In this issue: All about IRB; AHNA Research Grant Deadline February 1, 2010; Conference Poster Proposals must be submitted by December 1, 2009; Generating Research Questions; Research Profile-Colleen Delaney and much more.
Connections in Holistic Nursing Research
In This Issue
Protection of Human Subjects: The Internal Review Board
Don't Let the IRB Scare YOU
Research Profile: Colleen Delaney PhD, RN, AHN-BC
AHNA Research Grant Proposals Due Feb 1, 2010
AHNA Grant Reviewers Needed
Research Committee News
Generating Research Ideas
Research Tool Articles Needed
Researchers in Action
Research in the News
Upcoming Events
AHNA Discussion Forum
Present at AHNA's 2010 Conference
Quick Links
 
 
 
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Thoughts From Rorry
This is the 5th issue of our research eNews, Connections. With the major changes we foresee in the nations' health care system and the potential challenges and opportunities those bring it seems inevitable that our research will become even more essential to determine efficacy and safety of our approaches and modalities. We will also need to document and provide evidence for our work in order to obtain supportive funds for education as well as for developing clinical programs in the community and in institutions. The terms efficacy and effectiveness have become popular in current health care literature. Efficacy refers to studies that prove that the treatment or modality is effective using a rigorous quantitative approach such as the random controlled study. In holistic nursing this might be applicable to looking at interventions that can be controlled in a research situation. This is difficult but not impossible given the approaches and holistic philosophy that we bring to our practice. Effectiveness refers to how well an approach or intervention works in the real clinical situation. This result recognizes the complex nature and influence of human situations and allows for more variability in demanding statistical significance.

We predict that leaning about how to appreciate and use research, as well as conduct it, will be even more needed and expected by all practitioners and educators than it is now.  Some research committee members have suggested that we form small groups that have a similar research focus. Evelyn Clingerman at the University of Texas at Austin suggested that we create an interest group that focuses on the mind-body-spirit connection research. This would be more in concert with some of the emphases of NCCAM.  Are you interested? If so, please post some comments in the discussion forum?

We hope research eNews will contribute to both the holistic, healing and CAM knowledge base. We continue to ask for your research that is completed, in progress and even considered for our newsletter. Have you developed a tool, a new theory, a method that has been useful in learning more about holistic nursing? Have you read a good book that relates to holistic nursing research? How about reviewing it for us? Have you come across an interesting research article again that relates to holistic nursing practice? Let us know. Contribute to and participate in the online forum. We are hoping that you will send us our comments and suggestions about how we can make this newsletter and the research section of the web site valuable and useful to you. Contact me at rorryz@aol.com.
 
The next issue (Vol 2 no. 1) will be devoted to methods and tools that may be especially useful to Holistic nurses and our research. Please share your experience of that with us. Have you developed a tool? Found a tool? Discovered a method that might be uniquely applicable to HNR? Let us know by e-mailing me at rorryz@aol.com. Such information will also be stored on our web site for future use by students and others.
 
In this issue we will focus on the importance and components of IRB - protection of human subjects. Pat Winstead Fry has contributed an article below. Debra James has also contributed words of advice for obtaining an IRB.
 
We are also including information on applying for the AHNA research grant and the modified guidelines for grant submission. The new date for submission is Feb. 1, 2010.  Another date to keep in mind is the submission date for posters for the 2010 AHNA conference in Colorado Springs, Dec. 1, 2009.

Coleen Delaney is our featured researcher cameo. She received the AHNA research grant in 2007 for her study "The Influence of a Spirituality-Based Intervention on Quality of Life, Depression, and Anxiety in Community-Dwelling Adults with Cardiovascular Disease".

Rorry Zahourek PhD, PMHCNS-BC , AHN-BC
AHNA Leadership Council Coordinator for Research
rorryz@aol.com
 
Protection of Human Subjects: The Internal Review Board
By Patricia Winstead-Fry PhD, RN
 
 
The following is an excerpt of an article solicited by the research committee for research enews. The complete text can be found on the AHNA web site.
 
In practice, the protection of human rights in research is operationalized through the informed consent protocol. Many Offices of Research will offer a sample consent form for a researcher's review.  Rather than focus on the formalities of informed consent, I will discuss protection of specific human rights including self-determination, anonymity and confidentiality, privacy, fair treatment, and protection from discomfort and harm. (8)
 
Self-determination means potential research subjects need to know what the research is about, that they are asked to participate in research, that they  choose to voluntarily participate or not with no penalties, and they can withdraw from the study at any time with no penalties.  Anonymity and confidentiality protect the identity of research participants.  People have a right to share personal information or to keep secrets.  Researchers have to protect the identity of participants.  Many researchers use code numbers for data identification, especially is data collection is accomplished more than once in the course of a study.  Data can be stored in locked files with the consent form separated from the data; so identity cannot be linked with data.  It is even possible not to get a signed consent form, if that is the only link between the identity of the participant and the data.  The researcher says something to the effect that "Consent is implied if you return these questionnaires".  This is especially helpful when the data is collected electronically with a program such as Survey Monkey.

In exempt research, identities may not be protected because of the public nature of the participants.  In expedited and full reviews, anonymity and confidentiality issues are paramount.

Privacy needs to be assured for research participants.  This means that data cannot be recorded or videotaped without the person's knowledge.  Research participants who are going to be recorded or video-taped need to understand who will listen/view the materials; what specifically the researcher's are looking for and what will be done with the materials after the research is completed.  Researcher's need to be very clear about what their research question is and have questions phrased in such a way that answers are focused on the research question and don't allow respondents to say more than the research requires.

In qualitative research where a group may be convened to discuss their experience in research, privacy is a major concern.  A group member may let slip a participant.  The researcher needs to do everything possible to impress upon the participants the requirement of Privacy.

Fair Treatment requires a balance between risk and benefit, suitable subject selection, and respectful treatment by the researcher.  If a study is a nontherapeutic one, the researcher does not have to promise a benefit if there is none.  However, if a benefit is promised, it must be fulfilled.

Another aspect of fairness is subject selection. Patients have to be treated fairly during the study.  There should be clear understanding about what exactly the participant's role is, how much time it will take, and what benefits, if any, will be forthcoming.  The researcher's role should be equally defined for the participants.  No changes should be made without consulting the participants.

Protection from discomfort and harm requires that negative emotional, physiological, social and economic events be controlled for as far as possible.  It also requires that if any of these negatives are part of the research study, the patient knows about them in the informed consent process.
 
For specific IRB questions please contact Pat Winstead Fry at healer@together.net.
 
REFERENCES
  1. The Nuremberg Code.  In Metscherlich A, Mielke F. Doctors of Infamy: the story of Nazi medical crimes.  New York: Schuman; 1947.
  2. World Medical Association.  Declaration of Helsinki.  British Medical Journal; 1964;313(70): 53-6.
  3. Rothman DJ. Were Tuskegee and Willowbrook studies in nature?  Hastings Center Report. 1986;12(2):55-7.
  4. Levine RJ. Ethics and the Regulation of Clinical Research. Baltimore: Urban & Schwarzenberg; 1986.
  5. Rothman DJ. Were Tuskegee and Willowbrook studies in nature?  Hastings Center Report. 1986;12(2):55-7.
  6. Department of Health and Human Services.  Final Regulations amending basic HHS policy for the protection of human research subjects.  Code of Federal Regulations, Title 45 Public Welfare, Part 46, 1981. 
  7. American Nurses Association.  Human Rights Guidelines for Nurses in Clinical and Other Research. (Document No. D-46 5M). Kansas City: American Nurses Association, 1985.
  8. Burns N, Groves, SK.  The Practice of Nursing Research. 5 ed.  Philadelphia: Saunders; 2004.
Don't Let the IRB Scare YOU
by Debra Lee James, RN, BSN
RN II, Washington County Hospital
Hagerstown MD
Studying Reiki and Pain Control in Post-op Patients
 
So you finally decided that research is something you can handle. You have a great idea for a research project that will benefit your facility. However three little letters strike fear in your heart of hearts whenever you think of moving forward: IRB. While you may think the IRB (Institutional Review Board) has more interrogation techniques to break people than the CIA, this group is actually set up to make your life easier, to protect you, to protect your research participants, and to ensure frivolous research does NOT become the norm.
 
The best way I have found to prepare for IRB approval is to actually speak with someone on the board. There should be a point of contact for anyone wanting to conduct research. This person will provide you with general guidelines, information on when the IRB meets and submission deadlines, as well as information on mandatory training for researchers working with human subjects, research archiving requirements, and specific requirements for research conducted in your facility.
 
Each IRB is unique to the institution over which it governs. Just because you've been through the IRB review process in one facility, don't presume the same will hold true for another. There are even different requirements regarding archiving of research materials, updates to be provided to the IRB (monthly, quarterly, semi-annually, etc.) and length of time allowed to complete a research project.
 
So here are a few practical tips:
  1.  Be prepared to answer just about any question you can think of regarding your project.
    1. Ask yourself the obvious questions: does anyone even care about this? Will there be any benefit to this facility's patient population? Has anyone else done this research and what were there results compared to what I expect?
    2. It's ok to perform research that's been conducted elsewhere because your research will show how your facility can benefit in similar ways.
    3. After you've asked the obvious questions, then ask the off-the-wall questions. Trust me, there is a good chance someone will think one of the off-the-wall questions is not too far out there (been there, done that.).
  2. Make sure you have the resources lined up to perform your research.
    1. If you have grant opportunities, it's always nice to have that at least in the pipeline if not already lined up before you present to the IRB.
    2. If you don't have grant money, be prepared to have answers on how to fund your project, or have answers on why your project is so cost effective that the institution will be willing to put up the money. Don't forget the other researchers involved - will there be over-time charges to consider? Are people willing to "donate" their time/salaries to work this project? Do you have a paid statistician on hand or will this be contracted?
  3. Be honest about why you want to conduct the research and be passionate. If the IRB doesn't feel you're willing to fight for this research, they will be less likely to approve it.  Don't pick a project because it's convenient, but choose something in which you have a true interest. That true interest goes a long, long way in helping you prepare and follow-through.

Happy trails and happy research!
Research Profile: Colleen Delaney PhD, RN, AHN-BC
Colleen Delaney PhD, RN, AHN-BCColleen Delaney is an Associate Professor in the School of Nursing at the University of Connecticut. Her health outcomes research program is focused on examining questions related to the efficacy of holistic nursing interventions aimed at improving health related outcomes in community-dwelling elders with cardiovascular disease. 
 
"When the student is ready, the teacher appears" is a well-known saying that best describes the start of my holistic journey. For the first 15 years of my nursing practice, I devoted my career as a home care nurse to helping individuals and their families maximize their understanding and self-management skills during chronic illness. After many years of working with individuals, their families, and the staff who cared for them, I decided to pursue a MS and doctorate in nursing. I wanted to create knowledge to enhance the lives of individuals and their families who were experiencing physical and mental health transitions due to chronic illness and aimed to redirect my focus from having an impact on small numbers of patients to larger numbers of people through advanced education and research. In my first graduate course, my instructor was a holistic nurse and by the end of the semester so was I, this course launched my holistic journey and provided the foundation for my program of research. I have been a dedicated member of the American Holistic Nurses Association since 1998 and am certified in advanced holistic nursing.
 
My research program and professional passion is rooted in community/ public health nursing and particularly in the area of improving health-related outcomes for community-dwelling elders with chronic disease.  I have 3 focus areas: spirituality, home care patients with cardiovascular disease, and dementia patients and their family caregivers. The common thread among the studies in my research program is a philosophy grounded in holistic nursing that aims to address the whole older adult with chronic illness, in body, mind, and spirit in community settings.

Read more...
 It's AHNA Research Grant Proposal Time Again!
Note NEW DATE! 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 $2,500. Projects can be pilot projects or extensions, or replications of other studies; they can also be doctoral studies. If you submit your doctoral work, you must submit a letter from your chair person acknowledging and approving the submission for AHNA funding.
  
 Please e-mail grant proposals to both Kim Stiles (kstiles@ohlone.edu) and Jeanne Crawford (director@ahna.org). Consultation may be available as an aspect of the grant. For questions about the grant application process, please contact Kim Stiles (kstiles@ohlone.edu). For consultations or mentor information, contact both Kim Stiles and Ruth McCaffrey (rmccaffr@fau.edu).
AHNA Grant Reviewers Needed
We need you if you have a doctoral degree and are willing to volunteer to be a research grant reviewer--please contact Kim Stiles (kstiles@ohlone.edu) as soon as possible. To facilitate making the best reviewer-application matches, she will e-mail you a brief questionnaire to identify your preferred research methods and holistic nursing areas of expertise. In early February, Kim will send you 2-3 blinded study proposals with review forms for you to complete and return via e-mail within 3-4 weeks. Many reviewers make the job quick and easy, and are essential to helping us pick high-quality grant recipients, so please volunteer!
A Brief Overview of Qualitative and Quantitative Paradigms of Research
Click here to read an article and guide sent to us by Susanne Tracy RN, PhD from the University of New Hampshire. It is a guide she created for qualitative and quantitative paradigms in research. While we acknowledge other approaches as well and welcome articles from you about other approaches, this is a useful reference paper. She has included a grid of qualitative and quantitative designs that are adapted from a book by Polit and Beck (2004).
Research Committee News
The data from the collection of healing stories at the '09 conference are being analyzed. A meeting is planned of the investigators at conference 2010 to create a meta story of holistic nursing. Marlaine Smith, Diane Wardell, Joan Engebretson, Rorry Zahourek, Mary Hines, Carla Mariano, and Jeanne Crawford are the investigators.
 
The study looking at the development of a mentorship program has been given IRB approval and the data from the recipients of this year's conference being analyzed. Focus group methodology will be used at conference 2010 to explore the process and need for mentorship in holistic nursing research. Ruth McCaffery, Sue Robertson and Evelyn Clingerman are the investigators.
 
A new study is in the early planning stages called the "Legacy Project". This project plans to interview some of our most senior and sage leaders and to capture how they became holistic nurses. They are a valuable resource for our profession to honor and to learn from. A publication of their histories is planned. Investigators include: Bernadette Lange, Carla Mariano, and Rorry Zahourek. The researchers have been aware of their process as they have planned this project. They will present this process (Birthing a research project) in an expanded and extended consultation format at conference 2010 in Colorado Springs.
 
We need help:
  • Want to help edit and write for research eNews Connections?
  •  Want to help compile materials for our web site? Contact Rorry or Amber.
  •  How about reviewing grants when they begin to come in in February. Contact Kim Stiles (kstiles@ohlone.edu) if you can review.
  • Ideas for fund raising. Do you know a person or a company that might want to sponsor a grant for a research purpose? Or do you have other ideas for fundraising? Contact Rorry (rorryz@aol.com) or Amber (info@ahna.org).
Generating Research Ideas from General Press Reports
Some reports in the general press can highlight areas that might be good for Holistic Nurses to consider researching.  The following article, "Face masks something to smile about," from the San Francisco Chronicle is one that poses holistic nursing questions such as: what populations might find this especially helpful? Is there a difference in children's anxiety level when the nurse wears a plastic mask while caring for them in an ICU? Does reduced anxiety improve outcomes?
 
Jeanne Hahne's was a nurse was working with patients in a burn ward. She was dressed in head-to-toe protective gear - including a mask that covered most of her face."These people were in crisis and they were scared, and you'd see them every day and they wouldn't even recognize you," Hahne said. She had an idea: face masks made of clear plastic, so patients could see her smile and facial expressions. She explained, "There are a lot of studies about what this portion of the face conveys. A lot is said in facial expressions. We like to see the smile and reassurance. Anxiety is decreased when you can feel connected to somebody."

Hahne and California Pacific Medical Center will conduct studies to prove that her masks are as hygienic as current masks. Doctors, nurses and patients seem receptive to the new masks. They seem especially useful for young patients.

Hahne said her idea originally was geared toward easing patient anxiety, but now that doctors and nurses have actually tested the masks, she said one surprising aspect is how the masks help improve communication between health care workers. Click here to read the entire article.
 
A pain research study that recently captured the attention of the popular media was "Swearing as a Response to Pain." Participants were able to keep their hand in ice water longer when swearing than when repeating a neutral word such as table. Click here to read more.
 
Think for a minute about the further research questions that this article generates. Some that come to mind are why does this occur? What are the implications for clinical care? Should we ask patients to swear during painful procedures? How could we further research this?
 
Remember to keep your eyes and mind open for research questions.
We Need You!
For the next issue of Connections we are asking for information about assessment and evaluation tools and instruments. Please share your experience of that with us. Have you developed a tool? Found a tool? Discovered a method that might be uniquely applicable to HNR?

Send all articles to rorryz@aol.com and info@ahna.org. Thank you in advance.
AHNA Researchers in Action
Gayle Kipnis MSN, RNC-OB, AHN-BC and Cynthia Becket PhD, RNC-OB, LCCE recently published a study titled Collaborative communication: Integrating SBAR to improve quality/patient safety outcomes in the Journal of Healthcare Quality.  This study describes use of the Situation, Background, Assessment and Recommendation (SBAR) collaborative communication process in a pediatrics/perinatal services department of a hospital in Arizona. 
 
Deborah McElligott DNP, ANP-BC, AHN-BC recently had an article,
Health Promotion: Is there a healthy nurse in the house?,  in Applied Nursing Research. Results indicated nurses are stressed & not exercising. A holistic approach to management was recommended. 
 
We are adding an article, Metaphors: A Way of Being for Holistic Nurses, by Leighsa Sharoff EdD, RN, NPP, AHN-BC to our online article library. She has done research on the use of metaphor in holistic nursing and has two recent publications on this topic. Her publications on metaphor include:
Sharoff, L. (2007).  Metaphors: A Creative Expression of Holistic Nursing.  Spirituality and Health International, 8, 9-19.
Sharoff, L. (2008).  Exploring Nurses' Perceived Benefits of Utilizing Holistic Modalities for Self and Clients. Holistic Nursing Practice, 22(1), 15-24.
Sharoff, L. (2009).  The Power of Metaphors: Images of Holistic Nurses. Holistic Nursing Practice, 23(5), 267-275.
Sharoff, L.  (2009).  Expressiveness and Creativeness: Metaphorical Images of Nursing, Nursing Science Quarterly, 22(4) ,312-317.

Valerie Lincoln PhD, RN, AHN-BC and Mary Johnson PhD, RN, AHN-BC
recently published an article called Staff Nurses Perceptions of a Healing Environment in Holistic Nursing Practice. This study investigated staff nurses perceptions of the characteristics of the healing environment that supported their practice of holistic nursing.  Candid discussions resulted from their multiple method qualitative interview process. The themes identified as the essence of healing environments included context, connections and calling. Additional characteristics were identified within each category.
 
Rozzano Locsin, Ruth McCaffrey ND, ARNP, & Marguerite Purnell RN, PhD, AHN-BC published Nurses' experiences of being cared for in a hospital healing arts space in The UPNAAI Nursing Journal.

Rorry Zahourek PhD, PMHCNS-BC, AHN-BC recently had a book published, Intentionality: the Matrix of Healing, by VDM Verelag Dr. Muller Aktiengesellschaft & Co. Germany. Available on Amazon.com. This book describes the development of a theory of intention and intentionality in healing using the grounded theory qualitative research method. Research and literature is reviewed and the implications of the theory discussed related to other theories as well as to practice, education and future research. Models for understanding the theory and for devision implications are presented.

 
Rozzano C. Locsin and Marguerite J. Purnell RN, PhD, AHN-BC have a new book, A Contemporary Nursing Process: The (Un)Bearable Weight of Knowing in Nursing from Springer Publishing Co. AHNA member contributors to the book include : Richard Cowling, Marlaine Smith, Ruth McCaffrey and Christopher Johns. The book is available from Barnes and Noble. At the heart of a thoughtful practice process of nursing is coming to know persons. This book embraces the diverse philosophical and theoretical viewpoints of nurse scholars whose appreciation of persons as unitary human beings grounds their understanding of professional nursing practice. Opportunities are provided in each chapter for the practicing nurse to understand knowing the person through a lens that is responsive to  what matters and is grounded in what matters. The realization that nursing cannot truly take place without the intentional and knowing engagement of the nurse is emphasized.

We would love to hear about your research. Send your "Researcher in Action" to info@ahna.org
Research in the News
Weight Lifting and Lymphydema in Breast Cancer Patients
Breast cancer survivors with lymphedema who engage in a progressive, supervised weight-lifting program fare better than their counterparts who do not lift weights. (cnn.com, 8/09) Click on the title to read article.
 
Extra Exercise Trims LDL Cholesterol Levels in Women
One extra hour of moderate physical activity per week can reduce levels of LDL or bad cholesterol in middle-aged women, a nine-year study found. The benefits were greater for postmenopausal women. (New York Times, 8/09) Click on the title to read article.
 
Vitamin D Deficiency Increases Risk of Death Among Elderly
Researchers found low vitamin D levels in the elderly significantly raised their risk of death, especially from heart disease. (Reuters, 9/09) Click on title to read article.
 
Chocolate 'Cuts Death Rate' in Heart Attack Survivors
Heart attack survivors who eat chocolate two or more times per week cut their risk of dying from heart disease about threefold compared to those who never eat chocolate. (AFP, 8/09)
Click on the title to read article.
Upcoming Events
Application deadline for the Sigma Theta Tau International Small Grants: December 1,  2009. Learn more about research grant opportunities from STTI!
 
NCCAM's 10th Anniversary Research Symposium: Exploring the Science of Complementary and Alternative Medicine
December 8, 2009, Bethesda, MD
The symposium, the signature event celebrating NCCAM's 10th anniversary, will highlight exciting areas of science, framed within the key priority areas of natural products and mind-body medicine.
 
7th Annual Natural Supplements: An Evidence-Based Update. Scripps Center for Integreative Medicine January, 21-24 2010. San Diego Ca.  deadline for poster abstracts: December 11, 2009.
AHNA Discussion Forum
There are some requests for help on the AHNA Research Discussion Forums. Please read the following posts and reply if you are able to help. 
 
In the Latest Research Findings forum, a member writes: 
I am very interested in developing a research project around the effects of various enery modalities.  In my search for instruments, I have been unable to locate any "energy" assessment/evaluation tools with documented reliability and validity. Are there any out there? 
 
 
And in the AHNA Research Collaborative forum, another member writes:
Have collected  forms filled out by HCP to measure types of Complementary (Adjuncti ve) therapies they have experienced, their personal success with each type they have tried and the end result of if they have ever recommended actively to a patient... will be happy to discuss sharing the information to achieve an outcome study. 

To reply just click on the links above, you will be asked to login to the web site before being taken to the Discussion Forum. Then click the Reply button near the bottom of the screen. Write your comments into the editor and click Submit. You will be given a chance to review your comments before they are published to the web site.
 
You must have activated your AHNA online account to visit the Member's Only section. If you have not activated your online account, please click here.
Present Your Poster at AHNA's 2010 Conference
AHNA invites you to submit poster proposals for the 2010 Annual Conference, Re-Visioning Environment: Creating a Habitat for Healing, by  December 1, 2009.   All forms and guidelines for proposal submissions are available on the AHNA website.
 

The Voice of Holistic Nursing 

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