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Resumo A resolutividade é um dos princípios do Sistema Único de Saúde (SUS) no Brasil, com sua capacidade de resolver os problemas da população nos diferentes níveis de complexidade da saúde. O Subsistema de Atenção à Saúde Indígena (SASI-SUS) integra este sistema, respeitando as especificidades das populações indígenas. O objetivo deste artigo é analisar a percepção dos profissionais e gestores de uma Casa de Saúde Indígena (CASAI) a respeito da resolutividade no subsistema quanto às circunstâncias da pandemia. Pesquisa qualitativa, de caráter descritivo, à luz da Política Nacional de Atenção à Saúde dos Povos Indígenas (PNASPI) e da teoria hermenêutica de Paul Ricoeur. Foram realizadas entrevistas entre os participantes a fim de registrar as experiências no processo de trabalho dos atores que cuidam dos indígenas referenciados à Manaus, Amazonas. Foram identificadas, pelas entrevistas, quatro temáticas essenciais: cuidado cultural; educação permanente em saúde & educação em saúde; negociação & improviso e; acolhimento & infraestrutura. A CASAI é uma instituição que vai além de um centro de apoio ou alojamento, sendo ponto de articulação entre os diferentes níveis de atenção aos indígenas e local de produção de cuidados e de saberes, tal como da construção de suas relações, resultando em um espaço resolutivo.

Background: Discomfort in women with Crohn's disease is highly prevalent, even during remission. However, these women's lived experiences of discomfort are largely unknown. Aims: To explore the lived experiences of discomfort in women with Crohn's disease. Methods: Six women with Crohn's disease were recruited using purposive and snowball sampling. Semi-structured, audio-recorded interviews were conducted using Zoom and transcribed verbatim for analysis. van Manen's work guided the data analysis. Findings: Four phenomenological themes were identified: discomfort as an embodied experience, discomfort as a conscious experience, discomfort and social life, and discomfort as a way forward. Conclusion: Healthcare professionals and researchers can facilitate the recognition, impact and mitigating strategies of discomfort by acknowledging it as an essential phenomenon for women with Crohn's disease. Further research is recommended to understand better the experience of discomfort and its implications for women's quality of life and their social and therapeutic relationships.

The mystery of death is part of the enigma of life itself. In nursing, being next to someone dying makes us more aware of our strengths and limitations while caring for someone who walks into the unknown. As nurses, we are affected by these experiences, so how do we deal with them? What is the essence of caring for someone dying in the ICU? What makes each experience unique? Through the experience of being with someone as they are dying, we discover our limits, our finiteness. We cannot deny death’s disruptive and silent spirit that embodies us, yet death, like other aspects of life, is unique; it appears to teach us that life goes on, that life cannot wait for us.

This scoping review will map the available evidence on diabetes self-management education programs for older adults in Western countries.Self-management and education are crucial for controlling diabetes and its associated complications. The successful uptake of diabetes self-management education programs is not straightforward, and little is known about diabetes programs for older adults. Within this context, a broad overview of diabetes self-management education for older adults, considering all types of related evidence, is needed.All studies in English concerning diabetes self-management education for older adults (aged 65 years and older) living with type 1 and 2 diabetes will be included. This review is not specific to gender, sex, ethnicity, frailty, or other demographic variables. The review is restricted to Western countries (North America, Western and Northern Europe, and Australasia), where approaches to diabetes self-management education will be similar. Studies including older adults with and without diabetes will not be considered unless they provided separate analyses for the 2 cohorts.This scoping review will follow the JBI methodology for scoping reviews. We will conduct searches of electronic databases, including CINAHL, MEDLINE, and PubMed, from January 1, 2000, to the present to capture eligible articles. The review will consider all study designs, including quantitative, qualitative, mixed methods designs, text and opinion papers, and systematic reviews that meet the inclusion criteria. After duplicates are removed, titles and abstracts will be screened independently by 2 reviewers, and the full texts will be reviewed. The screening criteria and data extraction protocol will be pilot tested by the research team. The results will be summarized in tables accompanied by narrative text.

The objective of this scoping review is to map the current evidence about access to health and social services for women living on a low income in Canada.Women, especially those living on a low income, are disproportionately likely to suffer inequities in access to health and social services. There is insufficient understanding of how the interaction of socioeconomic factors and gender can affect women's access to these services. This review will provide an initial picture of what exists in the literature about access to health and social services for women living on a low income in Canada. The results of this scoping review may be used to inform subsequent qualitative and quantitative reviews on this subject.Literature addressing access to health and social services by women who are 18 years or older and living on a low income in Canada will be considered for inclusion. Health services will include health promotion and disease prevention; treatment of medical conditions; and rehabilitation, palliative, and end-of-life care. Social services are non-medical services designed to help members of a society who may need extra support or are considered to have social or behavioral risk factors.We will search relevant electronic databases (eg, MEDLINE, CINAHL, PsycINFO) and gray literature. The review will include all study designs, including qualitative, quantitative, and mixed methods methodologies (excluding economic analyses or clinical practice guideline development documents). Two reviewers will test the screening criteria and data extraction protocol.

In 2019, Colombia approved the combination of tenofovir disoproxil fumarate/emtricitabine for HIV Pre-Exposure Prophylaxis (PrEP). Therefore, we conducted a situational analysis in HIV-care providers to identify barriers and facilitators for PrEP implementation. A survey was applied to a non-probabilistic sample of health care workers of HIV-specialized clinics. We examined PrEP awareness and familiarity, comfort with PrEP-related activities, perceived barriers for PrEP implementation, concerns, and attitudes. Poisson regressions assessed the relationship between these factors and the variable "having a plan to offer PrEP". The participation rate was 41% and included physicians (42.6%) and other health professionals (57.4%). Fifty-one percent of the participants reported more than five years of experience caring for people living with HIV. Forty-two percent of non-physician health care workers were nurses. Most reported high familiarity/comfort with PrEP-relevant activities. Concerns about PrEP were prevalent (50%) and included causing more harm than good, reducing condom use, medication non-adherence, drug resistance, and healthcare system barriers. Physicians had a plan to offer PrEP (72.2%) more often than other health professionals (52.6). Having a plan to offer PrEP was related to PrEP knowledge and comfort assessing sexual behavior and providing HIV counseling. Overall, about half of HIV-care providers seemed ready to offer PrEP and constitute an asset for PrEP implementation efforts in Colombia. PrEP awareness among non-physicians, PrEP concerns, and negative attitudes need to be addressed to enhance implementation.

The purpose of this study was to explore patients' perception of reasons contributing to delay in seeking help and referral to a wound care specialist at the onset of a diabetic foot ulcer (DFU).Constructivist grounded theory study.The sample comprised 30 individuals with active DFU attending a wound care clinic in southeastern Ontario, Canada.Participants were selected through purposive and theoretical sampling. Semistructured interviews were conducted with participants until no new properties of the patterns emerged. All interviews were transcribed, coded, and analyzed using methods informed by constructivist grounded theory.The reasons contributing to delay to seek help and referral to a wound care specialist were (1) limited knowledge about foot care, (2) unaware of diabetic foot problems, (3) underestimation of ulcer presentation, (4) I thought I could fix it myself, (5) inaccurate diagnosis, and (6) trial and error approach by a nonspecialized wound care provider.Study findings suggest that patients and primary healthcare providers need additional education regarding the management of diabetic foot disease and DFU.

BACKGROUND Sexual violence is a term describing sexual acts where consent is not freely given. Registered nurses employed as sexual assault nurse examiners (SANEs) provide care to address the medical and legal needs of victims/survivors of sexual violence. Trauma-informed care (TIC) is an approach recommended when caring for individuals who have experienced trauma. PURPOSE The study purpose was to understand how SANEs incorporate trauma-informed approaches in the care of adult and postpubescent adolescent victims/survivors of sexual violence. METHODS Eight SANEs were purposively recruited to participate in online semistructured interviews. Interview data were analyzed using qualitative interpretive description. RESULTS Six themes emerged from the analysis: (a) the importance of understanding the patient's experience; (b) personalized connection: developing a safe nurse-patient relationship; (c) choice: the framework of how we do things; (d) rebuilding strengths and skills to support healing and posttraumatic growth; (e) a wonderful way to practise: facilitators and benefits of trauma-informed practice; and (f) challenges to trauma-informed practice. CONCLUSIONS These findings indicate the perceived value of TIC and the need for enhanced support of providers who deliver TIC. More research is warranted to strengthen the evidence about trauma-informed practice in SANE programs and across healthcare settings.

Este artículo describe facilitadores y recomendaciones de proveedores de salud de clínicas de VIH para la implementación de PPrE en Colombia. Se realizó un estudio cualitativo con entrevistas semiestructuradas a 20 proveedores de salud de 9 clínicas. Se utilizó el “Marco Consolidado para avanzar en la Ciencia de la Implementación” para guiar el análisis de contenido de los hallazgos. Los resultados fueron: Características de la intervención: los proveedores reconocen PPrE como una terapia innovadora, de demostrada efectividad; recomiendan que debe implementarse por normativa nacional del Ministerio de Salud y Protección Social, con compra centralizada de medicamentos y adaptaciones a las diversidades regionales. Para ensamblar la PPrE en las clínicas, recomiendan articularla a programas preventivos de salud sexual, orientados por equipos interdisciplinarios capacitados. Ambiente externo: se recomendó fortalecer el trabajo en red con las secretarias de salud, Profamilia y organizaciones LGTBI; cambiar condiciones de contratación con las Entidades Promotoras de Salud para incluir PPrE dirigido a parejas de pacientes con VIH, y financiar con recursos públicos a personas que no la pueden pagar. Ambiente interno: clima y disponibilidad de implementación percibidos como favorables para la adopción de PPrE; para reducir tensiones organizacionales por el cambio recomiendan expandir los planes de capacitación. Proceso de implementación: se recomienda el diseño de planes nacionales, locales e institucionales, así como la atracción de líderes clave internos y externos. Se concluye que los proveedores de salud de los clínicas para VIH en Colombia perciben un ambiente favorable para la adopción de PPrE en el país.

Resumo Objetivo Discutir as relações de poder entre profissionais de saúde em ambientes de cuidado intensivo e sua interferência no processo de construção do conhecimento. Métodos Neste artigo filosófico, exploramos a influência das relações de poder na construção do conhecimento, a partir das perspectivas foucaultiana e crítica de Gramsci e Freire em relação às práticas de enfermagem e cuidados de saúde. Resultados Há quatro fontes de poder organizacional (tomada de decisão, critério, controle de recursos e controle de conhecimento/rede) que atuam em diferentes níveis das organizações de saúde. As unidades de terapia intensiva são um importante segmento do ambiente de saúde, e a complexidade no cotidiano dos profissionais desse setor pode dificultar as relações de poder no processo de construção do conhecimento. Por exemplo, quando profissionais externos à equipe da UTI, que detêm conhecimentos específicos, precisam ser contatados para auxiliar em casos, como durante o processo de doação e transplante de órgãos. Nesta situação, é necessário desconstruir o poder competitivo para construir o poder colaborativo. Conclusão Usando as perspectivas de Freire e Gramsci, argumentamos que a falta de conhecimento contribui para o poder competitivo, que pode ser superado se os indivíduos envolvidos participarem no processo de aprendizagem em direção ao poder colaborativo. Portanto, as estratégias ou ações para lidar com os desequilíbrios de poder interprofissional podem contribuir para a transformação e mudança mútua. Resumen Objetivo Discutir las relaciones de poder entre profesionales de salud en ambientes de cuidado intensivo y su interferencia en el proceso de construcción del conocimiento. Métodos En este artículo filosófico, exploramos la influencia de las relaciones de poder en la construcción del conocimiento a partir de las perspectivas foucaultianas y la crítica de Gramsci y de Freire en relación con las prácticas de enfermería y los cuidados de salud. Resultados Hay cuatro fuentes de poder organizativo (toma de decisión, criterio, control de recursos y control de conocimiento/red) que actúan en distintos niveles de las organizaciones de salud. Las unidades de cuidados intensivos son un importante sector del ambiente de la salud, y la complejidad en la labor cotidiana de los profesionales de ese sector puede dificultar las relaciones de poder en el proceso de construcción del conocimiento. Por ejemplo, cuando profesionales externos al equipo de la UCI, que tienen conocimientos específicos, tienen que ser contactados para auxiliar en algunos casos, como durante el proceso de donación y trasplante de órganos. En esta situación se hace necesario deconstruir el poder competitivo para construir el poder colaborativo. Conclusión Usando las perspectivas de Freire y de Gramsci, argumentamos que la falta de conocimiento contribuye para el poder competitivo, que se puede superar si los individuos involucrados participan en el proceso de aprendizaje en dirección al poder colaborativo. Por lo tanto, las estrategias o las acciones para hacer frente a los desequilibrios de poder interprofesional pueden contribuir con la transformación y el cambio mutuo. Abstract Objective To discuss the power relations among health care professionals in acute care settings and its interference in the process of knowledge building. Methods In this philosophical paper, we explored the influence of power relations on knowledge building using a Foucauldian and critical perspective of Gramsci and Freire related to nursing and health care practices. Results There are four sources of organizational power (decision-making, discretion, control of resources, and control of knowledge/network) that act at different levels of healthcare organizations. Intensive care units are an important segment of healthcare setting, and the complexity involved in the daily activities of professionals in this sector can lead to difficult power relations in the process of knowledge building. For instance, when professionals external to the ICU team that hold specific knowledge need to be contacted to help in cases, such as during organ donation and transplantation process. In this situation it is necessary to deconstruct the competitive power in order to build the collaborative power. Conclusion Using Freire’s and Gramsci’s perspectives we argued that lack of knowledge contributes to competitive power which can be overcome if involved individuals engage in the learning process towards a collaborative power approach. Therefore, strategies or action to address interprofessional power imbalances can contribute mutual transformation and change.

Educators who recognize the value of authentic written exams for promoting student critical thinking may struggle with concerns about cheating. In this article, we explore how educators may use open-web take-home exams to help students develop integrity and evidence-based practice skills. Lang's theory is used to explore why students may cheat. We discuss the importance of caring assessment practices by drawing on critical caring pedagogy and universal design for learning. Throughout the discussion, we illustrate how authentic questions and instruction that is focused on dialogue, collaboration, and resource use may reduce cheating possibilities while improving student learning.

Objectives: Providing diabetes self-management education (DSME) in an evidence-based format that is accessible and tailored to the population needs is crucial for individuals living with diabetes mellitus. Our qualitative study explores the experiences of older adults living with diabetes while residing in a rural setting. Methods: Adults aged 65 or older and residing in a rural area of Ontario completed a photovoice activity and semi-structured interviews to illustrate their experience of living with diabetes and accessing DSME. Results: Fourteen participants (11 males; mean age = 74 years) completed the photovoice activity and interview. Four main themes were identified pertaining to learning about diabetes education, the depth and breadth of learning, applying knowledge to daily life, and engaging older adults in DSME. Discussion: Diabetes self-management education should account for older adults’ preferences in learning about diabetes and self-management to promote access to evidence-based information, bolster knowledge and self-management efficacy, and improve disease control.

The impact of the global COVID-19 pandemic cannot be overstated, affecting how we live, learn, work, and do research. Goals: Reflect on the impact of the global pandemic in a participatory research project with seniors living with diabetes. Method: This study follows a participatory action research and critical pedagogy approaches. Results: In this paper, we describe our experience as researchers working on a PAR project during the pandemic. We reflect on the challenges, the research modifications made in our efforts to move forward with distance-based participatory approaches, and the surprising (unimagined) benefits. Conclusions: We conclude with lessons learned and new visioning about how to maintain the collaborative nature of PAR in instances where it is impossible to work in close proximity with community members and conduct research in a co-located context.

Instead of instilling in nursing students critical thinking to challenge injustice and oppression in nursing practice, nurse educators often rely on outdated traditional approaches to education. This situation is certainly true in traditional methods of evaluation that often propagate a banking mode of learning. One of the most commonly used methods of evaluating students is traditional examinations, which have recently become a source of pedagogical conflict among educators. In this article, we outline how educators unknowingly encourage surface learning, uncaring practices, oppression, inequity, and cheating when they rely on traditional examinations. We draw on critical caring pedagogy and universal design for learning to advocate for increased use of authentic assessment in nursing education. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A31.

Objective. We evaluated the construct validity Spanish version of knowledge, stigma, norms, and self-efficacy scales regarding PrEP in MSM. Methods. Sample of 287 MSM. Exploratory confirmatory factor analysis and item response theory were used to validate the constructs. Correlations and confidence interval-based estimation of relevance analyses were conducted to correlate the scales with willingness and intention to use PrEP. Results. Attitude, stigma, and descriptive and subjective norms scales showed good construct validity and were related to intention and willingness to use PrEP. However, the knowledge scale and self-efficacy scales require further refinement. Conclusions. The study provides useful information for assessing information, motivation, and self-efficacy related to PrEP use. Our results could be used to test the scales and the theoretical model in other contexts to confirm their usefulness.

Background Asthma is a highly prevalent chronic disease among Ontario children; however, the extent to which rural status and distance are associated with unplanned emergency department (ED) use by this population is largely unknown. Objective To explore the impact of rurality and geographical distance to primary and specialist care services on healthcare utilization by analyzing the use of unplanned ED services. Methods A population level retrospective cohort study of Ontario children ages 5–14 with newly diagnosed asthma was conducted using health administrative data from Institute for Clinical Evaluative Sciences (ICES). Adjusted logistic regression models were used to analyze the association between unplanned ED use with rural status and distance to general practitioner/family physician (GP/FP) and specialist healthcare services, while controlling for confounders. Results In total, 19,732 individuals met the inclusion criteria. Individuals who lived in rural locations (OR 2.00, 95% CI 1.64–2.44) and travelled >50 km to a GP/FP (OR 1.25, 95% CI 1.06–1.48) or specialist (OR 1.20, 95% CI 1.05–1.38) were more likely to utilize an ED. Conclusion Children with asthma utilize healthcare services differently based on rural status and distance to services. To ensure equitable access to care, there is a need to accommodate for these factors in the planning and provision of asthma healthcare services.

In Canada, Indigenous peoples bear a greater burden of illness and suffer disproportionate health disparities compared to non-Indigenous people. Difficult access to healthcare services has contributed to this gap. In this article, we present findings from a dissemination grant aimed to engage Indigenous youth in popular theatre to explore inequities in access to health services for Indigenous people in a Western province in Canada. Following an Indigenous and action research approach, we undertook popular theatre as a means to disseminate our research findings. Popular theatre allows audience members to engage with a scene relevant to their own personal situation and to intervene during the performance to create multiple ways of critically understanding and reacting to a difficult situation. Using popular theatre was successful in generating discussion and engaging the community and healthcare professionals to discuss next steps to increasing access to healthcare services. Popular theatre and short dramas provide a venue for mirroring stigmatized care and expose racial biases in the delivery of care. The contributions of the students, their input, and their acting were to increase our awareness even more of the pervasiveness of the stigmatized care that Indigenous people experience.

Providing nursing care for people with dementia residing in long-term care facilities poses specific challenges regarding pain practices. With underlying communication barriers unique to dementia pathologies, this population is often unable to communicate verbal sentiments and descriptions of pain. In turn, nurses caring for older persons with dementia have difficulty assessing, managing and treating pain. Objectivity is an imperative factor in healthcare pain practices; however, it is difficult to objectively evaluate someone who cannot accurately communicate their experience of pain. Therefore, the authors believe that subjectivity is also an essential part of evaluating the person with dementia's experience of pain. In this critical reflection, the authors explore objectivity and subjectivity in relation to pain practices for dementia in long-term care. A historical summary of pain is provided outlining the evolution of objectivity and subjectivity related to pain practices. The authors discuss the complexities of assessing and managing pain and offer a new perspective about the role of objectivity (and co-existence of subjectivity) for nurses treating pain in the older adults with dementia.

Physiological observations or vital sign monitoring is a fundamental tenet of nursing care within an acute care setting. Surveillance of vital signs with algorithmic early warning frameworks aids the nurse in monitoring for early symptoms of clinical deterioration. The nurse must be cognizant of the factors that can influence the vital sign measurements because the framework score is only as reliable as the data inserted. Vital sign technology has made significant progress in its ability to objectify nursing subjective assessments. Early scientists have struggled with its relationship with subjectivity, claiming it has no relevance in true science. Quantitative measurements, regardless of how objectively they were created or obtained, need a subjective lens to interpret and act on the results. The skill of "making" the vital signs can be easily taught or done with technology, but it is the "taking" of the data for analysis of truth and action that requires a higher level of expertise. This paper will examine the truth of vital sign methodology and monitoring to explore the question, "Is true objectivity in the nursing practice of vital sign measurement possible?" The truth in vital sign recognition through a subjective lens will also be explored to challenge the philosophical scientific claims that objective data are the absolute truth.

This study aimed at uncovering the factors influencing individuals' ability to engage in self-management of diabetic foot ulcer (DFU) and presenting a theoretical model depicting these factors and the outcomes. We used constructivist grounded theory methodology to guide this study and recruited 30 participants with an active DFU attending a wound care clinic in Ontario, Canada. The study's findings indicate that participants' engagement in self-management of DFU was influenced by internal and external factors. While some factors contributed to enhance participants' engagement in everyday self-management, others seemed to have prevented them from achieving engagement and hence the desired DFU outcomes.

El presente trabajo presenta el uso de metodos participativos para desarrollar un programa de educacion para el autocuidado de la diabetes en adultos mayores en Canada. Objetivos; presentar nuestra experiencia con el uso de metodos participativos con una comunidad de adultos mayores con diabetes. Metodos: Para este estudio se uso una metodologia investigacion-accion participativa en una comunidad rural de Ontario, Canada. La implementacion de comite asesor, el uso del modelo de salud publica PRECEDER-PROCEDER es presentado, asi como el uso del World cafe o cafe del munod, finalmente se presenta el metodo de fotovoz que sera usado con la comunidad. Conclusiones. El uso de metodos participativos ha sido un proceso enriquecedor en donde le hemos dado voz a la comunidad para que guie el proyecto. Asimismo, hemos aprendido a conocer las necesidades de la poblacion de adultos mayores en esta comunidad. Igualmente hemos aprendido que el uso de metodos participativos debe estar basado en el contexto en donde la investigacion toma lugar.

Background Building research capacity in nursing academic units continues to be a challenge. There are a number of external contextual factors and internal factors that influence individual faculty as well as the collective to engage successfully in research. Purpose The overall aim of this opinion article is to provide an overview of the current external and internal, processes and structures, relevant to capacity of nursing faculty to engage in research. Methods To inform the external context, we reviewed national research funding trends for nursing. To inform the internal context, we provided an exemplar of the internal processes and structures designed to support research capacity building within our academic unit. Results Canadian Institutes of Health Research funding trends for research grants led by nurse principal applicants increased between 2010 and 2013, followed by a steady decline. In 2017 to 2018, there were only 24 research grants led by nurse principal applicants. These external challenges coupled with the traditional internal barriers, such as the imbalance between teaching and research time, threaten research capacity for nursing academics. Conclusion Organizational strategies to promote research capacity within academic nursing units are a necessary requirement to move forward.

Objectives Our aim in this study was to develop the first theory that could explain the processes of engagement in self-management for adults with diabetic foot ulcer (DFU). Methods A constructivist grounded theory, informed by Charmaz, and symbolic interactionism were used to guide the study design. Results The findings from 30 study participants with active DFU draw attention to the complexity that exists for individuals seeking to balance life and manage their diabetes and DFU. The categories/phases and set of associated concepts comprise the theory known as The Journey Toward Engagement in Self-Management. This theory consists of 5 phases: 1) perception of illness, 2) noticing foot changes, 3) realizing seriousness, 4) beginning to learn about self-management and 5) engaging in self-management. The theory’s phases describe the processes of engagement in self-management from participants’ unique experience of living and managing DFU. Conclusions The results show the pathways taken by participants to learn about self-management practices and how engagement in day-to-day management of DFU occurred. Engagement in self-management of an active DFU is complex and a developmental process that differs from participant to participant and changes over time. Although most participants preferred to take a more passive role in self-management of DFU (seen in phase 4), others demonstrated confidence to advance to another stage (seen in phase 5). At the advanced stage, they took an active role in self-management by expressing their needs and preferences, and were involved in their own care and decision-making related to treatment options.

Individuals living with rare conditions are faced with important challenges derived from the rarity of their conditions and aggravated by the low priority given to rare disease research. However, current realities of rare disease research require consideration of the relationship between subjectivity and 'traditional' objectivity. Objectivity in research has traditionally been associated with processes and descriptions that are independent of the investigator. The need for researchers to provide unbiased knowledge and achieve a balance between objectivity and the underlying values in nursing and scientific research requires an examination of how objectivity is conceptualized within the context of rare disease research. The aim of this paper is to examine scientific objectivity in rare disease research from a philosophical viewpoint and, in doing so, demonstrate the need to redefine it to reflect the current scientific environment. As such, healthcare providers working on this field need to redefine objectivity around ethical and moral obligation to advance science in an equitable manner with the end goal to produce knowledge that is trustworthy and beneficial to our patients.

As nursing continues to develop as a professional discipline, it is important for nurses to have a central question to guide their research. Since the 1800s, nursing practice and research have covered a wide scope in cooperation with other disciplines. This wide area of nursing practice and research has led to the proposal that the central question be: How can the well-being of a person, family, community, or population be improved? The proposed question must remain flexible and open to revision because nurses will continue to adapt to the changing needs of their patients and populations and to their complex and evolving work environments.