A Roy model study of adapting to being HIV positive.

Roy's adaptation model outlines a generic process of adaptation useful to nurses in any situation where a patient is facing change. To advance nursing practice, nursing theories and frameworks must be constantly tested and developed through research. This article describes how the results of a qualitative grounded theory study have been used to test components of the Roy adaptation model. A framework for "negotiating uncertainty" was the result of a grounded theory study exploring adaptation to HIV. This framework has been compared to the Roy adaptation model, strengthening concepts such as focal and contextual stimuli, Roy's definition of adaptation and her description of adaptive modes, while suggesting areas for further development including the role of perception. The comparison described in this article demonstrates the usefulness of qualitative research in developing nursing models, specifically highlighting opportunities to continue refining Roy's work.

Negotiating uncertainty: the transitional process of adapting to life with HIV.

Glaser's (1978) grounded-theory method was used to investigate the transitional process of adapting to life with HIV. Semistructured interviews took place with 8 male HIV-infected participants recruited from a clinic in South Wales, United Kingdom. Data analysis used open, substantive, and theoretical coding. Adapting to a life with HIV infection emerged as a process of adapting to uncertainty with "negotiating uncertainty" as a core concept. Seven subcategories represented movements between bipolar opposites labeled "anticipating hopelessness" and "regaining optimism." This work progresses the theoretical concepts of transitions, uncertainty, and adaptation in relation to the HIV experience.

Being a qualitative researcher.

This article, from a keynote address, is the result of some of the things which I learned about qualitative research during my many years of doing and teaching it. The main point I make is that qualitative researchers should present a good story which is based on evidence but focused on meaning rather than measurement. In qualitative inquiry, the researchers' selves are involved, their experiences become a resource. Researchers cannot distance themselves from the other participants, although they cannot fully present their meaning and experience. I also discuss voice, paradigm, and innovation as potentially problematic issues in qualitative research. These are terms often used but not always examined for their meaning in qualitative inquiry. If researchers are aware and sensitive, rather than overemotional or self-absorbed, qualitative research can be enlightening, person-centered, and humanistic.

My life: my encounters with insanity.

Evocative memories of an early career in mental health nursing contextualize an alienation from traditional psychiatric practices. These memories tell tales that center on exploring a personal rejection of mental health nursing practices that were based on a reductive-pharmacological approach. In its place, it is suggested, should be the adoption of more holistic ideology that places the person at the very center of mental health nursing as a holistic, human-centered activity. This process may be guided by, for example, the adoption of the principles of the Tidal Model.

Effects of music listening on adult patients' pre-procedural state anxiety in hospital.

UNLABELLED: EXECUTIVE SUMMARY: BACKGROUND: Anticipation of an invasive procedure in hospital is likely to provoke feelings of anxiety and stress in patients. An unfamiliar environment, loss of control, perceived or actual physical risk, dependence on strangers and separation from friends and family are all factors that can contribute to the development of such feelings. Recently, there has been considerable interest in the anxiolytic potential of music listening in a variety of clinical settings, yet thus far, little is known about the impact of music listening on the pre-procedural patient population. A systematic review of all literature to date was indicated to improve understanding of outcomes and impact of music listening on pre-procedural anxiety, thus helping nurses decide whether or not to incorporate music listening into practice and to highlight a need, or otherwise, for a related primary research agenda. OBJECTIVE: The objective of this review was to determine the best available evidence on the effectiveness of music listening in reducing adult hospital patients' pre-procedural state anxiety. INCLUSION CRITERIA: Types of studies This review included randomised controlled trials and quasi-experimental research designs that examined the efficacy of music listening in reducing state anxiety among pre-procedural hospital patients published between January 1985 and February 2006. The search was limited to publications after 1985 to coincide with the increasing interest and use of complementary therapies within health care during the 1980s and 1990s. Types of participants Participants of interest to the review were adult day patients, ambulatory patients and inpatients who were about to undergo any type of clinical procedure. Types of intervention The review focused on studies that investigated pre-procedural music listening employed and prescribed as a potentially therapeutic activity. It excluded any other form of music therapy. Types of outcome measures The primary outcome measures examined were alterations in state anxiety and a variety of physiological variables such as blood pressure and respiration and heart rates. SEARCH STRATEGY: A search for published and unpublished literature between January 1985 and February 2006 was conducted using all major electronic databases. A three-step search strategy was devised which consisted of using high-precision MeSH terminology and keywords to ensure that all material relevant to the review was captured. CRITICAL APPRAISAL: The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using the standard Joanna Briggs Institute (JBI) critical appraisal tools. DATA EXTRACTION AND SYNTHESIS: Data were extracted from the studies that were identified as meeting the criteria for methodological quality using a data-extraction tool developed for the review. Studies were grouped by outcome measure and summarised using tabular and narrative formats. RESULTS: The review demonstrated that state anxiety is defined and measured using both psychological and physiological parameters. Music listening had a consistently positive and statistically significant effect on reducing psychological parameters of pre-procedural state anxiety. However, the results from the measurement of various pre-procedural physiological parameters failed to reveal any consistent positive changes in patients who had listened to music. This calls into question the adequacy of the theories in this area which link anxiety and the automated and central nervous systems and the effect that music listening may have on these processes and physiological responses. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: 1 In order to reduce anxiety, it is likely that patients will benefit psychologically from having the opportunity to listen to music in the immediate pre-procedural period. 2 Patients do not appear to experience any alteration in physiological status as a result of listening to music. 3 Further research is indicated in order to replicate existing studies, to strengthen the evidence to support such interventions and to establish intervention parameters. 4 Further research is needed analysing the physiological mechanisms by which music listening is believed to reduce state anxiety and the contribution of the automated and other nervous systems to this reduction.

Effects of music listening on adult patients' pre-procedural state anxiety in hospital.

BACKGROUND: Anticipation of an invasive procedure in hospital is likely to provoke feelings of anxiety and stress in patients. An unfamiliar environment, loss of control, perceived or actual physical risk, dependence on strangers and separation from friends and family are all factors that can contribute to the development of such feelings. Recently, there has been considerable interest in the anxiolytic potential of music listening in a variety of clinical settings, yet thus far, little is known about the impact of music listening on the pre-procedural patient population. A systematic review of all literature to date was indicated to improve understanding of outcomes and impact of music listening on pre-procedural anxiety, thus helping nurses decide whether or not to incorporate music listening into practice and to highlight a need, or otherwise, for a related primary research agenda. OBJECTIVE: The objective of this review was to determine the best available evidence on the effectiveness of music listening in reducing adult hospital patients' pre-procedural state anxiety. INCLUSION CRITERIA: Types of studies This review included randomised controlled trials and quasi-experimental research designs that examined the efficacy of music listening in reducing state anxiety among pre-procedural hospital patients published between January 1985 and February 2006. The search was limited to publications after 1985 to coincide with the increasing interest and use of complementary therapies within health care during the 1980s and 1990s.Types of participants Participants of interest to the review were adult day patients, ambulatory patients and inpatients who were about to undergo any type of clinical procedure.Types of intervention The review focused on studies that investigated pre-procedural music listening employed and prescribed as a potentially therapeutic activity. It excluded any other form of music therapy.Types of outcome measures The primary outcome measures examined were alterations in state anxiety and a variety of physiological variables such as blood pressure and respiration and heart rates. SEARCH STRATEGY: A search for published and unpublished literature between January 1985 and February 2006 was conducted using all major electronic databases. A three-step search strategy was devised which consisted of using high-precision MeSH terminology and keywords to ensure that all material relevant to the review was captured. CRITICAL APPRAISAL: The methodological quality of included studies was assessed by two reviewers, who appraised each study independently, using the standard Joanna Briggs Institute (JBI) critical appraisal tools. DATA EXTRACTION AND SYNTHESIS: Data were extracted from the studies that were identified as meeting the criteria for methodological quality using a data-extraction tool developed for the review. Studies were grouped by outcome measure and summarised using tabular and narrative formats. RESULTS: The review demonstrated that state anxiety is defined and measured using both psychological and physiological parameters. Music listening had a consistently positive and statistically significant effect on reducing psychological parameters of pre- procedural state anxiety. However, the results from the measurement of various pre- procedural physiological parameters failed to reveal any consistent positive changes in patients who had listened to music. This calls into question the adequacy of the theories in this area which link anxiety and the automated and central nervous systems and the effect that music listening may have on these processes and physiological responses.

Nursing, healthcare, and culture: a view of the year 2050 from Germany and the United kingdom.

This column presents a dialogue with German nurse scholar Gerd Bekel and United Kingdom nurse scholars, Francis C. Biley and Kirstin Fragemann, who share their respective visions and understanding of each country's vision of nursing, healthcare, and quality of life in the year 2050.

Primum non nocere: thoughts on the need to develop an 'adverse events' register for complementary and alternative therapies.

Building a body of knowledge to support the efficacy and practice of complementary and alternative therapies is an imperative that should be fully embraced by all those involved. Additional endeavours to monitor adverse events related to complementary and alternative therapies should also be pursued. The history and extent of medical iatrogenesis is briefly outlined, as is the literature on adverse events related to complementary and alternative therapies. Allopathic medicine is slowly realising the negative impact of iatrogenesis and is starting to develop systems to monitor such events in order to reduce or eliminate their existence. It is suggested that a similar development is needed in complementary and alternative therapies, so that it can be ensured that, at a minimum, primum non nocere, the therapy should firstly do no harm.

Aesthetics, postmodern nursing, complementary therapies and more: an Internet dialogue.

Electronic means of communication opens up whole new realms of possibilities. Whilst discussing how Jean Watson's new book and CD could be reviewed in perhaps more unconventional ways an idea slowly emerged that we could conduct an e-mail interview and talk about several of the many issues that are raised by both of these works of art. Over a period of several months during the years 2000 and 2001, e-mails sped their way to and fro across the Atlantic, the interview soon took on a mind of itself. What follows is the emergent.

An exploration of the potential risks associated with using pet therapy in healthcare settings.

The widespread inclusion of companion animals into the homes and lives of humans has prompted a considerable amount of research into the health benefits of such relationships. Findings seem to confirm that if humans interact with companion animals they are likely to experience various health benefits. Programmes that encourage and facilitate pet visiting schemes in hospitals have developed and animals can often be found in in-patient and long-term care facilities, with the aim of contributing towards a positive therapeutic milieu. Despite supportive research evidence, the adoption of such a therapeutic activity may have been restricted by the belief that client safety could be compromised by an increase in the risk of infection acquired from animals, allergic responses and bites. This paper explores the literature on these risks and concludes that, in a controlled health care environment in urban Europe or North America and with responsible human behaviour the potential benefits of sharing our lives with companion animals, either at home or hospital, far outweigh the apparently insignificant risks. Recommendations aimed at limiting the potential risk of infection and guidelines for the safe management of pet therapy are developed.

Martha E Rogers.

Martha Rogers, a nurse leader and theorist whose significant contribution to the development of nursing theory', practice, education and research cannot be surpassed, died on March 12 at the age of 79.