In this issue: Story in research, Research Profile: Mary Koithan, Healing Touch Research Review and much more .
 
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Connections in Holistic Nursing Research
May 2011 
Volume 3 Issue 3

In This Issue
Responses to Editorial
Research Profile: Mary Koithan
Research Glossary
AHNA's 2011 Conference
Thank You to Research One on One Consultants
Healing Touch Research Article Review
Congratulations to AHNA Research Grant Winner
Researchers in Action
Research Web Library
Quick Links
Holistic Nursing: Tending to the Sacred Flow of Life

AHNA's 31st Annual Conference

AHNA's 31st Annual Conference
June 2-5, 2011
Louisville, KY.

 

Explore and understand the relationships between holistic nursing and the sacred flow of life.  You are invited to collaborate with hundreds of holistic nurses in vibrant Louisville, KY. Find out more here

 

Featured speakers include the founder of Mind-Body Health Sciences and author Joan Borysenko PhD,  innovator of midwifery and pioneer of the distance learning program, Eunice (Kitty) Ernst, RN, CNM, MPH, DSc (hon) and palliative care practitioner and university teacher, Kay Sandor PhD, RN, LPC, AHN-BC.

 

Research Committee Meeting at Conference

While at conference, please join us at the Research Committee Meeting from 6 to 7 pm on Saturday, June 4th in the Grandstand room. 

 

Why Story?  Nothing "bot" can save us...

By Jen Reich MA, MS, ANP-BC, ACHPN
 
Connections in Holistic Nursing Research 
Co-editor
 

Last night I was thinking about how much research has been directed into technological advances for improving healthcare.  A quick Google search led me to articles with referring to the use of robots often labeled as "robonurses," as one solution for managing the increasing number of older adults who need care.  In fact, searching for robots in healthcare pulls up an amazing 6,330,000 hits in 0.17 seconds on Google.  While I appreciate technology, as a holistic nurse researcher, I am disturbed by the term "robonurse," particularly the thought of robots being associated with anything considered to be nursing "care."  This issue of Connections is dedicated to story, and so I share the story below as food for thought as to why we need holistic nursing research to shift healthcare back to "care," that we all have an opportunity to heal.

 

In a couple weeks, I'm heading to Las Vegas for a nursing research conference.  In the early 90's, when I was in college, my brother, 4 years my senior, moved West from Ohio to Las Vegas. I went out to visit him shortly after my 21st birthday and had my first experience with gambling aside from the Church festivals and Bingo of my Catholic upbringing.  Back then, people still went to the machines with buckets of nickels or quarters and knew what they were spending based on what was left in the bucket. I got lucky my first time there and won a little bit of money.  We ate well and had a good time.  My favorite memory though from that trip was our relaxed time hiking Mt. Charleston and Red Rock together, away from the chaos of the city.

 

Like most things in society, technology has sped up gambling. It's easy to insert a paper ticket and watch money disappear at a pretty alarming speed.  Not that there aren't some lucky moments or winners, but odds aren't in favor for striking it rich in a casino.  So when I think of a nursing conference in Las Vegas, I think of the increased speed of technology in health care.  Certainly telemedicine and other technologies have the capacity to reach people in areas underserved or remote. The Internet provides vast amounts of health information at lightning speed.  Yet, we aren't any healthier as a society.  Maybe this is because in the time it takes to read through the copious amounts of diet and nutrition recommendations on the web, we could have taken a brisk walk, had a relaxing bath, and shared a slow meal with loved ones.

 

Have we just forgotten what it feels like to care for each other without our gadgets?  I used to feel overly anxious when I took time off email or forgot my phone.  This is a pretty sad testament to modern life.  However, when I do pry myself away from the screens for meditation, prayer and exercise, I realize I accomplish a whole lot more in a short period of time.  This holds true with regard to patient care, if we are fully present with an individual, listening attentively, sharing in their feelings, we never waste time.  With all the wonderful tools we have, I have learned, that when people are vulnerable, they need this presence, someone to hold their hand, hear their story, allow them to be human.  So while I have an appreciation for technological advances, I draw the line at thinking of humans being cared for by technology such as robots or nursebots, no matter how much money it may save.

 

Whether physical, emotional or spiritual, or a combination, we all have wounds.  Healing these wounds is part of our journey on this lifetime.  And though it is a personal journey, we need the love and support of others as we travel.  No computer or robot will ever feel what love is, nor can we feel love from the their language or commands.  When we come to see life as service to one another, we will realize that nothing "bot" can save us.  For true riches in life don't come from savings, they come from connection with all that is alive.  So though I'll probably put a few tickets in the machines in Vegas next week, I'll remember the lesson of the bucket days, to always leave enough change to spare for a fellow traveler in need.

 

Why study stories in holistic nursing research?  Numerous nurse researchers and theorists have addressed this question.  Dossey (n.d.) explained how listening to stories helps understand our own patterning, and the patterning of our patients as well.  She expressed that self-care includes listening to our own stories and brings more focus, connection and balance to our lives. She added that we come to our nursing then with a more authentic and genuine connection.  Dossey described this as "the art of nursing," a reciprocal relationship by which when we listen to others we recognize their patterns as well as the patterns that make up our own. Boykin and Schoenhofer, (1991) also addressed the opportunity for personal knowing presented in story. They explained that through the insight and understanding that story provides, nurses may find meaning into their own practice. Learn more...

Responses to Editorial

By Jackie Levin, RN, MS, AHN-C, CHTP
 
Connections in Holistic Nursing ResearchCo-Editor

 

The beauty of story is that it is non-linear and unbound to time and space; not likely to be part of a techno robot's programming. When patients, families and colleagues are given free reign to tell their story, the seemingly unrelated side tales come full circle, creating meaning, understanding and context for emotions, thoughts and confusions. Unfortunately, more often than not, the clinician typically feels a responsibility to "guide" these stories to a conclusion through multiple questions for "clarification". These interruptions sadly steer the story away from the storyteller's journey and an opportunity for their own healing and "aha".

One of the most priceless examples of this was experienced when I teaching new nurses in NYU Medical Center's Nurse Residency Program. I asked the nurses to write a narrative of an experience working with a patient in pain; then several nurses read their narratives out loud. One nurse told the story of a man, who late one night rang the call bell. She went into his room and asked him what he needed. As he told her of his worries, his pain, his distress, and the life changes that were occurring, she kept wondering, "What can I say that will help this man?" Several minutes passed by as the man told his story and she listened, continuously internally asking the same question, What can I say, what can I do? When the man came to the end of his story and took her hand he said, "Thanks for listening, I feel so much better." The nurse concluded her narrative with this, "And I realized I didn't have to say anything at all."

 

 ___________________________

 

By Rorry Zahourek PhD, PMHCNS-BC, AHN-BC
Research Coordinator, Leadership Council

 

Story is both a holistic research challenge and opportunity

 

 If we consider story as a research process we are in fact turning upside down or inside out the standard RCT paradigm for valid science. It is a method biased by its very nature and controlled only by the experience and perceptions of the teller and the listener. Story like myth and fable comes from each individual's perception of reality. Therefore, as a research methodology story fits most into a phenomenological theoretical framework and qualitative aesthetic approach. It provides richness to data that is not captured by counting and comparing in more quantitative methods and is therefore often a popular method of research for holistic nurses who are interested in the whole experience of a person in a whole context. If one goes on Google Scholar and enters Narrative Inquiry the results are plentiful for books and articles. Many are written from the field of education and business. When "nursing" is added the results are more specific and many papers and books are listed that are accessible.

 

Halloway and Freshwater (2009) explain that, "narrativity is an emerging method, and one which places the voices of the 'researched' as central to the research" (p. vii).  Narratives are "accounts of experiences over time within an overall plot with a beginning, middle and end, though not always told sequentially.  Rather like the experience of being a patient, a nurse or a researcher, the narrative plot is highly dependent upon the context" (p. vii).  Furthermore,  according to Bell (2002), "The shape of our stories and the range of roles available, the chains of causation, and the sense of what constitutes a  climax or an ending are all shaped by stories with which we were raised" (p. 207). Stories and how we tell them therefore reflect our culture, our experiences and all that influences our view of the world.

 

Narrative research has become increasingly popular, particularly in nursing and in education.  Halloway and Freshwater emphasize that this might have occurred as a result of disenchantment with the emphasis on "evidence based practice and clinical effectiveness; narratives present a different kind of evidence" (p. vii). Read more...

Research Profile: Mary Koithan PhD, RN-C, CNS-BC
Mary Koithan

Interview by Jen Reich MA, MS, ANP-BC, ACHPN
 

For this month's Research E-news cameo, I had the good fortune to sit down and  talk with prolific holistic nursing researcher. Mary Koithan PhD, RN-C, CNS-BC about her beginnings into the arena of holistic nursing research.  A sampling of Mary's research grants and papers provide inspiration for both new and experienced holistic nurse researchers embarking on a path of research.
Please click here for more on Dr. Koithan's research.

 
How did you get involved in research?
The thing that most influenced my research  were the patients in my care.  I noticed as a Clinical Nurse Specialist (CNS) caring for adults with chronic illness that many of the patients seemed healthier than people at the prime of their life.  I mean that that despite their illness, they had amazing strength and resilience and were happy.  My questions became why and how does this occur?
My research has led me to understand that  health  is different from the allopathic model. Health encompasses so much more than physical strength or perfection. That you can certainly find health and wellbeing, personal happiness and prosperity in the midst of chronic illness.  As a nurse, I realized the need to honor the patient's  experiences of health --- and that health is defined differently by people. .
Therefore, rather than researching health as defined by professionals, we should focus on researching health and wellbeing as defined by our patients.  Research driven by these patient care experiences is incredibly rich. These are the type of research questions are fascinating and so in line in with holistic nursing.
 
How can holistic nurses begin to get involved in research?
I encourage nurses to view clinical experiences as the beginning of knowledge development. And, if you believe that research helps to build knowledge, then our clinical experiences can be mined to build nursing knowledge.   This is one way to encourage the development of nursing knowledge. Further, knowledge developed through research must be contextualized in order to be used by nurses. Therefore, being involved in research runs to spectrum or continuum of research......bench to bedside. Knowledge developed by holistic staff nurses helps to contextualize research findings and guidelines.  

Who encouraged your path and how?
Martha Rogers had a big impact on my career.  Both Fran Reeder and Pamela Reed  encouraged me to go visit Martha.  I was fortunate to have two face-to-face visits with Martha when I was working on my PhD in nursing.  When I questioned how I could pull my understanding of philosophical inquiry all together, Martha told me "you have all the skills you need" and that I needed to learn to trust myself.  She suggested that I close my eyes and put my hands on the computer and type.   She boosted my confidence by expressing her confidence that I was going to push the discipline forward.
Marlaine Smith was also a great mentor and source of support.  She chaired my dissertation committee and she was always available to me by  phone; that kept me going. During my PhD program, my worldview and approach to nursing as well as life in general were greatly expanded.  I think this is true of most nurses who embark on the doctoral journey. Therefore, as I look back, all those sharing my doctoral journey encouraged and nurtured my development as a nursing scholar.  
Research Glossary

Hawthorne Effect

Diane Wind Wardell, PhD, RN, WHNP-BC and Diana Guthrie, Ph.D, ARNP, BC-ADM, CDE, FAAN, FAADE

  

The Hawthorne Effect is a placebo type effect that involves a change in the dependent variable resulting from subjects' awareness that they are participants under study (Polit & Beck, 2012, p. 729). This effect was identified in research by Henry Landsberger in 1955 by analyzing data from experiments carried out in Hawthorne, Chicago between 1924 and 1932, by Elton Mayo at the Western Electric Corporation (Shuttleworth, 2009).  It is the process where human subjects in an experiment change their behavior, simply because they are being studied. This is one of the hardest internal biases to eliminate or factor into a design. The fact that the workers in these studies were singled out or observed was enough to change the results of the studies.  Consequently, what has developed is an attempt to control for this innate human response to attention (Hawthorne effect and placebo effects) that modifies results. Instead, researchers attempt to design studies in which the variables that are being manipulated are not influenced by this attention.  In order to do so in modern day science it is believed that the participant needs to be "blinded" to their group assignment (intervention or control) so that this can not influence the outcomes that are being evaluated.  Additionally, the control group can not simply be "no treatment" but one that has a similar level of attention provided.  For example, if designing a meditation study one would have 10 minutes of meditation daily via tape and the control group would get equal attention by listening to 10 minutes of self-help information.

 

Not only does the "fact" of being observed or being a participant in a study influence the response of participants  but their expectations about the effectiveness, (or non), personal experiences, and beliefs about if they are in the control or active treatment group can also influence the outcome.  Luana and Miller (2011) recently wrote about these issues in relation to medication and behavioral studies and offered that it can be a complex function between participant, intervention, and presenting condition.  They provide an interesting review of these factors and suggest that this information is an element of clinical practice 

 

References:

Luana, C. & Miller, F. (2011). Role of expectation in health. Current Opinion in Psychiatry, 24(2), 149-15. DOI: 10.1097/YCO.0b013e328343803b.

 

Polit, D., & Beck, C.T. (2012). Nursing research: Generating and assessing evidence for nursing practice, 9th Ed. Philadelphia, PA: Lippincott Williams and Wilkins.

 

Shuttleworth, M. 2009. The hawthorne effect and modern day research. Retrieved from http://www.experiment-resources.com/hawthorne-effect.html


We are currently seeking to build a glossary of research terminology that will serve the holistic nursing community.  Each Research Enews, new term(s) will be featured and the glossary will be on the website as well. If you have a research term you think would benefit AHNA members, and would like to be a guest contributor to our glossary, please contact 
amber@ahna.org with your recommendation.

AHNA's 2011 Conference
Holistic Nursing: Tending to the Sacred Flow of Life
June 2 - 5, 2011, in Louisville, KY at the Marriott Downtown

AHNA's 31st Annual ConferenceFor more information about the conference, visit www.ahna.org/tabid/1200/Default.aspx
 

Research Committee Meeting

While at conference, please join us at the Research Committee Meeting from 6 to 7 pm on Saturday, June 4th in the Grandstand room.

 

Poster Presentations

Don't forget to view the poster presentations at conference in the Roses Atrium (next to Bluegrass room). The posters will be displayed throughout the conference, but view between 11-12 pm or 4-6 pm on Friday to visit with the authors. CNE available.

Thank You to Research One on One Consultants at AHNA Conference

Thank you to the following members who will be mentors in our One-on-One Research Consultations at conference.
 
Diane Wardell PhD, RN, WHNP-BC, AHN-BC, CHTP/I
Bernadette Lange PhD, DNS, AHN-BC
Darlene Hess PhD, AHN-BC, PMHNP-BC, ACC
Anne Vitale PhD, APN, AHN-BC
Joan Engebretson DrPH, AHN-BC, RN
Mary Koithan PhD, RN-C, CNS-BC
Kari Sand-Jecklin RN, EdD, MSN, AHN-BC
Leighsa Sharoff EdD, RN, NPP, AHN-BC  

Healing Touch Research Article Review

Curtis, A.R., Tegeler, C., Burdette, J., & Yosipovitch, G. (2011). Holistic approach to treatment of intractable central neuropathic itchJournal American Academy of Dermatology. Published online February 2, 2011. DOI: 10.1016/j.jaad.2010.02.023.

 

A case study approach is used to describe a 25 year old male patient who sustained a traumatic brain injury from being accosted with a baseball bat.  The young man received conventional high dose and aggressive pharmacotherapy and psychotherapy (10 sessions) to relieve an itch.  He described the itch as a 10 out of 10 on a 1-10 scale with 10 being the most severe and as being like "hundreds of mosquitoes biting me."  Failing these approaches he was diagnosed with intractable central neuropathic itch and was offered an unconventional approach. He received bi-weekly Healing Touch sessions from a Healing Touch provider.  After one month of sessions the itch decreased in severity from 10 to 2.  After four months of session it was reported that he is currently itch free.  The mechanism of action for this neurological dysfunction is described as similar to that which creates neuropathic pain.  The focus of the treatment was to reduce central hypersensitivity of nerve related to cognitive and behavioral factors. 

 

Wang, S., Huitema, B.E., Bruyere, R., Weintrub, K., Megregain, and P. Steinhorn, D. (2010). A touch healing technique affects pain perception in healthy adults: A preliminary prospective randomized controlled studyJournal Alternative Medical Research, 2 (1), 00-00.

 

This study is a RCT using 21 healthy subjects over two weeks of time who had induced pain from the use of capsaicin solution to the medial aspect of the forearm. They were randomized to a touch healing technique developed by Rosalyn Bruyere in which the practitioner withdraws or pulls energy from the client. The control was of no touch however, participants were told that the person was assessing their pain, not providing an intervention.  The participants rated their pain every two minutes for one hour.  A quantitative methodology was developed to specifically address three aspects of the pain experience (total pain, peak pain, within session pain).  All three measures were statistically significant with less pain being identified for the touch healing group.

Congratulations to AHNA Research Grant Winner

Congratulations to Bonnie Berk, the 2011 recipient of the AHNA Research Grant. Bonnie will be using the grant to study, "Quality of life and life satisfaction in cancer survivors after completing a community-based Integrative Therapy Program : Partners In Wellness."
AHNA Researchers in Action
Valerie Eschiti, Asstistant Professor at the University of Oklahoma School of Nursing was recently awarded the Provost's Research Award for Junior Faculty. The Provost's Research Award was established in the late 1980's to recognize meritorious research. Dr. Valerie Eschiti is the first member of the College of Nursing to receive this award.  Dr. Eschiti has built a program of research focused on cancer education and behavioral change across the continuum in American Indians of the Southern Plains, as well as complementary and alternative modalities used by them (traditional indigenous healing modalities) for cancer.  She has a strong record of research that is helping practitioners learn new ways to care for Native Peoples.  Dr. Eschiti should also be congratulated for her continuous efforts to disseminate her research through publications and presentations at the local, state and national levels. Learn more.

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" to
amber@ahna.org
Research Web Library
Holistic nursing research develops knowledge and assists in providing the evidence base needed to transform health care into holistic care.  The Holistic Nursing Research Web Library in the Research section of the AHNA Web site contains links to published research by AHNA members, an article library with full length articles, research from AHNA conferences and more.  This section will continue to grow as further research is conducted in holistic nursing. Click here to visit our library today!

If you would like your published research included in the Web Library, contact Amber at amber@ahna.org. Please include the citation for the book or article, a URL to the abstract or full text article, a short description (optional) and suggested category or categories.
 

The Voice of Holistic Nursing 

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Feel free to share the content in this eNewsletter with your e-mail contacts, list-serves, or favorite discussion boards/ blogs. Please just be sure to mention that Connections is a benefit of AHNA membership.

 

Connections in Holistic Nursing Research Co-Editors:
Jackie Levin RN, MS, AHN-C, CHTP
Jen Reich MA, MS, ANP-BC, ACHPN

    

AHNA Leadership Council Coordinator for Research:

Rorry Zahourek PhD, PMHCNS-BC, AHN-BC 
  

Although the AHNA supports the concepts of holism, it refrains from endorsing specific practitioners, organizations, products, services or modalities. Opinions expressed in this eNewsletter may not reflect the position of the AHNA.

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