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Cultural criticism is used to describe the political role of autobiographical illness narratives or pathographies. In expressing the subjective experience of illness, authors of pathographies illuminate ideological differences between patient and health care cultures, reveal the dominance of health care ideologies, and explicate patients' moral and political claims. The contributions of these literary works to nursing practice provide direction for relational restructuring. Gadow's concept of the relational narrative is proposed as a way to restore patient subjectivity and agency and establish the dialogue necessary for cultural pluralism in nursing and health care. [ABSTRACT FROM AUTHOR]

Background: Psychological distress is known to contribute to poor outcomes in orthopedic patients. Limited information exists concerning ethnic differences in psychological sequelae after musculoskeletal injury. This study examined ethnic variations in prevalence of posttraumatic stress disorder (PTSD) after musculoskeletal trauma., Methods: A secondary analysis was conducted using data collected for a study examining PTSD after musculoskeletal trauma. Two hundred eleven consecutive patients with musculoskeletal injuries were enrolled. Psychological status was assessed using the Revised Civilian Mississippi Scale for PTSD. A chart review was completed to gather demographic and injury information. Independent samples t tests, Fisher's exact, Chi-square, and logistic regression analyses were performed to assess differences., Results: Ninety-six (45.5%) Hispanic and 115 (54.5%) non-Hispanic White adults participated. Few significant demographic or health differences were found. No significant differences were found regarding injury characteristics. Fisher's exact tests indicated a higher prevalence of PTSD symptomatology among Hispanics than non-Hispanic Whites (p < 0.01). Additionally, U.S. born Hispanics were more likely than non-U.S. born Hispanics to have PTSD symptomatology (p = 0.004). Odds ratios indicated that women (OR = 2.2), persons with a psychiatric comorbidity (OR = 5.1), Hispanics (OR = 6.6), and persons born in the United States (OR = 3.7) had an increased likelihood of PTSD symptomatology., Conclusions: Results indicate an ethnic difference in prevalence of PTSD symptomatology after musculoskeletal injury. Hispanic participants were nearly seven times more likely to be positive for PTSD symptomatology. Furthermore, U.S. born Hispanic participants had a higher prevalence of PTSD symptomatology. Future research should explore factors contributing to these differences.

Reflective and insightful autobiographical accounts of illness not only illuminate fundamental disruptions in selfhood and continuity of life that accompany illness, but authors of such accounts also maintain that narration is an important way to make sense of an illness episode, to restore personhood and connectedness, and to reclaim the illness experience from the medical meta-narrative. That witnessing and helping to order illness narratives can be a caring/healing nursing practice modality with significant healing potential is supported both by narrative theory and by nursing's theoretical and philosophical legacy. The challenge for the nurse guided by narrative ideas is to give primacy to the patient's voice, to listen for meaning rather than for facts, and to provide a relationship enabling the evolution of the patient's story.

Meaningful examination of program outcomes is one of the most challenging tasks facing faculty and administrators involved in the design and delivery of educational programs. This article reports the outcomes for one doctoral program in nursing and elucidates salient conceptual and methodologic issues in educational outcomes research for this discipline. Career development, scholarly productivity, and professional leadership were the foci of this outcomes study. Three instruments were used; data were provided by alumni, graduate faculty, and alumni supervisors. Data analysis techniques included content analysis and descriptive and correlational statistics. Results showed that graduates embarked on diverse career paths with the majority employed in academic institutions. Most graduates reported active involvement in research, publications, presentations, and professional leadership. Employment pattern differences were noted between academic year and summer-only program graduates with associated divergence in career emphasis, research productivity, and job satisfaction. A positive correlation of time since degree conferral with scholarly productivity and professional leadership was noted. Recommendations for future research include refining outcomes, linking process to outcome, using longitudinal designs, and attending to unique nursing student and doctoral program characteristics.

Objective: To explore prediagnostic illness behavior in rheumatoid arthritis (RA)., Method: In this descriptive study, interview and medical records data from 50 female patients were analyzed using quantitative and qualitative techniques., Results: Findings revealed a high incidence of symptom normalization, self-treatment, symptom comparison, and prolonged time to diagnosis with multiple misdiagnoses and physicians consulted. Most subjects reported invalidation of initial symptoms, multifaceted emotional distress, and relief upon accurate diagnosis. Significant associations were found between (a) illness-related symptom attributions and fewer physicians consulted (P < 0.05) and less invalidation (P < 0.05); (b) life stress events and fewer physicians consulted (P < 0.05) and shorter time to diagnosis (P < 0.05); (c) remissions and time to diagnosis (P < 0.05), number of physicians consulted (P < 0.001), and number of misdiagnoses (P < 0.001)., Conclusion: Illness behavior in RA is prolonged, convoluted, and accompanied by personal and social stress. Invalidation of reported symptoms and relief upon definitive diagnosis are prominent features of the process.

Selected outcomes of an intensive, summer-only doctoral program in nursing were assessed using quantitative and qualitative data obtained from program-specific questionnaires and Educational Testing Service (ETS) Graduate Program Self-Assessment (GPSA) student and faculty questionnaires. Students evaluated the overall program as successful, satisfying, and stimulating, but also as stressful. Educational interventions to ameliorate student stress did not impact student evaluations of reported stress levels. Comparisons of summer-only and regular academic year students showed no differences in demographics, although differences between groups were found in long-term goals. Overall ETS questionnaire data were consistent with the Holzemer and Chambers (1986) baseline data for schools of nursing and showed no unusual patterns or trends. Summer-only and regular program student ratings were similar on all ETS scales.