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Connections in Holistic Nursing Research
In This Issue
Research Grant Proposals Due March 15
Research Profile
Marlaine Smith, RN, PhD, AHN-BC, FAAN
Researchers Wanted
Therapuetic Touch Affects In vitro Cells
AHNA 2009 Conference One-on-One
Mentoring and Research Proposals
Tips for Applying for a Research Grant
AHNA Research Grant Recipient Completes Study
Upcoming Events
Researchers in Action
Share your Knowledge
AHNA Adopts Policy on Research on AHNA Members
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by Rorry Zahourek PhD, PMHCNS-BC , AHN-BC
AHNA Leadership Council Coordinator for Research

Welcome to the second edition of research eNews, Connections in Holistic Nursing Research. We received a great deal of positive feedback about the first issue. We welcome your comments at info@ahna.org and encourage you to start or join a discussion on the AHNA Web site.
It is time to start thinking about submitting an AHNA research grant proposal. New this year: Grant application now is extended to doctoral students who wish to apply for funds to support their research.
While we have a growing store of various kinds of research in holistic nursing there is still a great need for us to answer questions about our holistic clinical work, holistic education and holistic administration. Research in these areas is difficult when one considers issues from a holistic perspective. Often process and results of our work are not crystal clear, or readily apparent in a timely fashion. Increasingly these difficulties and the importance of both qualitative and quantitative findings are appreciated in the world of evidence-based practice and by those who place highest emphasis on the gold standard of the randomized controlled trial. 
This issue of Connections is focused on helping people write proposals. I have asked several people to submit words of advice to people who might want to submit a proposal. Please also check out the guidelines for qualitative and quantitative proposals that are on the Web site. We also recognize that combined, historical, aesthetic and other more non- traditional approaches may be valuable in studying holistic phenomena. The theme we are adopting for holistic nursing research is "healing through holistic nursing"; please consider proposing your study within that frame.
Lynn Rew has coordinated the grant review process for the past several years. We are relieving her with many thanks and have asked Kim Stiles PhD, RN, AHN-BC to coordinate the process. Kim is a nursing professor at Ohlone College in California. Submit your research grant proposal by e-mail to both Kim Stiles at kstiles@ohlone.edu and Jeanne Crawford at director@ahna.org by March 15, 2009. Because our budget is small ($2500) we encourage you to submit pilot studies, smaller projects or stand-alone aspects of a larger project. Continuation, or replication of former studies are also encouraged.
Our Name
Thank you to Julia Balzer Riley RN, MN, AHN-BC, CET who sent in the winning name for the AHNA research eNewsletter. Our new name is Connections in Holistic Nursing Research. Thank you also to everyone else who suggested a name.
AHNA Research Grant Proposals Due March 15, 2009
AHNA members are encouraged to submit topics that relate to healing through holistic nursing. Submission guidelines and helpful advice for qualitative and quantitative studies are available on the AHNA Web site. Please e-mail grant proposals to both Kim Stiles (kstiles@ohone.edu) and Jeanne Crawford (director@ahna.org). Consultation may be available as an aspect of the grant. Questions, please contact Rorry Zahourek (rorryz@aol.com) or Kim Stiles or for consultations or mentor information contact Ruth McCaffrey (rmccaffr@fau.edu).
Research Profile -  Marlaine Smith RN, PhD, AHN-BC, FAAN
Marlaine Smith is an Associate Dean for Academic Programs and a Helen K. Persson Eminent Scholar at Florida Atlantic University where she teaches about caring in nursing. Dr. Smith has researched a wide range of topics including folk remedies, aromatherapy, massage and other touch therapies. Click here for a complete listing of Dr. Smith's publicationsMarlaine Smith

Everyone knows that research takes perseverance and passion, but not many will tell you that it often involves serendipity...being at the right place at the right time and being open to research opportunities that present themselves. This was certainly the case in my research career.

I've had an interest in holism and its place in nursing since the mid-1970s. I pursued my doctoral studies at New York University so that I could study unitary science with Martha Rogers, and my doctoral dissertation actually focused on the study of imagery in different sound environments, a test of the principles of integrality and resonancy. In 1988 I moved to the University of Colorado where I became a Faculty Associate in the Center for Human Caring. The Center existed to advance holistic caring-healing practices. One of the Center projects involved offering touch therapies such as massage and therapeutic touch to the patients at the University Hospital. We received testimonies from the patients, families, nurses and physicians about how these therapies were related to healing. One day at a meeting we decided that we needed to study these possible benefits more systematically. I knew that touch was important...I had experienced this caring for my patients so many times. So I embraced the challenge to study outcomes of touch therapies and this is how my 18 year research trajectory began.

My first study was an evaluation of the massage therapy program at the University Hospital funded by the Hospital Auxilliary & Gift Shop for $30,000. These funds paid for massage therapists who offered massage two days a week to patients on the rehabilitation, organ transplant, and neuroscience units. Patients in our study received two massages/week for two weeks. Patients and therapists completed surveys that measured several outcomes and included a qualitative dimension. We found that that those who received the massage therapy in the hospital identified a variety of benefits such as pain relief, relaxation, increased ability to function that they associated with massage.

When I reported these findings at a local meeting, one of the nurse administrators at the Denver VA Medical Center explained that one of the nurses on their oncology unit was a massage therapist and was offering massage to the patients on the unit. "Could we do a study on her unit?" she asked. "Absolutely!" I seized this opportunity and a second study of massage therapy was born. This study of massage therapy with cancer patients revealed that those patients who received massage therapy had less pain and distress from symptoms as compared to the control group who received verbal interaction without touch with the same nurse massage therapist for the same amount of time. Sleep quality stabilized in the hospital for those who received massage while it deteriorated significantly for those in the control group. Anxiety decreased for patients who received both massage and the verbal nurse interaction.

The Bone Marrow Transplant Unit at the University Hospital offered to their patients both massage and therapeutic touch as optional therapies. We heard anecdotes about how those getting therapeutic touch seemed to be engrafting much more quickly than normal. This was a fascinating observation and one that I decided to pursue with a colleague....another opportunity! This study was funded by an intramural grant. With each study I learned more, strengthening the design and methods. In this study we compared the effects of massage, therapeutic touch and the friendly visit (control) on time for engraftment, complications and perceived benefits of therapy for those undergoing bone marrow transplantation. We found no differences in the time for engraftment between those who received therapeutic touch, massage therapy or the control of the "friendly visit". But, we did find that those who received massage therapy had fewer neurological complications (anxiety, depression, insomnia, restlessness, etc.) than the control group. In addition, those who received massage or therapeutic touch perceived greater benefits from their therapies than those in the control group. 

Shortly after the completion of this study the National Center for Complementary and Alternative Medicine issued a call for proposals to study complementary therapies in palliative care. I had planned to submit a study of massage therapy, and a physician specialist in palliative care wanted to submit as well. We decided to combine our efforts. In our third and final submission to NCCAM we were funded for $1.2 million to study the effects of massage therapy on pain, symptom distress and quality of life on people with advanced cancer enrolled in hospices across the country. The results of this multisite randomized controlled trial revealed immediate effects of massage therapy on pain and mood. Those in the control group received a treatment that consisted of simply touching at 10 different locations on the body. This simple touch treatment was also beneficial to patients. Patients in both groups showed improvements at the end of the two weeks of receiving the touch therapies.

What's next? I have a list of questions that I want to explore.  As research questions are answered, additional ones emerge.  I've conceptualized touch as therapy within Rogers' and Watsons' nursing theories, and I've developed a middle range theory of healing through touch based on these research findings.  This is how any science grows.  Yes, research takes passion and perseverance. But, it also takes partnerships and seizing opportunities for research that present themselves. I would advise holistic nurses to be open to these opportunities and to seize take advantage of them. If you are a novice, partner with an experienced mentor.  The questions that come from practicing nurses will fuel the growth of the science underpinning holistic nursing.
 If You Need Help, Ask         
by Ruth McCaffery DNP, ARNP-BC

Working with AHNA to obtain research grant funding was a pleasant and fulfilling opportunity. As the interest and funding for AHNA sponsored research grows I am sure many in the organization will feel compelled to submit a research grant.
Writing a grant is not as daunting as you might think. This is especially true if you review the grant requirements and complete them systematically. If there are parts of the research plan or development that you are unsure about seek help from a mentor. It is important to thoroughly know the subject or area that you wish to research and what work has already been done in that area. Not only does the knowledge gained make your proposal better but it may provide you with wonderful ideas for the research you are planning in terms of method and analysis of data.
If you need a mentor for your research you should contact Ruth McCaffery at rmccaffr@fau.edu to get connected with an AHNA research mentor.
Tips for Applying for a Research Grant
by Lynn Rew EdD, RN, AHN-BC, FAAN 
1. Be sure the problem is significant and clearly stated
2. Provide convincing evidence from existing literature and previous studies that there is a problem that your study will help to solve. Just stating that something has not been done is not enough to warrant doing a study.
3. Include enough details about your method (e.g., design, setting, sample) and protocol (what will you do, to whom, when, where, and by what means) that reviewers know exactly what your plan is.
4. Include a conceptual or theoretical framework that is apparent throughout the components of the proposal.  It also helps to have a simple figure that includes all the variables you are addressing in the study.
5. Have you thought about using both a quantitative and qualitative mixed methods approach to get a more rounded idea of findings?
6. If you are doing a quantitative study, describe your plan for data measurement, management, and analysis in detail. Include reliability and validity of any measurement tools you will use and include them in an appendix.
7. If you are doing a qualitative study, describe your plan for data collection, management and analysis in detail.
8. State if an institutional review board (IRB) will be involved and explain your plan for protection of human subjects.
9. Give yourself plenty of time to have at least one trusted colleague review and critique your proposal prior to submission. 
10. Remember that all good writing is re-writing, and this goes for proposals too!
AHNA 2009 Conference One-on-One Research Consultation Sessions

Conf 2009 logoWe are offering a limited number of opportunities for attendees to discuss their research ideas, topics, or concerns with experienced researchers, published authors, and grant-writers.  In the "Research One-on-One Consultation Sessions" interested attendees can dialogue with seasoned holistic nurse researchers about such holistic research topics as:

  • grant writing,
  • writing for publication,
  • holistic cultural research,
  • holistic theory development,
  • holistic ethics, 
  • holistic education,
  • holistic self-care,
  • holistic environments,
  • relationship-centered care,
  • spirituality, and
  • holistic interventions. 

There is a $35 registration fee. This is a great opportunity for both novice and experienced researchers.

When using a "hard copy" registration form, the One-On-One Research Consultation is an option.  If you are already registered or are registering online call (800) 278-2462 Ext. 10 to register for a consultation. Later, you will be asked to complete a brief questionnaire about your goals so that the process of joining you with a consultant will more likely be successful.

Researchers Wanted
AHNA and the research committee are striving to build an online bank of resources for our members to find other researchers who are studying similar phenomenon.  Such a bank will provide opportunities for informal or formal collaboration and/or consultation and mentorship. In order to develop this data base of holistic nurse researchers and holistic nursing research we need for you to send us you name, credentials, where you are located, e-mail if you like, and topics that you have and/or are researching.
Send these to Ruth McCaffery at rmccaffr@fau.edu
Therapuetic Touch Affects In vitro Cells
In two recent studies Gloria Gronowicz took a look at how Therapuetic Touch affected the growth of cells in petri dishes. The two studies were published in Journal of Orthopaedic Research and The Journal of Alternative and Complementary Medicine. One of the studies was done on both healthy and cancerous bone cells in vitro. Of that study Gronowicz states, "Therapeutic touch appears to increase DNA synthesis, differentiation, and mineralization in normal bone cells, and decrease differentiation and mineralization in a bone cancer derived cell line." Learn more.
Resources for Researchers
APF visionary and Weiss grants seek to seed innovation through supporting research, education, and intervention projects and programs that use psychology to solve social problems. Deadline for application is March 15, 2009. Click here to download application.
"The Science of Unitary Human Beings: An Update on the Research" by Tae Sook Kim (Nursing Science Quarterly 21, 4 294-299, 2008) is a wonderful review of research using Rogerian Theory from 2004-2007. Twenty four studies were reviewed (15 quantitative and 9 qualitative). A variety of unique tools are describes including Barrett's Power as Knowing Participation in Change, Hastings-Tolsma's Diversity of Human Field Pattern Scale and Smith and Broida's Perceived Field Motion Scale. This is a very useful paper for those interested in unitary approaches to holistic nursing research.
The Web site www.scholarshipnet.info lists popular scholarship programs available globally and guides researchers through the application process. The scholarship tips include topics such as how to write a research proposal.
The Council for Healing (CFH) Provides a Useful Resource for Holistic Nurses
The CFH has a web site that includes research on healing that will be a useful resource for holistic nurses in practice, education and research. The site promotes awareness of healing and access to healing, with a special focus on ethics and healing research. A massive body of healing research references is now posted on the Web site of the Council for Healing.

The CFH goals include:
1. To alert you that these references are available and searchable.
2. To invite anyone who has contributed a study to the literature and who can provide an abstract to forward that to us to post on the site. This will provide more information and help to those who are seeking/ needing this information.
AHNA Research Grant Recipient Completes Study
Use of the Color Breathwork Relaxation Method to Reduce Anxiety 
Kari Sand-Jecklin EdD, MSN, RN, AHN-BC recently finished her study: "Use of the Color Breathwork Relaxation Method to Reduce Anxiety During Gynecologic Exam: A Feasibility Study." This study was funded by a research grant from AHNA. Gynecologic exams are often anxiety producing, and emotional stress can translate to muscular tension, resulting in an uncomfortable exam. The CBM technique is a relatively simple relaxation method combining breathing and visualization that individuals may be able to use independently after a brief instruction session.

A sample of 30 women scheduled for gynecologic exams at a University Student Health Services were instructed in the CBM technique, and encouraged to use the technique during their exams. Anxiety levels and vital signs were measured before and after the instruction and anxiety/discomfort during the exam was also measured. Almost 90% of participants rated the CBM method as helpful. In addition, participant anxiety ratings as well as diastolic blood pressure, pulse, and respiration measures were significantly lower after CBM instruction. 
The CBM technique is a potentially feasible holistic practice method for addressing anxiety in patients undergoing gynecologic exams.
Upcoming Event
National Coalition of Ethnic Minority Nurse Associations, Inc (NCEMNA) invites you to attend its 5th Annual Conference, Creating Research Careers: Leading the Way, March 13-15, 2009. Click here to learn more.
AHNA Researchers in Action
Some papers recently published by AHNA members: 
Dorothy Larkin RN, CS, MA, PhD received the first annual best paper award in Nursing Science Quarterly for her research paper "Ericksonian Hypnosis in Chronic Care Support Groups: A Rogerian Exploration of Power and Self-Defined Health-Promoting Goals". Dr. Larkin is an association professor at the College of New Rochelle Masters Program in Holistic Nursing and a clinical nurse specialist is psychiatric and mental health nursing. She is a consultant and a trainer for the conflict resolution and peer mediation program at Daniel Webster Elementary School in New Rochelle, NY.
 "Energy Psychology: A Review of the Preliminary Evidence" by David Feinstein PhD was published in Psychotherapy: Theory, Research, Practice, Training 45 (2), 199-213, 2008. The paper can be found at the ACEP (The Association for Comprehensive Energy Psychology) Web site. Feinstein's article reviews the preliminary research evidence on a growing technique in mental health. More than 2 dozen energy psychology techniques now are practiced but most well know are EFT, (Emotional Freedom Technique) TFT (Thought field therapy) and TAT (Tapas Acupressure Technique). The results that are anticipated with these techniques include: immediate reduction of elevated affect and hyperarousal, extinguishing conditioned responses, addressing complex psychological problems, and promoting optimal functioning or peak performance. Feinstein summarizes 23 studies. Additional research references on Energy Psychology and Energy Medicine can be found at www.tapintofreedom.com/research/other.html

Valeri Eschiti recently published several articles including "Grandmother breastfeeding support: What mothers need and want" in Birth: Issues in Perinatal Care and "The experience of being an Anishinabe man healer: Ancient healing in a modern world" with Roxanne Struthers RN, PhD, HN-BC and Beverly Patchell RN, MS, CNS. Valerie also published two articles on female-specific cancers; "A model of CAM use in women with female-specific cancers" in the Journal of Psychosocial Nursing and Mental Health Services and "Complementary and alternative modalities used by women with female-specific cancers" in Holistic Nursing Practice. Both articles offer continuing education.
Rorry Zahourek APRN, PhD, BC, AHN-BC and Dorothy Larkin RN, CS, MA, PhD published "Consciousness, Intentionality and Community: Unitary Perspectives and Research" in Nursing Science Quarterly.  The paper reviews research and theoretical perspectives of the relationship of consciousness and intentionality. Nursing research is reviewed and then these concepts are related to a non-local concept of community.
Elizabeth Repede MS, APRN-BC, FNP, CMH was part of a team that published an article on aromatherapy for emotional distress in the Journal of Psychosocial and Mental Health Nursing in October 2008. Elizabeth is a doctoral student.
Jennifer I. Rheingans RN, PhD, CPON wrote about "Pediatric Oncology Nurses' Management of Patients' Symptoms" and "Relationship Between Pediatric Oncology Nurses' Management of Patients' Symptoms and Job Satisfaction" both in the Journal of Pediatric Oncology Nursing. Jennifer received a Charlotte McGuire Scholarship in 2007 to help with the cost of a research study for her dissertation, these articles came out of that research. Editor's note: Doctoral students can now apply for AHNA research grants. See the article "AHNA Research Grant Applications Due March 15, 2009" above.
We would love to highlight your research publications here. Please send the citation, a link to the abstract and a brief description of the paper to Amber at info@ahna.org
Wanted: Your Words Here
Connections in Holistic Nursing Research is for and about AHNA members and we want your input and help in creating it. Do you have a great research technique, advice for would-be-researchers or access to a great resource? Would you like to write a micro article (5 paragraphs or less) for Connections? Send submissions to Amber at info@ahna.org
We would also be happy to let others know what you are doing. If you have you recently presented, started a new study, or are seeking volunteers or collaborators send your "News and Notes" to info@ahna.org
We also welcome your opinions on how we are doing and what you would like to see in future issues.
AHNA Adopts Policy on Research on AHNA Members
AHNA is an association comprised of skilled nurses with various educational and experiential backgrounds. Thus AHNA offers a rich source of data for individuals who wish to learn more about this group of nurses. The AHNA Research Committee has a developed a policy on how such research may be conducted. Click here to view policy.

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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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