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Connections in Holistic Nursing Research

June 2009 
Vol. 1 No. 3

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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, 7:30-9:00 pm

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 rorryz@aol.com


CarolResearch Profile -  Carol M. Baldwin, PhD, RN, CHTP, CT, NCC, ABMP, AHN-BC

Carol BaldwinOK, 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 of

Most 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. 

What do these studies mean for holistic care?

Each of these findings holds implications for holistic nursing care, holistic interventions, culture care, and point to future ideas for holistic nursing research. 

Henry David 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 and Japan 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

Complementary 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 2004-2006.


Selected Articles by Carol Baldwin

Click here to view complete article and all of Carol's references


On one of my research trips to Guanajuato, Mexico, I 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), 185-194.



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, 9, 459-476.

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, 561-568.

Baldwin CM, Kroesen K, Trochim WM, Bell IR. (2004). Alternative and conventional medicine: A concept map. BioMed Central: Complementary and Alternative Medicine 4:2 (www.biomedcentral.com/1472-6882/4/2).

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, 1697-1704.

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, 24, 96-105.


NCCAM Updates

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

Conf 2009 logo

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, Ann Henry.
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.


shamIs Sham Treatment Useful in Research    

by Rorry 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 is necessary."

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 reducing depression."

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.[
3] Caring is the foundation that provides a framework for nursing praxis.[2,4] Praxis is a synthesis of thoughtful reflection[2], 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
.[2] 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[
8]. Looking beyond personal experience to reflect the broader social and cultural implications of the situation is one tangible view of praxis[4].

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
.[4] 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 info@ahna.org


Connect with Connections

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.


Interested in Presenting at the 2010 AHNA Conference?

Visit the 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 Holistic Nursing 

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