Purpose: The purpose of this article is to provide conceptual clarification of secondary traumatic stress (STS) in nurses.Background: As an empathetic helping profession, nurses are at increased risk for STS. Interchangeable usage of related terms among multidisciplinary literature has resulted in lack of conceptual clarity resulting in conflation of terms. Conceptual clarity is necessary for a foundation for further research on treatment.Methods: Rodgers' evolutionary model of concept analysis.Results: Nurses are predisposed to STS due to exposure, empathy, bonding, and personal factors. Essential attributes were found to be posttraumatic stress disorderlike symptoms, biological symptoms, social symptoms, and psychological symptoms.Resultant consequences included an altered worldview, interpersonal difficulties, and decreased occupational commitment.Conclusion: This concept analysis, the first focusing on STS, provides conceptual clarity and a concept map of STS within the nursing population.

Background: Moral distress has detrimental effects on nurses which impacts the entire healthcare cycle. Described as a crescendo effect, resolved situations of moral distress leave residue on the nurse with three potential outcomes: moral numbing, conscious objection to the situation, and burnout. Objective: This metaethnography strives to achieve a fuller understanding of moral distress by interpreting the body of qualitative work of moral distress in emergency and critical care nurses. Method: This study used the Noblit and Hare’s approach of interpretative synthesis. Ten studies met the criteria and were used in this synthesis. Ethical considerations: Ethical issues were minimal since no human subjects were involved. Ethical requirements were respected in all study phases. Results: The synthesis of qualitative research on moral distress resulted in one central theme, “the battle within,” and five subthemes. Conclusions: The unique nature of this nursing specialty resulted in a lasting inner conflict for nurses that is consistent with the previously described crescendo effect. The effects are complex and long lasting and may potentially affect the nurses’ future patient care.

Diabetes distal symmetrical peripheral neuropathy (DSPN) is the most prevalent form of neuropathy in industrialized countries, substantially increasing risk for morbidity and pre-mature mortality. DSPN may manifest with small-fiber disease, large-fiber disease, or a combination of both. This review summarizes: (1) DSPN subtypes (small- and large-fiber disease) with attention to clinical signs and patient symptoms; and (2) technological diagnosis and screening for large- and small-fiber disease with inclusion of a comprehensive literature review of published studies from 2015-present ( N = 66). Review findings, informed by the most up-to-date research, advance critical understanding of DSPN large- and small-fiber screening technologies, including those designed for point-of-care use in primary care and endocrinology practices.

This chapter introduces complexity science as a framework for understanding the healthcare delivery system and the inherent challenges it poses for healthcare providers. The Institute for Healthcare Improvement's triple aim, which focuses on the patient experience, population health, and decreased costs, served the health disciplines for a short period of time. It was then recognized that the healthcare provider, the worker at the point of care, was instrumental in the success of the triple aim. This concept, the health and wellbeing of the worker, came to be crystallized as meaning and joy in one's work. The chapter explores this positive affect concept as well as that of compassion satisfaction along with negative affect occupational-based strains occurring for the healthcare provider as they navigate working in the complex healthcare delivery system of the United States.