Patient and Provider Decision-Making Experiences: A Qualitative Study.

The purpose of this qualitative descriptive study was to explore patient and provider experiences in making health care decisions. A convenience sample of primary care patients and providers was engaged in face-to-face and telephone interviews, to elicit participants' experiences in making health care decisions. Three main themes were identified in the data: Involvement, including being in control and accepting responsibility; seeking and confirming Information; and establishing communication and negotiating trust in the patient-provider Relationship. Themes identified in the data describe the elements involved in health care decision-making, and depict the relationship between patient and provider as being central to the making of health care decisions. In addition, the subthemes of control and negotiation merit additional in-depth exploration to illuminate the implicit and explicit expressions of hierarchy in the patient-provider relationship, as this hierarchy appears to hinder efforts at sharing decisions in health care encounters.

Paired practica as a pedagogical process in holistic nursing curriculum development.

Nurses have long advocated for significant transformations in the way that care is offered. Among advanced holistic nursing programs, there are no particular models for developing curricula and practica. This article describes a pedagogical process of a holistic health assessment as a context for paired practica of graduate and undergraduate nursing students to simultaneously engage in knowledge discovery.

A legacy building model for holistic nursing.

This pilot project was an effort to record the historical roots, development, and legacy of holistic nursing through the visionary spirit of four older American Holistic Nurses Association (AHNA) members. The aim was twofold: (a) to capture the holistic nursing career experiences of elder AHNA members and (b) to begin to create a Legacy Building Model for Holistic Nursing. The narratives will help initiate an ongoing, systematic method for the collection of historical data and serve as a perpetual archive of knowledge and inspiration for present and future holistic nurses. An aesthetic inquiry approach was used to conduct in-depth interviews with four older AHNA members who have made significant contributions to holistic nursing. The narratives provide a rich description of their personal and professional evolution as holistic nurses. The narratives are presented in an aesthetic format of the art forms of snapshot, pastiche, and collage rather than traditional presentations of research findings. A synopsis of the narratives is a dialogue between the three authors and provides insight for how a Legacy Model can guide our future. Considerations for practice, education, and research are discussed based on the words of wisdom from the four older holistic nurses.

The covered wagon journey: student chronicles in advanced holistic nursing.

This article recounts the experiences of a first cohort of graduate students in a newly implemented advanced holistic nursing (AHN) track, one of only a handful in the nation, and the first in Florida. The increasing popularity of complementary and alternative healing processes represents the insufficiency of a health system of fragmented care and a desire for holistic healing that is beyond mainstream allopathic care. Graduate holistic nurse education equips nurses to explore the commitment needed to advance the evolution of health care. The covered wagon journey is a metaphor for this meaningful participation. Students journaled their experiences as cotravelers in a lone wagon: embarking on a courageous journey, forging a path of discovery, and reaching their destination as pioneers. This cohort experience embodied the central tenets of holistic nursing, thus creating conscious change and unity within a learning community. The future of AHN is addressed in the context of the contemporary health care environment.

Creation of an American Holistic Nurses Association research consultation program.

A goal of the American Holistic Nurses Association (AHNA) Research Committee is to prepare holistic nurses to conduct holistic nursing research. This article describes the creation of a Research Consultation Program and how the knowledge gained from the program will contribute to the development of a formal research mentor program.

Cocreating a communicative space to develop a mindfulness meditation manual for women in recovery from substance abuse disorders.

Mindfulness-Based Stress Reduction (MBSR) programs are becoming more integrated into the treatment of persons with substance use disorders (SUDs). A focus of MBSR is to increase awareness of sensations in the body and accept them in the moment without judgment. Little is known about the readiness of women, with posttraumatic stress disorder (PTSD), and their level of comfort to participate in MBSR programs. Habermas' ideal speech situation guided a cooperative inquiry with 45 women at 3 treatment centers. Women engaged in activities of MBSR and shared opinions on how to develop a manual that would address the readiness of women with SUDs-PTSD to participate in MBSR.

Curriculum as environment: a focus group study.

Curricula development is critical for the advancement and evolution of holistic nursing education. Although the American Holistic Nurses Association offers advanced practice board certification for graduate nurses, there is a scarcity of available graduate holistic nursing courses and curricula. The researchers developed a curriculum for an advanced holistic nursing program at a university college of nursing in South Florida. The curriculum and process of development were presented at a workshop during a national holistic nursing conference. A portion of the workshop included an opportunity for attendees to voluntarily participate in a focus group research study. The specific aim of the research was to determine the best approaches for the development of curricula for the promotion of graduate holistic nurse education based on the insights of holistic nurses, nurse educators, nurse practitioners, and scholars. A content analysis identified 3 themes that addressed holistic nursing curriculum: (1) consider curriculum as an evolving blueprint for personal and professional growth; (2) embrace the uniqueness of students; and (3) encourage faculty to co-create the learning environment.

Creating a graduate holistic nursing program.

In Spring 2010, an innovative Master of Science in Holistic Nursing track was launched in as the realization of a vision for graduate holistic nursing held by the faculty of the Christine E. Lynn College of Nursing in Palm Beach County. As 1 of 6 such tracks in the nation and the only holistic master's program in Florida, there were few guideposts to lead the way. The development of holistic nurse education that answered to student, community, and faculty needs within an unpredictable health care environment involved courage, commitment, and risk taking. The purpose of this article is to describe the philosophical foundations, professional framework, and development process that gave form and shape to the advanced holistic nursing track.

An emic view of caring for self: grandmothers who care for children of mothers with substance use disorders.

In the US more than 3.4 million children live with a mother who has a substance abuse disorder (SUD) and at some time in their life will be cared for by a grandmother. Most studies have focused on the economic, physical and emotional burdens of the conflated role of mother/grandmother. This study explores how 11 grandmothers cared for themselves while caring for the children of mothers with SUDs. The domain of inquiry was the self-care practices of grandmothers from an emic (generic) view. An assumption of the study was that the grandmothers represent a unique sub culture of women with particular beliefs, values and practices. An ethnographic approach was used to collect data from observations, in-depth interviews, and participant observation in various community settings. Patterns and themes revealed relational aspects of caring for self focused on the emic beliefs of self-care. The themes of being obligated and dedicated; distancing oneself as a reasoned action; and accepting the magnitude of the problem clearly identified the ability of grandmothers to take actions and make decisions about how to care for themselves. Leininger's three modes of care are represented in a schema of the emic view of caring for self. The schema is an illustration of the dynamic capacity of grandmothers to know and meet their own self-care demands and needs in order to care for their grandchildren. The need for increased awareness to change public policy and legislation related to the complex issues of caregiving by grandparents is addressed.

Evaluating Mindfulness-Based Stress Reduction: analyzing stories of stress to formulate focus group questions.

The primary purpose of this analysis was to learn how therapeutic community (TC) residents describe Mindfulness-Based Stress Reduction (MBSR) delivered as part of their substance use recovery experience. A secondary purpose was to develop focus group questions guided by TC residents' descriptions. Two researchers independently analyzed 38 written stories about stress in the TC. The researchers used conventional content analysis; independent analysis was followed by consensus dialogue to identify key words and code definitions. Three themes emerged from the content analysis: utility, portability, and sustainability. Participants talked about MBSR as a tool which helped them "manage" their recovery, noting that they used MBSR techniques in the TC and off-site. They believed they could use MBSR even after exiting the TC. Three focus group questions were formulated, one for each theme. Content analysis of stories of stress provided substantive guidance for formulating focus group questions which incorporated the voice of participants through familiar terms and friendly language.

The usefulness of the community nursing practice model in grounding practice and research: narratives from the United States and Africa.

A community nursing practice (CNP) model is presented as the synthesis of a decade of experience of caring for persons and communities. Values form the basis of the model and provide the grounding for practice. Transcendent values of respect, caring, and wholeness are explicated in the actualizing values of primary health care: access, essentiality, empowerment, intersectoral collaboration, and community participation. Usefulness of the CNPM in providing a framework for community nursing practice at school-based community wellness centers in both the United States and Africa is described. Narratives of practice and research presented in the unique voice of three faculty members illuminate the model's values and paradigmatic view of person, nursing, community, and environment. These narratives provide insight into how the CNPM has served as a heuristic in the design of creative responses to calls for nursing in community nursing practice, education, and research.

Mutual moral caring actions: a framework for community nursing practice.

A community practice framework is presented as the synthesis of research findings from the analysis of a critical ethnonursing study of women in recovery from chemical dependence. Critical Social Theory is used to examine the paradoxical experiences of women from their lifeworld and system within the community. The framework focuses on the mutual moral caring actions of the community nurse and the women in the recovery. It is supported by the concepts of transcultural nursing ethics. The utility of the framework is to promote clarity of speech and parity of community membership for women in recovery from chemical dependence and their return to the community.

Anxiety in children with epilepsy.

Although the prevalence is unknown, affective disorders are more common in children with epilepsy than in healthy controls. The purpose of the present study was to examine the occurrence of anxiety in children and adolescents with epilepsy and to determine factors associated with elevation of these symptoms. Children and adolescents (n=101) between the ages of 6 and 16 years were given the Revised Children's Manifest Anxiety Scale (RCMAS). Mild to moderate symptoms of anxiety were reported by 23% of the patients. Based on regression analysis, factors significantly associated with increased anxiety included the presence of comorbid learning or behavioral difficulties, ethnicity, and polytherapy. Results suggest the need to monitor children and adolescents with epilepsy for affective symptoms in order to provide appropriate interventions.

Parental anxiety and quality of life in children with epilepsy.

Parental beliefs and attitudes concerning epilepsy may significantly impact adjustment and quality of life for both the child and family. The purpose of the present study was to examine the relationship between parental anxiety and quality of life in pediatric patients with ongoing epilepsy. Subjects were parents (n=200) of children between the ages of 6 and 16 years who had been diagnosed and treated for epilepsy for at least 1 year. Parents were given quality of life and anxiety questionnaires during the child's clinic visit. A stepwise regression analysis suggested that severity of comorbid conditions, parental anxiety, seizure control, and number of medications were significantly associated with quality of life for these children. Parents with increased anxiety whose children had poorly controlled seizures and a comorbid disability were found to have diminished quality of life.

The course of inattentive and hyperactive-impulsive symptoms in children with new onset seizures.

The purpose of the present study was to determine the prevalence of inattentive and hyperactive-impulsive symptoms in children with newly diagnosed epilepsy, explore the course of these symptoms over time, and examine factors associated with change in these symptoms. Parents of children (n=42) were administered the Attention Deficit Disorder Evaluation Scale-Home Version (ADDES-HV) at the time of diagnosis. The ADDES-HV was readministered after the child's seizures were controlled. Prior to initiation of anticonvulsant therapy, 31% of the children were rated as having clinically significant problems with inattention and 31% with hyperactivity-impulsivity. At follow-up, 27% had elevated symptoms of inattention and 24% had hyperactivity-impulsivity. Analysis of this change indicated that children with a normal MRI were more likely to have decreased hyperactive-impulsive behaviors following control of their seizures. Results suggest the need for assessment and monitoring of attention in children with epilepsy.

Symptom differences in children with absence seizures versus inattention.

Objective. Differentiation between the diagnoses of absence seizures and Attention Deficit Hyperactivity Disorder (ADHD), Predominantly Inattentive Type, is frequently confounded by similarities in symptom presentation. The purpose of the present study was to determine symptoms that would distinguish between the disorders.Methods. Prior to diagnosis, parents of children with absence seizures (n=17) or ADHD, Predominantly Inattentive Type (n=26), were administered the Attention Deficit Disorder Evaluation Scale-Home Version (ADDES-HV). A statistical model was developed based on age, gender, race, and items from the Inattentive Scale of the ADDES-HV.Results. Two items, "does not complete homework" and "does not remain on task," correctly classified 40 of 43 children. Children with absence seizures were rated by their parents as having a low rate of occurrence of these behaviors.Conclusion. Lack of sustained attention distinguished between the groups and was much more prevalent in children with ADHD, Predominantly Inattentive Type.

Factors Associated with Academic Achievement in Children with Controlled Epilepsy.

Children with epilepsy are at risk for academic underachievement. Multiple etiologies for this academic vulnerability have been suggested by past research including lower self-esteem, inattention, memory inefficiency, and lower socioeconomic status. The present study assessed 65 children (mean age = 10 years, 5 months) with well-controlled epilepsy on the four primary factors, as well as academic achievement and intelligence. A stepwise regression analysis was employed with academic achievement as the dependent variable and measures of self-esteem, attention, memory, and socioeconomic status as independent variables. When intelligence was controlled, attention was the only variable associated with achievement scores. Seizure variables including seizure type and duration of epilepsy were not associated with differences in academic performance. Findings support the importance of measuring attention skills in children with epilepsy and suggest that reduced auditory attention skills may be associated with decreased academic performance in these children.