Purpose: To describe the unmet needs of adult patients living with solid tumor cancer. Design: Survey design. Method: Adult patients living with solid tumor cancer from two outpatient clinics were mailed the Sheffield Profile for Assessment and Referral to Care, a holistic screening questionnaire for assessing palliative care needs, and a demographics questionnaire. One hundred fifteen patients returned the instruments, corresponding to a 62% response rate. Findings: There were no significant differences by cancer type (breast, non-breast) or gender. However, Caucasians reported significantly more psychological issues, such as anxiety, than non-Caucasians ([n = 101 (87.8%)] and [n = 14 (12.2%)], respectively, p = .032). Older patients reported more concerns about loss of independence/activity (p = .012) compared with younger age groups. Patients living with Stage III/IV cancer reported more distressed about independence/activity (p = .034), family/social issues (p = .007), and treatment side effects (p = .027) than patients living with Stage I/II cancer. Conclusion: Patients living with solid tumor cancer have a myriad of unmet needs regardless of age, gender, cancer type, or cancer stage. There appears to be important differences by cancer stage. The Sheffield Profile for Assessment and Referral to Care questionnaire provides a holistic approach for nurses to identify unmet needs and concerns. Future research should explore the preferred methods of receiving support and information.
Purpose: Pain is a common occurrence after orthopedic surgery. Patients need additional resources to manage their pain. The purpose of this study was to determine if listening to music has a positive effect on pain scores and satisfaction in the postoperative adult orthopedic patient. There are limited studies demonstrating statistically significant decreases in postoperative pain in this group. A secondary purpose was to expose nurses on a standard medical-surgical unit to an intervention, supported by the holistic nursing model that they could use in their care. Design and Method: This study was a descriptive, comparative, quasi-experimental design. Patients listened to prerecorded music on individual CD players and recorded pre–post pain scores with the intervention. A satisfactory survey was completed at discharge. Findings: Results demonstrated a statistically significant reduction in patients’ pain scores after listening to music. Length of listening time had no effect. Patients expressed overall satisfaction, and 100% of participants would recommend this intervention to others. Conclusions: Listening to music is beneficial as an adjunct to pain medication and contributes to increased patient satisfaction. It is hoped that the information gained from this study will lead to an enhancement in the standard of care for postoperative patients.
Purpose: This study was conducted to examine the level of infertility stress, marital adjustment, depression, and quality of life in infertile couples and assess the actor and partner effects in these areas using the actor–partner interdependence model. Design: Cross-sectional study. Method: Participants were 121 infertile couples. After pilot study, data were collected from November 2012 to March 2013 using the following questionnaires: the Fertility Quality of Life, Fertility Problem Inventory, Revised Dyadic Adjustment Scale, and Beck Depression Inventory. Findings: There was a gender difference in infertility stress, depression, and quality of life. Infertility stress had actor and partner effects on the quality of life. Marital adjustment had an actor effect on the quality of life for the wives. Depression had actor and partner effects on quality of life for the wives, but only an actor effect for the husbands. Conclusion: This study found that there were actor and partner effects of infertility stress, marital adjustment, and depression on the quality of life in infertile couples. These findings may help nurses be aware of such effects and can be used as a baseline data in the development of nursing interventions for infertile couples.
Purpose of study: Viewing the surgical patient holistically within their environment of care, the bedside nurse is aware of the possible complication of postoperative paralytic ileus that can lead to patient discomfort and increased medical costs. Acute care nurses observed postoperative patients watching televised cooking shows on a consistent basis and questioned if there was a mind–body link between bowel function and watching cooking shows. Design of Study: The study used an observational approach to examine the return of bowel sounds for postoperative patients. Method: Ninety-four patients that underwent abdominal surgery participated. A questionnaire was administered to capture total hours postsurgery of patient viewing cooking shows followed by chart review for age, height, weight, information specific to surgery, and documented first postsurgical flatus. Findings: This study found that non–bariatric general surgery patients who watch cooking shows during hospitalization are significantly more likely to experience return of appetite and stomach sounds within 1 day postsurgery than patients who do not watch cooking shows. Conclusions: Based on the results of this study, the authors suggest that, when possible, patients who receive non–bariatric abdominal surgery be encouraged to watch cooking shows to experience the potential benefits such as early return of bowel functioning.
Purpose: To examine how written communication between patients with hematological diseases and a nurse within a web-based communication service can be caring. Design: The study is based on qualitative deductive content analysis of 109 written messages between 10 patients and a responding nurse. The evaluated nursing intervention is a web-based communication service where patients could request support from a responding nurse during 2 months of use. A structured theoretical matrix based on Swanson’s theory of caring including compassion, competence, and upholding trust is used for the analysis. Findings: Nursing compassion emerges when patients share personal matters and the nurse has an opportunity to explicitly display genuine interest and understanding. Nursing competence is required when patients ask for or are in need of information, advice, and emotional support. The nurse can uphold trust when compassion and competence are exhibited and patients share their innermost feelings. Conclusions: Web-based communication has the potential to contribute to holistic well-being according to Swanson’s theory of caring. The written word lasts, can be read repeatedly, and in connection with writing there is time for reflection. However, the lack of nonverbal cues makes it important that the nurse answers in a fully accurate and explicitly caring way.
As part of a study of a larger study of self-identified holistic nurses, researchers asked nurses to describe practice situations where energy-based modalities (EBMs) were used. Four hundred and twenty-four nurses responded by writing free-text responses on an online survey tool. The participants were highly educated and very experienced with 42% holding graduate degrees and 77% having over 21 years of practice. Conventional content analysis revealed four themes: EMBs are 1) caring modalities used to treat a wide range of identified nursing concerns; 2) implemented across the life span and to facilitate life transitions; 3) support care for the treatment of specific medical conditions; and 4) Use of EBMs transcend labels of ‘conditions’ and are used within a holistic framework. The fourth theme reveals a shared vision of nursing work such that the modality becomes secondary and the need to address the ‘whole’ at an energetic level emerges as the primary focus of holistic nursing.
Background: There is a large and diverse literature on the concept of hope in health care. This literature covers a broad spectrum of perspectives, from philosophical, conceptual, and theoretical analysis through to attempts at measuring the concept of hope with differing health care users. Aims: To explore the concept of hope through the secondary analysis of existing data sets, with the intention of understanding hope in the context of person-centeredness. Research Question: What is the experience of hope among service users and informal carers in different health care contexts? Method: Secondary analysis of data derived from three research studies. Findings: We identified four key themes that together illustrate what we describe as a kaleidoscope of hope, reinforcing the view that there is no one presentation of hope and that practitioners must engage authentically with service users to determine the most effective and appropriate intervention strategies. Conclusions: Hope is not a singular phenomenon, and in the context of person-centered practice there is a need for practitioners to engage authentically with service users and listen carefully to what may bring hope for them.
Purpose: This study explored RN-BS students’ self-care and health-promotion (SCHP) practices in a semester-long holistic nursing course with emphasis on the utility of self-reflection through journal writing. Design: A qualitative single case study blended in practical action research. Method: Fifteen RN-BS students enrolled in the holistic nursing course completed (a) three reflective journal entries (beginning, midterm, and conclusion); (b) two IHWA-short form surveys (beginning and conclusion); and (c) one demographic form (beginning) of the course. Findings: Three reflective journals indicated that students’ understanding of their SCHP practices progressed from novice, to advanced, and finally to competent from the beginning, middle, and at the conclusion of the course. Four findings emerged in relation to reports of their SCHP practices: (a) new awareness of self, (b) application of SCHP practices knowledge, (c) role modeling, and (d) dedication to SCHP practices beyond the semester. Four findings emerged in relation to participation in the reflective journaling about reports of their SCHP practices: (a) self-discovery, (b) retrospective self-evaluation, (c) useful intervention for SCHP, and (d) beneficial learning tool in academic environment. Conclusions: Reflective journaling enhanced students’ SCHP practices and was recognized as useful instructional strategy to improve learning in the classroom.
Purpose: This study aims to evaluate the relationship between nurses’ views on spirituality and spiritual care and their level of burnout. Method: This cross-sectional study used a convenience sample that comprised 118 nurses from one state hospital in eastern Turkey. The data were collected through questionnaires that were filled by the nurses individually, using a sociodemographic characteristics form, the Spirituality and Spiritual Care Rating Scale, and the Maslach Burnout Inventory. Results: A statistically significant relationship was found between subscale scores of Maslach Burnout Inventory and total score of Spirituality and Spiritual Care Rating Scale. With the increase in nurses’ spiritual care mean scores, there was an increase in the mean scores of the Emotional Exhaustion, Depersonalization, and Personal Accomplishment subscales. Conclusions: Nurses’ burnout levels increased with the increase in their spirituality and spiritual care mean scores. This situation can be associated with the fact that providing spiritual care increases nurses’ workload. Therefore, similar studies are recommended to be conducted with wider groups of participants.
Purpose: The purpose of this qualitative study was exploring what the roles and challenges of health care providers working within Northern Canadian Aboriginal communities are and what resources can help support or impede their efforts in working toward addressing health inequities within these communities. Design: The qualitative research conducted was influenced by a postcolonial epistemology. The works of theorists Fanon on colonization and racial construction, Kristeva on semiotics and abjection, and Foucault on power/knowledge, governmentality, and biopower were used in providing a theoretical framework. Methods: Critical discourse analysis of 25 semistructured interviews with health care providers was used to gain a better understanding of their roles and challenges while working within Northern Canadian Aboriginal communities. Findings: Within this research study, three significant findings emerged from the data. First, the Aboriginal person’s identity was constructed in relation to the health care provider’s role of delivering essential health services. Second, health care providers were not treating the "ill" patient, but rather treating the patient for being "ill." Third, health care providers were treating the Aboriginal person for being "Aboriginal" by separating the patient from his or her identity. The treatment involved reforming the Aboriginal patient from the condition of being "Aboriginal."
Aim: To evaluate the psychometric properties of an Arabic version of the Spiritual Care-Giving Scale (SCGS) in a sample of Saudi nursing students. Method: A convenience sample of 202 Saudi nursing students was included in this descriptive cross-sectional study. The 35-item Arabic version of the SCGS (SCGS-A) was tested for internal consistency, stability reliability, content validity, and construct validity. Findings: The SCGS-A manifested acceptable internal consistency and stability reliability with computed Cronbach’s alpha ranges from .84 to .94, and an intraclass correlation coefficient of .97. The item-level content validity index ranged from .83 to 1, and the scale-level content validity index (average) was .98. The principal component analysis revealed five dominant components with eigenvalues greater than 1, and a cumulative contribution rate of 62.0%. The five factors were moderately to strongly correlated (r = .29-.56; p < .001) with each other and with the overall SCGS-A score (r = .57-.77; p < .001). Conclusion: The SCGS-A manifested an acceptable reliability and validity in Saudi nursing students, which supports its sound psychometric properties. With the establishment of this valid and reliable tool, timely and accurate assessment of student nurses’ perceptions about spirituality and spiritual care can be facilitated.
Delivery of care by nurses in virtual environments is rapidly increasing with uptake of digitally mediated technologies, such as remote patient monitoring (RPM). Knowing the person is a phenomenon in nursing practice deemed requisite to building relationships and informing clinical decisions, but it has not been studied in virtual environments. Purpose of Study: The intent of this study was to explicate the processes of how nurses come to know the person using RPM, one form of telehealth technology used in a virtual environment. Study Design and Method: The study was informed by Charmaz’s constructivist grounded theory and included 33 interviews and 5 observational experiences of nurses using RPM in 7 different settings. Findings: Getting a Picture evolved as the core category to a theoretical conceptualization of nurses knowing the person through use of RPM and other technologies, such as telephone and electronic medical records. Getting a Picture reflected a dynamic flow and integration of seven processes, such as Connecting With the Person and Recording and Reflecting, to describe how nurses strove to attain a visualization of the person. Conclusions: While navigating disparate and disconnected information and communication technologies, Getting a Picture was important for providing safe, holistic, person-centered care.
Purpose: This pilot study explored change over time in symptom management, health promotion, and quality of life following exposure to a holistic intervention combining group acupuncture with group sessions about health promotion for women with multiple sclerosis. Design: This was a pre/post nonexperimental design. Method: Fourteen women (average age 54 years) attended eight classes designed to help participants build the skills necessary to improve their health and consequently their overall quality of life. Acupuncture was provided in a group setting either immediately before or after each class. Findings: Self-reported fatigue, stress, pain, depression, anxiety, and sleep interference decreased significantly, and overall health-promoting behaviors, self-efficacy for health promotion, social functioning, and quality of life increased significantly. In addition, focus groups held with the participants indicated that they responded positively to the combination of acupuncture with an efficacy-building health promotion intervention. Conclusions: The results of this pilot study add to the growing literature demonstrating that holistic health promotion interventions may have positive benefits for people with multiple sclerosis. Delivering acupuncture to a small group of individuals attending wellness classes appears to be feasible and was generally well received by the study participants.
Choices in care during the end stages of life are limited by the lack of resources and access for rural people. Nursing advocacy based on the holistic understanding of people and their rural communities may increase the opportunity for choice and improve the quality of care for people living and dying at home. Pragmatism and nurse agency theory were used for a practical exploration of how district nurses successfully advocate for rural Australian end-of-life goals to begin the development of a practice model. In two stages of data collection, rural district nurse informants (N = 7) were given the opportunity to reflect on successful advocacy and to write about their experiences before undertaking further in-depth exploration in interviews. They defined successful advocacy as "caring" that empowers people in the "big and small" personal goals important for quality of life. The concepts described that enable successful advocacy were organized into a network with three main themes of "willing" investment in holistic person-centered care, "knowing" people and resources, and feeling "supported." The thematic network description provides deep insight into the emotional skill and moral agency involved in successful end-of-life nurse advocacy and can be used as a sound basis for modeling and testing in future research.
Acute care nursing is currently undergoing unprecedented change, with health systems becoming more open to nonpharmacological approaches to patient care. Healing Touch (HT) may be a valuable intervention for acute care patients. Research has shown that HT helps both the patient and the caregiver; however, no study to date has examined the impact that the education of nurses in and their use of HT have on daily care delivery in the acute care setting. The purpose of the current qualitative study was to examine the use of HT by registered nurses in the acute care setting during their delivery of patient care, as well as the impact of education in and use of HT on the nurses themselves. Five themes were identified: (1) use of HT techniques, processes, and sequence; (2) outcomes related to HT; (3) integration of HT into acute care nursing practice; (4) perceptions of HT, from skepticism to openness; and (5) transformation through HT. Education in HT and delivery of this modality by nurses in the acute care setting provide nurses with a transformative tool to improve patient outcomes.
Purpose: Presence is the essence of professional nursing in the nurse–patient connection. Nursing students have little exposure to strategies fostering presence. This pilot study explored students’ perceptions of strategies to encourage presence in the classroom. Design: A three-question survey was distributed to students in the last week of classes. Faculty not teaching that course administered the survey. Method: Four faculty used strategies aimed at encouraging presence. These strategies included starting class with a mindfulness minute, mindful movement, singing bowl, peace and power check in, and a discussion of a current event. Each class used only one strategy consistently through the semester. Participants were undergraduate and graduate students enrolled in one of seven classes taught by these faculty. Findings: Overall the students found strategies to be beneficial. In reflecting on the experience with the strategies, four themes emerged: calming/relaxing; focusing/centering; setting aside distractions; and feeling community and connection. Conclusion: These brief strategies were acceptable to most students and were helpful to the students in preparing for class. The response to mindfulness minute was most positive. Further research is needed on the introduction of strategies that help students in the classroom and may also increase presence at the bedside.
This study explored the frequency of providing aspects of spiritual care intervention and its association with nurses’ own spiritual well-being in a convenience sample of 355 Jordanian Arab Muslim nurses. The nurses were recruited from different hospitals, representing both public and private health care sectors in northern and central Jordan. A cross-sectional descriptive and correlational design was used. Results indicated that Jordanian Muslim nurses provided religious aspects of spiritual care intervention to their Muslim patients infrequently and that their own spiritual well-being was positively associated with the frequency of provision of spiritual care interventions. The study concluded that Jordanian Muslim nurses most frequently provided spiritual care interventions that were existential, not overtly religious, were commonly used, were more traditional, and did not require direct nurse involvement. Moreover, the findings revealed that spiritual well-being was important to those nurses, which has implications for improving the provision of spiritual care intervention. The study provides information that enables nurses, nursing managers, and nursing educators to evaluate the nurses’ provision of various aspects of spiritual care to their Muslim patients, and to identify aspects of spiritual care intervention where nurses might receive training to become competent in providing this care.
This qualitative study was designed to uncover the characteristics and behaviors of nurses identified by patients as providing exceptional nursing care. "Being present" and "Knowing the patient" were the major themes that captured the nurses’ experience. Four subthemes were identified: looking for commonalities, sharing personal experiences, use of humor, and caring for the spiritual needs of patients.
Background: Wounded, ill, and injured (WII) Military Service members experience significant stress and are at risk for developing chronic conditions including posttraumatic stress disorder and depression. Qigong, a meditative movement practice, may positively affect their ability to engage in successful rehabilitation. Purpose: We assessed the feasibility of Qigong practice in WII Service members returning from combat; effects on stress, sleep, and somatic symptoms; satisfaction; and participants’ experience with the practice. Design: Single-group, pre- and posttest, mixed methods approach. Method: Twenty-six WII were enrolled. The program was designed to include 20 classes over 10 weeks. Participants completed self-report questionnaires, practice logs, and an exit interview. Findings: Average attendance was 8.14 classes (SD = 4.9); mean engagement was 5.7 (SD = 3.5) weeks. Participants endorsed a high level of satisfaction with the practice. Qualitative themes included coping with stress; feeling more resilient and empowered; improvement in symptoms including sleep and physical function; and factors affecting practice. Participant-reported facilitators included accessibility and portability of the practice; barriers included scheduling conflicts and personal challenges. Participants recommended offering shorter programs with flexible scheduling options, increasing program awareness, and including significant others in future classes. Conclusion: Qigong was safe, portable, and easily adapted for WII Service members.
Purpose: To describe the impact of episodes of supraventricular tachycardia (SVT) on a person’s daily life from a holistic perspective. Method: A deductive descriptive design was used. Twenty semistructured interviews (12 women and 8 men) were conducted before planned ablation of SVT and were analyzed using qualitative content analysis. Results: Living with SVT had a complex impact on daily life. Initially, the patients described an inhibited existence due to demands to give up things that they had previously been doing, in case the unpredictable episodes of SVT would occur. The episodes caused fatigue and worry, which together created a barrier for living life to the full by making the person give up undertakings. The patients constantly needed to find short-term and long-term strategies to prevent new episodes from happening. Conclusion: Episodes of SVT entail a complex life situation as the person’s entire existence is affected in daily life. To understand the impact of SVT on daily life, nurses and other health care professionals need increased knowledge and understanding to be able to provide support through relevant information and take optimal care measures.
Aim: To examine the effectiveness of a bio-energy intervention on self-reported stress for a convenience sample of University students, faculty, and staff during finals week. We hypothesized that participants would report a decrease in stress after a 20 minute bio-energy intervention. Study Design: A quasi-experimental, single-group, pretest–posttest design was used. Method: Thirty-nine faculty, staff, and students participated. Participants served as their own controls. A specific technique was provided by each bio-energy practitioner for 20 minutes after participants had completed a visual analogue scale identifying level of stress and listing two positive and negative behaviors they were currently using in response to stress. Results: A one-sample t test indicates that bio-energy therapy significantly reduces stress, t(35) = 7.74, p < .0001. A multiple regression analysis further indicates that the decrease in stress levels is significantly greater for higher initial stress levels, t(31) = 4.748, p < .0001); decreases in stress are significantly greater for faculty and staff compared to students, t(31) = –2.223, p = .034; and decreases in stress levels are marginally significantly higher for older participants, t(31) =1.946, p = .061. Conclusion: Bio-energy therapy may have benefit in reducing stress for faculty, staff, and students during final examination week. Further research is needed.
Purpose: This study examined whether practicing Tai Chi (TC) along with music can maximize the effects of TC on compliance and fall-related risk factors (Dynamic Gait Index and fear of falling). Design: A convenient sample was recruited in a community senior center. Eighteen women aged 50 to 84 years (9 White, 9 Black) were block randomly assigned to a TC in silence (TC + S; n = 6) or a TC with music (TC + M; n = 12) class. Method: Thirteen participants (4 in TC + S group, 9 in TC + M group) with completed pre- and posttests were included in the final analysis. Paired t tests were conducted to examine changes within groups over time and analysis of covariance was used to assess group differences. Findings: After 15 weeks of intervention, balance increased in both groups with significantly higher benefits in the TC + M group (p < .05). Fear of falling scores improved in TC + M group and compliance rate was higher in this group. Conclusions: Practicing TC + M may help increase adherence in White and Black middle-aged and older women, and maximize the effects of TC on fall-related risk factors. Studies with more rigorous study design, including musical considerations, are warranted.
Purpose: This study had two aims: (1) to test the feasibility, safety, and efficacy of using a wireless pedometer in a cohort of nurses; and (2) to understand if wireless pedometer use increased number of steps walked, number of flights of stairs climbed, daily activity level, and improved personal perception of health. Design: This study used a nonexperimental exploratory design to test the feasibility and efficacy of using a wireless pedometer in a cohort of nurses. Pre- and posttest measures captured the number of steps walked, flights of stairs climbed, activity level, and perception of health. Results: Sample characteristics: 27 females, 3 males; 90% non-Hispanic Caucasian, 3% Hispanic; 47% between the ages of 55 and 65 years. Eighty percent of the participants reported that they were caregivers of other people. There was a significant increase from baseline to the end of the study in the following measures: self-perception of steps walked (p < .001), flights of stairs climbed (p < .005), self-perception of daily activity (p < .001), and although there was an improvement in self-perception of health, the change was not significant. Conclusions: The wireless pedometer was a feasible, safe, and efficacious device to use. This study may have implications for interventions aimed at improving caregiver health.
Purpose: Explore what spiritual care means to nurses who work in emergency care units. Design and Method: Nine nursing professionals from an emergency care unit at a private health institution affiliated with the Universidad de La Sabana participated in this descriptive qualitative study. Nonparticipant observation, field notes, and in-depth interviews with a question guide were used to collect the data, which were analyzed by means of content analysis. Results: Three themes and their corresponding subthemes were identified with respect to the significance of spiritual care: (1) interpretation of spiritual care, (2) the patient and the family in spiritual care, and (3) the role of the nurse in spiritual care. Conclusions: These findings provide a deeper understanding of spiritual care in terms of its significance. They also acknowledge its importance to nursing practice in emergency care units. The significance of spiritual care is based on theoretical, scientific, and humanistic points of reference (the discipline of nursing) that strengthen the therapeutic relationship between the patient/family–nurse dyad. The study also offers evidence for holistic nursing practice that requires theoretical-academic, administrative, and assistance support.
Background: The percentage of overweight and obese Canadian children and youth is dramatically increasing. Approaches to reducing obesity in adolescents should include the promotion of physical activity (PA) because a continued physically active lifestyle into adulthood may lower rates of chronic diseases associated with unhealthy body weight. Purpose: The current study expands on existing assessments of PA to include predictors based in a multidimensional adolescent wellness and ecological model. Method: Canadian adolescents (N = 603) were surveyed and the resulting data analyzed using multiple regression analysis. Findings: Overall, 57.5 and 52.9% of the unique variance in PA for females and males, respectively, were explained by the predictors. Significant predictors for females included age, recreational time, family, leadership, and social comparison (cognitive development) skills. For males, equipment at home was also associated with increased PA. Conclusions: The finding that social comparison and leadership skills are significant predictors of PA in adolescents is new. Nurses should consider a holistic approach to promoting PA whereby these developmental dimensions are included in assessment and prioritized in providing nursing care. Additionally, individualized PA intervention strategies can then be tailored to this unique population.
Student nurses experience significant stress during their education, which may contribute to illness and alterations in health, poor academic performance, and program attrition. The aim of this pilot study was to evaluate the feasibility and potential efficacy of an innovative stress management program in two baccalaureate nursing programs in Connecticut, named NURSE (Nurture nurse, Use resources, foster Resilience, Stress and Environment management), that assists nursing students to develop stress management plans. An explanatory sequential mixed-methods design was used to evaluate the effects of the intervention with 40 junior nursing students. Results from this study provide evidence that the NURSE intervention is highly feasible, and support further testing to examine the effect of the intervention in improving stress management in nursing students.
Purpose: Despite the significant rise in the use of complementary and alternative medicine (CAM) in Israel, the factors affecting the decision to do so remain unclear. Thus, the purpose of the study was to explore factors that affect Israelis’ intention to use CAM, using the theory of planned behavior (TPB). Design: A quantitative correlational study. Method: A convenience sample of 200 Hebrew-speaking Israelis aged 21+ completed a questionnaire based on the TPB. Findings: Respondents expressed moderate intention to use CAM. The TPB predictability of this intention was 57% (R2 = .57), with behavioral beliefs being the most influential factor. The family was identified as another significant factor. Previous experience with CAM was also found to raise the intention to use it in the future. Conclusions: When referring a patient for services of CAM, it is important to provide in-depth explanations emphasizing positive anticipated outcomes of these services in order to effect a change in the patient’s behavioral beliefs. Patient’s family should be considered as a possible resource to promote usage of CAM.
Purpose of Study: This pilot study evaluated whether short (less than 10 minutes) structured meditations decrease compassion fatigue and improve compassion satisfaction in oncology nurses. Design of Study: A nonrandomized, pre-post intervention study. Methods Used: Participants used specific meditations designed to establish a sense of calm, relaxation, and self-compassion 5 days a week for 4 weeks. Meditations were provided on an audio-CD after brief individual instruction. The Professional Quality of Life Survey, Version 5, was administered pre and post intervention along with supplementary questions. Findings: Fifteen nurses participated in the study over a 6-month period in 2014. Paired t test revealed that the intervention demonstrated a statistically significant increase in Compassion Satisfaction scores (mean difference = –2.66, 95% confidence interval [CI] = [–4.98, –0.36], t[14] = –2.48, p = .027, d = 0.63) and decreases in Burnout (mean difference = 4.13, 95% CI = [1.66, 6.60], t[14] = 3.581, p = .003, d = 0.92) and Secondary Trauma (mean difference = 3.00, 95% CI = [0.40, 5.96], t[14] = 2.174, p = .047, d = 0.56) scores. All participants reported increased feelings of relaxation and well-being on supplemental questions. Conclusions: Even in this small sample, the practice of short breathing and meditation exercises was effective in improving nurse outcomes. A larger study is warranted including tracking sustained effects relative to maintaining a meditation practice.
The aim of this article is to relate how nursing students in a graduate curriculum can learn, personally practice, and prepare to disseminate stress management strategies to patients. Advanced practice nurses often provide care for patients experiencing stress-related disorders while concurrently trying to manage their own high levels of stress. Through the innovative Try-It-On teaching–learning strategy, graduate students experimented with holistic stress management approaches, with the intention of sharing with patients what worked effectively. Student comments on course evaluations were positive regarding Try-It-On. In the pilot trial of a quantitative survey to expand the evaluation of the strategy, students who trialed holistic stress management techniques reported satisfaction, engagement, perceived relevance, and intention to trial techniques with patients in future clinical courses. Modeling role modeling theory and the Kirkpatrick evaluation model guided the project, which filled gaps in current knowledge about experiential learning in graduate nursing programs.
Purpose: We sought to gather perspectives of veterans with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) regarding suicide risk factors, warning signs, and protective factors. We also aimed to modify an existing Veterans Health Administration tool, the Suicide Risk Assessment Guide Pocket Card, for HIV/AIDS provider use. Methods: Twenty male veterans participated in audio-recorded semistructured interviews that were transcribed and coded for themes. Findings: Veterans highlighted personally relevant psychosocial stressors (i.e., poverty, social isolation and loneliness, and physical health). Although the concept of warning signs did not seem salient to participants, they named indicators of elevated imminent risk for self-directed violence (i.e., "relapse," "not take’n medications," and "miss’n appointments") and few protective factors. No themes emerged regarding recommended pocket card changes. Conclusions: This sample of veterans identified self-directed violence risks noted in the general population and others with HIV/AIDS, as well as proximal events associated with increased risk. Care providers are encouraged to explore the relevance of noted imminent and persistent indicators of increased risk with veterans seeking care.
Background: The Christine E. Lynn College of Nursing at the Florida Atlantic University is grounded in the Nursing as Caring theory. A transcultural caring immersion experience for nursing students is provided within the tribal community of the United Keetoowah Band of Cherokees. Aims: The purpose of this study was to ascertain descriptions of nursing students’ transcultural immersion experience. Design: A qualitative descriptive approach was used via the Talking Circle method. The consensual qualitative research analytical approach was used to categorize participant responses. Findings: Six themes emerged that are consistent with the Nursing as Caring theoretical key concepts: (1) persons are caring as diverse human beings, (2) persons care from a unique cultural perspective moment to moment, (3) persons are whole and complete in the moment when engaging with diverse others, (4) personhood is a process of living with meaningful purpose by diverse persons, (5) personhood evolves while caring for diverse others in nurturing relationships, and (6) connecting nursing as both a profession and a discipline occurs among unique and diverse persons. Conclusions: The findings from this study reveal the value of providing a transcultural caring immersion experience to students from a Nursing as Caring theoretical perspective.
Purpose: Auricular acupuncture treatments are becoming increasingly available within military treatment facilities, resulting in an expansion of nonpharmacologic treatment options available to veterans with posttraumatic stress disorder (PTSD). This study aimed to explore the self-reported benefits of auricular acupuncture treatments for veterans living with PTSD. Design: A qualitative research methodology, thematic content analysis, was used to analyze data. Method: Seventeen active duty veterans with PTSD provided written comments to describe their experiences and perceptions after receiving a standardized auricular acupuncture regimen for a 3-week period as part of a pilot feasibility study. Findings: A variety of symptoms experienced by veterans with PTSD were improved after receiving auricular acupuncture treatments. Additionally, veterans with PTSD were extremely receptive to auricular acupuncture treatments. Four themes emerged from the data: (1) improved sleep quality, (2) increased relaxation, (3) decreased pain, and (4) veterans liked/loved the auricular acupuncture treatments. Conclusions: Veterans with PTSD reported numerous benefits following auricular acupuncture treatments. These treatments may facilitate healing and recovery for veterans with combat-related PTSD, although further investigations are warranted into the mechanisms of action for auricular acupuncture in this population.
Purpose: The objective of this study was to determine if complementary and alternative medicine therapies are associated with mental health in postdisaster environments. Design: Pregnant women (N = 402) were interviewed between 2010 and 2012 as part of a larger cross-sectional study on hurricane recovery and models of prenatal care. Methods: Symptoms of depression (Edinburgh Postnatal Depression Screen), prenatal anxiety (Revised Prenatal Distress Questionnaire), posttraumatic stress (PCL-S), and perceived stress (PSS) were examined. Logistic regression was used to adjust for income, race, education, parity, and age. The most commonly reported therapies were prayer, music, multivitamins, massage, and aromatherapy. Findings: Mental illness symptoms were common (30.7% had likely depression, 17.4% had anxiety, and 9.0% had posttraumatic stress). Massage was protective for depression (Edinburgh Postnatal Depression Index [EDSI] >8; adjusted odds ratio [aOR] = 0.6, 95% confidence interval [CI] = 0.3-0.9), while use of aromatherapy (aOR = 1.9, 95% CI = 1.1-3.2) and keeping a journal (aOR = 1.9, 95% CI = 1.1-3.2) were associated with increased odds of depression. Aromatherapy was associated with symptoms of pregnancy-related anxiety (aOR = 2.0, 95% CI = 1.1-3.8). Conclusions: Symptoms of mental illness persist after disaster, when untreated. Nurses should consider assessing for complementary and alternative medicine utilization in pregnancy as a potentially protective factor for mental health symptoms.
This prospective pilot study was implemented to determine whether a Healing Touch (HT) treatment postoperatively would have an effect on pain, anxiety, blood pressure, and pulse rate in adult postoperative outpatients. Using a randomized control trial design, participants were assigned to a control or intervention group. The control group received traditional nursing care (TNC), and the intervention group received a HT treatment in addition to TNC. Pre- and postdata collection included measurement of pain, anxiety, blood pressure, and pulse. HT treatment was at least as effective as TNC for reduction in pain and more effective in reducing anxiety. Posttreatment anxiety ratings in the intervention group had a significant decrease (0.55; p = .029), while the reduction in anxiety in the control group was not significant (0.25; p = .22). Neither group showed any difference pre- versus posttreatment in blood pressure or pulse. The intervention group had a decrease in pain rating of 1.0 (p < .001), and the control group had a decrease of 0.64 (p = .02). There was a trend toward a decrease in the use of narcotics with HT. HT is an appropriate modality to decrease anxiety, may be appropriate for pain reduction, and may decrease the amount of narcotics needed postoperatively. Patient comments reflected the relaxing effects of receiving HT. The findings support the use of HT as an effective complementary intervention for surgical outpatients, however additional research is recommended.
Objective: To better understand current self-care practices and health-promoting behaviors of nursing staff in a rural hospital and determine if there is a need for further development of a holistic self-care program for nursing staff in the hospital. Method: In this cross-sectional, descriptive study, a structured questionnaire was used to collect data on current self-care practices and health needs and interests of hospital registered nurses, licensed practical nurses, and certified nursing assistants from inpatient, outpatient, and emergency departments. A convenience sample of 45 was employed. Results: Most prevalent self-care practices included humor/laughter/play, music, spirituality/prayer, healthy sleep habits, reading, healthy nutrition, and walking. At least 75.6% answered to be extremely or likely to use three of five fitness programs (95% confidence interval [CI: 63.05%, 88.15%]). All four nutrition education programs were rated extremely likely or likely by at least two thirds of respondents (66.7%; 95% CI [52.93%, 80.47%]). Other programs of interests included health education programs and job stress management programs. Majority would participate in self-care program at work if one was offered (73.3%; 95% CI [60.37%, 86.23%]). Conclusions: Majority of nursing staff recognize the importance of self-care. There is a strong preference toward fitness programs and nutrition education programs at work to other programs.
The purpose of this study was to uncover the essence and meaning of healing through narrative accounts of holistic nurses, using a qualitative, descriptive design integrating narrative and story inquiry. Twenty-five stories were collected. Seven stories revealed personal healing and have been published in a prior article. Eighteen stories, the focus of this analysis, revealed healing of another. A hybrid method blending narrative and story guided the overall process for the study. Nine themes emerged describing healing of another within three story segments: The Call to Healing, The Experience of Healing, and Insights. The theme within The Call to the Healing Encounter was Drawn by Compassion to the Vulnerability and/or Suffering of Another. Five themes describe the Experience of Healing: Connection: Cocreating Relationships; Taking Risks and Dealing With Skeptical Colleagues; Use of Modalities and Actions as Tools in Developing Self as an Instrument of Healing; Profound, Ineffable Events; and Using Metaphor and Rituals to Describe Healing. Three themes describe Insights: Mutual Transformation, Change, and Reciprocity; Gratitude for the Healing Encounter; and Leaving a Legacy. The metastory, a reconstructed story created by the researchers, was the final phase of research synthesizing and demonstrating themes of healing of another. Results were compared to existing healing literature.
Purpose: The purpose of this study was to evaluate the effect of training nurses in Jin Shin Jyutsu® self-care methods and to correlate the training with measurement of the nurses’ personal and organizational stress and their perceptions of their caring efficacy for patients. Design: A quasi-experimental, pretest, posttest, and 30- to 40-day posttest design was used. Method: In all, 20 participants received three 2-hour Jin Shin Jyutsu self-care training sessions from a certified Jin Shin Jyutsu self-care trainer (who was also a registered nurse). The training took place over a 1-month period, and participants agreed to practice the self-care daily. Two study instruments, one measuring organizational and personal stress and the second measuring caring efficacy, were completed before the first training, after the last training, and 1 month after the trainings had been completed. Findings: Analysis of data from the Personal and Organizational Quality Assessment–Revised by paired t tests showed significant increases in positive outlook, gratitude, motivation, calmness, and communication effectiveness and significant decreases in anger, resentfulness, depression, stress symptoms, time pressure, and morale issues. Nurses reported less muscle aches, sleeplessness, and headaches. Analysis of the Coates Caring Efficacy Scale measures showed statistically significant increases in nurses’ caring efficacy in areas of serenity in giving care, tuning in to patients, relating to patients, providing culturally congruent care, individualization of patient care, ability to decrease stressful situations, planning for multiple needs, and creativity in care. Conclusions: This small study suggests that Jin Shin Jyutsu self-care may be a valuable tool for nurses, to decrease stress, both emotional and physical, and increase caring efficacy. Administrators may wish to invest in such a program, which may improve quality of care delivered. The Watson caring model, which reminds us that nurses who care for themselves and feel good about their work can better care for others, proved an accurate framework for this study.
Background: Although there is growing recognition of the importance of integrating spirituality within health care, there is little evidence to guide clinicians in how to best communicate with patients and family about their spiritual or existential concerns. Methods: Using an audio-recorded home hospice nurse visit immediately following the death of a patient as a case-study, we identify spiritually-sensitive communication strategies. Results: The nurse incorporates spirituality in her support of the family by 1) creating space to allow for the expression of emotions and spiritual beliefs and 2) encouraging meaning-based coping, including emphasizing the caregivers’ strengths and reframing negative experiences. Discussion: Hospice provides an excellent venue for modeling successful examples of spiritual communication. Health care professionals can learn these techniques to support patients and families in their own holistic practice. Implications for Practice: All health care professionals benefit from proficiency in spiritual communication skills. Attention to spiritual concerns ultimately improves care.
This study aims to describe and analyze healthy individuals’ expressed experiences of touch massage (TM). Fifteen healthy participants received whole body touch massage during 60 minutes for two separate occasions. Interviews were analyzed by narrative analysis. Four identifiable storyline was found, Touch massage as an essential need, in this storyline the participants talked about a desire and need for human touch and TM. Another storyline was about, Touch massage as a pleasurable experience and the participants talked about the pleasure of having had TM. In the third storyline Touch massage as a dynamic experience, the informants talked about things that could modulate the experience of receiving TM. In the last storyline, Touch massage influences self-awareness, the participants described how TM affected some of their psychological and physical experiences. Experiences of touch massage was in general described as pleasant sensations and the different storylines could be seen in the light of rewarding experiences.
Purpose: Older adults living in long-term care experience high rates of chronic pain. Concerns with pharmacologic management have spurred alternative approaches. The purpose of this study was to examine a nursing intervention for older adults with chronic pain. Design: This prospective, randomized control trial compared the effect of aromatherapy M technique hand massage, M technique without aromatherapy, and nurse presence on chronic pain. Chronic pain was measured with the Geriatric Multidimensional Pain and Illness Inventory factors, pain and suffering, life interference, and emotional distress and the Iowa Pain Thermometer, a pain intensity scale. Method: Three groups of 39 to 40 participants recruited from seven long-term care facilities participated twice weekly for 4 weeks. Analysis included multivariate analysis of variance and analysis of variance. Findings: Participants experienced decreased levels of chronic pain intensity. Group membership had a significant effect on the Geriatric Multidimensional Pain Inventory Pain and Suffering scores; Iowa Pain Thermometer scores differed significantly within groups. Conclusions: M technique hand massage with or without aromatherapy significantly decreased chronic pain intensity compared to nurse presence visits. M technique hand massage is a safe, simple, but effective intervention. Caregivers using it could improve chronic pain management in this population.
Purpose: The purpose of this study was to examine the relationship between self-transcendence and medication adherence among older adults prescribed antihypertensive medication. Design: Descriptive, correlational research design. Method: Forty-six older adults who were prescribed antihypertensive medications from an independent living facility participated in this study. Participants were given a survey that included a demographic questionnaire, the Morisky Medication Adherence Scale, and Reed’s Self-Transcendence Scale. Findings: No significant relationship was found between medication adherence and self-transcendence (r = –.20, p = .18). Ninety percent of the participants however, admitted to cutting back or stopping their medication without notifying their providers. Conclusion: Continued investigation is needed to identify reasons why older adults fail to adhere to taking prescribed hypertension medications in order to improve health outcomes in this population.
Purpose: The purposes of this pilot study were to measure pain associated with dressing changes, assess the presence of infection, and document healing times of burn-injured Amish in central Ohio using an herbal therapy consisting of Burns and Wounds™ ointment (B&W) and burdock (Arctium ssp.) leaves. B&W contains honey, lanolin, olive oil, wheat germ oil, marshmallow root, Aloe vera gel, wormwood, comfrey root, white oak bark, lobelia inflata, vegetable glycerin, bees wax, and myrrh. Design: A prospective, case series design guided the study within a community-based participatory research framework. Methods: Amish burn dressers provided burn care. Registered nurses monitored each case and documented findings. Pain scores were noted and burns were inspected for infection during dressing changes; healing times were measured from day of burn to complete closure of the skin. All cases were photographed. Results: Between October 2011 and May 2013, five Amish were enrolled. All had first- and second-degree burns. B&W/burdock leaf dressing changes caused minimal or no pain; none of the burns became infected, and healing times averaged less than 14 days. Conclusion and Implications: The use of this herbal remedy appears to be an acceptable alternative to conventional burn care for these types of burns. The trauma of dressing changes was virtually nonexistent. Nurses working in communities with Amish residents should be aware of this herbal-based method of burn care and monitor its use when feasible.
Purpose: Veterans Health Administration (VHA) mental health (MH) professionals are providing care to increasing numbers of veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). This study aimed to describe MH clinicians’ views of OEF/OIF veteran needs and how providers meet those needs within a large system of care. Design: Qualitative research methodology, specifically qualitative description, was used to explore VHA MH clinicians’ experiences providing MH services to OEF/OIF veterans. Methods: Thirteen VA MH providers participated in semistructured interviews, which included questions regarding the following areas: psychiatric needs of OEF/OIF veterans; collaboration and referral; needs and resources; and the personal/professional impact of providing services to this cohort. Findings: Themes emerged which highlighted complex challenges faced by OEF/OIF veterans, barriers associated with matching the unique needs of these veterans with existing treatments, and the challenges and rewards associated with providing care to members of this population. Conclusions: Capturing provider perspectives within MH services suggest potential areas for innovation aimed at providing patient-centered care to this cohort of veterans. Results may also inform future work aimed at meeting the needs of both OEF/OIF veterans and MH providers.
Purpose:This pilot study compared the effects of an essential oil mixture versus standard care on skin reactions in breast cancer patients receiving radiation. Method: Using an experimental design, 24 patients were randomized to standard care (i.e., RadiaPlexRx™ ointment) or an essential oil mixture. Products were applied topically three times a day until 1 month postradiation. Weekly skin assessments were recorded and women completed patient satisfaction and quality of life (QOL) instruments at 3-, 6-, and 10-week intervals. Results: No significant differences were found for skin, QOL, or patient satisfaction at interim or follow-up time points. Effect sizes were as follows: skin = .01 to .07 (small-medium effect); QOL = .01 to .04 (small effect); patient satisfaction = .02 (small effect). Conclusion: The essential oil mixture did not provide a better skin protectant effect than standard care. These findings suggest the essential oil mixture is equivalent to RadiaPlexRx, a common product used as standard care since it has been shown to be effective in protecting skin from radiation. Thus, this pilot provides evidence to support botanical or nonpharmaceutical options for women during radiotherapy for breast cancer.
Aims: The aim of this study was to explore and describe the experiences of persons attending a cancer support center, providing emotional support to cancer patients through self-selected complementary therapies offered free of charge through qualified volunteer therapists. A grounded theory methodology was used. Sources of data were 16 semistructured interviews with persons attending the center. Interviews were digitally recorded and transcribed verbatim. Analysis was conducted using the constant comparative method. Findings: The overarching theme that emerged in this study was the benefits attributed to attendance at the cancer support center. The center was described as an "oasis" in the hospital, and three aspects relating to this were identified: (a) facilitating comfort, (b) increasing personal control, and (c) helping make sense of the cancer experience. Conclusion: A drop-in center offering complementary therapies appeared to enable coping with the diagnosis and treatment of cancer by facilitating comfort and increasing perceptions of personal control. The center also helped some participants to make sense of their experience with cancer. This research has provided a unique insight into the ongoing emotional needs of cancer patients, and directions for further development and research into the provision of holistic care for patients within a hospital setting.
Purpose: To describe a treatment for osteoarthritis known as ginger therapy applied by anthroposophic nurses for a specific personality type. Background: Ginger has been used medicinally in Asia since ancient times to bring inner warmth. Ginger therapy is part of the tradition of anthroposophic nursing, when managing chronic inflammatory conditions such as osteoarthritis. Osteoarthritis is a progressive disease of the synovial joint tissue that primarily affects those older than 65 years, causing pain on movement. Design: A patient with specific characteristics suffering osteoarthritis received 7 consecutive days of ginger therapy by anthroposophic nurses at an integrative medical center. Two weeks after the therapy, education was given to enable self-treatment in the home for a further 24 weeks. Data were obtained using body physiological recordings, a case diary and pain scale, and self-report arthritis Health Assessment Questionnaire. Findings: Ginger therapy activated a marked relief of osteoarthritis symptoms that progressively improved over the 24 weeks, with no negative effects reported. Ginger therapy needs to be considered by nurses caring for specific personality types with osteoarthritis.
African Americans experience a disproportionate rate of stress-related health conditions compared to European Americans. Mindfulness meditation has been shown to be effective for managing stress and various stress-related health conditions. This study explored the cultural relevance of mindfulness meditation training for African Americans adults. Fifteen African American adults with past or current experience with mindfulness meditation training were interviewed. Participants felt that mindfulness meditation helped them with enhanced stress management, direct health improvement, and enhanced self-awareness and purposefulness. They felt that they would recommend it and that other African Americans would be open to the practice but suggested that its presentation may need to be adapted. They suggested emphasizing the health benefits, connecting it to familiar spiritual ideology and cultural practices, supplementing the reading material with African American writers, increasing communication (education, instructor availability, "buddy system," etc.), and including African Americans as instructors and participants. By implementing minor adaptations that enhance cultural relevance, mindfulness meditation can be a beneficial therapeutic intervention for this population.
Aim: This article is a report of a study evaluating changes in health status before and after topical ginger treatment for adults with moderate to severe osteoarthritis. Method: In 2011, 20 adults with chronic osteoarthritis were randomly assigned to one of two groups for 7 consecutive days of topical ginger treatment by trained nurses: Group 1 received a manually prepared ginger compress and Group 2 a standardized ginger patch. Participants had the option to continue self-treatment using the ginger patch for a further 24 weeks. A brief arthritis health questionnaire was completed weekly for 3 weeks and 4 weekly for 24 weeks. Results: The mean scores for Group 1 and Group 2 show a notable decline following 1-week topical ginger treatment; scores in pain, fatigue, global effect, and functional status reduced by 48%, 49%, 40%, and 31%, respectively, whereas health satisfaction improved from 80% dissatisfied to 70% satisfied. Scores for all participants in all five domains progressively reduced over the following 24 weeks of self-treatment. Conclusion: Topical ginger treatment has the potential to relieve symptoms, improve the overall health, and increase independence of people with chronic osteoarthritis.
Research suggests that family efficacy—defined as a family’s beliefs in its capability to manage different situations in order to achieve a desired outcome—is linked to a decreased likelihood of adolescents to engage in risky health behaviors. It is not clear, however, if this is true for immigrant families when they are encountering with increased challenges in their host countries. To provide holistic nursing care to immigrant families, it is important to know the sources of family efficacy particularly for immigrant adolescents when they are developing health behavior. This integrative review examined existing literature to learn about the sources of family efficacy among immigrant adolescents and how different domain of family efficacy is related to risky behaviors. We examined 22 studies on the topics of immigration, adaptation, risky adolescent behavior, and family function. Findings showed that multidimensional sources of family efficacies (specifically those in the relational, pragmatic, and value-laden domains) exert significant positive effects on immigrant adolescents’ health behaviors.
It is common for young students to enter nursing school with untested or immature spiritual belief systems. This exploratory study elicited feedback from nursing students in response to a guided reflection about spiritual health. As a precursor to classroom teaching, participants wrote a short, nongraded anonymous response to a series of 10 broad questions, with no single answer considered right or wrong. At the conclusion of this classroom activity, students completed a survey indicating the extent to which they believed it was beneficial. The majority of the participants (97%) considered it important to identify their own beliefs about spiritual matters prior to entering the clinical setting. As a result of the classroom reflection activity, most of the participants agreed or strongly agreed that the exercise (a) heightened their awareness about spiritual issues, (b) encouraged them to consider spiritual matters they had never thought about before, (c) caused them to feel more confident discussing spiritual matters with patients, and (d) inspired them to learn more and/or seek clarity regarding the questions presented. Based on the findings, nursing faculty should consider adding a similar classroom reflection activity prior to entering the clinical setting where patients and/or family members ask questions about spiritual matters.
The purpose of this research was to study the way faculty establish course social presence in an online course. The community of inquiry model by Garrison, Anderson, and Archer distinguished the area of social presence as an important component of online learning, and this study sought to understand how faculty perceive and create social presence in their online classroom. By employing a grounded theory approach, a substantive theory was developed to explain the way in which faculty create and maintain an online course climate. The sample consisted of 10 nursing faculty teaching various master’s in nursing courses. Through a rigorous qualitative process using nursing faculty interviews and online course analysis, humanization was found to be the core category in setting online course climate. Faculty’s efforts to humanize the climate lead each member of the community to view the other members as real, thereby enabling the establishment of online social presence.
This article analyzes the components of Florence Nightingale’s visionary leadership for global health and nursing within the historical context of Great Britain’s colonization of India. The descriptive study used the qualitative approach of narrative analysis to analyze selected letters in the Nightingale Letter Collection at the University of Alabama at Birmingham that Nightingale wrote to or about Dr. Thomas Gillham Hewlett, a physician and health officer in Bombay, India. The authors sought to increase understanding of Nightingale’s visionary leadership for global nursing and health through a study of the form and content of the letters analyzed as temporally contextualized data, focusing on how the narratives are composed and what is conveyed. Several recurring themes central to Nightingale’s leadership on global nursing and health emerge throughout these letters, including health and sanitation reform, collaborative partnerships, data-driven policy development, and advocacy for public health. These themes are illustrated through her letters to and testimony about Dr. Thomas Gillham Hewlett in her vivid descriptions of health education and promotion, data-driven policy documents, public health and sanitation advice, and collaboration with citizens, medicine, policy makers, and governments to improve the health and welfare of the people of India. The focus on leadership in nursing as a global construct highlights the lessons learned from University of Alabama at Birmingham’s Nightingale Letter Collection that has relevance for the future of nursing and health care, particularly Nightingale’s collaboration with policy leaders, her analysis of data to set policy agendas, and public health reform centered on improving the health and well-being of underserved populations.
Purpose: The purpose of the study is to examine liminal experiences of living with the uncertainty of life-threatening illness. Increasing numbers of people with life-threatening illness live in-between the promise of treatment and the threat of recurrence or progression of disease, and yet this experience is not well understood. Design: A narrative inquiry methodology within a constructionist frame was used. Method: Semistructured in-depth interviews were conducted with 32 participants from three populations of interest: (a) 10 people living with cancer, (b) 13 people with chronic renal disease, and (c) 9 people living with HIV/AIDS. Findings: An overarching theme of "pervasive liminality" and four narratives are identified: storying into fear(lessness), being alive but not living; knowing and not knowing, and the (in)visibility of disease. Conclusions: Over time, living with a life-threatening illness produces complex and paradoxical experiences that do not easily fit within familiar categories of experience. Findings highlight pervasive liminal experiences as in-between narratives that are neither problematic nor need to be resolved, and endure over time.
Purpose: The purpose of this study was to describe humor and laughter in persons with cognitive impairment (PWCI) and caregivers who were recalling a shared experience in a focus group. Design: Twenty participants attended an Art Engagement Activity at the Andy Warhol Art Museum, which included a guided tour and an art project. All PWCI had medically diagnosed cognitive disorders and all caregiver participants did not. Four focus groups were conducted and transcripts of audio-recorded sessions were transferred to a qualitative software program. Method: Words, phrases, and episodes of humor and laughter were used to construct codes, which were refined during group analysis using constant comparison. Findings: Humor and laughter were present in all four focus groups. Emerging themes of humor included silliness, sarcasm, and commenting about hardships of dementia. Laughter was identified in segments with and without humor. Some PWCI were unable to follow social cues. Conclusions: Humor and laughter played a role in creating a safe social environment. PWCI were able to engage in humor during social interactions, yet some had difficulty recognizing social cues. Further study may reveal roles of humor and laughter in adaptation to cognitive decline and holistic interventions for improved quality of life.
Health care workers have the most challenging of professions. They are expected to work long hours while demonstrating compassion and care for the patients that they serve. Although health care practitioners are among the most disciplined of working professionals, they are often some of the unhealthiest of individuals, facing enormous amounts of stress in their lives. Healing the Healer: One Step at a Time is a 6-week health fitness program. It explores the unique challenges faced in the field of health care and teaches techniques to address those challenges head on. Healing the Healer uses Nordic walking as the exercise portion of the class. The case study examines the structure, purpose, and design of this 6-week course. Special attention is given to four basic sections: balance, pacing, joy, and discipline. The arguments presented in this article are theory based and supported by case study evidence.
Purpose: To assess the feasibility of mindfulness-based stress reduction (MBSR) for veterans with mental health conditions and to evaluate its efficacy on psychological well-being and stress reduction. Design: Single-group, pretest–posttest design. Method: 30 veterans within a mental health clinic of a VA (Veterans Administration) medical center were enrolled in an 8-week standard MBSR program. Perceived stress, sleep, mindfulness, and depression were measured via self-reports at baseline and study end. Feasibility was measured by compliance and satisfaction with the course. Findings: Scores on the Perceived Stress Scale (p =.002) and Beck Depression Inventory–II (p = .005) were significantly reduced (p = .002). The global measure for sleep from the Pittsburgh Sleep Quality Index improved significantly (p = .035). Satisfaction and compliance were high. Conclusion: MBSR is a feasible intervention that has potential efficacy for veterans with mental health conditions. Future controlled trials are needed in this area.
Purpose: Spirituality is a mechanism that supports coping with chronic illnesses such as cancer, and has been frequently used in the African American (AA) population. Measures of spirituality are needed, which are culturally sensitive, appropriate, and psychometrically sound. Design: A critical literature review was performed to identify instruments measuring spirituality as a response to illness. Method: Whittemore and Knafl’s method was used to search pertinent databases for instrumentation assessing spirituality and its applicability in AA cancer survivors. Findings: In all, 13 research articles detailing nine instruments were obtained and included for analysis. Of the nine instruments, only two (Perspectives of Support From God Scale and Connections to God Scale) were psychometrically tested in populations of AAs who had completed primary treatment for their cancer. Cultural validity was tested in only the Perspectives of Support From God Scale, showing a deficit in the assessment of cultural appropriateness of these instruments to the population. Conclusions: Further research is needed to confirm validity of these measures. Cognitive pretesting and assessment of cross-cultural validity can be used to ensure proper understanding of terminology and avoid potential biases. Repeated testing of the instrument in the desired population is necessary to confirm that constructs and items are understood and cognitively processed as intended.
Multiple factors contribute to sleep disturbances in women at midlife. Poor sleep is a common occurrence in women transitioning through midlife and is associated with significant morbidity. Factors that are known to disturb sleep in women at midlife include vasomotor symptoms, nocturia, sleep apnea, and stress. Stress in particular has a significant impact on sleep. Various treatments, pharmacologic and nonpharmacologic, are available to treat sleep disturbances. One nonpharmacologic option includes mind-body medicine, which encompasses several therapies. Practices within this realm have been shown to moderate the experience of stress and help restore sleep quality. Each woman’s experience of disturbed sleep and transition through midlife is unique. By having a broad awareness of all evidence-based therapeutics, the clinician is able to present a diverse set of options for women at midlife who are affected by poor sleep.
The American Holistic Nurses Credentialing Corporation (AHNCC), certifying body for nurses practicing within the precepts of holistic nursing, uses a systematic process to guide program development. A previous publication described their early work that distinguished basic and advanced holistic nursing and development of related examinations. A more recent publication described the work of AHNCC from 2004 to 2012, including a role-delineation study (RDS) that was undertaken to identify and validate competencies currently used by holistic nurses. A final report describes the RDS design, methods, and raw data information. This article discusses AHNCC’s goals for undertaking the 2012 Holistic Nursing RDS and the implications for the certification programs.
Purpose: To gain an understanding of everyday anxiety among late adolescents during high school. Design: An interpretive phenomenological approach was utilized. A purposive sample of eight males and females in late adolescence with everyday anxiety were interviewed. Method: Individual interviews were conducted. Data analysis was undertaken throughout the research study by utilizing a thematic analysis of text in which themes emerged to understand the lived experience of everyday anxiety among late adolescents during high school. Findings: The study revealed themes reflective of the lived body in time and space and in relation with others. The three themes were (a) the embodied experience of anxiety with the subtheme of the body and mind responds; (b) feeling uncomfortable in the lived space of school with the subthemes of the lived relations of bullying, the internal/external space of isolation, and the constant pressure to perform well; and (c) life at home with the subthemes of the lived space of home, the lived relations of pressure from parents, and life will get better. Conclusions: Nurses need to provide holistic care for late adolescents experiencing everyday anxiety by focusing on healing the whole person through the unity of body, mind, emotion, spirit, and environment.
Purpose: To explore the perceptions of homeless women regarding their experience in a shelter-based garden project to promote mental wellness. Participants planted and tended the vegetable garden and prepared and ate the fruits of their labor. Design: A qualitative descriptive design with a conventional content analysis of narrative data. Method: Data were gathered in semistructured interviews. Participants were homeless daytime shelter guests who had participated in at least eight gardening sessions over 4 weeks. The project was started in the fall of 2010 and the interviews were conducted over 2 months in the summer of 2011. Findings: Two polarized themes were identified in the narratives, clustering around negative and positive thoughts. The "dark" theme centered on marginalization and the oppressiveness of shelter life. The "light" theme centered on stress relief, feeling socially included, and personal change. Conclusion: The gardening experience interrupted the participants’ negative ruminations, offering stress relief and elements of social inclusion and self-actualization. Gardening is an inexpensive and positive intervention for a population with a high incidence of mental illness and distress.
The purpose of this study was to uncover the nature, experiences, and meaning of personal healing for holistic nurses through their narrative accounts. The study employed a qualitative descriptive design with methods of narrative and story inquiry. Participants were nurse attendees at an American Holistic Nurses’ Association conference who volunteered for the study. They were invited to share a story about healing self or another. Twenty-five stories were collected; seven were about personal healing, and these are the focus of this analysis. Data were analyzed using a hybrid approach from narrative and story inquiry methods. Eleven themes were clustered under three story segments. The themes within the Call to the Healing Encounter are the following: recognition of the need to resolve a personal or health crisis, knowledge of or engagement in self-care practices, and reliance on intuitive knowing. Themes under the Experience of Healing are the following: connections; profound sensations, perceptions, and events; awareness of the reciprocal nature of healing; inner resolution: forgiveness, awakening, and acceptance; use of multiple holistic approaches; and witnessing manifestations of healing. The themes for Insights are the following: gratitude and appreciation and ongoing journey. A metastory synthesizing the themes is presented, and findings are related to existing literature on healing.