In this issue: Measurement Methods and Tools, AHNA Research Grant Deadline February 1, 2010, Research Profile-Diane Wardell, useful Web sites, Mental Health and Holistic Nursing and much more.
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Connections in Holistic Nursing Research
  January 2010
  Volume 2 Issue 2

In This Issue
AHNA Research Grant Proposals Due Feb 1, 2010
Research Profile: Diane Wind Wardell PhD, RN, WHNP-BC, AHN-BC, CHTP/I
Comfort Touch
Researchers in Action
Grant Opportunities
Book Reviews Needed
tal Health and Holistic Nurses
Research in the News
Quick Links
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Thoughts From Rorry Zahourek, Coordinator for Research AHNA
Happy New Year to all and may 2010 be wonderful, bringing you health and joy. It's been a busy and great year for the research committee. We are now in the process of reorganizing into three major sub committees: monitoring AHNA research projects, and education liaison, a dissemination of information chair. These sub-committees will address various projects including: choosing the annual research grant, conducting research on healing, building the research section of the web site and developing projects in conjunction with other educational efforts that will not only meet needs of the members but also generate funds. Several have volunteered to work in these sub committees.
This month the goal of this newsletter is to focus on measurement methods and tools that might be especially helpful for holistic nurses and HN research. Therese Dowd, PhD, RN, C. Associate Professor Emeritus, The University of Akron, Akron, OH and Kathy Kolcaba, PhD, RN, C.  Associate Professor Emeritus, The University of Akron, Akron, OH provided information on a frequently used comfort scale and I reviewed the Brief Serenity Scale by MaryJo Kreitzer et al. We want to develop a page on the research section of the web site devoted to tools and methods; please send us any scale or tool you have found helpful in your work.
I have also been struck in the last couple of months by the 'integrative' and more holistic literature in the psychiatric mental health field. There has always been a complementary relationship between holistic approaches and the interventions used in mental health. The random control trial (RCT) has been the most trusted form of evidence in both fields but researchers in both fields acknowedge the value of other types of evidence on which to base practice. Clinicians in both holistic nursing and in mental health deal with many chronically ill clients (patients) who may not always respond to conventional approaches. Clinicians in both fields value the mind-body connection. In psychiatry now the spiritual connection is increasingly valued and in some areas energy interventions are being practiced and researched (Energy psychology). See the articles listed below on mental health and holistic nursing and the studies from mental health that support a holistic approach. 
This month we are honored to feature Diane Wardell as our research cameo. She has been the recipient of an AHNA research award and for a decade chaired the research committee for Healing Touch International.  

Rorry Zahourek PhD, PMHCNS-BC , AHN-BC
AHNA Leadership Council Coordinator for Research
 It's AHNA Research Grant Proposal Time Again!
LAST CHANCE! Grant Proposals are due February 1, 2010. AHNA members are encouraged to submit topics that relate to healing through holistic nursing. Grant application instructions, submission guidelines, and the grant review forms are available on the AHNA Web site. The budget for your grant proposals should be no greater than $3,500.
Please e-mail grant proposals to both Kim Stiles ( and Jeanne Crawford ( Consultation may be available as an aspect of the grant. For questions about the grant application process, please contact Kim Stiles ( For consultations or mentor information, contact both Kim Stiles and Ruth McCaffrey (
Research Profile: Diane Wind Wardell PhD, RN, WHNP-BC, AHN-BC, CHTP/I
Diane WardellDiane Wind Wardell PhD, RN, WHNP-BC, AHN-BC, CHTP/I is an Associate Professor in the School of Nursing at The University of Texas Health Science Center Houston.  Her research career has embraced complementary therapies and alternative views of health and healing.  She was the Research Director for Healing Touch International, Inc for a decade from 2000-2009. 
My world of research has been one of interesting twists and turns, not unlike a spiral in which each area builds upon the next and later interconnects to the whole. The underlying principle is an exploration and unfolding in the areas of complementary therapies and women-child health.  The foundation for this work stems from working with an open mind, developing collaborative teams, and from a solid clinical base in holistic nursing practice.  In order to study energy therapies one must be willing to embrace mystery and to create an expanding view of the science and art of nursing.  
Early in my researcher career I collaborated with a clinical group of nurses to meet the needs of premature babies who had "lost" the pacifier that was typically being used for them, that of a bottle nipple stuffed with cotton and sealed with tape.  The funded team consisted of another holistic nurse researcher, Dr. Joan Engebretson, and a NICU nurse.  This journey took us through a holistic search of what babies would be doing "naturally" if still within the womb.  Ultrasound pictures of babies sucking on their thumbs helped lead us into designing a pacifier that truly "fit" the small palates of premature infants.  The Wee ThumbieŽ is still in use today, 20 years after it was initially designed using this holistic approach!
My focus in women's health as a nurse practitioner has resulted in extramural funding received for a study with Dr. Barbara Czerwinski and military co-investigators entitled, "Combat readiness: Hygiene issues related to military women (DAMD 17-96-2-6025)." Two publications (Czerwinski et al. 2001 & Czerwinski and Wardell, 2001) resulted from this study and importantly, a change in the structure of education and management for military women related to hygiene issues.
Not long afterwards my interest in complementary approaches to health and healing shifted to energy medicine.  The first studies were done with Reiki and utilized both psychological and physiological measures.  These studies were funded by an independent Reiki organization and the American Holistic Nurses Association.  Publications from these studies were helpful in identifying me as an energy medicine researcher nationally and internationally. 
After a sabbatical with Janet Mentgen in 1998 to gain a more in-depth understanding of Healing Touch I "knew" that my research interests were to continue following the development of energy medicine and the science behind it.  For the last 10 years this has been my sole focus in the area of research.  During this time I have conducted further studies in Healing Teach and published a number of articles on energy medicine.   
It is my pleasure to consult to various individuals and groups in the area of energy medicine.  I served as the Research Director to Healing Touch International, Inc., member of the Council for Healing, and as a panel reviewer for the National Institutes of Health National Center for Complementary and Alternative Medicine (NCCAM) during the last ten years. I have also consulted with various individuals interested in energy medicine and presented on this topic worldwide. 
My latest research proposal is in review with NCCAM and builds on my expertise in energy therapies with a maternal-child focus. Currently I am working with an esteemed group of nurses through the AHNA in reviewing stories of healers. I am currently working on two other projects: one on the Experience of Healing Touch (non-funded) and Healing Touch with Elderly funded through a UT-SON  Partners Grant with Dr. Shelia Decker as the PI.
Being a holistic nurse has always influenced and guided my research.  It has also given me like-minded colleagues to grow and share with within the healing arts.

Read more
Measurement Tools: Comfort Touch
The assessment of patient comfort is a holistic and positive way to measure the effects of interventions designed to promote overall health and well being. Kolcaba's technical definition of comfort is the physical, psychological, spiritual, social, cultural, and environmental aspects of human experience which are perceived simultaneously.

Instruments that measure comfort are sensitive to the previously unmeasurable effects of holistic comforting actions in research or practice settings. These comfort outcomes have been consistently positive and have been found to be reliable predictors for more effective healing and/or management of chronic health concerns. Comfort also is of primary importance in facilitating a peaceful death.
The General Comfort Questionnaire (GCQ) is designed to measure holistic changes in comfort levels. Multiple adaptations of the GCQ have been developed for specific purposes. Notable are the instruments developed by Kolcaba et. al such as the Bladder Function Questionnaire, the Healing Touch Comfort Questionnaire, the Hospice Comfort Questionnaire, and the Radiation Therapy Comfort Questionnaire. These instruments have demonstrated changes in comfort levels in patients receiving holistic or complementary interventions in numerous research projects. In addition, the Verbal Rating Scale for Comfort can be readily used in practice settings.

In total, 32 instruments are known adaptations of the GCQ: 14 by Kolcaba et al., 8 adaptations by other professionals, and 10 foreign language translations. All are available at Kolcaba's Web site: The award winning Web site describes how to modify existing comfort instruments and invites you to do so should you want to measure the outcome of comfort for specific populations.
Dowd, T., Kolcaba, K. & Steiner, R. (2000).  Cognitive strategies to enhance comfort and decrease episodes of urinary incontinence.  Holistic Nursing Practice, 14(2), 91-102.
Kolcaba, K., Dowd. T., & Steiner, R. (2006). Development of an instrument to measure holistic client comfort as an outcome of healing touch. Holistic Nursing Practice, 20, (3), 122-129. 
Dowd, T., Kolcaba, K., Fashinpaur, D., Steiner, R., Deck, M., & Daugherty, H. (2007). Comparison of healing touch and coaching on stress and comfort in young college students. PDF Format
Kolcaba, K., Dowd, T., Steiner, R. & Mitzel, A. (2004). Efficacy of hand massage for enhancing comfort of Hospice Patients. Journal of Hospice and Palliative Care, 6(2), 91-101. 
Novak, B., Kolcaba, K., Steiner, R., & Dowd, T. (2001). Measuring comfort in families and patients during end of life care. American Journal of Hospice and Palliative Care, 13(3), 170-180. 
Kolcaba, K. & Fox, C.  (1999).  The effects of guided imagery on comfort of women with early-stage breast cancer going through radiation therapy.Oncology Nursing Forum, 26(1), 67-71.
The Serenity Scale - A Review
SerenityM.J. Kreitzer, et al. (2009). The brief serenity scale a psychometric analysis of a measure of spirituality and well being. Journal of Holistic Nursing. 27, 1 7-16.

This study is a factor analysis of a 22 item version of the Serenity Scale developed by Kruse et. al.  (2005) to measure spirituality and well being in a sample of 87 post solid organ transplant patients. Kreitzer et. al. felt the original scale was too long for such an ill population. Their factor analysis yielded three subscales: acceptance, inner haven and trust. The scale was positively associated with positive affect and mindful awareness and negatively associated with measures of stress and depression. Blue (2009) in her companion commentary of the study supported their conclusions that the revised tool had merit but that it needed to be tested with other populations and in other life circumstances. That the shortened scale is missing the three factors: belonging, contentment and cognitive restructuring needs to be carefully examined in the context of evaluating spirituality.
The Spirituality Scale: Development, Refinement, and Psychometric Testing of an Instrument to Assess the Human Spiritual Dimension
Colleen Delaney PhD, RN, AHN-BC
Purpose: Spirituality is a universal phenomenon in the human health experience. It is a broad and abstract construct that has been part of human existence since antiquity yet it continues to evade a consensual definition and defies definitive description. Mounting evidence of the positive relationship between spirituality and health has made the assessment of spirituality an important consideration for heath care professionals. This study sought to examine the variables that represent the human spiritual dimension and to develop, refine and begin psychometric testing of an instrument to measure these variables. The Spirituality Scale (SS) is a holistic assessment instrument that attempts to illuminate the beliefs, intuitions, life-style choices, practices and rituals representative of spiritual wellness and is designed to guide spiritual interventions.
Research Questions:
 1. Is there evidence to support the factorial structure of the Spirituality Scale? 
 2. What is the alpha internal consistency of the Spirituality Scale?
Framework: An extensive review of the literature was conducted from a broad interdisciplinary perspective to identify references referring to spirituality, assessment instruments and research applications. It was discovered that current instruments are predominately biased by religion, limited in scope, and are not representative of the emerging understanding and multiple expressions of this construct. Following concept analysis and synthesis, a definition and theoretical model of spirituality that integrated and expanded upon the emerging understanding of spirituality was developed. Spirituality - as a unique human dimension pertains to a dynamic process that involves a search for meaning, purpose, truth, love/caring and a connection to others, nature, and a belief in a Higher Power
Methods: A researcher-developed instrument was designed to assess spirituality from a holistic perspective. Items were generated to measure 4 conceptualized dimensions of spirituality. The instrument is a 42-item questionnaire in a Likert-type format. The SS was distributed to 310 adults nursing students over age 18 in Connecticut. Demographic characteristics relative to age, gender, race/ethnicity, marital status, work status, educational level, income level and religion were collected.
Results and Conclusions: Initial testing of the SS revealed provided strong evidence to support the reliability and validity of the instrument. Principal factor analysis revealed a meaningful 4-factor solution explaining 53% of the variance. Reliability estimates ranged from .79 - .87 for the subscales and .93 for the total instrument. Four factors of spirituality supportive of the theoretical framework were identified: Self-Discovery, Relationships, Eco-Spirituality, and Higher power Additional items in the revised scale may further broaden the scope and improve psychometric characteristics of the scale
Implications: The SS offers several conceptual, methodological, and pragmatic advantages over current instruments. From a conceptual perspective, the SABS integrates the emerging knowledge of spirituality, incorporates its multiple expressions, and introduces the subscale of eco-spirituality. Methodological precision is used to provide valid evidence of reliability and validity. Finally, from a pragmatic perspective, the scale can be completed in 10 minutes and results can guide interventions to specific areas of spirituality such as self, relationships, connectedness, faith or religious concerns.
For more information or to recieve a copy of the spirituality scale, contact Colleen Delaney at AHNA members can view an article about the Spirituality Scale in the Journal of Holistic Nursing, Vol. 23, No. 2, 145-167. Click here for instructions on accessing JHN online archives.
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Behavioral and Social Sciences Research Interactive Textbook
Under a contract from the NIH Office of Behavioral and Social Sciences Research, The New England Research Institutes (NERI) has developed an interactive, online course on research methods and tools for researchers engaging in behavioral and social sciences research on health-related topics. To learn more click here.
Useful Web Sites
MethodSpace is a free site sponsored by SAGE publishers. It is a discussion forum on which books and videos are reviewed and discussions are occurring on problems one encounters with methodology.  
The mission of the Samueli Institute is to transform health care through the scientific exploration of healing. The vision is a world in which healing processes are the formative concept for achieving and maintaining wellness and ameliorating chronic disease. This site has a research section. The Institute is funding efforts to support healing environments and to advance the understanding of healing.
The Association for Comprehensive Energy Psychology (ACEP) is an organization of mental health professionals and allied energy health practitioners who are dedicated to developing and applying energy psychology methods.
This web site also has a site on research on which reviews of research on energy psychology can be found. The association is particularly interested in EFT. Emotional Freedom Technique and demonstrating its effectiveness.

The National Center for Complementary and Alternative Medicine (NCCAM) has a very useful Web site. Several new funding opportunity announcements are now posted. NCCAM's 10th Anniversary Research Symposium: Exploring the Science of Complementary and Alternative Medicine is now available for viewing on videocast. Speakers discussed topics including natural products, mind-body medicine, and the intersection of behavioral science and integrative medicine. And there is so much more.

Grant Opportunities
Funding Opportunity Announcements from NCCAM
Several new funding opportunity announcements are now posted on the NCCAM Web site.
The NIH is soliciting grant proposals from researchers in the pain field to stimulate and foster a wide range of basic, clinical, and translational studies on pain. The announcement states that "new advances are needed in every area of pain research, from the micro perspective of molecular sciences to the macro perspective of behavioral and social sciences."
Connections Wants You
Would you like to write for Connections?We are currently seeking book reviews for this newsletter. If you know of a book that may be useful to other holistic nursing researchers, please send a short review to Rorry at We also welcome other relevant articles or ideas.
An AHNA member has recommended the book Narrative Matters: The Power of the Personal Essay in Health Policy. This anthology brings together the personal stories of patients, physicians, policy makers, and others whose writings humanize discussions and deliberations about health policy. Drawn from the popular "Narrative Matters" column in the journal Health Affairs, the essays epitomize the policy narrative, a new genre of writing that explores health policy through the expression of personal experiences.
Mental Health and Holistic Nurses

In the Oct/Nov, 2009 Vol 15 No. 5  Issue of Journal of Psychiatric and Mental Health Nursing are five articles on Transcranial Magnetic Stimulation and the implications for nursing science and practice. This is an alternative treatment in place of Electro Convulsive Therapy (ECT) for severe depression.

The following are studies presented in other mental health journals that are of potential interest to holistic nurses. 
October 2009 was a big month for articles about CAM efficacy and depression:
S. A. Saeed et al. (Oct, 2009). CAM for your depressed patient: 6 recommended options. Current Psychiatry. 8, no 10. Audio on the web  pp. 39-47.

Two thirds of severely depressed patients use some form of CAM to treat their symptoms in addition to conventional treatment. They reviewed the evidence for efficacy of these treatments and concluded that there is sufficient efficacy to recommend the following as complementary treatments: Yoga, Exercise, Bibliotherapy, SAMe, Polyunsaturated fats, St. John's wort. Insufficient evidence exists for L-trytophan and acupuncture.
Lake, J.  (Oct, 2009). Natural products used to treat depressed mood as monthoerapies and adjuvants to antidepressants: A review of the evidence. Psychiatric Times. Oct, 2009.  P. 51-56.         
In addition to the substances reviewed in the first article he also provides information on Folic acid, B vitamins, other amino acids, DHEA.
In addition, in psychiatric nursing, the following article investigated the use of CAM with women with breast cancer.
Wyatt, G., SIkorskii, a. Willis, C.E., & Hong, S.A. (2010). Complementary and alternative medicine use, spending and quality of life in early stage breast cancer. Nursing Research. 59, 1 58-75.

The objective of this study was to investigate the association between CAM use, spending, demographic variable, surgical treatment and QOL.
Method: a secondary analysis with 222 women with early breast cancer.
The results indicated that the majority of women used at l CAM therapy with biological interventions (Vitamins in particular) the most common. More educated, employed with lower quality of life were the most likely to use CAM.
AHNA Researchers in Action
Edward F. Mackey RN, CRNA, MS, DIH, BCH. (2010). Effects of Hypnosis as an Adjunct to Intravenous Sedation for Third Molar Extraction: A Randomized, Blind, Controlled Study. International Journal of Clinical and Experimental Hypnosis. 58(1), 21-38. doi:10.1080/00207140903310782
We would love to hear about your research. Send your "Researcher in Action" to
Research in the News
Improve Pain Relief Naturally
Recent research points to ways to ease pain naturally. One study found that a mini-course in meditation may be all it takes to assist in pain management. According to another group of researchers, thinking about a loved one might help reduce physical pain. The findings show the importance of social relationships and of staying emotionally connected. And finally, just thinking pleasant thoughts may be helpful for those in pain. And a study done by Boston University School of Medicine and Boston Medical Center has found that yoga may be more effective than traditional treatments in alleviating back pain, especially in minorities.

Medical QiGong Improves Quality of Life With Cancer
Qigong appears to have passed the test as an alternative therapy that can improve quality of life for those living with cancer.

Cup of Mint Tea is an Effective Painkiller 
An herb called Brazilian mint treats pain as effectively as some synthetic drugs, English researchers report.


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