Research Profile: Sue Robertson, RN, PhD, CNE
this issue we profile Sue
RN, PhD, CNE,
Sue Robertson, RN, PhD, CNE, Associate
Professor, School of Nursing,
Coordinator, Nurse Educator
Concentration, California State
Associate Professor, School of Nursing,
Coordinator, Nurse Educator Concentration,
California State University, Fullerton. Sue
is Chair of the Research Committee of AHNA and
an active holistic nursing researcher.
What is your current area of research?
working with Colleen Delaney, Cindy Barrere, and
Rorry Zahourek on a self-care intervention study.
Could you tell us how you got started in
research and how it evolved over the years?
participated in research while working at the San
Diego VA Medical Center, but my dissertation
research was my first study. It looked at how
individuals define health following a near-death
experience (NDE). Not surprisingly, it is a
holistic process of understanding the meaning of the
NDE, applying that meaning to health beliefs and
behaviors, and manifesting that in the complexity of
I began teaching, my research has primarily focused
on classroom and online pedagogy. One area of
interest is how to make holistic practice explicit
in pedagogical models - do we need to modify
existing models or develop new models? A second
area is identifying successful holistic
teaching/learning strategies. After working with
stressed students, I am also interested in how to
promote student self-care. Nursing programs are
intense, and students feel they have little time for
themselves. How do we best promote self-care and
what strategies are most effective?
What were some of your biggest challenges,
surprises and joys in doing holistic nursing
initial challenges were finding holistic researchers
who share the same research interests and research
mentors. Becoming a member of the Research
Committee (RC) provided incredible opportunities to
meet and network with other holistic nurse
researchers. My colleagues have influenced my
thinking about and understanding of holistic
research in many ways. Rorry Zahourek, especially,
has been a wonderful mentor.
What are you excited about as you lead the
excited about working with a great leadership team,
the new programs we are implementing, and
collaborating with the talented members of the RC.
Colleen Delaney has made research much more visible
to the Board of Directors, and is the RC champion.
Cindy Barrere is implementing an innovative
Research Consultation Program that will provide much
needed support to holistic nurse researchers.
Michalene King, Pamela Crary, and Sue Roe are
putting their imprint on the Research e-Newsletter
and the RC website, and Evelyn Clingerman is the RC
"voice" on the 2014 Conference Planning Committee.
We are building on the work of the many holistic
nurse researchers who have guided and influenced our
thinking about and practice of holistic nursing
first Research Webinar (Bernadette Lange, Wendy
Stiver, and I) will be in October, and will be
hosted by the RC and Education and Practice
Committees. Beginning in February, 2014, the RC
will have four research webinars each year, with
topics of interest to both holistic nurse
researchers and holistic practitioners who want
evidence for practice. We initiated the Research
Journal Club in August, 2013; Barry Gallison
discussed his research on spiritual care practices
of acute care nurses.
What are your goals for the Research
RC goals are to continue to identify member needs
related to holistic nursing research, explore best
methods of making research (evidence, how-to)
accessible to members, support holistic nurse
researchers, and both expand RC membership and
increase member involvement in RC activities. The
last is so important. We cannot move forward without
the active participation of RC members, but with
their expertise and commitment, we can accomplish so
An Interview with Kelly Hilcove,
RN, BSN, HNB-BC - A Research Study Conducted by a Staff
by Sue Roe, DPA, MS, BSN, RN
Kelly Hilcove, a staff nurse on the Oncology Unit
at Scottsdale Healthcare Shea (SHC), was Primary
Investigator and Study Coordinator in an Institutional
Review Board approved trial, investigating whether "Mindfulness
Based Yoga Decreased Stress Levels in Healthcare
A Glimpse into Kelly's Holistic Nursing Journey
Kelly's journey into holistic healing started at a very
young age in South Africa where she was born. She grew up
in a family who embraced natural healing modalities as a
complement to traditional medicine. Kelly came to the US in
2001 and pursued a degree in nursing. Since that time Kelly
has become a certified holistic nurse, a certified Yoga
instructor, a certified Yoga Nidra Facilitator (Guided
Relaxation), a certified Brain Management Consultant, and a
certified Healing Touch Level 3 Practitioner.
The Study, Results, and Impact on Practice
Kelly felt the pressure and stress that her colleagues were
surrounded by daily and knew she had a tool to help them
recharge. She said, "I noticed that my day unfolded in a
totally different way if I had done my yoga practice."
Her study emanated from her experience with SHINE,
Scottsdale Healthcare's Investment in Nursing Excellence, a
program open to Registered Nurses which encourages
professional growth and development. She conducted a change
project entitled "Helping Nurses Stay Healthy" which offered
free yoga classes as a way to relieve stress and tension,
lower anxiety, and prevent burnout.
That change project led to this study funded by Scottsdale
Healthcare. It was a randomized control trial of 80
healthcare professionals conducted from February 2011
through July 2011. Methodology included the completion of
pre and post intervention measurements of burnout, stress,
vitality and sleep. The treatment group (n = 41) attended a
weekly yoga class and practiced yoga at home for six weeks.
Significant differences were noted on the Perceived Stress
Scale, Vitality Scale, and Pittsburgh Sleep Quality Index
and the Maslach Burnout Inventory when comparing the Yoga
group with the control group.
The positive effects of this study went way beyond the
outcomes that were measured. Some comments from participants
in the study:
I have incorporated the techniques I have learned to
help reduce stress and tension. It is much more rewarding to
take care of others when you are taking care of yourself.
I feel that I can approach patients in a more relaxed
state, transferring that feeling onto my patients.
I use the yogic breath with my patients before painful
procedures or when I see or sense they are stressed.
Challenges Conducting the Study
Initially, recognizing the volume of work that went into
planning and implementing the study was a challenge. It
became two full time jobs for a period of time. Kelly also
commented that it was not easy taking a leadership role and
holding people accountable, especially if you are the one
with a BSN and everyone else on the study team had a
master's or higher degree.
What Was Learned and the Surprises
Kelly learned that research takes time and being passionate
about what is being studied is paramount. She saw the study
as an awesome opportunity to reflect once again and
recognize the importance of taking care of herself as a
Holistic Nurse. Surprises were how much more participants
got out of the study beyond the selected measurement tools.
The importance of Research for Holistic Nursing
It provides a starting point for one's own thinking and
understanding and it encourages questioning and exploration.
New insights and knowledge are gained. More importantly the
key is putting what is being taught into practice - to
experience growth as a whole person.
Advice for Staff Nurses Who Would Like to Conduct
Holistic Nursing Research
Be sure to select a topic you are passionate about so when
the going gets tough you can remember "why" you set out to
do it. When asked if she would conduct research again, she
enthusiastically said YES, it was my joy and honor to share
and inspire others to be the best they can be.
If anyone would like to reach out to Kelly she can be
AHNA Researchers in Action
Marlaine C. Smith,
Rothlyn Zahourek, Mary Enzman Hines, Joan Engebretson,
and Diane Wind Wardell. (Sept. 2013).
Holistic Nurses' Stories of Personal Healing.
Journal of Holistic Nursing, 31(3),
text available to AHNA member.
Deborah Kramer, Rochelle Bukatman,
Phyllis Gordon, and Pamela Mermelstein (Sept. 2013). Energy
Dialogue Technique in Healing and Health: Relieving Side
Effects and Thyroid Dysfunction in a Male With
Hemophilia Receiving Pegylated Interferon and Ribavirin
Treatment for Hepatitis C Virus-An Anecdotal Case Study. Journal
of Holistic Nursing, 31(3), 204-213.
text available to AHNA member.
Apostolidis, B., Morrison, H., Smith, L., & Fortinsky
randomized trial of telemonitoring and self-care
education in heart failure patients following home care
discharge. Home Health
Care Management & Practice,
Colleen Delaney, PhD, RN, AHN-BC,
Cynthia Barrere, PhD, RN, AHN-BC,
Zahourek, PhD, RN, PMHCNS, AHN-BC and
Sue Robertson, PhD, RN were awarded a
$1,000 research grant from the Sigma Theta Tau Mu
Chapter for their study entitled The Use of
Simulation to Instruct Nursing Students in Stress
Management: Pilot Testing of the NURSE Intervention.
The aim of this experimental pilot study is to evaluate
a simulation-based educational program that assists
nursing students to develop stress management plans. The
intervention, termed NURSE (Nurture nurse, Use
resources, Resilience, Stress and Environment
management) is used to describe components of a
comprehensive stress management education program.
Valerie Eschiti, PhD, RN, AHN-BC, CHTP, CTN-A,
long-time AHNA member and Research Committee member:
of Oklahoma American Indian Preferred Smokeless
Tobacco Cessation Strategies, Perceived Barriers,
Facilitators, and Motivators." In this mixed
methods study utilizing a CBPR approach, an
interdisciplinary team of investigators seek to
discover which smokeless tobacco cessation
interventions are preferred by adult American
Indians in Oklahoma, as well as perceived barriers,
facilitators, and motivators to cessation. We will
be working with the seven tribes of southwest
Oklahoma (Apache, Caddo, Fort Sill Apache, Comanche,
Delaware, Kiowa, and Wichita tribes), Choctaw
Nation, Chickasaw Nation, and Indian Healthcare
Resource Center of Tulsa. 7/1/13-6/30/14. Eligible
to apply for continuance of additional one year of
funding. Oklahoma Tobacco Research Center. Funding:
$50,358. Role: PI. Co-PI: Janis Campbell, PhD;
Co-I's: Lancer Stephens, PhD, Nasir Mustaq, PhD,
Jessica Blanchard, PhD, Michael Peercy, MPH, MT
(ASCP)H, and Tracy Davis, RN; Community Outreach
Specialists: Stacey Sanford, LPN and Stacy Berg, MS,
Valerie has also been
selected to serve on an NINR study section. The NRRC
is a standing Study Section in the NINR, and it
reviews Fellowship (F) and Career Award (K)
applications, focusing on fostering the training and
career development of junior investigators.
Valerie's expertise in minority health using CBPR
and mixed methods was sought for this committee. The
NINR Initial Review Group (NRRC 58) meeting will be
held on October 21-22 at Bethesda, Maryland.
Cowens-Alvarado, R., Vogel,
O., Valerie Eschiti, Samos, M., Wiener,
D., Ohlander, K., & Royals, D. (2013, online first).
Circle of Life revision: Giving voice to American Indian
and Alaska Native communities. Journal of Cancer
Johannigman, S. & Valerie Eschiti. (2013).
Medical use of marijuana in palliative care: Oncology
nursing considerations. Clinical Journal of
Oncology Nursing, 17(4), 360-362. Oncology
Nursing Society Mentor/Fellow Writing Project
Valerie Eschiti, Weryackwe, L.,
Sanford, S., & Flores, Y. (2013). "My mammogram was
my best friend": Donna Wahnee's story. Native
People's Wellness: Breast Cancer Prevention,
Detection, and Care, inside cover. Centers for
Disease Control and Prevention. Available at
Valerie Eschiti, Weryackwe, L.,
Sanford, S., & Flores, Y. (2013). Go pink day: The
Comanche Nation celebrates National Breast Cancer
Awareness Month (October). Native People's Wellness:
Breast Cancer Prevention, Detection, and Care, p. 8.
Centers for Disease Control and Prevention.
AHNA members names in
bold. We would love to hear about your
research. Have you started your dissertation, had a paper
published, presented, etc. Send your "Researcher in Action"
email@example.com. For publications, click on the
article title for link to abstract (if available).
Call for Research
Corey Benziger, RN, MSW is a member of the AHNA, a board
member (Secretary) for the Touch for Health Kinesiology
Association (TFHKA), and a certified Touch for Health
Instructor/Consultant. TFHKA is educational nonprofit,
teaching a holistic health system developed in the 1970's.
They certify instructors and have begun a consultant program
for people working one to one with individuals. Their
instructors are able to award continuing education (CE's)
credits to RN, acupuncturists, professional trainers and
Corey is requesting research be conducted using their system
that has been in practice for 40 years and has helped people
all over the world live better lives.
If you feel like this could be a viable research topic for a
PhD nursing student please contact Corey. She would love to
discuss ideas with you regarding generating more research in
the area of holistic or CAM therapies. Corey's number is
(910) 520-3422 and her email is
Hybrid Model of Concept Analysis
By Anita Catlin, DNSc, FNP, FAAN,
Research and Ethics Consultant, Pope
analysis in nursing refers to a
multifaceted analysis of a term.
Examples for holistic nurses might be
deeper looks into the concepts of
therapeutic touch, caring or alternative
medicine. The concepts chosen for
analysis by nurses are often those felt
deeply about and used in research and
Concept analysis is initiated by
"What is it that I am interested
"How would this term be defined in
the Webster's or Oxford
"What similar terms can describe
This would be followed by a literature
search. The intent is to find a term or
terms similar to the one being looked
at. Decisions are made on time frames.
Data may come from long ago, when
Florence Nightingale, for example,
defined "hygiene," or from more recent
times, such as "what is a rapid
response?" Articles are sorted into
which articles actually contributed to
the meaning of the term, and which
articles were not useful in the
analysis. It is common to start off with
more than 100 abstracts and hone down to
25 articles. The literature is then
closely scrutinized to develop a
definition of the concept for nursing.
Defining the concept begins with several
attributes of the concept ("What is
contained in it?"),
antecedents to the concept ("What
has to occur for the concept to take
and consequences of the concept
("When the concept occurs, what
Cases are then developed; a perfect
example of the concept in narrative
form, borderline cases, and opposite
cases. At the end, a discussion occurs
as to how the concept can be
theoretically applied to nursing and
implications for clinical practice.
After some years of conducting concept
analyses, Schwartz-Barcott and Kim
(1993) took the analysis further calling
the process hybrid analysis and included
fieldwork. It was suggested that after
the literature review, definitions,
attributes, antecedents and consequences
were studied, the researcher must go
into the clinical area and test the
"Did the concept appear in reality
as it did in theory?"
"Were the definitions correct?"
"Do the people affected by this
"What are their opinions of how the
concept is used?"
"How do nurses apply the concept?"
"Will it work in clinical practice?"
Various methods of testing the concept
can be done such as focus groups,
surveys, and interviews. The researcher
attempts to gather real time information
from those who use or will use the
concept. Clinical reality may influence,
change and/or verify that the concept is
correctly defined and useable.
An example of concept analysis in
holistic nursing is Makaroff (2012) who
provided an interesting analysis on the
"unsayable." Going back to 1959, she
reviewed 1557 articles and texts that
might contribute to when there were
topics in patient care which simply
could not be talked about, were taboo,
or were not consciously expressed
In another example, Catlin and
colleagues (2008) were concerned about
patients at the end of life receiving
technological life extending therapies
which seemed to be causing suffering.
The concern was that the nursing care
being delivered was not of benefit to
the dying patient and was perhaps
causing harm. Conscientious objection to
care orders that cause suffering at the
end of life was considered. A concept
analysis of the literature was conducted
with much of it from the military rather
than from nursing. After defining the
concept, attributes, antecedents, and
consequences of conscientious objection,
these researchers surveyed 66 nurses
concerning their feelings about
conscientious objection to futile care
in neonatal and pediatric patients.
Recommendations for practice came from
both the theoretical work and clinical
reports of the surveyed nurses.
Concept analyses provide clarity when a
nurse wishes to implement a new program
or begin an intervention study. Holistic
nurses will find that using concept
analysis will benefit patients through
increased knowledge of the evidence
backing the care provided.
Bonis, S. A. (2013). Concept analysis
method to enhance interdisciplinary
conceptual understanding. Advances
In Nursing Science, 36(2), 80-93.
Catlin, A., Armigo, C., Volat, D.,
Valle, E., Hadley, M., Gong, W., Bassir,
R., & Anderson, K. (2008). Conscientious
objection: A potential neonatal nursing
response to care orders that cause
suffering at the end of life? Study of a
concept. Neonatal Network, 27(2),
Cronin, P., Ryan, F., & Coughlan, M.
(2010). Concept analysis in healthcare
research. International Journal of
Therapy & Rehabilitation, 17(2),
Makaroff, K.L.S. (2013). The unsayable:
A concept analysis. Journal of
Advanced Nursing, 69(2), 481-492.
Rodgers, B.L. & Knafl, K.A. (1993).
Concept development in nursing.
Philadelphia, PA: W.B. Saunders.
Schwartz-Barcott, D. & Kim, H. (Chapter
8, 1993) in Rodgers, B.L. & Knafl, K.A.
(1993). Concept development in
nursing. Philadelphia, PA: W.B.
Walker, L.O. & Avant, K.C. (2000).
Strategies for theory construction in
nursing. Upper Saddle River, NJ:
Wilson, J. (1963). Thinking with
concepts. London: Cambridge
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