Energy and enthusiasm permeated the atmosphere during the research proceedings of the 25th Annual American Holistic Nurses Association (AHNA) Conference, held in King of Prussia, Pennsylvania. In this age of evidence-based practice, holistic nurses were drawn to learning about research in order to improve their nursing practice and gain credibility. Nurses, as a group, have tended to shy away from research, viewing it as an "ivory tower" exercise and not always recognizing its vital connection to nursing practice. After hearing the research presentations, however, one participant exclaimed, "I thought research was boring, but you made it fun!"
AHNA defines holistic nursing this way: "Holistic nursing embraces all nursing which has as its goal the enhancement of healing the whole person from birth to death. Holistic nursing recognizes that there are two views regarding holism: that holism involves identifying the interrelationships of the bio-psycho-social-spiritual dimensions of the person, recognizing that the whole is greater than the sum of its parts; and that holism involves understanding the individual as a unitary whole in mutual process with the environment. Holistic nursing responds to both views, believing that the goals of nursing can be achieved within either framework."
There are times when holistic nursing may involve the use of complementary and alternative modalities (CAM). The National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health, defines CAM as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." Some CAM has not yet been researched adequately to determine efficacy and safety.
Integrative medicine is a related term, referring to the combination of "mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness." Many holistic nurses use CAM and integrative modalities in their practices. It is imperative that research involving CAM be conducted, so that holistic nurses can ensure excellence in patient care, as well as patient safety.
AHNA has a Position Statement on Research and Scholarship, upholding research activity for holistic nurses: "AHNA supports nursing research and scholarship that builds scientific knowledge through empirical work and that extends humanistic understanding through qualitative investigations and creative expressions. AHNA endorses and supports nursing scholarship relevant to learning, documenting and comprehending that which is the science and art of holistic nursing with the goal of producing dependable and relevant information to practitioners and the public."
AHNA has an active Research Committee; its purpose is to identify needs and resources for the organization. Missions include increasing the quantity and quality of research presentations at AHNA annual conferences, mentoring developing holistic nurse researchers, and enhancing the visibility of research within and beyond AHNA.
The newly installed President of AHNA, Carla Mariano, EdD, RN, AHN-BC, FAAIM, briefly addressed the research preconference attendees. "Research gives us credibility," she said. "Through research, we're going to demonstrate that holistic nursing is effective."
Dr. Mariano acknowledged the difficulties inherent in studying CAM and integrative modalities. "How do we really do research in this arena? Many of the phenomena of interest in this area are not measurable -- yet. We need more qualitative research and measurement instruments that focus on the complex interrelationships of body-mind-emotion-spirit. We have some real challenges." She added, however, "I'm unbelievably optimistic."Enhanced Credibility Through Research
A dynamic group of 30 holistic nurses participated in the day-long Holistic Nursing Research Preconference on June 16. Rorry Zahourek, PhD, APRN, BC, AHN-BC, a private psychotherapist and adjunct faculty member at the University of Massachusetts, Amherst, served as the coordinator and moderator. She and Carol Baldwin, PhD, RN, CHTP, AHN-BC, Associate Professor, College of Nursing and Healthcare Leadership, Arizona State University, Tempe, served as cochairs of the AHNA Research Committee this year. Both organized the research proceedings of the conference.
This was the largest attendance at an AHNA research preconference, as holistic nurses are increasingly turning to research to improve nursing practice and enhance credibility.
The morning sessions were devoted to the "nuts and bolts" of conducting holistic nursing research. Dr. Zahourek asked participants to write a description of a problem they would like to pursue, or questions regarding research they would like answered. Submitted topics ranged from how to study self-healing, how to identify funding sources, how to generate interest from mainstream institutions, and how to match clinicians with nurse researchers in holistic nursing. These inquiries guided the remainder of the preconference.
The process of formulating a research problem was discussed by Mary Koithan, PhD, RN, APRN, BC, Associate Professor at the University of Nevada School of Nursing, Las Vegas, and Visiting Associate Professor at the University of Arizona College of Medicine, Program in Integrative Medicine, Tucson. Dr. Koithan delineated the differences between qualitative and quantitative methodologies. Participants were delighted by her "recipe" for research, which helped demystify the process and make it accessible in their nursing practices. Dr. Koithan provided ample analogies. For instance, she described the process of developing a research question and the ensuing research design: "The question drives the machine down the road."
Leighsa Sharoff, EdD, RN, NPP, AHN-BC, Assistant Professor at Hunter College, New York, NY, presented her funded proposal on how holistic nurses experience the modalities they use in their holistic nursing practices.[8,9] Dr. Sharoff employed a warm sense of humor to allay participants' fears about research. She asserted, "The real educated consumer wants to know what we are doing."
Dr. Koithan then led a group discussion to integrate lessons learned from the presentations. The group discussed how those lessons relate to participants' clinical practices and to the development of research questions and study designs. The discussion included problem identification and choice of method.
Sharon Weinstein, MS, RN, CRNI, FAAN, Assistant Clinical Professor of Public Health and Administrative Nursing and Instructor, Institute for Healthcare Innovation at the University of Illinois, Chicago, discussed the development of a survey instrument called the Health Assessment Scorecard. Ms. Weinstein studied the self-assessments of 410 North American nurses and 48 nurses from the United Kingdom. Her presentation served as a guide for how to create and test a research instrument.
Dr. Koithan provided a thorough review of funding sources, including specific ones that give money for holistic nursing research. Often, such research involves considerable expense. Dr. Koithan encouraged participants to seek funding when it is needed, and not to be discouraged when grant applications are rejected. "When the proposal is rejected, you resubmit. You've got to have a really tough skin and remember that the rejection is not about you personally, but perhaps the clarity of the writing. Try again."
Afternoon sessions were devoted to the "Marriage of Research and Holistic Nursing Practice." Participants engaged in an armchair walkthrough of the research process, identifying an area of interest, producing a statement of a problem, and choosing qualitative or quantitative methodology.
Publishing and presenting as a means of disseminating holistic nursing research was discussed by Valerie Eschiti, RN, MSN, CHTP, AHN-BC, Assistant Professor at Midwestern State University, Wichita Falls, Texas, and a doctoral nursing student at Texas Woman's University, Denton. Ms. Eschiti emphasized the need for spreading the word about holistic nursing research findings, so that other professionals, as well as the public, are well-informed of current advances. She provided resources such as journal references and informative Web sites to help develop publishing and presentation skills.
A group discussion provided confirmation that holistic research findings are implemented into nursing practice on a regular basis. Areas discussed included use of reflexology for pain relief, use of imagery in patients receiving joint replacement, and influencing reimbursement for holistic modalities. However, further research is needed in many areas to strengthen evidence-based holistic nursing practice.Research Showcase
An unprecedented group of about 200 people attended the Research Panel on June 18. Dr. Zahourek served as the panel coordinator and moderator. The purpose of the panel was to showcase some of the research conducted by holistic nurses, as well as highlighting particular methods used and problems encountered when conducting the research.
"Whether you want to give yourselves credit or not, you are all doing research every day; looking at your environment, looking at what you do, evaluating it, trying to understand what you do," said Dr. Zahourek. "That is research ... Research is a process we're all engaged in every day."
"Research in the current time is looking at holism and healing," she added. "We now have new methods, more precise methods, a variety of methods ... so we're in a position now where the conventional world is also willing to accept concepts of healing and to integrate these with concepts of cure. It's a very exciting time!"
Joan Effinger, DNSc, AHN-BC, APRN, BC, a consultant and health promotion practitioner in Bonita Springs, Florida, explained the philosophical underpinnings for her phenomenologic research in simple, down-to-earth terminology by providing an example of research that she and her colleagues have conducted.
Dr. Effinger studied spirituality in resiliency in women leaders. She said most respondents felt their spiritual strength -- which was not necessarily religious -- was a concomitant basis for their resiliency, regardless of other human supports. She summarized her thoughts about the debate of qualitative vs quantitative research: "One is not necessarily bad, and one is not necessarily good. They both have their strengths."
Beverly Patchell, MS, RN, CNS, adjunct faculty, University of Oklahoma, and integrative health practitioner, Oklahoma City, Oklahoma, joined Ms. Eschiti in presenting research conducted by colleague Roxanne Struthers, RN, PhD, AHN-BC, Assistant Professor, University of Minnesota, Minneapolis. Ms. Eschiti began by discussing the numerous health and healthcare disparities experienced by Native Americans. These disparities may be minimized by the use of traditional indigenous healing. Storytelling was mentioned as a way to collect and analyze data, as well as to disseminate findings. Ms. Patchell shared a poignant story of a Native American cancer survivor to illustrate the use of storytelling as a valid research method.
Difficulties in recruiting and retaining multiethnic, low-income individuals for research studies were described by Priscilla Abercrombie, RN, NP, PhD, a private practitioner in women's health, San Anselmo, California, and Assistant Clinical Professor, University of California at San Francisco. She experienced high attrition with such a sample when doing a pilot study to examine the feasibility of a Mindfulness-Based Stress Reduction (MBSR) program for women with abnormal Pap smears.
She explained, "This is what we call in the research literature a failed study. Because so many people dropped out, we don't know that we're making a big difference. My argument is that we need to get this in the literature. People need to know about failed studies. We need to know when things don't work, and we need to have a discussion about why they didn't work." Abercrombie provided recommendations for conducting future research with such vulnerable populations. "We need to engage the folks we work with," she concluded.
Dr. Sharoff emphasized the benefits of the critical incident method in holistic nursing research, as well as the use of summative focus groups, both of which she used in her recent study investigating how certified holistic nurses learned to become competent practitioners. She defined critical incident method: "General assumptions are embedded in and can be ascertained from specific descriptions of critical events."
Dr. Sharoff had asked certified holistic nurses to think of an important event and how it affected their practice, as well as lessons learned from the event. The nurses responded via email, and she found this an effective way to collect vital information. Dr. Sharoff also conducted telephone interviews in her research, which were convenient when it was necessary to communicate with holistic nurses across the United States.
Dr. Sharoff also discussed findings from her research of why nurses went into holistic nursing. "They felt they needed to find something that resonated within their own being. Traditional nursing was just not doing it anymore. There had to be something else out there." Using a focus group of certified holistic nurses to collect data, along with the information obtained from critical incident descriptions, allowed her to achieve triangulation in her study, thereby increasing its rigor.Research in Practice
Holistic nurses are particularly interested in the implementation of CAM in bedside nursing practice. Informal conversations with attendees during breaks provided opportunities for discovery. Several clinical nurses from The Valley Hospital, Ridgewood, New Jersey, are currently implementing evidence-based practice and conducting holistic nursing research in their hospital. Mary Sudano, RNC, Same Day Surgery Manager at the hospital, shared information about using ginger tea and peppermint tea for nausea in postoperative patients, based on a review of the literature and work done at other institutions.
Her colleague, Kathleen Weith, RN, ONC, HNPC, a charge nurse at the hospital's Total Joint Institute, revealed that Valley has approved the use of black pepper essential oil to ease intravenous starts, based on reports of its vasodilatory action in some patients. This may contribute to ease of venipuncture, thereby lessening patient discomfort. Flavia Romero, RN, staff nurse in Same Day Surgery, described a proposal for a study on the impact of holistic principles to help patients prepare for surgery.
Mary Jo Assi, RN, APNC, Director of Advanced Practice Nursing, reported that the hospital is 2/3 through a 2-year grant cycle from the Robert Wood Johnson Foundation/New Jersey Health Initiatives, with partners from the BirchTree Center for Healthcare Transformation. Part of the grant involves the collection of both qualitative and quantitative data on 2 inpatient pilot studies. The studies examine the impact of integrating holistic practices and principles on nurse satisfaction in the workplace. Such satisfaction may be linked to nurse recruitment and retention, which are vital areas of concern because of the current nursing shortage.
Ms. Assi also noted that several research proposals are being developed to test clinical aromatherapy. These include the use of Lavendula Angudtifolia (lavender) essential oil inhaled to control anxiety prior to cannulation for hemodialysis patients, as well as the use of Citrus Bergamia (bergamot) essential oil inhalation to control pain and anxiety prior to chest tube removal in cardiac surgery patients.Looking Toward the Future
Holistic nursing research is abundant with possibilities. High attendance at the AHNA Annual Conference and research activities illustrates a growing interest and need for holistic nursing research. As consumers become increasingly savvy and demand evidence of CAM safety and effectiveness, holistic nurses are in a prime position to provide such information through ongoing research. Holistic nurse researchers are poised with knowledge and skills to conduct valid and reliable research. The results may provide nurses with information they can use in the clinical setting to achieve safety and excellence in patient care.References
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Cite this: Valerie S Eschiti. Research Comes to Life - Medscape - Sep 28, 2005.