Journal of Holistic Nursing recent issues

Writing Well: Concept and Theory Development

Cowling, W. R. — Tue, 15 Sep 2009 08:33:56 PDT

Theoretical Frameworks and Concept Development

Wind Wardell, D. — Tue, 15 Sep 2009 08:33:56 PDT

Does A View of Nature Promote Relief From Acute Pain?

Kline, G. A. — Tue, 15 Sep 2009 08:33:56 PDT

Inadequate control of acute pain is a well-recognized and serious problem. Distraction is one of the methods used in adjunct with medications to relieve pain. Nature-related sensory stimuli are frequently used for both distraction and relaxation. The human response model that focuses on individual adaptation to health conditions is used in this article to guide an analysis of relevant studies. Four studies in clinical settings evaluated the effect of nature (as a visual stimulus) to determine whether it promoted relief of acute pain. All these studies also used audio stimuli (nature sounds or music). Distracting visual and auditory stimuli used together provided stronger evidence of pain reduction than when either type of stimulus was used alone.

Complementary Therapy Used by Hispanic Women During Treatment for Breast Cancer

Owens, B., Jackson, M., Berndt, A. — Tue, 15 Sep 2009 08:33:56 PDT

The purposes of this study are to assess Hispanic women’s use of complementary interventions during breast cancer treatment and delineate the association between the most burdensome side effects and the most frequently used complementary and alternative medicine (CAM). The researchers examined both descriptive statistics and correlational relationships between side effects and CAM. Data were collected from a convenience sample (N = 125). The mean age was 54, the educational average was less than 10 years, and the median income level was less than $20,000 per year. CAM was positively correlated with family income. Prayer was used by 93% of the women, humor was used by 83%, and 65% used exercise. The most frequent side effect of hair loss (70%) was the most bothersome side effect. The most burdensome and unmanageable side effects were bowel problems and nausea. Nurses play a key role in offering affordable, culturally appropriate symptom management interventions.

Understanding the Paradox of Patient Pain and Patient Satisfaction

Daly Quinlan-Colwell, A. — Tue, 15 Sep 2009 08:33:56 PDT

Pain, in all probability, is the most common symptom experienced by individuals who interact with health care providers. It is understood as a complex and highly individual experience. This complexity is reflected in the paradoxical relationship between patient satisfaction and patient reported pain scores. Using a holistic, caring approach, nurses can optimize the effect of analgesia and facilitate comfort for the person living in pain. Caring for the patient in pain begins with heartfelt compassion and intention to help the person who is suffering. The author describes how the complex relationship and interchange between the patient and the holistic nurse explains the paradox.

"Continuing Nursing Education: Understanding the Paradox of Patient Pain and Patient Satisfaction"

Tue, 15 Sep 2009 08:33:56 PDT

Holistic Nurses' Examinations: Past, Present, Future

Erickson, H. L. — Tue, 15 Sep 2009 08:33:56 PDT

Social and professional paradigm shifts of the 1990s moved holistic nursing into the mainstream of health care, resulting in the need for national certification of Holistic Nurses. Given the assumptions that certification examinations are based on the knowledge, skills, and abilities prerequisite for competent practice in a given specialty, and that the certification credential tells the public and peers that the certificant has such knowledge, The American Holistic Nurses Association’s Leadership Council (AHNA-LC) initiated certification processes in 1994. On the request of AHNA-LC, the American Holistic Nurses’ Certification Corporation (AHNCC) assumed these responsibilities in April, 1997. Since then, AHNCC has overseen the revision of the first certification process for holistic nursing prepared at the baccalaureate level and development of a second one designed for holistic nurses prepared in graduate nursing programs. This article describe these developmental processes.

Knowledge of Motivational Interviewing

Goodwin, A. C., Bar, B. B., Reid, G. G., Ashford, S. A. — Tue, 15 Sep 2009 08:33:56 PDT

Purpose: The overall goal of this pilot study was to determine the effects of a motivational interviewing (MI) educational program on MI knowledge. Design: Pretest/posttest intervention study. Method: Eleven participants completed a 20-item test prior to a 6-hour course on motivational interviewing. Six of those participants completed a second 2-hour educational session and a posttest. Findings: On average, participants increased their score from the pretest (mean [M] = 12.7, range 8-16; standard error [SE] = 1.256) to the posttest (M = 15.5, range 14-17; SE = 0.428). Although, this difference was not significant, t(5) = –2.49; p = .055; r = .55, given a standard level of significance of .5, the effect size was large, representing a substantive change. Conclusions: The motivational interviewing intervention was deemed clinically successful by the multidisciplinary committee based on the large effect size.

It's Your Journal

Cowling, W. R. — Thu, 14 May 2009 10:23:27 PDT

Self-Renewal in Nursing Leadership: The Lived Experience of Caring for Self

Brown, C. J. — Thu, 14 May 2009 10:23:27 PDT

Nurse leaders are often vulnerable to stress as experienced in the workenvironment, including long hours, patient overloads, and challenging work settings. If ignored, these stressors may lead to physical, emotional and behavioral symptoms with possible resulting medical errors, absenteeism, health challenges, and job burnout. Purpose: This study was designed to assess the meaning of caring for self by registered nurse leaders who had participated in a holistic caring-for-self project. Design/Setting: Hermeneutic phenomenology was the research method used in this study to explore the lived experience of caring for self from the perspective of 10 nursing leaders. Individual taped interviews were conducted with the participants in a private room in their work setting, a 185-bed community hospital. Findings: The nursing leaders communicated four common themes: Reflections on the Journey of Life, Why to Care for Self on the Journey, How to Care for Self on the Journey, and the Wisdom Learned Along the Path. Conclusions: Based on the reflections of the nursing leaders, recommendations include implementing creative, holistic methods to encourage self-renewal in the work environment.

The Effects of Therapeutic Touch on Pain

Monroe, C. M. — Thu, 14 May 2009 10:23:27 PDT

Purpose: To better understand how Therapeutic Touch can be used in today's health care arena, this integrative literature review will examine current research that will help answer the question, Does Therapeutic Touch reduce pain? Method: An extensive search was conducted of the online databases MEDLINE, CINAHL, Cochrane Library, EMBASE, PsychLIT, and PubMed to retrieve research articles published from 1997 to 2007. Findings: Seven studies that were conducted between 1997 and 2004 were found and only five of the seven were included as pertinent evidence to answer the question. All of the research that was reviewed to answer whether Therapeutic Touch could significantly reduce pain revealed a majority of statistically significant positive results for implementing this intervention. Conclusion: Because there are no identified risks to Therapeutic Touch as a pain relief measure, it is safe to recommend despite the limitations of current research. Implications: Therapeutic Touch should be considered among the many possible nursing interventions for the treatment of pain.

Women's Initial Experience of Abnormal Papanicolaou Smear

Mitchell, S., Hall, V. P. — Thu, 14 May 2009 10:23:27 PDT

To discover the early subjective experience of women affected by abnormal Papanicolaou smear, a qualitative study was undertaken with 8 North Carolina women, 4 to 12 months postnotification of their first abnormal result. Data were analyzed via grounded theory methodology to identify a core theory that could guide interventions to improve follow-up for cancer prevention. This theoretical process is described as a labyrinth journey—an imperative healing process undertaken by all participants, who undertook the following tasks: evaluating peril, seeking refuge, obtaining information, and reframing their self-image. Women who also learned they were infected with the human papillomavirus faced a prolonged sense of threat to their sense of sexual well-being. Their additional tasks related to reevaluating their sexual self-image, and they continued to work on these reframing tasks throughout their 1st year's journey. Progress through the labyrinth depended upon emotional or spiritual support, nonjudgmental acceptance and access to accurate information.

Tai Chi and Meditation: A Conceptual (Re)Synthesis?

Posadzki, P., Jacques, S. — Thu, 14 May 2009 10:23:27 PDT

The aim of this article is to review the literature on Tai Chi and meditation. A coherent construct is developed that includes a comparative analysis and conceptual synthesis of existing theories. The authors discuss a set of assumptions that justify this synthesis; they also argue that this construct would facilitate greater understanding of Tai Chi from the perspective of meditation. Such synthesis may bring "additional" benefits to Tai Chi practitioners as they could recognize that this mind—body technique holds the essence of meditation. Within the scope of this article, the evidence shows a majority of common features when concerning Tai Chi and meditation. These mutual similarities should be taken into account when performing this type of mind—body medicine by patients and/or therapists. Finally, the authors suggest that this inspiring compilation of movements and mindfulness can be used for practical purposes.

Health Promotion Through Forgiveness Intervention

Recine, A. C., Stehle Werner, J., Recine, L. — Thu, 14 May 2009 10:23:27 PDT

The purpose of this article is to offer evidence-based forgiveness interventions clinically useful to nurses in holistic health promotion for individuals, families, and communities. Forgiveness interventions are developed and described within four approaches inspired by midrange nursing theorists who have adapted their theories from Bandura's Social Learning Theory and Frankl's Theory of Meaning. Interventions are also assimilated from a comprehensive review of theoretical and research literature. The four interventional approaches include persuasive information, vicarious experience, awareness of physiological reactions, and enactive attainment. Barriers to implementation are discussed as well as ways to individualize the interventions.

Continuing Nursing Education: "Health Promotion Through Forgiveness Intervention"

Thu, 14 May 2009 10:23:27 PDT

A Conceptual Model of Intentional Comfort Touch

Connor, A., Howett, M. — Thu, 14 May 2009 10:23:27 PDT

This article discusses the application and integration of intentional comfort touch as a holistic nursing practice. A review of the literature on touch and its related concepts is included. Although nurses use touch frequently in patient encounters, it is not always used intentionally or deliberately to enhance care. The article compares and contrasts intentional comfort touch with nonintentional or procedural touch. The use of intentional comfort touch in innovative clinical settings with diverse and at-risk populations is described. Based on clinical experiences and the current literature, a conceptual model of intentional comfort touch is proposed. The application of touch is discussed as is the meaning and importance of intentional touch for students, faculty, and patients.

Reflection on My Mother Dying: A Story of Caring Shame

Johns, C. — Thu, 14 May 2009 10:23:27 PDT

In this story, the author reflects on visiting his mother the day before she died, just a few days after her transfer from the general hospital. Previously, his mother had lived in a residential home for 3 years before stumbling and breaking her leg. Then she required hospital admission. Three months later, clearly dying, "they" transferred her to the nursing home. The story is an expose of poor care and the despair this caused for the family at such a critical time. The story is offered as a call for action.

Embodying Nursing Openheartedness: An Existential Perspective

Galvin, K. T., Todres, L. — Thu, 14 May 2009 10:23:27 PDT

In this article, the authors attempt to articulate one view of the nature of nursing openheartedness and its central role for guiding caring in complex nursing situations. To do this, vignettes of everyday nursing life situations are used to illustrate the following three essential dimensions that constitute nursing openheartedness: (a) the infinity of otherness: keeping open the other's difference, (b) embodiment: our shared vulnerable heritage, and (c) practical responsiveness: embracing the value of the objectified gaze and technology. Each of these dimensions is philosophically informed by distinctive insights from the work of Heidegger, Levinas, and Merleau Ponty. Furthermore, guided by Gendlin's contributions regarding the nature of embodied understanding, a writing style that attempts to present the nature of nursing openheartedness as a possible experience rather than as an abstract theory is employed.

A Force for Social Change

Cowling, W. R. — Mon, 23 Mar 2009 12:00:26 PDT

The Brief Serenity Scale: A Psychometric Analysis of a Measure of Spirituality and Well-Being

Mon, 23 Mar 2009 12:00:26 PDT

Purpose: This article describes a factor analysis of a 22-item version of the Serenity Scale, a tool that measures spirituality and well-being. Method: A sample of 87 participants, enrolled in a National Institutes of Health—funded clinical trial examining the impact of mindfulness-based stress reduction on symptom management post-solid organ transplantation, completed the abbreviated instrument. Findings: Exploratory factor analysis yielded three subscales: acceptance, inner haven, and trust. The Serenity Scale was positively associated with positive affect and mindful awareness and inversely related to negative affect, anxiety, depression, health distress and transplant-related stress. Conclusions: Serenity, a dimension of spirituality that is secular and distinct from religious orientation or religiosity, shows promise as a tool that could be used to measure outcomes of nursing interventions that improve health and well-being. Implications: Spirituality is recognized as being an essential component of holistic nursing practice. As nurses expand their use of spiritual interventions, it is important to document outcomes related to nursing care. The Serenity Scale appears to capture a dimension of spirituality, a state of acceptance, inner haven and trust that is distinct from other spirituality instruments.

Commentary on "The Brief Serenity Scale: A Psychometric Analysis of a Measure of Spirituality and Well-Being"

Blue, C. L. — Mon, 23 Mar 2009 12:00:26 PDT

The Provision of Spiritual Care by Registered Nurses on a Maternal--Infant Unit

Dunn, L. L., Handley, M. C., Dunkin, J. W. — Mon, 23 Mar 2009 12:00:26 PDT

Purpose: This study explores the spirituality, spiritual well-being (SWB), and spiritual care provision of registered nurses on a maternal—infant unit. Methods: Data collection instruments included a demographic and spiritual care form, Spiritual Perspective Scale (SPS), and Spiritual Well-Being Scale (SWBS) to address the study's research questions. Findings: Significant positive correlations were found between SPS and SWBS as well as religious well-being (RWB) and existential well-being (EWB; subscales of SWBS). Religious attendance was significantly correlated with SPS, SWBS, and RWB but not EWB. Frequency of spiritual assessment themes was first encounter and when needed, whereas reaching up and reaching out described their provision of spiritual care. Conclusion: The sample was highly spiritual, spiritually well, and provided varied spiritual care. Implications: More spiritual care research is needed. Content on providing spiritual care must be enhanced within nursing curriculums as well as with nurses in practice.

Commentary on "The Provision of Spiritual Care by Registered Nurses on a Maternal--Infant Unit"

Porter Lewallen, L. — Mon, 23 Mar 2009 12:00:26 PDT

Continuing Nursing Education: "The Provision of Spiritual Care by Registered Nurses on a Maternal--Infant Unit"

Mon, 23 Mar 2009 12:00:26 PDT

Existential and Spiritual Needs in Mental Health Care: An Ethical and Holistic Perspective

Koslander, T., da Silva, A. B., Roxberg, A. — Mon, 23 Mar 2009 12:00:26 PDT

This study illuminates how existential needs and spiritual needs are connected with health care ethics and individuals' mental health and well-being. The term existential needs is defined as the necessity of experiencing life as meaningful, whereas the term spiritual needs is defined as the need of deliverance from despair, guilt and/or sin, and of pastoral care. It discusses whether or not patients' needs are holistically addressed in Western health care systems that neglect patients' existential and spiritual needs, because of their biomedical view of Man which recognizes only patients' physical needs. It excludes a holistic health care which considers all needs, expressed by patients in treatment of mental illness. Addressing all needs is important for patients' improvement and recovery. For some patients, this is the only way to regain their mental health and well-being.

Commentary on "Existential and Spiritual Needs in Mental Health Care: An Ethical and Holistic Perspective"

Burkhardt, M. A. — Mon, 23 Mar 2009 12:00:26 PDT

Being in Nature: An Innovative Framework for Incorporating Nature in Therapy With Older Adults

Berger, R. — Mon, 23 Mar 2009 12:00:26 PDT

This article describes a creative framework in which nature is incorporated in therapy with older adults. Using an example from practice, it illustrates how the integration of concepts from the narrative approach and the innovative nature therapy framework can help older people expand their perspectives, connect with strength, and expand their coping strategies, while gaining a wider sense of acceptance and completion in life.

Teaching Massage to Nursing Students of Geriatrics Through Active Learning

Adler, P. A. — Mon, 23 Mar 2009 12:00:26 PDT

The use of massage in nursing practice has declined through the years in favor of high-tech interventions. This article describes a project using active learning to teach nursing students massage with dementia residents in assisted living. Students participated in a workshop to practice basic relaxation massage techniques with the guidance of their clinical instructor and then provided massages to resident volunteers. Afterward, students discussed their experience and completed a resident assessment form. The students requested more such activities, and the residents and facility management invited the students to return for another session. The instructor observed growth in the students' assessment skills and in their confidence. Use of massage to teach nursing students how to care for and relate to older adults with cognitive impairment is recommended. Further research is needed on the use of massage as an active learning method for nursing students in long-term care.

Creating Change: Using the Arts to Help Stop the Stigma of Mental Illness and Foster Social Integration

Lamb, J. — Mon, 23 Mar 2009 12:00:26 PDT

Stigma is a social justice problem that plagues persons with psychiatric disabilities, their families, and society. It fuels the fear underlying discrimination; undermines consumer self-efficacy; and blocks rehabilitation, recovery, and social integration. The author hopes to create a passion for change and suggest a way that everyone can help stop stigma. This approach is simple: to nurture the artistic talent many clients possess and connect them with public venues for their artworks. On display, too, will be the "ability" in "disability." This will reduce stigma while building self-efficacy and empowerment. Anecdotal evidence supports this hypothesis. However, research is needed; a design for a study to test this hypothesis is described. Significantly, an antistigmal arts intervention can be conducted by any aware practitioner; one does not need to be an art therapist or have any background in art, only a desire to make a difference and resources on which to draw.

Collaboration for the Arts in Healthcare: An Opportunity

Barbato Gaydos, H. L. — Tue, 06 Jan 2009 18:00:46 PST

Feeling Like a Nurse: Re-Calling the Spirit of Nursing

Spence, D., Smythe, E. — Tue, 06 Jan 2009 18:00:46 PST

Purpose: To explore the essential meaning of being a nurse. Design: Nine registered nurses were each asked to write a story of a time when they felt like a nurse. Analysis was informed by Heideggerian hermeneutic philosophy, seeking to reveal the phenomenon of "feeling like a nurse." Methods: As part of a workshop on phenomenological methodology, participants were invited to reflect on a personal experience of feeling like a nurse. These documents were analyzed according to the method of van Manen. Participants were kept informed throughout each phase. Findings: Feelings announce primordial meaning of feeling like a nurse. Nurses experience the call as mood attuned by an anxiety that creates possibilities for authentic caring. It is a way of being that encompasses watching and acting, doing to and caring for, and taking over and giving back. Moreover, it is after the encounter that the essential meaning is more clearly revealed. We argue that there is value in continuing to question the meaning of "being a nurse." Amid a complex and increasingly technological world, this calls the profession to remember the human encounter at the heart of all nursing.

Commentary on "Feeling Like a Nurse: Re-Calling the Spirit of Nursing"

Cowling, W. R. — Tue, 06 Jan 2009 18:00:46 PST

Interconnectedness in Nursing: A Concept Analysis

Love, K. L. — Tue, 06 Jan 2009 18:00:46 PST

Aim: Interconnectedness will be clarified and defined by providing a description and context and take an important step toward increasing use in nursing literature and research. Background: The literature is limited by focusing on relationships between people, but connection can be physical as with physics or spiritual by reflecting a higher power or purpose. Thorough examination will increase understanding of interconnectedness in nursing. Methods: Chinn and Kramer's method for creating conceptual meaning includes definitions, visual images, popular/classical literature, music, poetry, and professional research across many disciplines. Findings: Interconnectedness reflects that people and the universe are connected in a powerful way. Its essential meaning reflects that regardless of the worldly barriers of politics, religion, or culture, people can share in a universal reciprocity of love and responsibility. Conclusion: Nursing maintains the values of compassion, responsibility, holism, and to greater meaning in experiences, and interconnectedness will likely have increased significance in nursing.

Commentary on "Interconnectedness in Nursing: A Concept Analysis"

Wind Wardell, D. — Tue, 06 Jan 2009 18:00:46 PST

Continuing Nursing Education: "Interconnectedness in Nursing: A Concept Analysis"

Tue, 06 Jan 2009 18:00:46 PST

Nurses' Experiences of Practicing the HeartTouch Technique for One Month

Jelonek Walker, M. — Tue, 06 Jan 2009 18:00:46 PST

Stress plays a significant role in almost every aspect of health. Appraisal (thoughts and feelings) of a situation determines the level of stress experienced. Purpose: To describe the nurses' experiences of practicing the HeartTouch (HRTT) technique, an internal tool designed to help nurses change their thoughts and feelings, especially in stressful situations. Method: After an education session discussing the effects of thoughts and feelings on stress and health, nurses learn HRTT. After practicing HRTT for 1 month during their daily life, 48 nurses answer 7 open-ended questions about their experience. Content analysis is used to analyze the data. Findings: Nurses notice physical, mental, and emotional benefits for themselves, patients, colleagues, and family members. Nurses feel less stressed and experience an increased sense of control and ability to notice and change their thoughts and feelings. Nurses also discuss meaningful connections with self, others, and a Higher Power and greater work satisfaction.

Commentary on "Nurses' Experiences of Practicing the HeartTouch Technique for One Month": Burnout and Stress--Where Have We Been, Where Are We Going?

Enzman Hines, M. — Tue, 06 Jan 2009 18:00:46 PST

The Sense of Coherence in Hospitalized Cardiac and Cancer Patients

Bruscia, K., Shultis, C., Dennery, K., Dileo, C. — Tue, 06 Jan 2009 18:00:46 PST

The sense of coherence (SOC) is a measure of one's global orientation toward the world; it is the extent to which one perceives life as comprehensible, manageable, and meaningful. The study assesses the SOC of cardiac and cancer inpatients, and examines whether age, gender, race, education, and length of illness predict SOC. Participants comprise 172 patients (84 women, 88 men) at an urban hospital in the Northeastern United States, 122 with cardiac conditions and 50 with cancer. The mean age is 59.8. Results show that the SOC of cardiac and cancer patients is slightly lower than the general population. There are no differences in SOC between cardiac and cancer patients. Multiple regression shows that age and length of illness predict SOC (R = .26, R² = .07, p = .002); however because of the small effect size and collinearity, their exact contributions need further study. SOC does not vary according to gender, race, or education.

Commentary on "The Sense of Coherence in Hospitalized Cardiac and Cancer Patients"

Taliaferro, D. H. — Tue, 06 Jan 2009 18:00:46 PST

Absorption: An Individual Difference to Consider in Mind-Body Interventions

Menzies, V., Taylor, A. G., Bourguignon, C. — Tue, 06 Jan 2009 18:00:46 PST

Given that mind–body interventions constitute a major portion of complementary and alternative medicine used by the public, it seems important to explore those human characteristics that may contribute to the efficacy of mind–body interventions in those who are most likely to benefit. One such characteristic, absorption, reflects an individual's cognitive capacity for involvement in sensory and imaginative experiences in ways that alter an individual's perception, memory, and mood with behavioral and biological consequences. Thus, one's level of absorption may potentially create differential treatment effects in mind–body intervention outcomes. Conducting practical clinical trials helps address the challenge of determining whether a specific mind–body modality intervention may be effective. Such trials may be strengthened by including measures of personality dimensions such as absorption.

"There's Just Something About Ron": One Nurse's Healing Presence Amidst Failing Hearts

Wilson, M. H. — Tue, 06 Jan 2009 18:00:46 PST

Chronic disease can be devastating to the patient, family, and nurses who care for them. Patients and family members struggle with the debilitating effects and uncertainties that abound in living with a chronic disease, such as heart failure. The nurse has a unique opportunity to foster a therapeutic relationship through the use of nursing presence. The phenomenon of nursing presence has been defined in the literature by six features: uniqueness, connecting with the patient's experience, sensing, going beyond the scientific data, knowing (what will work and when to act), and being with the patient. Nursing presence, when exhibited, may facilitate healing, promote comfort, and improve patient satisfaction. The story in the article depicts how one professional nurse in a heart failure clinic exemplified the nurse as a healing presence. Through his example, nurses may better understand the significance that their presence may have when caring for patients diagnosed with a chronic illness.

Hold My Hand . . . Don't Let Go: Moments of Caring From a Patient's Perspective

Ergott, K. M. — Tue, 06 Jan 2009 18:00:46 PST

The author provides her perspective, as a patient, on the holistic nursing she received during the birth of her second child. The moments of caring and compassion she encountered are described. Four years later, the author reflects on the spiritual and emotional journey she has had as a result of this experience.