largest nursing labor union organization in the United States representing almost 225,000 members (National Nurses United, 2023). Nurses today remain divided regarding the ethics and professionality of nursing labor unions: Some perceive unions as a venue for advocacy and professional solidarity and others as a threat to nursing ethics and professionalism (Essex & Weldon, 2022).
Unionization and Terminology
The process of forming a labor union in the United States is both protected by law and regulated by the National Labor Relations Board (NLRB, 2022a). A collective bargaining unit refers to a group of bargaining unit members or workers represented by a labor union. Unionization occurs either when employees request to form a labor union and the employer mutually agrees to recognize the union, or when a vote is held among prospective bargaining unit members that is supervised by the NLRB.
Following unionization, collective bargaining typically takes place, which refers to the process of negotiating a contractually enforceable collective bargaining agreement that outlines attributes of the workplace and working conditions (NLRB, n.d.-b). Topics addressed by collective bargaining agreements vary by union but may include compensation structures, benefits, availability or use of instruments to complete work, or patient-to-nurse ratios. Importantly, after unionization occurs, employers may not make unilateral changes to the terms or conditions of employment unless the change is agreed-upon by the union. Additionally, employers may not bypass the union to bargain with individual employees (NLRB, n.d.-a).
Methods
Design
This study utilized focused ethnography, a method aimed at understanding the dynamic cultural context of a specific phenomenon, subgroup of people, or social setting. Ethnography emphasizes description of the culture of participants from the “native’s view.” Ethnographic researchers are often “outsiders on the inside” who have privileged access to the group of interest and are active participants in data collection and analysis (Aamodt, 1982). Consistent with the use of focused ethnographies, this study focused on the distinct phenomenon of union activity among a subgroup of nurses (Wall, 2015).
Researcher Context
Like other ethnographic studies, some members of the research team held some insider knowledge regarding general nursing culture and union culture. One researcher was an active union member at [hospital name redacted] throughout the study period who provided additional insight and confirmation or clarification of research findings. Another researcher was employed as a temporarily contracted staff nurse practitioner working clinically at [hospital name redacted] but was not included in the collective bargaining unit during the study period. Their clinical work in the facility provided additional context by proximity to study participants (Draper, 2015). The third researcher was engaged in clinical and academic nursing work but has never been a member of a nursing labor union.
A fourth researcher was a union member in two past positions as staff nurse. For this study, they served as an expert in ethnographic methods.
Participants, Study Context, and Protection of Human Subjects
Study participants consisted of nurses who were members of the [union name redacted for blinding] and union organizers who were not bargaining unit members but materially involved in union organization and/or collective bargaining. Union organizers were not nurses or members of the collective bargaining unit but were present to assist as experts in legal and regulatory procedures inherent in unionization and collective bargaining. In this study, union-active nurses refers to nurses who actively participated in the union during the study. Not all participants in the study were union-active; one interviewed participant was against unionization and several had evolving feelings on their approval of the union throughout the duration of the study. The term union nurses in this study refers to nurses in the collective bargaining unit regardless of their relationship or stance towards unionization.
The hospital [name redacted] is a large tertiary care center in [city redacted], New York, that employed approximately 850 nurses during this study. The study was reviewed and approved by the informal leaders of the nursing union (as the union leadership structure had not been formalized at the commencement of this study). Researcher presence at union meetings, collective bargaining sessions, private digital chat, and at picketing events were approved by union leadership and announced to union members. Union members were informed of researcher presence at each union meeting and collective bargaining session observed. Interview participants provided verbal informed consent. Only limited demographic data was collected to protect the confidentiality of study participants. This study was reviewed and approved by the [institution name redacted] Institutional Review Board for ethics in human research.
Data Collection
Data collection took place over a period of prolonged engagement from January 2022 through January 2023, during the union’s collective bargaining efforts. Data collection ended shortly after the first collective bargaining contract was ratified by the new union. Data were collected by one researcher via participant observation, field notes, audio-recorded interviews, participation in a private digital group chat of union members, and a review of published union documents. The researcher observed union meetings and collective bargaining sessions approximately one to two times monthly. About 60 people attended meetings and collective bargaining sessions regularly. Observation also occurred during picketing events, including one informational picket and an unfair labor practices strike, attended by approximately 200 and 400 people, respectively. The researcher recorded field notes that included their observations on topics discussed during meetings and collective bargaining sessions, and personal responses to the experience (for bias checking). Only portions of the field notes that included observations of union nurses and union organizers were used in analysis. Observational data obtained from community members at picketing or strike events were removed from the dataset prior to analysis.
Interviews were conducted with 25 nurses in the bargaining unit and six union organizers. Private unstructured interviews took place over a secure digital platform and were recorded and transcribed verbatim using Otter.ai (2024), an automated transcription service. All transcripts were reviewed and cleaned for accuracy. Chat data was downloaded from the digital platform and union publications were provided to the researcher by union leadership.
Demographic data collected from interview participants was limited to area of practice only to protect the identity of participants due to concerns for management retaliation if identified. Nurses who were interviewed worked in a variety of departments in the hospital, including post-operative care, critical care, medical-surgical, neurosciences, and psychiatric.
Analysis
Three researchers participated in ethnographic data analysis to generate a description of the culture, context, and cultural changes within the people included in this study (Aamodt, 1982; Hammersley & Atkinson, 2019). Analysis was an iterative process of considering relationships between data observed and collected, triangulating observational and interview data, reflection upon the relationships between data points and the context experienced, and describing the research findings (Hammersley & Atkinson, 2019; Reeves et al., 2013).
Results
We present our findings in two parts. First a narrative chronology of the process of unionization comprised of four time periods: early bargaining, stalled bargaining and the informational picket, stagnant bargaining and the unfair labor practices strike, and reaching an accord and aftermath. Part two describes the evolution of three identified cultural values that were salient throughout the study: community, empowerment, and disillusionment.
Part I: Process of Unionization Early Bargaining
Nurses involved in early bargaining efforts described two priorities: coming together as a bargaining unit [comprised of all non-managerial clinical nurses within the hospital] and developing a mutually agreeable working relationship with hospital administrators. The union ratification vote (a simple majority vote open to all prospective collective bargaining unit members to support or to reject unionization) took place several months before collective bargaining commenced. Union-active nurses described their discussions with both anti-union nurses and ambivalent nurses as laced with cynicism. Several union members reported that skeptical coworkers were unconvinced that unionization would improve staffing ratios, inclusion in workplace decision-making, or wages, and some were anxious that the union would require union dues without tangible benefits. Union-active nurses addressed how to approach coworkers and address cynicism in union meetings. One interview participant summarized the issue: “There’s a lot of people who just don’t believe that it’s [workplace changes through the union] possible but are broadly supportive.”
Union-active nurses responded by demonstrating diligent efforts to make material improvements to the workplace and build trust among the collective bargaining unit. Union-active nurses prioritized developing a comprehensive contract proposal to propose to hospital administrators when collective bargaining talks commenced rather than the usual process of developing the contract in parts. To increase transparency in bargaining, union leadership opted to open collective bargaining sessions to all union members rather than bargaining solely with a designated bargaining committee. Union leadership also opted to forego collecting union dues until the collective bargaining contract was ratified. Union-active nurses conveyed cautious optimism that they could work toward mutually beneficial goals with hospital administration like increasing wages of nurses, reducing dependency on nonpermanent staff [like travel nurses], and negotiating appropriate patient-to-nurse ratios.
Stalled Bargaining and the Informational Picket
Approximately six months after collective bargaining commenced, unionactive nurses were frustrated because progress toward a contract agreement was slowing. Union members felt cynical about statements made by the hospital administrative bargaining team. One nurse commented during a union meeting, “It’s like a petty divorce where we’re fighting over who gets what DVDs.” One source of cynicism for union-active nurses was the perception that hospital administrators viewed nurses as interchangeable. Union-active nurses endorsed and advocated for limitations to nurse floating to care areas solely within the nurse’s expertise (e.g., a critical care nurse would be restricted to floating to other critical care units), which was met with opposition by administrators at bargaining meetings. Administrative opposition to nurse floating limitations was perceived as a statement that nurses’ expertise was not relevant; union-active nurses felt dismissed and were concerned that failure to address nurse floating would negatively impact patient care outcomes.
While bargaining had slowed, the number of union-active nurses increased. Camaraderie within the bargaining unit and outwardly demonstrating solidarity to administrators now became a priority to potentially prevent a labor strike in the coming months. After eight months of bargaining, a vote of no-confidence in hospital administration and a concurrent informational picket (an event with a picket line that visually appears similar to a strike but does not include an employee walkout)
authorization vote took place; both were ratified by union members. One union organizer wrote: “[The] most important thing anyone can do is confirm any coworkers who have said they are coming and turn more people out [to the informational picket].” Nurses who attended the informational picket felt energized and empowered by seeing other hospital employees, members of the community, other labor unions, and local politicians come to the picket line to support the union cause. One nurse wrote: “So many cars took videos as they were driving by honking!”
Stagnant Bargaining and the Unfair Labor Practices Strike
Several contract issues, such as parking arrangements and uniform guidelines, were settled in the months following the informational picket; however, the two preeminent issues remained unsettled: patient-to-nurse ratios and wages. Union-active nurses described both issues as connected, asserting that wage increases were necessary to attract permanent staff and thus reduce reliance upon temporary travel nurses. While both issues were priorities, several union-active nurses stated if they had to choose to prioritize only one issue, they would choose to codify patient-to-nurse ratios over a contract that substantially increased wages.
Administrative opposition to nurse floating limitations was perceived as a statement that nurses’ expertise was not relevant; union-active nurses felt dismissed and were concerned that failure to address nurse floating would negatively impact patient care outcomes.
As bargaining stagnated, two prominent union-active nurses (the union president and vice president) were placed on administrative leave by the hospital pending an investigation regarding the use of their lunch breaks while on shift. Union-active nurses interpreted the disciplinary actions as both retaliation for union activities and as a threat aimed at union members to persuade them into accepting the hospital administrators’ contract proposals. The disciplinary actions galvanized nurses into action; unfair labor practices charges were filed with the NLRB and a vote to authorize an unfair labor practices strike was announced. Union-active nurses and organizers emphasized the need to have a substantial majority vote (ideally greater than 95%) in favor of the strike combined with high voter turnout. The strike vote was aimed at pressuring administrators to make concessions in the collective bargaining agreement; a strong vote in favor of striking could pressure a contract settlement in the days or hours before the strike. Despite a strong turnout and a greater than 90% majority vote in favor of authorizing a 48-hour unfair labor practices strike, administrators declined to bargain at the scheduled bargaining session or add new bargaining sessions to avert a strike. One union-active nurse described her cynicism: “The day before a strike [during a scheduled collective bargaining session], and the hospital is not even trying to avert a strike if they won’t even come in the [bargaining] room.” Resistance by hospital administrators to bargain in the lead-up to the strike was perceived by many nurses as evidence that administrators did not intend to bargain in good faith and that efforts to appeal to good faith were therefore futile.
The strike took place 12 months after collective bargaining commenced. Strike demonstrations took place for approximately 12 hours a day and included union members, concerned community members, and other local labor unions picketing. Union members described the strike as energizing, especially after the drawn-out bargaining efforts. One participant stated, “I just felt so pumped up that if we had to go to an open-ended strike [strike without a predefined duration], I swear to God, I feel like I would actually go forward with it even though I can’t afford it
just because something’s got to be done.” Another participant described the strike: “It was so empowering to see how much local community support we have. That was so astronomical to me, like overwhelming. It made me so happy I could have cried.”
Reaching an Accord and Aftermath
Union-active nurses felt empowered and invigorated by support from the local community, local politicians, and other local labor unions immediately following the unfair labor practices strike. Several study participants described personal encounters with patients’ family members who expressed gratitude for their activism and the union participated in the city’s Labor Day parade in early September 2023. Others described their meetings with politicians to advocate for issues in health care, like a federally proposed bill on hospital staffing ratios.
Several union-active nurses noted that administrative members of the hospital staffing committee were far more receptive to nursing staffing recommendations post-strike, and the hospital administrative committee presented a potential compromise to the union’s staffing proposals. The compromise consisted of negotiating staffing ratios through the hospital staffing committee as proposed by hospital administrators with a contractual enforcement of the agreed-upon staffing ratios. Unionactive nurses were open to a potential compromise but described the need to include safeguards to protect against administrators making unilateral changes to staffing ratios or excluding union-active nurses from the staffing committee. One union-active nurse stated: “I have no faith in [hospital administrators] being accountable to grids [a structured staffing ratio guideline] that aren’t in the contract.” Other nurses concurred, particularly as the flurry of bargaining compromises slowed several weeks after the strike, and union members began talking about a second strike. One union-active nurse wrote in group chat: “I have NO faith in this administration, and I knew we would again be at this point of going on a longer strike to get what we desperately deserve. Their whole game strategy has been to stall and string us along as far into the colder months, so they think we won’t be able to or want to strike again.”
Approximately six weeks after the first unfair labor practices strike, a second strike was authorized with both a larger voter turnout and a higher percentage of votes to authorize the 5-day strike. Unlike the first strike authorization vote, union-active nurses expressed very little anxiety about a second strike. One nurse summarized: “No reason to be scared. We’ve done this before. We’re just trying to fix a place we love. Unfortunately love and care doesn’t speak to [hospital administration], but money does—so let’s just stick strong together and see what comes of [bargaining sessions before the strike date] next week.”
Two consecutive lengthy bargaining sessions took place. Unionactive nurses described the sessions as fevered by a constant backand-forth bargaining, ultimately culminating in a preliminary contract agreement and cancellation of the 5-day strike. Many nurses described the contract as a major victory and a preliminary step forward. One nurse commented: “Just want to say how proud I am of our whole bargaining unit and all our nurses who have continued to sacrifice so much of their time, energy, and dedication in working to achieve this contract. I am amazed at how much this movement has changed
things already.” The contract included an enforceable commitment for the hospital to adhere to patient-to-nurse staffing ratios, union nurse inclusion in staffing committee decision-making, and wage increases. Despite the optimism, some nurses felt underwhelmed by the process and end results. One nurse commented that the overwhelming amount of effort undertaken was not worth the results, and others expressed cynicism that hospital administrators would adhere to the contract. One union-active nurse described how the process was bittersweet and blended with disillusionment: “Just because we finally have reached a contract after a year of bargaining, a strike, and an additional strike threat does not undo the damage our [hospital administration] has caused. I am hopeful for the future to rebuild [the hospital] and restore it to a highly respected, top-rated, quality-centered hospital, but we are very far from that designation right now.”
Part 2: Changes in Culture
The second part of this study will describe how the culture among nurses changed throughout the collective bargaining process described chronologically in Part 1.
Community
Community refers to a perception of social solidarity, connectedness with others, and belonging to a group with shared ideals and goals. Early in the process of collective bargaining, union-active nurses in this study described a rediscovered “family feeling” with their coworkers from across the hospital. Some participants described a sense of isolation in their unit they weren’t aware of until after they started coming to union meetings. One remarked, “That almost-family interconnectedness is kind of coming back as a result of the union.” They described the solidarity they felt with other union members as a reason to keep engaging in union activities. Numerous nurses described a sense of duty to both their newfound community of union members and to serve the needs of nurses who were not union-active but could nonetheless benefit from union activities.
Disillusionment
Disillusionment with hospital administration was pervasive throughout the study, even among nurses who were not steadfast supporters of the union. Some nurses described worries that a unionization vote would result in administrative retaliation and worsen their working condition. Union nurses who initially voted ‘no’ to unionization questioned the union’s ability to materially improve the workplace. Skepticism gradually dissolved over time; a growing group of nurses within the collective bargaining unit regained hope that they could effectively advocate through the union.
While disillusionment with the union diminished over time, disillusionment with hospital administration worsened throughout the process of collective bargaining. There was a sense that the nominal trust nurses had in administrators prior to unionization was severely damaged by perceived repeated acts of disrespect combined with a failure to bargain with nurses in good faith, including administrators’ efforts to enforce a very stringent uniform policy, repeated perceived labor law violations, positions taken during bargaining that nurses felt denigrated their expertise
(like opposition to floating limitations), and discipline of union leadership perceived as retaliation by administrators. One nurse summarized their disappointment with the disrespect they perceived during a bargaining session: “You can literally sit there [in the bargaining room] all day and management won’t even come in. That was kind of shocking to me.” Even after an accord was reached with hospital administrators and the collective bargaining contract was ratified, nurses felt they would have to be vigilant to ensure the contract was honored because they felt hospital administrators would attempt to circumvent the agreement.
Empowerment
Prior to the commencement of this study, nurses voted in favor of forming a labor union to represent their interests because they felt they were disempowered in their healthcare institution. Nurses who voted in favor of the union described their vote as a demand for their voices to be heard by hospital administrators they felt were disinterested in nursing decision-making input. The union provided a venue for nurses to voice their concerns and demand acknowledgement in a setting where they otherwise felt disempowered. Moreover, the union represented a gradual transition from disenfranchised from decision-making authority to empowerment. Small victories like administrative concessions in collective bargaining negotiations and blocking administrators from making unilateral changes to working conditions during the bargaining period, along with community support both within and outside of the hospital, built comfort that empowerment was both feasible and acceptable for nurses who wanted greater decision-making authority. The process of gradual empowerment throughout the collective bargaining period prepared union nurses for the possibility that a labor strike may be required to reach a collective bargaining agreement they found acceptable. One nurse summarized: “This [unionization and advocacy for improved staffing ratios] is the foundation on which the rest of the improvement of health care will stem from.”
Discussion
The preeminent motivator for union activity in this study was the desire to effect changes to improve patient care standards and working conditions for nurses. This study utilized ethnography to understand how the
culture of nurses in the newly formed collective bargaining unit changed throughout the process of collective bargaining. In this study, nurses developed a newfound sense of community and belonging with one another and with the community at large. Union nurses felt increasingly empowered to effect positive change through their union activities and became less disillusioned with the notion of self-empowerment and advocacy as bedside nurses. However, union nurses in this study became increasingly disillusioned with hospital administrators and their responses to the nurses’ concerns.
New union formation and engaging in collective bargaining can be a turbulent period for bargaining unit members and administrators alike. Unions are sometimes blamed for creating division [due to inviting “outsiders” into the employee-employer relationship], strained communications, anxiety, and opposition between union members and leadership/administration (Foster, 2024; Stichler et al., 2019; Yun & Weber, 2024). However, participants in this study described a poor organizational culture in which they felt disregarded and even denigrated by a hierarchical leadership structure that predated collective bargaining efforts. Participants in this study felt that the union enabled them to more effectively challenge pre-existing hierarchical structures and instead redevelop a more collaborative and equitable organizational culture. Research from other industries has noted similar perceptions regarding the utility of unionization to deconstruct hierarchy and promote greater decision-making equity in the workplace (Gautam & Gautam, 2023; Jenkins, 2023; Sanfey, 2024).
The union provided a venue for nurses to voice their concerns and demand acknowledgement in a setting where they otherwise felt disempowered. Moreover, the union represented a gradual transition from disenfranchised from decision-making authority to empowerment.
While union nurses felt disillusioned with and disempowered by hospital administrators, nurses in this study found empowerment through their union activity by effecting positive change for both patient care and their working conditions. Disillusionment with or poor trust in hospital administrators may stem from a breach in the psychological contract between employer and employees (Brewer et al., 2024). Nurses sometimes perceive conflicts of interest between the financial interests of businessminded administrators and the psychological contract duties implied by the employer-employee relationship, which includes a duty to provide resources that nurses need to accomplish patient care duties, (Brewer et al., 2024; Christianson et al., 2023). Nurses in this study interpreted the cultural divide between their values and the values they perceived administrators to have as incompatible. Participants felt this impasse was not satisfactorily resolvable given pre-existing hierarchical structures, and therefore used unionization as a method to lessen hierarchical barriers to addressing cultural differences. While some nurses in this study reported a desire to work together with administrators, many participants became increasingly cynical about the possibility of collaboration with administrators throughout the duration of this study.
Some literature focuses on provision of empowerment opportunities to nurses by formal leaders (Gottlieb et al., 2021; Moura et al., 2020). However, empowerment opportunities may also be won regardless of leaders or administrator approval. The shift in culture from disempowered to empowered, together with the protections afforded by U.S. labor law, enabled union nurses in this study to successfully advocate for a collective bargaining agreement to improve both patient care and nurse working conditions. Further research is needed to better understand how nurse empowerment occurs, with and without encouragement from employers or organizational leadership.
Empowerment Through Community
Union-active nurses described a desire to serve the communities of people served by their hospital at the beginning of this study. However, a deeper sense of connection to those communities of people served by the hospital and other local labor unions also developed over time as the community expressed affirmations, gratitude, and provisions of material support. While there is existing literature on community being fostered by the behaviors or leadership styles of formal leaders (Christianson et al., 2023; Cronin et al., 2023; McKee et al., 2011; Xu et al., 2022), this study offers an alternative viewpoint. Community is not contingent upon leadership, but instead may be formed by a group of people with a shared vision, solidified by mutual support and camaraderie. Further research is needed to better understand how workplace communities form and how healthcare workplace communities interact with communities served by the healthcare institution.
Community formation, both within the workplace and with the community served by the hospital, served as a motivator and source of empowerment among participants in this study. The union allowed nurses access to a powerful tool for self-empowerment: U.S. labor laws. However, a union is not mandatory to community formation or empowerment in all workplace settings. Nurses who are not union members, feel unready to form a union themselves, or who do not feel a union is necessary in their workplaces might consider other methods for self-empowerment.
Methods to self-empower could be small in scope, such as declining excessive or unwanted overtime requests, filing incidents or grievances using pre-existing incident reporting systems, or opening dialogues about workplace issues with coworkers. Nurses who feel more empowered may consider collaborating with other nurses to engage in actions similar to the non-strike actions unions use. These actions may include writing letters to healthcare institution board members or local politicians about the impact of institutional decisions, obtaining media training to articulate how workplace issues affect the community to media outlets, or organizing protests that will not disrupt healthcare delivery like “no-smile strikes” (an action taken by flight attendants to bring awareness to emotional labor performed in their roles) (Eurofound, 2022; Noh & Hebdon, 2022).
Conclusion
This study highlighted how one group of nurses chose to use labor organization through unionization to effect changes that would improve patient care and working conditions for nurses. Unionization is an important tool for nurses to work collectively to enact and enforce working conditions that lead to safer and higher-quality patient care as well as healthier, more empowered employees. Further research is needed to explore additional avenues for nurse empowerment, particularly among nurses who work in environments with limited opportunities for patient and professional advocacy.
n References
Aamodt, A. (1982). Examining ethnography for nurse researchers. Western Journal of Nursing Research, 4(2), 209–221.
Aldhafeeri, N. A. (2024). Organizational culture: A concept analysis. Nursing Science Quarterly, 37(4), 365–372. https://doi .org/10.1177/08943184241269891
Apesoa-Varano, E., & Varano, C. (2004). Nurses and labor activism in the United States: The role of class, gender, and ideology. Social Justice for Workers in the Global Economy, 31(3), 77–104. https:// www.jstor.org/stable/29768259
Bevan, N. A., & Emerson, A. M. (2020). Freirean conscientization with critical care nurses to reduce moral distress and increase perceived empowerment: A pilot study. ANS Advances in Nursing Science, 43(3), E131–E146. https://doi.org/10.1097/ANS.0000000000000307
Brewer, K. C., Dierkes, A. M., & Norful, A. A. (2024). Organizational trust breaches among nurses and aides: A qualitative study. Nursing Ethics, 31(8), 1524–1536. https://doi.org/10.1177/09697330241230520
Burden, M., Astik, G., Auerbach, A., Bowling, G., Kangelaris, K. N., Keniston, A., Kochar, A., Leykum, L. K., Linker, A. S., Sakumoto, M., Rogers, K., Schwatka, N., & Westergaard, S. (2024). Identifying and measuring administrative harms experienced by hospitalists and administrative leaders. JAMA Internal Medicine, 184(9),1014–1023. https://doi.org/10.1001/jamainternmed.2024.1890
Chaison, G., & Bigelow, B. (2002). Unions and Legitimacy. Cornell University Press.
Christianson, J. (2023). Why we work: Exploring the relationships between work rewards, work-related burnout, and intention to leave for professional nurses [Dissertation, Marquette University]. https://www.proquest.com/openview/ c3e16f9c8e5f863bd161601c782cb03d/
Christianson, J., McCarthy, M., Sommers-Olson, B., Guttormson, J., & Johnson, N. L. (2023). Community or commodity? Perceived nurse support during the COVID-19 pandemic. Nursing Management, 54 (12), 44–53. https://doi.org/10.1097/ nmg.0000000000000079
Cronin, C. E., Choyke, K. L., & Franz, B. (2023). For-profit hospital reflections on community relationships in the time of COVID-19. Journal of Healthcare Management, 68 (1), 25–37. https://doi.org/10.1097/JHM-D-22-00015
Dahlke, S., & Hunter, K. F. (2020). How nurses’ use of language creates meaning about healthcare users and nursing practice. Nursing Inquiry, 27(3), e12346. https://doi.org/10.1111/nin.12346
Draper, J. (2015). Ethnography: Principles, practice and potential. Nursing Standard, 29(36), 36–41. https://doi.org/10.7748/ns.29.36.36.e8937
Emerson, C. (2017). Calling to nursing: Concept analysis. ANS Advances in Nursing Science, 40 (4), 384–394. https://doi.org/10.1097/ ANS.0000000000000185
Essex, R., & Weldon, S. M. (2022). The justification for strike action in healthcare: A systematic critical interpretive synthesis. Nursing Ethics, 29(5), 1152–1173. https://doi.org/10.1177/09697330211022411
Eurofound. (2022). Collective labour disputes in the EU. Publications Office of the European Union, Luxembourg. https://www .eurofound.europa.eu/system/files/2022-05/ef21026en.pdf
Foster, L. (2024, October 23). UMC nurses set to strike on Oct. 25. The Tulane Hullabaloo. https://tulanehullabaloo.com/67419/news/ umc-nurses-set-to-strike-on-oct-25/
Fowler, M. D. (2021). The Nightingale still sings: Ten ethical themes in early nursing in the United Kingdom, 1888–1989. The Online Journal of Issues in Nursing, 26(2). https://doi.org/10.3912/OJIN .Vol26No02PPT722
Fragkos, K. C., Makrykosta, P., & Frangos, C. C. (2020). Structural empowerment is a strong predictor of organizational commitment in nurses: A systematic review and meta-analysis. Journal of Advanced Nursing, 76(4), 939–962. https://doi.org/10.1111/jan.14289
Gautam, P. K., & Gautam, R. J. (2023). Organizational culture orientation and union influence. Management Dynamics, 26(1), 43–55. https://doi.org/10.3126/md.v26i1.59150
Gottlieb, L. N., Gottlieb, B., & Bitzas, V. (2021). Creating empowering conditions for nurses with workplace autonomy and agency: How healthcare leaders could be guided by strengths-based nursing and healthcare leadership (SBNH-L). Journal of Healthcare Leadership, 13, 169–181. https://doi.org/10.2147/JHL.S221141
Hammersley, M., & Atkinson, P. (2019). Ethnography: Principles and Practice (4th ed.). Routledge.
Higgins, C. (2016). Nursing education: Unions and their place in the curriculum [Master’s thesis, St. Catherine University].
Jenkins, T. (2023). Building we: Labor & management’s shared obligation to cultivate organizational culture. https://www.local3241.org/ local-3241-files/building-we-labor-management-s-shared-obligationcultivate
Jennings, K., & Western, G. (1997). A right to strike? Nursing Ethics, 4(4), 277–282. https://doi.org/10.1177/096973309700400403
McKee, M. C., Driscoll, C., Kelloway, E. K., & Kelley, E. (2011). Exploring linkages among transformational leadership, workplace spirituality and well-being in health care workers. Journal of Management, Spirituality & Religion, 8 (3), 233–255. https://doi.org/10.1080 /14766086.2011.599147
Moura, L. N., Camponogara, S., Santos, J., Gasparino, R. C., Silva, R. M. D., & Freitas, E. O. (2020). Structural empowerment of nurses in the hospital setting. Rev Lat Am Enfermagem, 28, e3373. https://doi .org/10.1590/1518-8345.3915.3373
National Labor Relations Board. (n.d.-a). Bargaining in good faith with employees’ union representatives. Retrieved Jun 25, 2024, from https://www.nlrb.gov/about-nlrb/rights-we-protect/the-law/ bargaining-in-good-faith-with-employees-union-representative
National Labor Relations Board. (n.d.-b). National Labor Relations Act. Retrieved June 25, 2024, from https://www.nlrb.gov/guidance/keyreference-materials/national-labor-relations-act
National Labor Relations Board. (2022a). Home | National Labor Relations Board. Retrieved August 12, 2024, from https://www .nlrb.gov/
National Labor Relations Board. (2022b). Union election petitions increase 57% in first half of fiscal year 2022. Retrieved Aug 17, 2024, from https://www.nlrb.gov/news-outreach/newsstory/union-election-petitions-increase-57-in-first-half-of-fiscalyear-2022
National Nurses United. (2023). About National Nurses United. Retrieved November 19, 2024, from https://www.nationalnursesunited .org/about
Noh, S.-C., & Hebdon, R. (2022). Unbundling workplace conflict: Exploring the relationship between grievances and non-strike industrial actions and the moderating effect of voice mechanisms. Journal of Industrial Relations, 65(1), 22–43. https://doi .org/10.1177/00221856221099788
Otter.ai. (2024). Otter.ai. In https://otter.ai/ Reeves, S., Peller, J., Goldman, J., & Kitto, S. (2013). Ethnography in qualitative educational research: AMEE Guide No. 80. Medical Teacher, 35(8), e1365–1379. https://doi.org/10.3109/01421 59X.2013.804977
Sanfey, D. (2024). ‘Enough is enough’: A mixed methods study on the key factors driving UK NHS nurses’ decision to strike. BMC Nursing, 23(1), 247. https://doi.org/10.1186/s12912-024-01793-4
Scott, B. (2018). Transitioning from RN to MSN: Principles of Professional Role Development. Springer Publishing Company.
Seidman, J. (1970). Nurses and collective bargaining. Industrial and Labor Relations Review, 23(3), 335–351. https://doi.org/10.2307/2522109
Stichler, J. F., Pelletier, L. R., & Thomason, T. (2019). An exploratory, descriptive study of nurse leaders’ personal and work experiences during union negotiations and strike events. The Journal of Nursing Administration, 49(1), 42–47. https://doi.org/10.1097/ NNA.0000000000000706
Wall, S. (2015). Focused ethnography: A methodological adaptation for social research in emerging contexts. Forum: Qualitative Social Research, 16(1). https://doi.org/10.17169/fqs-16.1.2182
Xu, J. M., Stark, A. T., Ying, B. H., Lian, Z. M., Huang, Y. S., & Chen, R. M. (2022). Nurses’ workplace social capital and the influence of transformational leadership: A theoretical perspective. Frontiers in Public Health, 10, 855278. https://doi.org/10.3389/ fpubh.2022.855278
Yun, K., & Weber, R. (2024). A message about collaborating with our participating faculty. Retrieved Oct 26, 2024, from https://today .marquette.edu/2024/10/a-message-about-collaborating-with-ourparticipating-faculty/
Do Persons Age in the Same Manner, Related to Their Date of Birth?
Marilyn Klainberg, EdD, RN
Irene Auteri, PhD, RN
Joy Scharfman, PhD, RN, CNS
Bridget Maley, PhD, RN, CNE
William Jacobowitz, EdD, RN, PMHCNS-BC
Mercy Joseph, PhD, MSN, RN, ANP-C
Patricia Pope, EdD, RN
Catherine R. Bell, DNP, RN
n Abstract
Background: Progressive growth of the aging population has been brought into the concern of healthcare providers. The gerontological data available, however, are mainly based on the broad knowledge of aging over the age of 65. An extensive literature search has suggested that aging should be identified using a multidimensional approach in that a person ages differently depending on various factors, including health determinants, socialization, independence, and self-perception of one’s health status.
Purpose: To elucidate the complex factors affecting the relationship between chronological age, health perception, socialization, and independence related to specific age groups over 65.
Method: This descriptive, quantitative study utilized the continuity theory (Cavan et al., 1949) and the activity theory (Havighurst, 1961) of adaptation of a life course to explore the impact of aging on health perception, socialization, and independence over the age of 65. One hundred and seventy-five convenience sample subjects were recruited in suburban and metropolitan New York living independently and in assisted-living facilities.
Results: The impact on aging is a multifactorial phenomenon. Adults considered themselves as “healthy” (87%), reported they have not fallen within the past 6 months, do not adhere to a special diet (79%), do exercise regularly (72%), and are evenly divided for getting eight or more hours of sleep per night. Most socialize with both friends and family (89%). Concerning self-care, less than half drink the standard recommended 65 oz of water per day (40%), most take daily rest periods (73%), most exercise daily (72%), and participate in enjoyable daily activities (91%).
Conclusions: The results of our analysis indicate that nurses and healthcare providers need to be aware of and understand the attitude toward healthy aging. Interventions to help bolster seniors’ psychological and physical strength are recommended. Relevance to clinical practice: This study emphasized seniors’ psychological, social, and independence needs throughout the aging process. Therefore, improvements in moral support would provide psychological reinforcement for seniors’ attitudes on aging. Informing healthcare providers is necessary to reduce the stigmatism of aging.
Keywords: aging, self-perception, socialization, health perception, biological aging
Marilyn Klainberg, EdD, RN, College of Nursing and Public Health, Adelphi University, Garden City, New York
Irene Auteri PhD, RN, College of Nursing and Public Health, Adelphi University, Garden City, New York
Joy Scharfman, PhD, RN, CNS, College of Nursing and Public Health, Adelphi University, Garden City, New York
Bridget Maley, PhD, RN, CNE, College of Nursing and Public Health, Adelphi University, Garden City, New York
William Jacobowitz, EdD, RN, PMHCNS-BC, College of Nursing and Public Health, Adelphi University, Garden City, New York
Mercy Joseph, PhD, MSN, RN, ANP-C , College of Nursing and Public Health, Adelphi University, Garden City, New York
Patricia Pope, EdD, RN, College of Nursing and Public Health, Adelphi University, Garden City, New York
Catherine R. Bell, DNP, RN, College of Nursing and Public Health, Adelphi University, Garden City, New York
Background
According to the United States Census Bureau, America is a “graying nation.” By 2030, the baby boomers will be 65 years and older and one out of five Americans will be of retirement age (Centers for Disease Control and Preventions, n.d.). The population of people 65 and older is projected to outnumber children for the first time in U.S. history by 2034 (U.S. Census Bureau, 2023) with this population doubling in size from 49 million in 2016 to 95 million in 2060. The U.S. Census Bureau (2023) also projects that the number of people in the United States who are 85 years and older will more than double from 2022 to 2040, and nearly triple by 2060. It is time to consider the quality of life in older adults and the factors influencing healthy aging.
Living longer offers older people opportunities to pursue passions, education, and interests, which may enrich the person, their family, and society. The aging process is biological, psychological, and social and must be viewed holistically. Every person ages differently and their experience is influenced by numerous factors, including genetics, social and physical environment/support, personal characteristics, life transitions/losses, chronic health conditions, and early adverse experiences. Ageism refers to prejudice, behaviors, attitudes, and policies that discriminate against older people. Research reveals that older adults’ self-perception of aging impacts the quality of their lives, highlighting the importance of understanding individuals’ perceptions of aging to support successful, positive aging (Hausknecht et al., 2019).
Persons age differently depending on various factors, including health determinants, socialization, independence, and self-perception of one’s health status. In order to meet the needs of an aging population, the researchers look at variables that affect aging, such as health perception, chronic conditions, health status, mental health, social connections, community involvement, financial issues, and environmental factors. Healthcare systems across the globe may be ill-prepared to shift resources to meet the demands of geriatric care and chronic disease treatment and management (McMaughan et al., 2020). This descriptive study examines if differences in aging of persons 65 or older are dependent upon chronological age or issues related to socialization, health determinants, and perception of one’s health.
Biological/Physiological Aging
The diseases that frequently develop with aging often impact one’s quality of life. Aging begins at the cellular level, marked by decreased oxygen supply to organs and tissues. Hypoxia may contribute to developing inflammatory diseases as well as cardiac disease, diabetes, chronic kidney disease, Alzheimer’s disease, Parkinson’s disease, and other neurodegenerative diseases (Leyane et al., 2022). Vascular aging causes arterial degeneration, which impairs vascular function and leads to vital organ damage. Chromosomal changes, specifically the shortening of telomeres and nucleoprotein structures, result in chromosomal instability linked to aging (Noto, 2023). Problems such as hearing loss, cataracts, osteoarthritis, chronic obstructive pulmonary disease, osteoporosis, dementia, and depression are experienced more as people age. Disease processes that interfere with the ability to perform activities of daily living affect health-related quality of life (HRQOL). However, it is possible to improve and maintain HRQOL with healthy lifestyle habits, including diet, exercise, or antiaging interventions,
The findings that super-agers had higher gray matter volume and showed slower gray matter atrophy, specifically in the medial temporal lobe, than individuals in the typical older group may explain resistance to age-related memory loss.
focusing on vascular aspects of the aging process to extend the health span rather than prolonging lifespan (Hamczyk et al., 2020; Noto, 2023).
Physical Activity and Healthy Aging
A positive connection has been identified between exercise and cognitive health. Focusing on neurobiological and executive functioning enhances creativity and related cognition. Exercise impacts social, emotional, mental, and physical health throughout life. (Martini et al., 2024).
Garo-Pascual et al. (2023) conducted an observational study to delineate factors of individuals deemed super-agers. The authors assert that cognitive abilities, especially memory, typically diminish with age. Super-agers are people aged 80 years or older with episodic memory of a healthy person 20 to 30 years younger. Brain structure, demographics, lifestyle, and clinical factors were examined. The findings that superagers had higher gray matter volume and showed slower gray matter atrophy, specifically in the medial temporal lobe, than individuals in the typical older group may explain resistance to age-related memory loss. Super-agers self-reported better mental health, lower straight-trait anxiety, and lower geriatric depression scores compared to typical older adults. The researchers identified three essential variables of super-agers as related to mental health: less depression, anxiety, and increased resilience (Garo-Pascual et al., 2023). These findings align with those of Lai et al. (2020), who report that happier people are more likely to be physically active and enjoy better sleep habits and practices. Their findings showed that overall resilience was strongly and positively associated with happiness.
Social Determinants of Health and Aging
Van Leeuwen et al. (2019) conducted a thematic synthesis of multiple studies regarding quality of life. The researchers identified nine domains: autonomy, role and activity, health perception, relationships, attitude and adaptation, emotional comfort, spirituality, home and neighborhood, and financial security. The study ascertained that feeling healthy, having the ability to self-manage, the ability to participate in enjoyable activities, maintaining close relationships, having an emotional support system, spirituality and faith, financial security, and access to their neighborhood are all factors that determine the quality of life for people; however, all these factors are intertwined as a dynamic web. The social determinants of health impact a person’s quality of life and how they age from both a subjective and objective perspective.
Social connectedness and support have been identified as critical for optimal aging. Rhee et al. (2021) examined the association of the diversity of social networks and perceived quality of social support with HRQOL. They included respondents above age 65 or older. The researchers found that the diversity of social networks is more important than the perceived quality of social support for HRQOL in the older population. They also found that low socioeconomic levels—like low income, education, and employment—were negatively associated with diverse social networks. Higher socioeconomic factors were positively associated with HRQOL (Rhee et al., 2021).
Wu & Sheng (2019) conducted a path analysis study in China to understand the pattern of relationships between social support networks, social support, self-efficacy, and health-promoting behavior among adults 60 years and older and how it affects healthy aging. They found that neighbor networks had a more significant impact on healthy aging than family and friend networks. Friend networks had a more substantial effect on health-promoting behavior and self-efficacy when compared to family networks. They also found that self-efficacy had a considerable impact on healthy aging. Support from family members helps in health-promoting behavior and healthy aging. They concluded that social support networks play a significant role in healthy aging (Wu & Sheng, 2019). Social support, self-efficacy, and healthy lifestyle behaviors have consistently been associated with positive aging.
Theoretical Framework
This study draws upon two theories of aging: activity theory and continuity theory. The study explores the impact and differences of aging related to specific age groups over 65. The investigators explored if there was a difference between age groups concerning their health status, socialization, and independence.
Activity Theory
The activity theory of aging, suggests that older adults who maintain high levels of social interaction, engage in various activities, garden, volunteer, and attend plays and social functions tend to experience greater life satisfaction (Havighurst, 1961; Morgan et al., 2019). Activity theory is based on the premise that healthy aging occurs when older adults remain active and socially connected as they did in their younger years (Morgan et al., 2019). Drew (2023) suggests that aging individuals who stay socially active may delay aging. It also suggests that aging individuals lose past life roles, such as entering into retirement. Aging individuals may find gratification in retirement by engaging in activities on their “bucket lists,” such as learning a new language, playing an instrument, completing educational endeavors, or maintaining close relationships with family and friends.
Continuity Theory
The continuity theory suggests an individual’s personality, behavior, and lifestyle will remain the same as they age and that aging individuals will adapt to life changes by using the same lifestyle strategies as in their younger years. The idea of a continuity theory can be traced back to Cavan et al. (1949), who argued “The best adaptation to advanced age depends
on continuity between middle and advanced age” (Nimrod & Kleiber, 2007, p. 2). Subsequently, Atchley (1989) expanded Cavan’s concept and is considered to be the “father” of continuity theory (Nimrod & Kleiber, 2007). Atchley (1989) postulated aging is shaped by an individual’s history, values, and social interactions. He perceived continuity in aging as a dynamic and developmental process. Individuals grow and change but adapt to new circumstances and environments connected to their past experiences, using strategies to maintain the continuity of individual structure (Drew, 2023).
This theory can be subdivided into an individual’s internal structure, i.e., personality traits, ideas, emotions, and belief systems that remain unchangeable throughout their lifetime. On the other hand, an individual’s external structure, such as relationships, activities, and social roles, helps them to preserve an unwavering self-concept and a way of living (Drew, 2023). Both support aging adults as they adapt to life’s evolution. The activity theory asserts a positive relationship exists between older people’s perceived life satisfaction and their participation in social activities. The continuity theory emphasizes the natural progression of life from birth to the end of life.
Methods
Upon institutional review board approval from the researchers’ home institution, a quantitative descriptive study was conducted. One-hundred and seventy-five (175) convenience sample subjects were recruited. Informed consent was obtained.
The sample consists of active older Americans from the New York metropolitan region who experience a chronic illness without significant health-related limitations or the need for professional home health assistance. The responses were evaluated according to the following age ranges: 65–69, 70–79, 80–89, 90–99, and 100 and over.
Results
Overall, the sample can be characterized as being aged 70 to 79 years (71%), female (58%), married (58%) or widowed (23%), Caucasian (73%), non-Hispanic (84%), residing on Long Island, New York (56%), or in New York City (27%), and having graduated high school (94%). Participants were living at home and/or in assisted or independent living situations. In this study, 87.4% of the sample population perceived themselves as healthy even though 62.3% had chronic illnesses. Fifty-four of the participants have a family member living within one mile, and 85 reported that they do not feel lonely. Eighty-nine percent socialize with family and friends. The positive findings were that 84.6% did not feel lonely, even though 77.0% lived alone. From a mental health perspective, 80.0% did not feel sad, and 90.9% engaged in enjoyable daily activities. Of this study’s population, 96.6% stated they exercise, 50.3% get 8 hours of sleep or more, and 73.1% took rest periods. Another vital factor is socialization with friends and families (88.6%). A small percentage continue to work (10.5%) full-time or part-time. Missing data ranged from 2.0% to 43.0% of cases depending on the question. These factors identified from the data included that exercise, sleep, and rest periods play significant roles in well-being. This study highlighted the need for exercise, time for rest and sleep, and socialization with friends and families in the older population.
A systematic scoping review on older adults’ self-perceptions of aging revealed that various perspectives guide each individual’s point of view. Attitudes toward aging, self-stereotypes and self-stigma, successful aging, how old a person feels, views of the future, their aging body, the limitations of aging, and definition of aging are factors that contribute to each individual’s notion of aging (Hausknecht et al., 2019).
Healthcare providers need to address these protective factors when caring for older adults. Future studies may be needed to determine health-enhancing factors for the aging population.
Discussion
Knowing the meaning of aging and its impact on each individual may lead to an awareness of what constitutes an environment that supports healthy aging. A systematic scoping review on older adults’ self-perceptions of aging revealed that various perspectives guide each individual’s point of view. Attitudes toward aging, self-stereotypes and self-stigma, successful aging, how old a person feels, views of the future, their aging body, the limitations of aging, and definition of aging are factors that contribute to each individual’s notion of aging (Hausknecht et al., 2019). Recognizing that multiple factors influence an older adult’s self-perception of age is critical. Aging is shaped by multiple influences, individual and societal, which must be considered in promoting a healthy population.
This research revealed that self-perception and self-efficacy affects a person’s view of aging. Self-perceptions are multidetermined and reflect attitudes toward aging, including self-stereotypes, self-stigma, and subjective opinions of how old a person feels about themselves (Hausknecht et al., 2020). Persons age uniquely. The aging phenomena is associated with and influenced by a person’s genetic makeup, health behaviors, social support, and culture (Hausknecht et al., 2020).
Limitations of the study
The findings of this study represent a population limited to suburban and metropolitan regions of New York. The researchers suggest comparing this data to other areas nationwide in the future.
Conclusion
The findings of this study provided further insight into the aging process and its relation to birth year. The study demonstrates that it is invaluable to explore the process of aging. As this method studies environmental relationships, it resonates well with the multidimensional aspects of the aging phenomenon. Researchers are more aware of the influences described in this study. Research supports that most individuals are able to maintain their well-being and mobility by choosing healthy habits and sustaining health.
The results of our analysis indicate that nurses and healthcare providers need to be aware of and understand the attitudes toward healthy aging. Interventions to help bolster seniors’ psychological and physical strength are recommended. The significance of this study for nursing is its impact on the health care and well-being of the aging population and dispelling ageism in the care of older adults. This study emphasized seniors’ psychological, social, and independence needs throughout aging. Educating healthcare providers is essential to reduce the stigmatism of aging and improve the health care of older adults. Furthermore, these findings demonstrate that future studies are needed to explore how environmental connections, including technology, contribute to a society’s contribution to successful aging.
Table 1
Demographic Characteristics
Table 2
Table 3 Self-Care Habits
n References
Atchley, R. C. (1989). The continuity theory of normal aging. The Gerontologist, 29 (2), 183–190. https://doi.org/10.1093/ geront/29.2.183
Cavan, R. S., Burgess, E. W., Havighurst, R. J., & Goldhamer, H. (1949). Personal adjustment in old age. Chicago: Science Research Associates, Inc.
Centers for Disease Control and Prevention. (n.d.). Publications and Information Products. https://www.cdc.gov/nchs/products/index.htm
Drew, C. (2023). Continuity theory of aging: Definition, Examples & Criticism. https://helpfulprofessor.com/continuity-theory-of-aging/ Frith, E. (2022). Long live creativity: Exploring the exercise-creative cognition link in later life. Translational Issues in Psychological Science, 8 (1), 47. https://doi.org/10.1037/tps0000297
Garo-Pascual, M., Gaser, C., Zhang, L., Tohka, J., Medina, M., & Strange, B. A. (2023). Brain structure and phenotypic profile of super-agers compared with age-matched older adults: a longitudinal analysis from the Vallecas Project. The Lancet Healthy Longevity, 4(8), e374–e385. https://doi.org/10.1016/S2666-7568(23)00079-X
Hamczyk, M. R., Nevado, R. M., Barettino, A., Fuster, V., & Andrés, V. (2020). Biological versus chronological aging: JACC focus seminar. Journal of the American College of Cardiology, 75(8), 919–930. https://doi.org/10.1016/j.jacc.2019.11.062
Hausknecht, S., Low, L. F., O’Loughlin, K., McNab, J., & Clemson, L. (2019). Older adults’ self-perceptions of aging and being older: A scoping review. The Gerontologist, 60 (7), e524–e534. https://doi .org/10.1093/geront/gnz153
Havighurst, R. J. (1961). Successful Aging. The Gerontologist, 1(1), 8–13. https://doi.org/10.1093/geront/1.1.8
Holstein, M. B., & Minkler, M. (2003). Self, society, and the “new gerontology.” The Gerontologist, 43(6), 787–796. https://doi .org/10.1093/geront/43.6.787
Lai, D. W., Lee, V., & Yan, E. (2020). Factors Associated With Positive Aging and Happiness of the Older People in Hong Kong. Innovation in Aging, 4(Suppl 1), 115. https://doi.org/10.1093/geroni/igaa057.378
Leyane, T. S., Jere, S. W., & Houreld, N. N. (2022). Oxidative stress in ageing and chronic de-generative pathologies: Molecular mechanisms involved in counteracting oxidative stress and chronic inflammation. International Journal of Molecular Sciences, 23(13), 7273. https://doi.org/10.3390/ijms23137273
Martini, M., Enoch, J., & Kramer, A. F. (2024) The effects of a short exercise bout on executive functions in healthy older adults. Scientific Reports, 14(1), 28827. https://doi.org/10.1038/s41598024-79685-5
McMaughan, D. J., Oloruntoba, O., & Smith, M. L. (2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health, 8, 231. https://doi.org/10.3389/ fpubh.2020.00231
Mock, S. E., & Eibach, R. P. (2011). Aging attitudes moderate the effect of subjective age on psychological well-being: Evidence from a 10-year longitudinal study. Psychology and Aging, 26(4), 979–986. https://doi.org/10.1037/a0023877
Morgan, G. S., Willmott, M., Ben-Shlomo, Y., Haase, A. M., Campbell, R. M. (2019). A life ful-filled: Positively influencing physical activity in older adults—a systemic review and meta-ethnography. BMC Public Health, 19(1), 362. https://doi.org/10.1186/s12889-019-6624-5
Nimrod, G., & Kleiber, D. A. (2007). Reconsidering change and continuity in later life: Toward an innovation theory of successful aging. International Journal of Aging and Human Development, 65(1), 1–22. https://doi.org/10.2190/Q4G5-7176-51Q2-3754
Noto, S. (2023). Perspectives on aging and quality of life. In Healthcare, 11(15), 2131. https://doi.org/10.3390/healthcare11152131
Quadagno, J. (2007). Aging and the life course: An introduction to social gerontology (4th ed.) McGraw-Hill Humanities, Social Sciences & Languages.
Rhee, T. G., Marottoli, R. A., & Monin, J. K. (2021). Diversity of social networks versus quality of social support: Which is more protective for health-related quality of life among older adults? Preventive Medicine, 145, 106440.
U.S. Census Bureau. (2020). Demographic turning points for the United States: Population projections. From 2020 to 2060. Retrieved from https://www.census.gov/content/dam/Census/library/ publications/2020/demo/p25-1144.pdf
Van Leeuwen, K. M., Van Loon, M. S., Van Nes, F. A., Bosmans, J. E., De Vet, H. C. W., Ket, J. C. F., Widdershoven, G. A. M., Ostelo, R. W. J. G. (2019). What does quality of life mean to older adults? A thematic synthesis. PLoS One, 14 (3), e0213263. https://doi .org/10.1371/journal.pone.0213263
World Health Organization. (2017). Global strategy and action plan on aging and health. Geneva: World Health Organization. Accessed April 17, 2023, https://www.who.int/publications/i/item/globalstrategy-and-action-plan-on-ageing-and-health
Wu, F., & Sheng, Y. (2019). Social support network, social support, selfefficacy, health-promoting behavior and healthy aging among older adults: A pathway analysis. Archives of Gerontology and Geriatrics, Section III Human. https://doi.org/10.1016/j.archger.2019.103934
Trauma-Informed Care in Nursing Education
Joy Scharfman, PhD, RN, CNS
Mercy Joseph, PhD, MSN, RN, ANP-C
n Abstract
Purpose: The purpose of this article is to understand the need for trauma-informed care (TIC) in nursing education.
Rationale: Trauma occurs as a result of an event or series of events experienced by an individual as physically or emotionally harmful or life threatening. Trauma can happen to anyone irrespective of age, sex, gender, or socioeconomic status. Adverse childhood experiences (ACE) are potentially traumatic events a child may experience during the first 18 years of life. Children who are abused, neglected, witnessed family violence or divorce, or grew up in a family with mental illness or substance abuse may suffer from mental and physical problems later in life. Trauma-informed care is essential in treating patients in all healthcare settings. Thus, it is important to include TIC in nursing education and nursing curriculum.
Position statement: It is important to educate nursing students about TIC and its principles in order to care for patients who experienced trauma and avoid retraumatization.
Conclusion: It is essential to incorporate TIC in nursing education, as every patient needs to be cared with using “universal trauma precautions.”
Keywords: trauma, trauma-informed care (TIC), trauma-informed education (TIE), adverse childhood experiences (ACE), neurobiology of trauma, trauma-informed care in nursing education, social determinants of health
Introduction
Society is now recognizing the impact of trauma on physical and emotional health. An expanded awareness of how trauma manifests in the human body has earned the attention of individuals throughout the world, including those practicing in the healthcare system, educational system, legal system, and law enforcement. Understanding what constitutes trauma has enlightened many people about the obvious sources of trauma as well as the hidden, implicit traumatic experiences affecting the population. Trauma-informed care (TIC) is now established as an important element in healthcare. Nurses are often the first to encounter patients who are victims of trauma, therefore, including TIC in nursing education is essential. An extensive literature review was done using CINAHL, PubMed, and PsycNet to understand the effect of trauma on children, as well as on adults, and explore the existence of TIC in baccalaureate nursing education. TIC has been included in the professional education of many healthcare disciplines. However, it is just
beginning to be included in nursing education. Traumainformed education (TIE) in the health sciences exists in social work, psychology, medicine, and dentistry. Goddard et al. (2022) published a concept analysis on TIE in nursing, revealing there are no competencies for TIC in nursing or nursing education. They assert a trauma-informed approach is critical in nursing as it is essential for healing (National Child Traumatic Stress Network [NCTSN], 2017).
TIC in nursing education includes teaching students about different types of trauma, its impact on health, and how to address trauma in patient care. In order to provide patient-centered care, nurses need to develop partnership with patients, understanding their lived experience, values, and preferences. Since patient safety and quality care are fundamental to nursing, nurses need to be proficient on how to safely attend to patients who have experienced trauma. Addressing how to communicate with people about sensitive topics such as violence and abuse needs to be incorporated
Joy Scharfman, PhD, RN, CNS, College of Nursing and Public Health, Adelphi University, Garden City, New York Mercy Joseph, PhD, MSN, RN, ANP-C, College of Nursing and Public Health, Adelphi University, Garden City, New York
into nursing education. Developing self-awareness, nonjudgmental attitudes, and effective communication skills are important for nursing students. Nursing students need opportunities to learn, practice, assess, and intervene in situations involving violence. It is essential to help the students develop awareness about ethical dilemmas when working with those who experienced trauma (Burton et al., 2019).
Literature Review Impact of Trauma
Trauma is a major public health and community health issue. Trauma can happen to anyone irrespective of their age, sex, gender, sexual orientation, socioeconomic status, and ethnic origin (U.S. Department of Health & Human Services [HHS] 2014). Trauma can be acute or prolonged and has devastating effects at any time in a person’s life. Each individual’s experience of trauma is unique, and an event that may be perceived as trauma for one individual may not be perceived by another individual as traumatic. In case of sexual or physical abuse, the victim can experience the sense of humiliation that can lead to self-blame, shame, and guilt. When a child is abused by a trusted caregiver, the child can feel betrayed and the trust is shattered. Many times, it is accompanied by silencing which may lead to fear of reaching out for help. Trauma involves interaction of trauma experiences, neurobiology and support systems, and social factors. It has long-term consequences on health (Wathen et al., 2023). Nurses are frequently the first contact person in most of the healthcare settings. Therefore, it is important to educate nursing students about TIC and its principles. According to American Association of Critical-Care Nurses (AACN), nurses need to understand the influence of political, social and economic factors on health care and their effects on the population.
Social Determinants of Health (SDOH) and Trauma
Social Determinants of Health (SDOH) are conditions in which people are born, live work and age. The SDOH are mostly shaped by distribution of money, power, and resources available and these factors contributes to health inequities. These can be at all levels: local, national, and global (Demarco & Walsh, 2024). It includes economic stability, healthcare access, educational access and quality, and neighborhood and community. SDOH can contribute to health disparities, racism, discrimination, and violence. Poverty, lack of access to health care and education, and an unsafe environment have been identified as adverse experiences which impact growth, development, and subsequent health of those impacted (Human Services [HSS], n.d.); Sable et al., 2024 & U.S. Department of Health). The impact of SDOH may be traumatic. It is critical that nursing students understand and identify the impact of SDOH on both physical and mental health and quality of life.
Adverse Childhood Experiences
The adverse childhood experiences (ACEs) emerged as a set of powerful, potentially traumatic events which a child may experience during the first 18 years of life (Centers for Disease Control and Prevention [CDC], 2019). The seminal study that identified the relationship between ACEs
and both physical and emotional problems was conducted by Felitti et al., between 1995 and 1997, and published in 1998 in Southern California as part of Kaiser Permanente’s Health Appraisal Centre. This retrospective study collected data from 17,337 participants found that approximately two-thirds of the sample experienced at least one ACE and 12.5% reported four or more ACEs. The study revealed a dose-dependent relationship between adverse experiences and the onset of cognitive, emotional, and/ or behavioral problems. The person with four ACEs had an increased risk of depression, suicide attempts, and substance use (Felitti et al., 1998). The questionnaire included 10 items which addressed the original three categories of ACEs: abuse (physical, emotional, and sexual), neglect (physical and emotional), and household dysfunction (parental loss, separation, divorce, intimate partner violence, parental incarceration, and drug/alcohol abuse). Children who were abused or neglected, witnessed family violence or divorce, or grew up in a family with a parent with mental illness or substance abuse suffered from a variety of psychological and/or physical problems. This research focused on examining the relationship between ACEs and subsequent onset of physical, cognitive, emotional, and behavioral sequelae confirms an increased risk of developing psychiatric problems such as anxiety, depression, post-traumatic stress disorder (PTSD), suicidality, and psychosis (Karcher et al., 2020). Nurses need to be aware of the impact of ACEs on human development and human conditions. Reflecting on and understanding their own trauma history will help them to develop a heightened sensitivity to the experience of others (Burton et al., 2019).
Additional ACEs
Systematic reviews and meta-analyses of the literature reveal that the original list of childhood adversities, while extensive, is not allinclusive (McKay et al., 2021; Thurston et al., 2023). Awareness of the longitudinal effects of ACEs has alerted advocates and researchers to consider other ACEs. A multitude of life experiences have emerged as potentially traumatic such as human trafficking, exposure to mass shootings, violence, and moving, and racism (Polanco-Roman et al., 2024; Sabel et al., 2024). In the last two decades, people in the United States have witnessed several traumatic events, including national disasters, acts of terrorism, and pandemic not previously experienced in the last century. The distress associated with the coronavirus 19 (COVID-19) pandemic contributed to an onslaught of emotional problems for children and young adults throughout the world (Solberg et al., 2024). Social isolation, distancing, and stay-at-home precautions placed individuals in unstructured, confusing, and frightening situations. Numerous reports of increased child abuse, intimate partner violence, and drug and alcohol use resulted (Solberg et al., 2024). It is crucial to equip future nurses with the tools to assess and care for patients who are victims of trauma and ACEs.
Global Crises and Trauma
Global crises impact children and adolescents, adding another layer of adversities. The events of mass trauma in war includes physical torture, psychological abuse, social torture, and destruction (Musisi & Kinyanda, 2020). Children may be orphaned, abandoned, and/ or experience homelessness. They may have to beg for or steal food for survival. They can become victims of substance abuse and crime. These
children often suffer from chronic traumatization. Recurring trauma can lead to developmental disorders (Musisi & Kinyanda, 2020; Syam et al., 2019). Since global crises are escalating due to war, civil unrest, and natural disasters, nurses need to be prepared to care for these victims.
The Impact of Trauma on Neurobiology
Trauma impacts neurobiology, causing neurochemical and developmental changes in children and dysregulation of the survival response system (Nelson et al., 2020). Trauma dysregulates the hypothalamic-pituitaryadrenal (HPA) axis and disrupts the physiological return to the homeostasis of an individual. This results in a disturbance of the sense of self and feeling of safety in their world. Changes in thinking and memory, decreased concentration, increased arousal, and negative cognitions are some of the consequential symptoms identified (American Psychiatric Association, 2022). This can result in learning changes, altered cognitive processing, and future health problems (Buettel & Abram, 2022; Edelman, 2023; Felitti et al., 1998; Greenwald et al., 2023; Wheeler, 2018). Survivors of trauma may have difficulties regulating their emotions and may resort to selfmedicating with substances, self-injury, eating disorders, or compulsive behaviors (spending, gambling, overworking) (van der Kolk, 2014). Many times, survivors of trauma who are experiencing psychological and mental disorders are seen in emergency rooms and in primary care settings. Therefore, it is very important for nurses to learn about TIC and to assess these patients using TIC principles.
Trauma-Informed Care (TIC)
Respecting patient’s experience of trauma, recognizing signs and symptoms of trauma, incorporating trauma knowledge and practices, and avoiding retraumatization are core principles of trauma-informed care (TIC) (National Center for Trauma-Informed Care [NCTIC], 2018). TIC acknowledges the potential for secondary trauma and the need to protect against triggering retraumatization. Retraumatization can result from a tone of voice, question, look, and smell or touch. Being mindful, introducing yourself and your role, explaining every step of your encounter using clear, simple language, and maintaining open, nonthreatening body language are key to ensure a sense of safety (Buettel & Abram, 2022). The five key ingredients of TIC are patient’s empowerment, choice, collaboration, safety, and trustworthiness (HHS, 2014). The six principles of trauma-informed care approach as outlined by the U.S. Department of Health & Human Services Substance Abuse and Mental Health Services Administration (2014) include safety, trustworthiness, peer support, collaboration, empowerment, culture, historic and gender acknowledgement. The framework of TIC relies on physical, psychological, and emotional safety, which will help survivors for empowerment and build sense of control. This can be applied as universal principle (Greenwald et al., 2023). Repeating detailed personal accounts of traumatic events and circumstances may cause retraumatization (Edelman 2023). A pedagogical approach of incorporating the key ingredients and the principles of TIC in nursing education, as explained by SAMHSA (2014), will help nursing students to care for patients who had trauma experience. Harvey and Snell (2024) explain how to integrate TIC approach, supporting undergraduate nursing students in clinical environment. They state that utilizing the principles of HSS (2014) nurse educators can create
a TIE environment that includes physical and psychological safety. It is important to consider cultural historical, and genders issues and avoid retraumatization. Encouraging students to identify their strengths and weaknesses, empowering them, and providing them opportunities to voice their choices are important to enhance learning (Harvey & Snell, 2024). These principles can be utilized in the curriculum development using the new AACN essentials.
Resilience
Resilience is considered to be a multidimensional attribute that supports the process of making psychological and physiological adjustments to cope with trauma or adversity (Friedberg & Malefakis, 2018). The American Psychological Association (APA) (2016) suggests multiple ways to build resilience: a strong belief in self and positive connections with people, family, and friends; moving toward realistic goals; and taking decisive actions to encounter stressful situations. A positive view and perception of one’s own self-worth will build resilience. Taking care of physical and emotional health boosts resilience. Attempting to understand and support the factors that build resilience can help strengthen a person’s ability to cope with trauma. Resilience is an important element of TIC. Working with people to nurture and fortify their resilience is an important part of developing tools to cope with the uncertainty of life. (Wheeler & Philips, 2021). Educating nursing students with the tools for providing TIC, opportunities for self-reflection and awareness, and providing the skills to practice self-care in curricula will help to improve TIC implementation (Pfeiffer & Grabbe, 2022).
Post-Traumatic Growth (PTG)
Post-traumatic growth (PTG) is another concept that needs to be considered in TIC. PTG refers to positive psychological changes which transform an individual who has experienced highly stressful events (Henson et al., 2021). These positive changes increase one’s ability to overcome adversities and favor existential changes, stemming from a reevaluation of one’s philosophy of the meaning of life, improvements
Post-traumatic growth refers to positive psychological changes which transform an individual who has experienced highly stressful events. These positive changes increase one’s ability to overcome adversities and favor existential changes, stemming from a reevaluation of one’s philosophy of the meaning of life, improvements in interpersonal relationships, and openness to new possibilities in life (Henson et al., 2021).
in interpersonal relationships, and openness to new possibilities in life (Henson et al., 2021). Improving personal and spiritual strength inspires greater empathy toward other people and being more humane (Kang et al., 2024; Serpa-Barrientos et al., 2023). Serpa-Barrientos et al. (2023) studied the relationship between positive and negative stress and PTG in university students and found that resilience plays a major role in PTG and negative stress. They suggest that this has relevance in clinical interventions and public health. Resilience can be considered as a major factor in designing interventions for developing PTG in people who undergo negative stress, including the challenges experienced in university settings (Serpa-Barrientos et al., 2023). Including TIC principles and TIC approach care in nursing curriculum will help PTG in nursing students who have experienced trauma and adverse childhood experiences in their own life. This will better equip nurses to take care of their patients who have traumatic experiences and help them in their PTG.
Trauma-Informed Care in Nursing Education and Practice
Trauma awareness practice for all healthcare workers is crucial whether they have minimal or extensive contact with trauma victims (Schimmels & Schneider, 2024; Wheeler, 2018; Yang et al., 2019). Trauma-enhanced practice training for higher-level healthcare workers who deal with victims who experienced psychological trauma will help to enhance TIC practice (Edelman 2023). The rapidly growing evidence regarding the impact of trauma and SDOH on physical and emotional health needs to be addressed in nursing education. The new AACN essentials (2021) for baccalaureate education focus on patient-centered care and population health, which includes the SDOH. SDOH can adversely affect experiences. Therefore, it is important for nursing education to incorporate TIC in nursing curricula.
Understanding how trauma emerges as health problems is fundamental in the nursing profession. Nurses are often in an ideal position to provide TIC with patients and families, because they have the most contact with patients in healthcare settings. Nurses are taught about establishing a therapeutic relationship, as described by Peplau (1952), attending to the patient’s needs, and fostering trust and creating a safe space for sharing details related to past experiences, including trauma (Isobel & Delgado, 2018; Molitierno, 2018). Integrating trauma competencies, assessment, diagnosis and care, and knowledge of how to stabilize, ameliorate, and develop resilience to trauma responses in nursing curricula is essential (Schimmels & Schneider, 2024; Stokes et al., 2017; Wheeler, 2018). Wheeler (2018) suggests incorporating TIC in undergraduate nursing education in therapeutic communication and mental health.
Screening for ACE and SDOH needs to be part of TIC education, as many factors influence ACE screening in routine primary care. Setting aside time to inquire about stressful life events reflects genuine concern and caring. Screening for early developmental disabilities affords early interventions and decreased costs. Having access to resources and referrals for care decreases providers’ level of discomfort and reluctance to screen for ACEs (Kalmakis et al., 2018). Developing the sensitivity, awareness, and skill to avoid secondary trauma is crucial.
Developing an awareness of ACEs and nurses’ self-reflection on personal experiences is essential in practice settings. Stokes et al. (2017)
explored nurses’ perceptions and experiences with TIC. Participants asserted that principles of TIC are central to patient-centered care and the therapeutic nurse-patient relationship and emphasized the need to adopt a “universal precautions” approach with all patients in case they may have experienced trauma. This approach can be applied in all clinical settings (Elliott et al., 2024; Stokes et al., 2017). Developing an approach to care for trauma victims requires accepting the person where they are and acknowledging that each individual’s experience of trauma is unique. It is critical for nurses to understand the variable effects of trauma and the range of physical and psychological problems which may emerge and change rapidly as a consequence of traumatic experiences. Being sensitive and mindful to avoid retraumatization is critical (Buettel & Abram, 2022).
Heeding the impact of trauma on nurses and nursing students is critical. Cultivating trauma awareness requires self-reflection. The process of becoming sensitized to trauma can be uncomfortable. Preventing vicarious trauma and retraumatization of students requires specific strategies, including self-care (Schimmels & Schneider, 2024; Yang et al., 2019; Young et al., 2019). Nursing students can be overwhelmed by academic burdens, stress, fatigue, illness, and family matters, which can influence their ability to focus and function effectively. Students must practice self-care to cope with their own trauma. The school may provide an opportunity to address its students’ trauma in order to help them provide TIC to their patients (Cannon et al., 2020; Schimmels & Schneider, 2024). The ideal is to develop a trauma-responsive school and educational system for the future (Schimmels & Schneider, 2024; Yang et al., 2019). Self-care for nurses when caring for victims of trauma can help protect against feeling depleted and burnout (Buettel & Abram, 2022; Schimmels & Schneider, 2024). It is important for nurses to safeguard themselves and their colleagues from the negative toll associated with trauma work. Support and respite are critical. The student nurse-educator relationship is potentially an ideal platform for transmitting knowledge about regulation and stress management (Goddard et al., 2022).
Conclusion
According to the World Health Organization (2024), exposure to any form of trauma experienced in childhood and adolescence can increase the risk of mental illness, suicide, alcohol and substance abuse, chronic diseases, and social problems. Trauma-informed nursing care needs to be provided for all patients, regardless of diagnoses or setting. It is important for nursing schools to develop a TIC curriculum, since all nurses may encounter patients who have experienced trauma in their life. TIC curriculum needs to include theoretical knowledge, different kinds of trauma and its effect, ACEs and its impact on neurobiology, and assessment techniques. This can be a separate course or incorporated throughout the nursing courses. Using simulations, case studies, or role-playing in classroom settings, followed by discussions, will help nursing students learn TIC in a nonthreatening environment. TIC and approach may be utilized in the clinical setting with opportunities for reflection. Teachers need to be proficient in teaching TIC and trauma-informed approaches. This can be done using certification courses or attending presentations. It is essential to prepare nursing students to equip themselves with TIC approaches in their nursing education and clinical practice.
n References
American Association of Colleges of Nursing (2021). The essentials: Competencies for professional nursing education. https://www .aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf
American Psychiatric Association. (2022). Trauma- and stressorrelated disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). https://doi.org/10.1176/appi .books.9780890425787
American Psychological Association. (2016). The road to resilience. www.apa.org/helpcenter/road-resilience.aspx
Buettel, A., & Abram, M. D. (2022). Implementing trauma-informed care. American Nurse Journal, 17(9), 18–21.
Burton, C. W., Williams, J. R., & Anderson, J. (2019) Trauma-informed care education in baccalaureate nursing curricula in the United States: Applying the American Association of Colleges of Nursing essentials. Journal of Forensic Nursing, 15(4), 214–221. https://doi.org/10.1097/JFN.0000000000000263
Cannon, L. M., Coolidge, E. M., LeGierse, J., Moskowitz, Y., Buckley, C., Chapin, E., Warren, M., & Kuzma, E. K. (2020). Trauma-informed education care: Creating and pilot testing a nursing curriculum on trauma-informed care. Nurse Education Today, 85, 10444526. https://doi.org/10.1016/j.nedt.2019.104256
Center for Pediatric Traumatic Stress. (2018). D-E-F protocol for traumainformed pediatric care [Brochure]. https://healthcaretoolbox .org/what-providers-can-do/d-e-f-protocol-for-trauma-informedpediatric-care.html
Centers for Disease Control and Prevention. (2019). Adverse Childhood Experiences (ACEs). https://www.cdc.gov/vitalsigns/aces/index .html
DeMarco, R. F., & Walsh, J. H. (2024). Community and public health nursing: Evidence for practice (4th ed.). Wolters Kluwer. Edelman, N. L. (2023). Trauma and resilience informed research principles and practice: A framework to improve the inclusion and experience of disadvantaged populations in health and social care research. Journal of Health Services Research & Policy, 28(1), 66–75. https://doi.org/10.1177/13558196221124740
Elliott, R., Giannotti, N., Pfaff, K., & Cruz, E. (2024). Trauma-informed care in undergraduate nursing education: An integrative review. The Journal of Nursing Education, 63(11), 737–745. https://doi-org .adelphi.idm.oclc.org/10.3928/01484834-20240617-04
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of child abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Friedberg, A., & Malefakis, D. (2018). Resilience, trauma, and coping. Psychodynamic Psychiatry, 46(1), 81–113. https://doi.org/10.1521/ pdps.2018.46.1.8
Goddard, A., Jones, R. W., Esposito, D., & Etcher, L. (2022). Traumainformed education in nursing: A concept analysis. Journal of Nursing Education, 61(6), 296–302. https://doi.org/10.3928/0148483420220404-15
Greenwald, A., Kelly, A., Matthew, T., & Thomas, L. (2023). Traumainformed care in the emergency department: Concepts and recommendations for integrating practices into emergency medicine. Medical Education Online, 1–8. https://doi.org/10.1080/ 10872981.2023.2178366
Harvey, G., & Carter-Snell, C. (2024). Implementing a Trauma-informed approach in undergraduate nursing student clinical education: Strategies for clinical nurse educators. Nurse Education in Practice, 81, 104187. https://doi-org.adelphi.idm.oclc.org/10.1016/j .nepr.2024.104187
Henson, C., Truchot, D., & Canevello, A. (2021). What promotes post traumatic growth? A systematic review. European Journal of Trauma & Dissociation, 5(4), 1–6. https://doi.org/10.1016/j.ejtd.2020.100195
Isobel, S., & Delgado, C. (2018). Safe and collaborative communication skills: A step towards mental health nurses implementing trauma informed care. Archives of Psychiatric Nursing, 32291–296. https://doi.org/10.1016/japnu.2017.11.017
Kalmakis, K., Shafer, M. B., Genevieve, E., Elizabeth, A., & Roberts, S. J. (2018). Screening for childhood adversity among adult primary care patients. American Association of Nurse Practitioners, 30(4), 193–200. https://doi.org/10.1097/JXX.0000000000000033
Kang, H., Fischer, I. C., & Dickinson, S. (2024). Posttraumatic growth in U.S. military veterans: Results from the national health and resilience in veterans study. Psychiatric Quarterly, 95, 17–32. https://doi.org/10.1007/s11126-023-10061-8
Karcher, N. R., Niendam, T. A., & Barch, D. M. (2020). Adverse childhood experiences and psychotic-like experiences are associated above and beyond shared correlates: Findings from the adolescent brain cognitive development study. Schizophrenia Research, 222, 235–242. https://doi.org/10.1016/jschres.2020.05.045
Li, Y., Cannon, L. M., Coolidge, E. M., Darling-Fisher, C. S., Pardee, M., & Kuzma, E. K. (2019). Current state of trauma-informed education in health sciences: Lessons for nursing. Journal of Nursing Education, 58(2), 93–101. https://doi.org/10.3928/01484834-20190122-06
McKay, M. T., Cannon, M., Chambers, D., Conroy, R. M., Coughlan, H., & Dodd, P. (2021). Childhood trauma and adult mental disorder: A systematic review and meta-analysis of longitudinal cohort studies. Acta Psychiatry Scandinavica, 143(3), 189–205. https://doi.org/10.1111/acps.13268
Molitierno, T. (2018). Trauma-informed care as part of nursing school curricula. Journal of Psychosocial Nursing, 56(5), 5–6. https://doi.org/10.3928/02793695-20180322-03
Musisi, S., & Kinyanda, E. (2020). Long-Term impact of war, civil war, and persecution in civilian populations—Conflict and post-traumatic stress in African communities. Frontiers in Psychiatry, 11(20), 1–12. https://doi.org/10.3389/fpsyt.2020.00020
National Center for Trauma-Informed Care [NCTIC]. (2018). Trauma-informed care & alternatives to seclusion and restraint. https://tash.org/nctic/
National Child Traumatic Stress Network, Schools Committee (2017). Creating, supporting, and sustaining trauma-informed schools: A system framework. National Center for Child Traumatic Stress. https://www.nctsn.org/resources/creating-supporting-andsustaining-trauma-informed-schools-system-framework
Nelson, C. A., Bhutta, Z. A., Harris, N. B., Danese, A., & Samara, M. (2020). Adversity in childhood is linked to mental and physical health throughout life. BMJ, 1–9. https://doi.org/10.1136/bmj.m3048
Peplau, H. (1952). Interpersonal Relations in Nursing. New York: Putnam.
Pfeiffer, K. M., & Grabbe, L. (2022). An approach to trauma-informed education in prelicensure nursing curricula. Nursing Forum, 57(4), 658–664. https://doi-org.adelphi.idm.oclc.org/10.1111/nuf.12726
Polanco-Roman, L., Satinsky, E. N., Benau, E. M., & Ebrahimi, C. T. (2024). Racism-related experiences and traumatic stress symptoms in ethnoracially minoritized youth: A systematic review and metaanalysis. Journal of Clinical Child & Adolescent Psychology, 53(2), 1–18. https://doi.org/10.1080/15374416.2023.2292042
Sabel, C. E., Pedersen, C. B., Antonsen, S., Webb, R. T., & Horsdal, H. T. (2024). Changing neighborhood income deprivation over time, moving in childhood, and adult risk of depression. JAMA Psychiatry, E1–E9. https://doi.org/10.1001/jamapsychiatry.2024.1382
Schimmels, J., & Schneider, J. (2024). Trauma informed care for nursing action: Bachelor of science in nursing course. Journal of Nursing Education, 63(4), 233–240. https://doi.org/10.3928/0148483420240207-06
Serpa-Barrientos, A., Calvet, M. L. M., Acosta, A. G. D., Fernández, A. C. P., Díaz, L. H. R., Albites, F. M., A., & Saintila, J. (2023). The relationship between positive and negative stress and posttraumatic growth in university students. BMC psychology, 11(1), 348. https://doi.org/10.1186/s40359-023-01400-2
Solberg, M. A., Peters, R. M., Templin, T. N., & Albdour, M. M. (2024). The relationship of adverse childhood experiences and emotional distress in young adults. Journal of the American Psychiatric Nurses Association, 30 (3), 532–544. https://doi.org/10.1177/10783903221140325
Stokes, Y., Jacob, J. D., Gifford, W., Squires, J., & Vandyk, A. (2017). Exploring nurses’ knowledge and experiences related to traumainformed care. Global Qualitative Nursing Research, 41–10. https://doi.org/10.1177/2333393617734510
Syam, H., Venables, E., Sousse, B., Severy, N., Saavedra, L., & Kazour, F. (2019). “With every passing day I feel like a candle, melting little by little.” Experiences of long-term displacement amongst Syrian refugees in Shatila, Lebanon. BMC, 13(45), 1–12. https://doi.org/10.1186/s13031-019-0228-7
Thurston, C., Murray, A. L., Olsen, H. F., & Meinck, F. (2023). Prospective longitudinal associations between adverse childhood experiences and adult mental health outcomes: A protocol for a systematic review and meta-analysis. BMC, 12(181), 1–23. https://doi.org/10.1186/s13643-023-02330-1
U.S. Department of Health & Human Services, Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. [HHS publication no. SMA 14-48840]. https://library.samhsa.gov/sites/ default/files/sma14-4884.pdf
U.S. Department of Health & Human Services, Social Determinants of Health. (n.d.). Healthy People 2030. From https://odphp.health.gov/ healthypeople/priority-areas/social-determinants-health/healthypeople-partners-and-sdoh
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.
Wathen, C. N., Schmitt, B., & MacGregor, J. C. D. (2023). Measuring trauma- (and violence-) informed care: A scoping review. Trauma, Violence, & Abuse, 24(1), 261–277. https://doi.org/10.1177/15248380211029399
Wheeler, K. (2018). A call for trauma competencies in nursing education. Journal of the American Psychiatric Nurses Association, 24(1), 20–22. https://doi.org/10.1177/1078390317745080
Wheeler, K., & Phillips, K. E. (2021). The development of trauma and resilience competencies for nursing education. Journal of the American Psychiatric Nurses Association, 27(4), 322–333. https://doi.org/10.1177/1078390319878779
World Health Organization. (2024, October 10). Mental health of adolescents. https://www.who.int/news-room/fact-sheets/detail/ adolescent-mental-health
Yang, L., Cannon, L. M., Coolidge, E. M., Darling-Fisher, C. S., Pardee, M., & Kuzma, E. K. (2019). Current state of trauma-informed education in the health sciences: Lessons for nursing. Journal of Nursing Education, 58(2), 93–101.
Young, J., Taylor, J., & Paterson, B. (2019). Trauma-informed practice: A paradigm shift in the education of mental health nurses. Mental Health Practice, 1–6. https://doi.org/10.7748/mhp.2019.e1359
THE JOURNAL
of the New York State Nurses Association
Call for Papers
The Journal of the New York State Nurses Association is currently seeking papers.
Authors are invited to submit scholarly papers, research studies, brief reports on clinical or educational innovations, and articles of opinion on subjects important to registered nurses. Of particular interest are papers addressing direct care issues. New authors and student authors are encouraged to submit manuscripts for publication.
Information for Authors
For authors’ guidelines and submission deadlines, go to the publications area of www.nysna.org or write to journal@nysna.org
HEALTHCARE LITERATURE HIGHLIGHTS
WHAT YOU NEED TO KNOW
Healthcare Literature Highlights provide concise summaries of relevant published studies or articles that may be of interest to registered nurses (RNs) and advanced practice
A
registered nurses (APRNs). We recommend that readers consult the original publications for further insights and comprehensive information.
Sleep-Promoting Schedule Could Improve Sleep Quality for Patients in the Intensive Care Unit
Long, K., Hundt, B., Wiencek, C., & Little, J. (2025). Impact of a sleeppromoting schedule on sleep quality in the intensive care unit. Critical Care Nurse, 45(2), 33–40. https://doi.org/10.4037/ccn2025288
NURSING PRACTICE – CRITICAL CARE
Key Findings: An evidence-based quality improvement project in a 28-bed medical intensive care unit (MICU) measured how sleep deprivation could be reduced by implementing a 4- to 6-hour sleep-promoting protocol. All licensed independent practitioners and patient-facing staff members on the unit were educated on the protocol which required interprofessional team members to minimize their interactions with patients (N = 292) between midnight and 4 a.m. Practitioners rescheduled timed medical interventions and placed written nursing orders for minimized patient interactions between the selected hours. Nurses and other staff members performed routine assessments and interventions outside of the protected hours and removed unnecessary monitoring equipment from the rooms if possible. Call light monitoring and rounding were performed to identify and treat urgent and emergent patient care issues.
Patients in the preintervention group were 83 to 94% likely to have their sleep interrupted for blood draws or medication administration;
while patients in the post intervention were 32 to 35% likely to have their sleep interrupted for the same reasons. The Richards-Campbell Sleep Questionnaire (RCSQ) was utilized to measure the patients’ perception of their sleep quality on a scale of 0 to 100. Patients scored themselves on perceived sleep depth, ability to fall asleep, amount of sleep, ability to return to sleep after awakening, and overall average sleep. Patients reported increases in the amount and quality of sleep in all categories in the pre-intervention phase. The mean post-intervention RCSQ score was 62.1% higher than the pre-intervention RCSQ score.
Practice Significance: Patient monitoring and patient treatment interventions are usually ongoing in critical care areas. While these activities are designed to improve care delivery and patient health outcomes, they sometimes lead to multiple sleep interruptions and possible sleep deprivation. Decades of research have shown that sleep is vital for health and well-being and sleep disturbance can influence the risk of disease. This quality improvement project highlights the positive impact of protected sleep time on quality of sleep and demonstrates that protecting sleep time is possible in fast-paced critical care environments.
Using a Tiered Skills Acquisition Model to Improve Onboarding of Newly Licensed Registered Nurses
Joswiak, M. E. (2018). Transforming orientation through a tiered skills acquisition model. Journal for Nurses in Professional Development, 34( 3), 118–122. https://doi.org/10.1097/NND.0000000000000439
NURSING EDUCATION
Key Findings: Investigators conducted a qualitative study to assess the efficacy of a tiered skills acquisition model (TSAM) in improving the orientation experiences for newly licensed registered nurses (NLRNs). The TSAM categorizes nursing tasks as simple skills, medium level skills, and complex skills. During preceptored orientation with a full assignment, NLRNs progress gradually from simple skills to complex skills. In the early stages of orientation, the orientee (new nurse) would perform simple skills independently for all assigned patients and observe as the preceptor performs higher level interventions and skills. Some critical aspects of the study include:
1. Consistency: The orientee was paired with the same preceptor for the entire orientation so that they could be assessed and progressed.
2. Flexibility: A specified number of days were allotted for the completion of each tier, but preceptors had the ability to adjust this based on the orientee’s progress.
3. Resource Time: Approximately every 2 weeks during orientation, the preceptor and orientee were given 2 to 4 hours away from the clinical unit for teaching and learning.
The TSAM was utilized for orienting 188 registered nurses across multiple care settings. The results were an 18% decrease in orientation time and a 45% increase in patient experiences for the new nurse.
Practice Significance: Patricia Benner identified that nursing expertise is significantly enriched by real-world experiences and reflective
Using a Tiered Skills Acquisition Model to Improve Onboarding of Newly Licensed Registered Nurses (continued)
practices. She says that nurses move through five levels of nursing competence as their practice evolves. Each stage from novice to expert is valuable, and organizations improve patient outcomes and promote nursing excellence by recognizing and supporting nurses at all stages of their development. The TSAM model aligns with Benner’s premise of gradual learning, and through this study, the TSAM model is shown as useful to improving the orientation process, making it more efficient and effective. NPD practitioners should consider utilizing this model for orienting newly licensed nurses and experienced nurses who have transferred to a new setting.
Prescribing Music as an Adjunctive Treatment
Winegar, R., & Hixenbaugh, D. (2025, April). Prescribing music as an adjunctive treatment. The Journal for Nurse Practitioners, 21(4), 105349. https://doi.org/10.1016/j.nurpra.2025.105349
ADVANCED NURSING PRACTICE
Key Messages: Nurse practitioners (NPs) are fundamental partners in the holistic care of patients, and they should consider incorporating music therapy.
• Music therapy, is an emerging modern profession with recent roots in World Wars I and II, but with historical connections dating to over 20,000 years ago.
• Music impacts human beings in many ways and can be useful in addressing issues of the body and mind.
• Researchers have found that music therapy has physical benefits, such as improved motor skills and coordination and mental benefits such as reduced pain, anxiety and depression, better focus, and memory.
• To effectively incorporate music therapy into their practice, NPs are encouraged to seek education about the types of music therapy (active and passive), the benefits of music therapy, and how to identify patients who may benefit from music therapy.
• Individual financial and other barriers, such as patient resistance and cultural consideration, should be explored as NPs help their patients determine if the treatment is suitable and cost-effective for them.
Practice Significance: Incorporating music therapy into nursing practice can provide immense benefits for patients and providers. By embracing this therapeutic tool, NPs can enhance patient experiences and contribute to better health outcomes across diverse clinical settings. Embracing music as a part of treatment plans enables NPs to foster a more enriching healing environment for their patients. Patients may participate actively by singing or creating music, or passively by listening to music created by others. A simple playlist may be a low-cost way of introducing music therapy to a patient with financial challenges.
CE Activity: Do Persons Age in the Same Manner, Related to Their Date of Birth?
Thank you for your participation in “Do Persons Age in the Same Manner, Related to Their Date of Birth?” a new continuing education (CE) activity offered by NYSNA. NYSNA members and nonmembers are invited to take part in this activity, and you do not need to be a resident of New York State.
INSTRUCTIONS
To receive a contact hour (CH) for this educational activity, participants are to read the article presented in this issue of The Journal, complete and return the posttest and evaluation form, and earn 80% or better on the posttest.
This activity is free to NYSNA members and $10 for nonmembers. Participants can pay by check (made payable to NYSNA) or credit card. The completed answer sheet and evaluation form may be mailed or faxed back to NYSNA; see the evaluation form for more information.
The New York State Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.
This program has been awarded 1.0 CH through the New York State Nurses Association Accredited Provider Unit.
New York State Nurses Association is accredited by the International Association for Continuing Education and Training (IACET) and is authorized to issue the IACET continuing education unit (CEU).
The New York State Nurses Association is authorized by IACET to offer 0.1 CEU for this program.
To receive the CH and CEU, participants must read the entire article, fill out the evaluation and get 80% or higher on the posttest.
Presenters disclose no conflict of interest.
NYSNA wishes to disclose that no commercial support was received for this educational activity.
All planners and authors involved with the development of this independent study have declared that they have no vested interest.
NYSNA program planners and authors declare that they have no conflict of interest in this program.
INTRODUCTION
It is projected that the number of people in the United States who are 85 years and older will more than double by 2040 and nearly triple by 2060. In this era of our “graying nation,” it is expected that the number of retirement-age Americans will likely outnumber the number of children within the next ten years. Research indicates that meeting the collective needs of an aging population requires knowledge of the various factors through which persons age differently. To best accomplish this, shifting resources to meet the demands of geriatric care may be dependent on studying issues related to socialization, health determinants, and perception of one's health. Healthy aging is a concept that requires awareness and understanding, by both those undergoing
it and their healthcare providers. Working to reduce stigmatization can improve moral support that psychologically reinforces seniors’ attitudes on aging and therefore impacts their health outcomes. More so, results from this descriptive, quantitative study recommend interventions to help bolster seniors’ psychological and physical strength, emphasizing their psychological, social, and independence needs throughout aging, and supporting the notion that aging individuals can maintain their well-being and mobility by choosing healthy habits and sustaining health.
LEARNING OUTCOME
Participants will deliver patient-centered and equitable care by incorporating an understanding of aging factors that impact elderly patients’ health and well-being.
OBJECTIVES
At the completion of this learning activity, the learner will be able to:
1. List the factors that influence how persons age.
2. Recognize aging differences among age groups related to health status.
3. Identify aging differences among age groups related to socialization.
4. Discuss self-perception and how it impacts a person’s health status.
Please answer either True or False to the questions below. Remember to complete the answer sheet by putting the letter of your corresponding answer next to the question number. Each question has only one correct answer.
The 1.0 CH and 0.1 CEU for this program will be offered until June 30, 2028.
1) According to the United States Census Bureau, America is a “graying nation.”
a. True
b. False
2) Researchers identified seven (7) domains for determining what quality of life means to older adults.
a. True
b. False
3) Social determinants of health impact a person’s quality of life and how they age from both a subjective and objective perspective.
a. True
b. False
4) Researchers found that low socioeconomic levels, like income, education, and employment were positively associated with diverse social networks.
a. True
b. False
5) Family and friend networks were found to have a more significant impact on healthy aging than neighbor networks.
a. True
b. False
6) Support from family members has no effect on health-promoting behavior or healthy aging.
a. True
b. False
7) Aging is shaped by multiple influences—individual and societal— which must be considered in promoting a healthy population.
a. True
b. False
8) The aging phenomenon is often associated with, and influenced by, a person’s genetic makeup, health behaviors, social support, and culture.
a. True
b. False
9) Most individuals maintain their health and mobility by choosing healthy habits and sustaining health.
a. True
b. False
10) Knowing the meaning of aging and its impact on each individual may lead to an awareness of what constitutes an environment that supports healthy aging.
a. True
b. False
Answer Sheet
Do Persons Age in the Same Manner, Related to Their Date of Birth?
Please print legibly and verify that all information is correct.
First Name:
Daytime Phone Number (Include area code):
Email:
Profession:
NYSNA Member # (if applicable):
PAYMENT METHOD
Licensed in NY State? Y / N (Circle one)
ACTIVITY FEE: Free for NYSNA members/$10 nonmembers
Check—payable to New York State Nurses Association (please include “Journal CE”on your check).
Credit Card: Mastercard Visa Discover American Express
Card Number:
Expiration Date: / CVV#
Name: Signature: Date: / /
Note: CH and CEU for this program will be offered until June 30, 2028.
Please print your answers in the spaces provided below. There is only one answer for each question.
Please complete the answer sheet above and course evaluation form on reverse. Submit both the answer sheet and course evaluation form along with the activity fee for processing. Email to: journal@nysna.org
Mail to: NYSNA, attn. Nursing Education and Practice Dept. 131 West 33rd Street, 4th Floor, New York, NY 10001 Or fax to: 212-785-0429
Learning Activity Evaluation
Do Persons Age in the Same Manner, Related to Their Date of Birth?
Please use the following scale to rate statements 1–7 below:
1. The content fulfills the overall purpose of the CE Activity.
2. The content fulfills each of the CE Activity objectives.
3. The CE Activity subject matter is current and accurate.
4. The material presented is clear and understandable.
5. The teaching/learning method is effective.
6. The test is clear and the answers are appropriately covered in the CE Activity.
7. How would you rate this CE Activity overall?
8. Time to complete the entire CE Activity and the test? ____ Hours (enter 0–99) _____ Minutes (enter 0–59)
9. Was this course fair, balanced, and free of commercial bias? Yes / No (Circle one)
10. Comments:
11. Do you have any suggestions about how we can improve this CE Activity?
Do Persons Age in the Same Manner, Related to Their Date of Birth?
Note: CH and CEU for this program will be offered until June 30, 2028.
CE Activity: Trauma-Informed Care in Nursing Education
Thank you for your participation in “Trauma-Informed Care in Nursing Education,” a new continuing education (CE) activity offered by NYSNA. NYSNA members and nonmembers are invited to take part in this activity, and you do not need to be a resident of New York State.
INSTRUCTIONS
In order to receive a contact hour (CH) for this educational activity, participants are to read the article presented in this issue of The Journal, complete and return the posttest and evaluation form, and earn 80% or better on the posttest.
This activity is free to NYSNA members and $10 for nonmembers. Participants can pay by check (made payable to NYSNA) or credit card. The completed answer sheet and evaluation form may be mailed or faxed back to NYSNA; see the evaluation form for more information.
The New York State Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.
This program has been awarded 1.0 CH through the New York State Nurses Association Accredited Provider Unit.
The New York State Nurses Association is accredited by the International Association for Continuing Education and Training “IACET” and is authorized to issue the IACET continuing education credit (CEU).
The New York State Nurses Association is authorized by IACET to offer 0.1 CEU for this program.
In order to receive the CH and CEU, participants must read the entire article, fill out the evaluation, and get 80% or higher on the posttest.
Presenters disclose no conflict of interest.
NYSNA wishes to disclose that no commercial support was received for this educational activity.
All planners/authors involved with the development of this independent study have declared that they have no vested interest.
NYSNA program planners and authors declare that they have no conflict of interest in this program.
INTRODUCTION
Trauma-informed care has been increasingly regarded as an essential element in the healthcare field. Nurses are often the first to encounter patients who are victims of trauma, and in these instances, applying a practice that involves trauma-informed care is essential for ensuring patient safety and quality care. Despite this practical need, the inclusion of the subject of trauma-informed care in nursing education is only just beginning. Understanding root causes of trauma and anticipating ethical dilemmas may make a significant impact on successful patient care, especially if the patient is at risk of retraumatization. For this to be best actualized throughout our healthcare industry, the requisite understanding, communication skills, and “universal precautions” must be first integrated into nursing curricula. Doing so will not only strengthen nursing students’ comprehension of the myriad physical and psychological
problems that may emerge as a consequence of traumatic experiences, but will also help them practice self-care strategies that prevent burnout and optimize the nurse-patient relationship.
LEARNING OUTCOME
Participants will understand how incorporating trauma-informed care into nursing education is an essential component of patient-centered care.
OBJECTIVES
At the completion of this learning activity, the participant will be able to:
1. Understand the significant factors of trauma, including social determinants of health and adverse childhood experiences.
2. Identify ways in which trauma intersects with both sociopolitical issues and neurobiological issues.
3. Define the key components and core principles of trauma-informed care.
4. Learn how to prioritize resilience and post-traumatic growth in patient-centered care.
5. Articulate the strength of incorporating trauma-informed care into nursing education.
Please answer either True or False to the questions below. Remember to complete the answer sheet by putting the letter of your corresponding answer next to the question number. Each question has only one correct answer.
The 1.0 CH and 0.1 CEU for this program will be offered until June 30, 2028.
1) While social determinants of health are important factors in overall well-being, they cannot contribute to health inequalities or negatively impact physical and mental development.
a. True
b. False
2) Research indicates that there is a positive correlation between adverse childhood experiences and an increased risk of developing psychiatric disorders.
a. True
b. False
3) Despite significant sociopolitical issues in the United States over the last two decades, there have been no reports of increased child abuse, intimate partner violence, and drug and alcohol use.
a. True
b. False
4) Survivors of trauma have a well-regulated hypothalamus pituitary adrenal axis, resulting in an undisturbed sense of self and safety.
a. True
b. False
5) The five key components of trauma-informed care are: patient’s empowerment, choice, collaboration, safety, and trustworthiness.
a. True
b. False
6) Avoiding retraumatization is a core principle of trauma-informed care.
a. True
b. False
7) One’s ability to overcome adversities and make improvements in their interpersonal relationships is unrelated to their post-traumatic growth.
a. True
b. False
8) Taking decisive actions to encounter stressful situations is typically understood as harmful to one’s attempt to build resilience.
a. True
b. False
9) A “universal precautions” approach taken with all patients is a traumainformed care methodology to avoid secondary trauma.
a. True
b. False
10) Self-care is not important for nurses when caring for victims of trauma, as it is a distraction and will negatively impact their effective function.
a. True
b. False
Answer Sheet
Trauma-Informed Care in Nursing Education
Please print legibly and verify that all information is correct.
First Name: MI: Last Name: Street Address:
Daytime Phone Number (Include area code): Email:
Profession:
NYSNA Member # (if applicable): License #:
PAYMENT METHOD
Licensed in NY State? Y / N (Circle one)
ACTIVITY FEE: Free for NYSNA members/$10 nonmembers
Check—payable to New York State Nurses Association (please include “Journal CE”on your check).
Credit Card: Mastercard Visa Discover American Express
Card Number: Expiration Date: / CVV#
Name: Signature: Date: / /
Note: CH and CEU for this program will be offered until June 30, 2028.
Please print your answers in the spaces provided below. There is only one answer for each question.
Please complete the answer sheet above and course evaluation form on reverse. Submit both the answer sheet and course evaluation form along with the activity fee for processing.
Email to: journal@nysna.org
Mail to: NYSNA, attn. Nursing Education and Practice Dept. 131 West 33rd Street, 4th Floor, New York, NY 10001 Or Fax to: 212-785-0429
Learning Activity Evaluation
Trauma-Informed Care in Nursing Education
Please use the following scale to rate statements 1–7 below:
1. The content fulfills the overall purpose of the CE Activity.
2. The content fulfills each of the CE Activity objectives.
3. The CE Activity subject matter is current and accurate.
4. The material presented is clear and understandable.
5. The teaching/learning method is effective.
6. The test is clear and the answers are appropriately covered in the CE Activity.
7. How would you rate this CE Activity overall?
8. Time to complete the entire CE Activity and the test? ____ Hours (enter 0–99) _____ Minutes (enter 0–59)
9. Was this course fair, balanced, and free of commercial bias? Yes / No (Circle one)
10. Comments:
11. Do you have any suggestions about how we can improve this CE Activity?
Trauma-Informed Care in Nursing Education
Note: CH and CEU for this program will be offered until June 30, 2028.
