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Vol. 1 No. 3
AHNA Research Grant
AHNA Awards and Scholarships
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by Rorry Zahourek PhD, PMHCNS-BC, AHN-BC
AHNA Leadership Council Coordinator for Research
Our times "they are a changing" and very rapidly. The
advent of a new administration in Washington and the promise of a revamping
of our failing illness oriented 'healthcare system' poses opportunities for
a new look at research from various perspectives. Holistic nurses
base their practice, education and research in a framework of holism that
can be called 'praxis'. Mary Enzham Hines has
contributed an article for this issue on just what this rather esoteric
term means. Carol Baldwin was chosen for the Research Profile this
issue because her work has been multi-focused, multi-method and has
application for numerous populations worldwide. Holistic nursing research
is based in a holistic approach and philosophy which means it may not
always fit into the standard formats of nursing research that we all taught
about in school. A goal of this eNewsletter is to
widen our perspective from quantitative, qualitative and triangulated
approaches to include other approaches such as historical and aesthetic,
and methods of appreciative and narrative inquiries, transpersonal
approaches. Our own leading nurse theorists have had research methods
developed around their theories. In this and future issue of Connections we will address these
other methods and approaches. If you have found a method and a research
approach you would like to share with others please let me know and we can
publish your article in Connections.
One of the challenges faced by holistic nurses researching a
complementary modality is the issue of controlling variables and doing sham
treatments as a means to reduce placebo effect. See the article below about an AHNA
member's questions about sham treatments and share your thoughts about this
issue in the AHNA Discussion Forum.
One of our goals for Holistic nursing research has been to do a
widely based multi site research project on 'What is Healing through
Holistic Nursing?' The 'brainstorming' research agenda sub committee
(Marlaine Smith, Joan Engebretson, Diane Wardell, Jeannie Crawford and Rorry Zahourek) has been
working on this since conference last summer. A project is now planned
to collect narratives at conference this year from you all about your
experiences with healing. Learn more about this project and other research
projects being conducted at conference below. We hope you will take
the time to contribute to this valuable research for AHNA and indeed for
the field of holistic-integrative care. You will find instructions at the
conference. This project also will be conducted online and again we encourage
you to contribute to our growing knowledge base.
Your Invited to the Research Committee Meeting at Conference, Friday,
Please join us at the Research Committee Meeting in the Caucus room
on Friday night from 7:30-9:00 pm. Desert will be provided.
If you are not attending conference and would like to
share your ideas with the AHNA Conference Committee, please
contact Rorry Zahourek at firstname.lastname@example.org
Profile - Carol M. Baldwin, PhD, RN, CHTP, CT,
NCC, ABMP, AHN-BC
OK, so I am an old hippie. In the words of Joseph Gallivan, "Old hippies don't die, they just lie
low until the laughter stops and their time comes round again." People
might still be laughing, but my time came round again when I got serious
about research. Ask me what my research focus is and I would have to
respond 'holistic eclectic' with culture care and quality of life themes. I
am a product of the 60's (that would be the 1960's). My research interests
were shaped by being brought up in a Beatles, 'Make Love not War,' 'Peace,'
'Far Out Man,' 'Don't be part of the problem, be part of the solution'
loving family that valued healthy skepticism, opportunities that evolved
from crises, and a strong appreciation for differences while recognizing
the connectedness of all things.
For me, holistic nursing is trans-disciplinary and
incorporates mixed-methodology (quantitative and qualitative components).
The development of scholarship teams (nurses, physicians, anthropologists,
psychologists, biostatisticians and 60's hippies) increase collaborative
activities that culminate in health promotion and disease prevention,
resources to assist with future funding for intervention and outcomes
studies, and integrates current research into clinical and academic
practice that is evidence-based. The sleep research that I have been doing
also involves collaborators in central Mexico,
and is being expanded to South America (Brazil,
Chile, Colombia, Ecuador), Korea and China. Sleep research is going
global to foster culturally responsive holistic care, including nurse
fatigue and patient safety.
My NIH, Air
Force, Veteran Administration and foundation grants have included studies
recently, my trans-disciplinary mixed-methods research has culminated in
the English to Spanish translation and validation of the sleep measure that
was used in the multi-center, multi-ethnic NIH
NHLBI Sleep Heart Health Study. We know very little about sleep and quality
of life of Spanish-speaking Mexican Americans because of the lack of
validated and culturally relevant assessment measures.
these studies mean for holistic care?
these findings holds implications for holistic nursing care, holistic
interventions, culture care, and point to future ideas for holistic nursing
Thoreau, one of the original hippies (who was from
the 1860's) wrote, "Go confidently in the direction of your dreams.
Live the life you've always imagined." Although I never imagined that
I would devote a large part of my life to holistic nursing research, I find
that some of my ideas for research come to me through dreams, and I draw on
imagination to develop and implement studies. So, I took a road less
traveled without a true 'research trajectory.' Holistic eclectic. Works for
me. I can only hope it makes some small difference for others. It
made all the difference for me. Groovy!
The photo shows me with one of our PhD students and
two colleagues in Guanajuato, Mexico.
Left to right: Cipriana Caudillo, PhD(c), RN,
Director, School of Nursing and Obstetrics, University
of Guanajuato, Leon, Mexico;
Adriana Perez, PhD(c), RN, ASU Nursing & Healthcare Innovation; Sergio
Marquez-Gamino, MD, PhD, Institute for Human
Work, University of Guanajuato, Leon;
Carol Baldwin, the Holistic Eclectic Hippie Researcher.
I am the
Southwest Borderlands (SWB) Scholar for our College of Nursing &
Healthcare Innovation (the SWB Initiative focuses on reducing health
disparities of Mexican Americans in Arizona and along its borders); and
Director of the Office of World Health Promotion & Disease Prevention
for the college. I am a Registered EEG Technologist, have an Associate
Degree in Nursing from Milwaukee Area Technical College, a BA with a double
major in Communication and Home Economics (emphasis on nutrition and family
studies) from Mount Mary College, Milwaukee, an MA in Communication (minor
in Family Counseling) from Marquette University, Milwaukee, PhD in
Biological Psychology (minor in Counseling and Guidance) from the
University of Arizona, Tucson, and BSN/MSN from the University of Phoenix,
Tucson campus. I did post-doctoral studies in sleep, environmental and
cardiopulmonary epidemiology at the University
of Arizona, College of Medicine.
I lived and taught in Korea
for 3 years and had the opportunity to do cross-cultural research, studied
ikebana, Buddhism, Asian life and culture, including death rituals (most of
my clinical work was in hospice and hospice home care). I am a Certified
Healing Touch Practitioner, Certified Thanatologist,
National Certified Counselor, and Fellow with the American Board of Medical
Psychotherapists. I am very proud to be a Board Certified Advanced Practice
Holistic Nurse. I have been selected for Fellowship in the American Academy
of Nursing and will be inducted at the annual meeting in Atlanta this fall.
I have been
a member of AHNA since 1999, an AHNA ad hoc Committee Member drafting the
position paper on
and Alternative Medicine in Nursing Practice (presented before the White House Commission on CAM (12/8/01),
reviewer for the JHN since
2002, a Charlotte McGuire Scholarship recipient in 2003, Planning Committee
Member (Research) for the 2006 American Holistic Nurses Association and
American Holistic Medical Associations joint Conference, St. Paul, MN
(6/7-10/06), and Co-chair (appointed) of the AHNA Research Committee from
Articles by Carol Baldwin
Click here to view complete article and all of
On one of my research trips to Guanajuato,
provided a guest lecture and demonstrated Basic Healing Touch to a class of
50 sophomore nursing students with translation provided by a bilingual
faculty member. This energetic modality was well-received and little was
lost in translation. Healing Touch is akin to some of the folk traditions
practiced in Mexico.
Baldwin CM, Grant M, Wendel C, Rawl S, Schmidt CM, Ko C, Krouse RS. (2008). Influence of intestinal stoma on
spiritual quality of life of U.S. veterans. Journal of Holistic Nursing, 26(3),
Melnyk B, Baldwin CM. (2008).
Evidence-based Practice. In B.M. Dossey and L. Keegan (Eds.), Holistic nursing: A handbook for practice
(5th Ed.). Boston, MA: Jones & Bartlett.
Baldwin CM, Bootzin
RR, Schwenke DC, Quan,
SF. (2005). Antioxidant nutrient intake and supplements as potential
moderators of cognitive decline and cardiovascular disease in obstructive
sleep apnea. Sleep Medicine Reviews,
Buck T, Baldwin CM, Schwartz GE. (2005). Influence of worldview on health
care choices among persons with chronic pain. Journal of Alternative and Complementary Medicine, 11,
Baldwin CM, Kroesen K, Trochim
IR. (2004). Alternative and conventional medicine: A concept map. BioMed Central: Complementary and Alternative Medicine
Baldwin CM, Long K, Kroesen KW, Brooks AJ, Bell IR. (2002). A
profile of military veterans in the southwestern United States who use
complementary and alternative medicine: Implications for integrative care. Archives of Internal Medicine, 162,
Baldwin CM, Griffith K, Nieto FJ, O'Connor GT,
Walsleben JA, Redline SR. (2001). The association
of sleep disordered breathing and sleep symptoms with quality of life in
the Sleep Heart Health Study. Sleep,
Keep up to date on news and opportunities from the National Center
for Complementary and Alternative Medicine (NCCAM) at NIH. NCCAM offers
several options for receiving news including eNewsletters
and RSS feeds, click here to learn more and subscribe.
Here is a recent news item from NCCAM Updates, "Several
initiatives are being offered by NCCAM to help fulfill the goals of the
American Recovery and Reinvestment Act (ARRA) to help stimulate the economy
through support of biomedical and behavioral research. http://nccam.nih.gov/recovery/"
Research Studies at Conference
The AHNA Research Committee is proud to announce that four research studies
are being conducted at the 29th Annual AHNA Conference.
1. In concert with our desire to explore the overall research theme
adopted by the Research Committee, "What is Healing Through Holistic
Nursing," Marlaine Smith, Diane Wardell,
Joan Engebretson and Rorry Zahourek designed a
study entitled "Holistic Nurses' Stories of Healing." Narratives
of your healing experiences will be collected at conference. A
raffle will be held for those who participate and a free one-year
membership in AHNA will be awarded to three winners, and reduced membership
to six. This study will be expanded to the web. Selected participants will
be interviewed or asked to write more extensive narratives using Chris
John's methodology and coordinated by Mary Hines.
2. Another study seeks to increase our understanding of how
holistic nurses perceive their needs for mentorship: "The Effect of
Research Mentoring on Holistic Researchers" is being conducted by Ruth
McCaffrey, Sue Robertson, and Evelyn Clingerman.
The purpose of this study is to identify factors that support or impede
mentoring and determine the effectiveness of mentee/mentor
research meetings where experienced mentors meet with less experienced or
newer researchers. Participants will be obtained from the list of mentees and mentors at the 2009 conference. Mentors and
mentees agreeing to participate in the study will
be asked to complete a short (10-15 minute) survey and demographic
questionnaire immediately following the consultation. This study will be
expanded to include focus groups in the future.
There will be two studies involving students:
3. "How AHNA membership and conference participation
fosters holistic practice" Interested RN members will be interviewed
regarding how they feel the AHNA organization and conference experience
support the profession, prevent burnout, and foster holistic creativity
delivering care to clients. Interviews will be conducted at the conference
at a time convenient to you, lasting approximately 30 min. You will be paid
$15 for participating in the interview. Findings may lead to strategies to
retain nurses who might otherwise leave the profession due to struggles
experienced in practice and may assist the nursing profession to gain
insight into how to better support nurses in holistic practice. This study
is conducted by Sue Peck and students Carrie Diehn,
4. Another study is being conducted by Glenda Christiaens,
Jo Ann Abegglen and 12 undergraduate nursing
students. They will conduct a continuation of the study they did last year
at conference. The purposes of the study are to: 1) Describe the advice
that expert holistic nurses give to nursing students regarding the theory
and practice of holistic nursing, and 2) Describe nursing students'
experience and perceptions of their interaction with expert holistic
nurses. Six expert holistic nurses will be invited to participate in the
study via email or in person. Each participant will be interviewed by a pair
of nursing students during the 2009 AHNA conference.
Is Sham Treatment Useful in Research
Zahourek PhD, PMHCNS-BC , AHN-BC
One of the
challenges faced by holistic nurses researching a complementary modality is
the issue of controlling variables and doing sham treatments as a means to
reduce placebo effect. The following e-mail discussion is partially
reproduced with the originating author's (Barbara Note) permission. She
writes, "I am conducting a research study at my hospital with a
co-investigator and another author outside of the hospital. The title
is "The Impact of Reiki on Total Knee Replacement Patient's Perception
of Post Operative Pain and Return to Daily Activities". This study is
halfway completed and we have been funded by a Foundation. Recently a
new chairman has taken over the Foundation and has asked us to add an arm
to this study. This would be a Sham Control arm in addition to the
Experimental and Control... Now we are using a Control group (which
receives standard care) and an Experimental that receives Reiki pre-op and
post-op and then three days afterwards. I'd like your opinion if this
I responded, "Your question is an important one in Holistic Nursing
Research. The whole issue of sham treatment and placebo effect is one that
has confounded research on energy based modalities and other CAM modalities. Janet Quinn tried to do sham TT and
be her own control but she was unable to control for her
intention to heal. When you review the TT research and also look at
the problems regarding a lot of CAM
research, the issue of sham treatment and placebo effect is always both a
problem and a potential therapeutic effect because you cannot control for
intent of the practitioner who just waves their hands over someone in a
sham treatment. Is a placebo response not actually a therapeutic
response based on suggestion and indicative of a strongly connected integral
mind-body effect? My opinion is that a "no treatment group" is
about as good as you can get in trying to initiate a control group. Also,
if you add a third group you will need a bigger sample."
Ruth McCaffery responded to her as follows,
"In several research studies that I have completed I used a comparison
group rather than a sham group. For example, in a study using guided
imagery and mindful walking for depression in the elderly, I used an art
therapy group as a comparison because there is quite a bit of literature on
the ability of art therapy to reduce depression. Therefore if the guided
imagery walking group had as much, or nearly as much, of a reduction in
depression as the art therapy group then the intervention was successful in
This 'problem' and issue is now posted on the AHNA Discussion Forum. Please join the
discussion. Share your experience and your knowledge it will help us all.
Editor's Note: Due to the advice from AHNA members the study was able
to go forward as originally planned.
Extra Bonus for AHNA Conference Attendees
This year AHNA Conference attendees will receive a free one-year subscrition to Shift magazine (Institute
of Noetic Sciences) and one-year digital
subscriptions to the International Journal of Healing and Caring
(Dan Benor, MD), Bridges magazine (ISSSEEM)
and Norm Shealy's monthly eNewsletter. Many thanks to our Gold Media Sponsors!
Caring and Holism: A Philosophical Model for Nursing Praxis
The following is are the highpoints from a
comprehensive article by Mary Enzham Hines on
Praxis for Holistic nursing. Please see the entire article.
It has been predicted that our greatest advances in the next decade will
not come from technology but from our deeper understanding of what it means
to be a human, spiritual being [1, p. 1]."Bringing
together "knowing" and "doing" is praxis-the
synchronous, thoughtful reflection and
action to create a desired future of emancipatory
change"[2, p. 22].
Today, each nurse and advanced practice nurse is challenged to engage
in practice with patients from a myriad of backgrounds, cultures, and
healthcare challenges. Although always focused on the primary prevention of
disease and a health promotion model, nurses have been encouraged to
maintain nursing theory and research as a basis for their practice.
The Art of Caring and Holism as a
Philosophical Model for Nursing Praxis
Caring is a human mode of being. Caring is the foundation that
provides a framework for nursing praxis.[2,4] Praxis is a
synthesis of thoughtful reflection, caring,
and action within a theory and research-driven practice.
The "art of nursing" is a phrase that is familiar yet lacks
clarity of definition in the nursing literature.
Aesthetic knowing has been distinguished from scientific knowing as an
expressive rather than a formal or descriptive way of knowing. Aesthetic knowing
involves the creation and appreciation of a singular, particular,
subjective expression of possibilities or realities. Chinn and
Kramer[2, p. 81] extended the definition of
patterns of knowing to include emancipatory
knowing, "a fundamental pattern of knowing in nursing related to the
perception of deep meanings, calling forth inner creative resources that
transform experience into what is not yet real, but possible".
Praxis is the bringing together of "knowing" and "doing";
praxis requires both inward and outward reflection[4, p. 81].
Nursing praxis, therefore, is more than the clinical skills and knowledge
that nurses possess and use. Praxis is a coherent structure of the nurse's
work that integrates guiding values, specific actions consistent within the
social mission of the profession, knowledge construction, community
awareness, and the realization that within a profession lies the process of
bringing about some human good. Looking beyond personal
experience to reflect the broader social and cultural implications of the
situation is one tangible view of praxis.
Chinn and Kramer pose that praxis is value-grounded, thoughtful reflection
and action that occurs in synchrony and integrates knowledge with the
nurse's caring human potential in the patient encounter. Nursing is a holistic, humanistic, caring practice.
It occurs when scientific competence, therapeutic use of self,
moral/ethical comportment, and transformative acts occur in synchrony.
It is the responsibility of each nurse to define her essence of practice
through the translation of knowledge, theory, and research; a professional
praxis. When the constructs of praxis are synchronous, a nurse reveals the
essence of holistic caring. Integrating Watson's Theory of Human Caring
into practice provides a holistic, humanistic view of the person which
challenges the nurse to see the patient as a whole being in need of care.
AHNA Researchers in Action
We would love to highlight your research here. Please send the
citation, a link to the abstract and a brief description of the paper to
Amber at email@example.com
Connect with 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 firstname.lastname@example.org
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 email@example.com
welcome your opinions on how we are doing and what you would like to see in
Presenting at the 2010 AHNA Conference?
AHNA Web site in July 2009 for more information about submitting a proposal
to present at the 30th Annual AHNA Conference June 3-6, 2010. The Re-Visioning Environment: Creating a Habitat for
Healing themed conference will be held in Colorado Springs, Colo.
The Voice of
American Holistic Nurses Association
323 N. San Francisco St. #201
Flagstaff, AZ 86001