Healing Touch: A Strategy for Acute Care Nurses' Stress Reduction.

The purpose of the study is to determine whether administering healing touch (HT) is more effective than deep breathing (DB) for reducing acute care nurses' stress during a shift. A randomized cluster trial assessed 150 nurses' vital signs and Visual Analog Scale for Stress (VASS) levels pre, post, and at follow-up to achieve a power of .7 and medium affect size. Open-ended questions following the intervention enriched quantitative findings describing the experience, facilitators, and barriers to potential use in nursing. The generalized estimating equation 1 (GEE1) comparisons of mean change over time, found that nurses in the HT intervention, had significantly lower VASS stress scores at posttreatment (-0.95, p = .0002) and at follow-up (-0.73, p = .0144) than the DB group, and the respiratory rate (RR) rate differences were nearly significant at post-intervention and significant at follow-up, respectively (1.36, p = .0568 and -2.28, p = .0011), indicating lower RR after HT. These findings support the use of HT as an effective stress reduction strategy as a relevant strategy to sustain a viable nurse work force post-COVID-19.

Reflection and moral maturity in a nurse's caring practice: a critical perspective.

The likelihood of nurse reflection is examined from the theoretical perspectives of Habermas' Theory of Communicative Action and Moral Action and Sumner's Moral Construct of Caring in Nursing as Communicative Action, through a critical social theory lens. The argument is made that until the nurse reaches the developmental level of post-conventional moral maturity and/or Benner's Stage 5: expert, he or she is not capable of being inwardly directed reflective on self. The three developmental levels of moral maturity and Benner's stages are presented with discussion on whether or not there can be self-reflection because of an innate vulnerability that leads to self-protective behaviours. It is only when the confidence from mastery of practice has been achieved can the nurse be comfortable with reflection that enables him or her to become enlightened, emancipated, and empowered. The influences and constraints of the knowledge power between nurse and patient are acknowledged. The power hierarchy of the institution is recognized as constraining.

A critical lens on the instrumentation of caring in nursing theory.

Critical Social Theory (CST) is a methodology that enables the researcher to examine the pressures and constraints in any society, posing the following questions: What is the false consciousness, the gaps and the silences as well as restraining, historical and mindlessly accepted norms. This CST lens is applied to Sumner's theory The Moral Construct of Caring in Nursing as Communicative Action and its instrumentation. The pilot testing data are discussed using Fontana's CST process: critique, context, politics, emancipatory intent, democratic structures, dialectic analysis, and reflexivity. Ideal communication in the nurse-patient relationship is bidirectional, multifaceted, complex, and difficult to achieve.

The Moral Construct of Caring in Nursing as Communicative Action: the theory and practice of a caring science.

This article presents an instrument and data testing a theory of the Moral Construct of Caring in Nursing as Communicative Action. Pilot testing involved 185 items administered to 82 nurses in 3 countries. The instrument includes 7 subscales addressing the nurse's personal and professional selves, the patient's personal and illness selves, the bidirectional interaction, the moral maturity of both, and the current state of nursing practice. Results suggest that the theory provides predictive control of the phenomena, drawing attention to the founding of evidence-based practice on practical, workable theory. Research continues, focusing on refining construct definitions and improving reliabilities.

Is caring in nursing an impossible ideal for today's practicing nurse.

This qualitative study's objective was to examine the nurse/patient relationship in the present acute healthcare delivery system in 3 countries: the United States, New Zealand, and the United Kingdom. The hypothesis was that both nurse and patient were vulnerable and in need of a fundamental considerateness. The subjects were 9 female and 1 male white nurses who had a baccalaureate degree or its equivalent and less than 5 years' practice experience. Critical social theory was the method utilized, which permitted the researcher to examine the underlying power structure, its barriers, silences, and how the nurses were coping. The themes were "being normal," "little things," the hardness of nursing, practice organization, malcontent, and power and control. The conclusion is that nurses are passionate about their work, they are proud of what they do, and they try to maintain the highest standard of care, but they are tired. All have a silent cry for considerateness.

A case study: the clinical application of quadrangular dialogue--a caring in nursing teaching model.

Teaching caring in nursing is expected of nursing faculty, but the practical application is rarely explained. It has been regarded as the moral responsibility of faculty to teach in a caring way. This case study relates how one faculty applied the concepts to quadrangular dialogue a caring model of nursing education to the experience of baccalaureate student nurses in their first clinical rotation. The components of quadrangular dialogue will be described, and applied to a specific patient who was cared for by students in one semester. This model is developed from Habermas' (1995) Theory of Communicative Action and Moral Consciousness, Bishop and Scudder's (1990) Triadic Dialogue and a caring in nursing paradigm developed by this author. It explains how the patient, nursing student and nursing faculty are all first person in the interaction, while the illness is object. By acknowledging the humanness of participants, validation and fulfillment for each follow.

Why are nurses leaving nursing?

The causes of nurses' exodus from acute health care delivery practice may lie more in intrinsic factors rather than the heretofore overtly expressed reasons. This article examines bureaucratic factors, issues related to the medical profession and medical/scientific discourse, and factors within the nursing profession itself that may contribute to a nurse's unhappiness and dissatisfaction that causes him or her to leave. Nursing as emotional work and the implications for the individual nurse, and nursing as moral and moral distress are discussed. Suggestions to facilitate retention are made for changing the work environment to feel valued for their skillfully applied humanness.