Osteomyelitis, diabetic foot ulcers and the role of the community nurse.

Community nurses face numerous challenges in both diagnosing and effectively treating their patients. The diabetic patient has complex needs requiring a holistic approach. With a reported increase in diabetic patients, and a possible decline in some routine screening following Covid-19 pandemic, complications in diabetic patients are likely to rise. It is estimated that 25% of diabetic patients will develop a diabetic foot ulcer (DFU), with a reported 43% of DFU already infected at first presentation to a health professional. NICE categorise the level of infection in DFU based on standardised assessments such as SINBAD. A high categorised DFU has the possibility of osteomyelitis. It is imperative that osteomyelitis is treated immediately to achieve positive outcomes, benefitting the patients' health and wellbeing in addition to reducing the financial implications to the NHS.

Nurses' spiritual attitudes and involvement-Validation of the Polish version of the Spiritual Attitude and Involvement List.

BACKGROUND: Spirituality is vital in the holistic approach to nursing care. The personal spirituality of nurses has been documented to have an impact on the spiritual nursing care they provide. AIM: To validate the Polish version of the Spiritual Attitude and Involvement List (SAIL) among nurses and to describe spiritual attitudes and involvement of nurses as measured with the tool. DESIGN: A cross-sectional, validation study was performed according to the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. METHODS: Study involving 163 nurses, with the use of four tools: (a) the SAIL; (b) the Self-Description Questionnaire; (c) the Scale of Spiritual Transcendence; and (d) the Brief Religious Coping questionnaire. RESULTS: The Explanatory Factor Analysis identified six factors and 25 items were retained explaining a total variance of 67.96%. In the Confirmative Factor Analysis, acceptable index fit values were obtained. Correlations were found between SAIL and the Brief Religious Coping questionnaire, the Self-Description Questionnaire, and the Spiritual Transcendence Scale. Nurses reported the highest scores on 'Meaningfulness' (= 4.95 out of 6.0, Standard Deviation [SD] 0.56) and the lowest on the 'Transcendent Experiences' factor (= 3.21 out of 6.0, SD 0.93). A strong correlation was found between 'Spiritual Activities' and the religious involvement of nurses (r = 0.506), and between 'Connectedness with nature' and the nurses' age and work experience (r = 0.315 and r = 0.321, respectively). CONCLUSION: The Polish version of SAIL shows acceptable psychometric properties and construct validity. With the validation of SAIL, future studies can be undertaken with the aim of measuring the personal spirituality of nurses in various settings (hospital vs. community), cultures, and countries, thus increasing the opportunity to compare findings. Moreover, more studies should be performed in order to assess whether there is any connection between personal spirituality and the spiritual nursing care provided to patients.

Social justice as an expression of caring through holistic admissions in a nursing program: A proposed conceptual model.

AIM: This paper presents HAR as an expression of caring to create social justice within nursing and achieve a workforce that is representative of those being served. BACKGROUND: The lack of diversity within the health professions has been expressly linked in the literature to health disparities among underrepresented and marginalized groups. RECOMMENDATIONS: Recognizing the value of diversity within healthcare has been the impetus for some health profession programs to use holistic admissions review (HAR) in the assessment and evaluation of applicant suitability. While current HAR recommendations in nursing broaden the lens on which criteria should be used to determine applicant suitability beyond standard academic metrics, existing models do not examine applicants' caring capacity. CONCLUSION: Given caring is the essence of nursing, the authors offer a guiding framework to supplement the American Association of Colleges of Nursing criteria for HAR and a model by which nursing applicants are evaluated on their capacity to care.

Mindfulness-Based Stress Reduction for Health Care Staff: Expanding Holistic Nursing Paradigms to the Whole System.

Mindfulness-based stress reduction (MBSR) is a well-known mindfulness meditation program for patients that also may benefit health care providers and clinic staff themselves. An abbreviated MBSR program adapted into 6 weekly 75-minute sessions held during staff lunch breaks provided a feasible and acceptable staff training approach within the workplace setting.

Maximizing Effectiveness of the Holistic Admission Process: Implementing the Multiple Mini Interview Model.

BACKGROUND: Nursing programs have responsibility to become more holistic in admission practices, ensuring they admit applicants based on more than grades and test scores to determine the best fit for their program. PROBLEM: One frequently cited holistic admissions barrier is incorporating qualitative measurement of applicant characteristics through interviews. Finding the best interview model is a challenge, depending on a program's intent to learn about applicants. APPROACH: This article describes the planning and implementation process for incorporating the Multiple Mini Interview (MMI) model into an existing holistic nursing program admission process. OUTCOMES: MMI model implementation resulted in more congruency in student attributes with the college vision, mission, and values and increased diversity. CONCLUSION: An efficient, well-organized MMI interview model was implemented, allowing achievement of overall admission goals and ensuring selected applicants demonstrate attributes aligned with college values and vision and increased diversity.

Factors associated with spiritual care competencies in Taiwan's clinical nurses: A descriptive correlational study.

AIMS AND OBJECTIVES: To determine factors associated with nurses' spiritual care competencies. BACKGROUND: Holistic nursing care includes biopsychosocial and spiritual care. However, nurses are limited by a lack of knowledge, time constraints and apprehension of assessing spiritual issues, which leaves them unable to assess and meet patients' spiritual needs. Thus, when patients experience spiritual distress, clinical nurses lose the opportunity to support spiritual growth and self-actualisation. In Taiwan, spiritual care, religion and culture are unique compared to those in other countries. Overall, factors associated with Taiwanese nurses' spiritual care competencies lack comprehensive exploration. METHODS: This study adopted a descriptive correlational design using cross-sectional survey (see Appendix S1). Cluster sampling was used to select clinical nurses from fourteen units of a medical centre and a regional hospital. Data were collected from January-June 2018 with a 97.03% response rate. Clinical nurses completed a background questionnaire, spiritual care practice questionnaire, spirituality and spiritual care-related scales. Data were analysed using descriptive and linear regression. This report followed the STROBE checklist. RESULTS: Spiritual care competence ranged from 44-123 (mean 84.67 ± 12.88; range 27-135). The majority of clinical nurses rated their spiritual care competence as moderate (64-98). The significant factors associated with nurses' spiritual care competence were education, religion, interest in spiritual care, having role models, past life events, barriers to providing spiritual care of the spiritual care practice score, and spiritual attitude and involvement score. The overall model was significant (p < .001) and accounted for 55.0% of variance (adjusted R2  = .488). CONCLUSIONS: Most clinical nurses have moderate spiritual care competence. Objective factors identified affect clinical nurses' spiritual care competencies. RELEVANCE TO CLINICAL PRACTICE: To improve nurses' spiritual care competencies, objective factors that affect clinical nurses' spiritual care competencies must be emphasised. Multiple strategies for enhancing nurses' own spiritual well-being can be provided via employee health promotion projects and activities, and promoting nurses' spirituality and spiritual care competencies can be explored in clinical settings through bedside teaching, situational simulation, objective structured clinical examinations and self-reflection.

The holistic assessment and care planning in partnership intervention study (HAPPI): A protocol for a feasibility, cluster randomized controlled trial.

AIM: During an initial phase of this research, an e-Delphi survey was conducted to gain consensus among stakeholders on the components of a nurse-led assessment and care planning intervention for older people who live with frailty in primary care. This feasibility randomized controlled trial (fRCT) will test the proposed intervention and its implementation and determine methods for the design of a conclusive randomized controlled trial. METHODS: The fRCT, with embedded qualitative study, aims to recruit 60 participants. Moderately and severely frail older people will be identified using the electronic frailty index (eFI) and the intervention will be delivered by senior community nurses. The control participants will receive usual primary care for frailty. The study is funded by the National Institute of Health Research (NIHR; funding granted in May 2016, ref: ICA-CDRF-2016-02-018) and received NHS and University Research Ethics Committee approval in 2018. DISCUSSION: There is evidence that the delivery of complex interventions for community-dwelling older people can reduce care home and hospital admissions and falls, there is less evidence for the benefit of any specific type or intensity of intervention or the additional benefits of targeting the frail population. This trial will determine feasibility of the intervention, define recruitment and retention parameters and trial logistics, and decide outcome measures. IMPACT: This study aims to address the limitations of current research by using a systematic method of frailty diagnosis and participant identification, trialling implementation of a person-centred intervention, and testing of feasibility parameters. TRIAL REGISTRATION NUMBER: ISRCTN: 74345449.

Holistic nursing competence scale: Turkish translation and psychometric testing.

AIM: This study aimed to culturally adapt and evaluate the reliability and validity of the Holistic Nursing Competence Scale for application in the Turkish context. BACKGROUND: Nurses are expected to assess well-being of individuals by considering physical, social, psychological, cultural and spiritual dimensions to enhance adaptation to diseases. In Turkey, no tools have been developed to date for the evaluation of competencies in holistic nursing in the country. METHODS: The study was conducted with 288 nurses working in two hospitals in Ankara equipped with over 500 beds. A confirmatory factor analysis was performed in order to identify whether the items and the sub-dimensions of the adapted scale complied with the original structure comprising 36 items and five sub-scales, namely 'general aptitude', 'staff education and management', 'ethically oriented practice', 'nursing care in a team' and 'professional development'. Cronbach's alpha value was used as an estimate for reliability analysis. RESULTS: Opinions of 11 experts were obtained for content validation of the scale, and the content validity index was 0.90. The adaptation was observed to be acceptable on the basis of structural equation model fit indices in confirmatory factor analysis. Cronbach's alpha value was estimated to be 0.97 and 0.90, respectively, for the complete scale. CONCLUSION: The study identified the Turkish version of Holistic Nursing Competence Scale as a valid and reliable tool for the evaluation of competence in holistic nursing among nurses. IMPLICATIONS FOR NURSING AND NURSING POLICY: The instrument may now be utilized as a tool of measurement in nursing practice, as well as in education and research, for identifying the level of competence in the holistic nursing practices among the nurses in Turkey.

Evaluating the feasibility of a nurse-led self-management support intervention for kidney transplant recipients: a pilot study.

BACKGROUND: To support effective self-management after kidney transplantation, a holistic nurse-led self-management support intervention was developed using the Intervention Mapping approach. The primary aim was to evaluate the feasibility, acceptability and fidelity of the intervention for kidney transplant recipients and professionals. The secondary aim was to explore preliminary effects on outcomes. METHODS: A pilot study was conducted in 2015-2017 to evaluate the intervention. Nurse Practitioners (NP) guided recipients in assessing 14 life areas using the Self-Management Web. Participants were supported in developing self-regulation skills which can be applied to self-management of the illness. Strategies included goal setting, action planning, and promotion of motivation and self-efficacy. Adult recipients from an outpatient clinic of a Dutch University Hospital who underwent their transplant at least 1 month ago, were invited to participate. NPs, nephrologists and recipients were interviewed to assess feasibility, fidelity and implementation experience. Consultations were videoed and analysed to assess fidelity. To assess the preliminary effects, the intervention group completed baseline (T0) and follow-up (T1) questionnaires on self-management behavior, self-efficacy, quality of life and quality of care. A historical control group of kidney transplant recipients completed the same questionnaires at T1. RESULTS: Twenty-seven recipients agreed to participate in the intervention group, of which 24 completed the intervention and 16 completed baseline and follow-up surveys. The control group consisted of 33 recipients. Professionals and recipients appraised the open, holistic focus of the intervention as a welcome addition to standard care and felt that this helped to build a relationship of trust. Recipients also felt they became more competent in problem-solving skills. The within-group analysis showed no significant increase in patients' self-management skills. The between-groups analysis showed significantly higher medication adherence among the intervention group (P = 0.03; G = 0.81). The within-groups analysis showed a significantly higher perceived quality of care (P = 0.02) in the intervention group. CONCLUSION: This holistic nurse-led self-management support intervention was found to be feasible and acceptable by professionals and recipients alike. This pilot had a small sample therefore further research is needed into the potential effects on self-management behavior and well-being of transplant recipients. ISRCTN Trial Registry: ISRCTN15057632 (registered retrospectively on 20-07-2018).

The Experience of Holistic Nurse Coaching for Patients With Chronic Conditions.

Purpose: The purpose of this study was to explore and describe the lived experience of adults with chronic conditions receiving holistic nurse coaching. Method: A qualitative phenomenological research design was used for this study. A purposive sample of 15 patients with varied chronic conditions participated. Institutional review board approval was obtained from the participating university prior to data collection. The patients' stories of their experiences with holistic nurse coaching were analyzed using Colaizzi's method of phenomenological analysis. Findings: Eight theme clusters emerged when the formulated meanings were organized into the following categories: (1) Seeking Guidance to Navigate Life's Challenges, (2) Entering a Safe Sacred Place, (3) Feeling Empowered and Accountable, (4) Developing Strategies to Access Different Ways of Knowing, (5) Finding the Answers Within, (6) Making Healthy Behavioral Changes, (7) Forming a New Caring Relationship with Self, and (8) Transforming to a Brand-New Approach to Life. Conclusions: Findings from this study provide insight into experiences of holistic nurse coaching for patients with chronic conditions. Further research is needed to examine the influence of holistic nurse coaching on health outcomes related to chronic conditions such as quality of life, patient empowerment, and targeted metrics related to specific chronic conditions.

Suggesting a Practical Theory to Oncology Nurses: Case Report of a Child in Discomfort.

PURPOSE: Children with cancer are faced with many challenges related to their disease that disturbs their comfort. The aim of this study was to apply Kolcaba's comfort theory for a child with cancer. DESIGN: A case study design was used. METHODS: We applied Kolcaba's comfort theory for a young boy with cancer who was sad and in discomfort because of intravenous access procedures. Following Kolcaba's taxonomy of needs for comfort in the spiritual and mental level, we designed a new intervention. FINDINGS: Kolcaba's comfort theory is an appropriate approach which not only helps to assess and evaluate comfort holistically but also assists in performing innovative interventions to provide comfort for children with cancer. CONCLUSIONS: Kolcaba's comfort theory is a practical theory for oncology nurses. CLINICAL RELEVANCE: Nursing theories can improve the quality of clinical care.

The Effect of Listening to Music on Postoperative Pain in Adult Orthopedic Patients.

PURPOSE: Pain is a common occurrence after orthopedic surgery. Patients need additional resources to manage their pain. The purpose of this study was to determine if listening to music has a positive effect on pain scores and satisfaction in the postoperative adult orthopedic patient. There are limited studies demonstrating statistically significant decreases in postoperative pain in this group. A secondary purpose was to expose nurses on a standard medical-surgical unit to an intervention, supported by the holistic nursing model that they could use in their care. DESIGN AND METHOD: This study was a descriptive, comparative, quasi-experimental design. Patients listened to prerecorded music on individual CD players and recorded pre-post pain scores with the intervention. A satisfactory survey was completed at discharge. FINDINGS: Results demonstrated a statistically significant reduction in patients' pain scores after listening to music. Length of listening time had no effect. Patients expressed overall satisfaction, and 100% of participants would recommend this intervention to others. CONCLUSIONS: Listening to music is beneficial as an adjunct to pain medication and contributes to increased patient satisfaction. It is hoped that the information gained from this study will lead to an enhancement in the standard of care for postoperative patients.

Transformational Leadership: A Model for Advanced Practice Holistic Nurses.

Advanced Practice Holistic Nurse (APHN) leaders could provide a model of leadership to advance value based health care systems in the United States. The American Nurses Association has recognized Holistic Nursing as a specialty because of the emphasis placed on patient-centered care, the development of therapeutic relationships, interconnection, and holism. Transformational leadership is a framework that uses vision, inspiration and intellectual stimulation to motivate people toward needed change. The APHN is well positioned to use transformational leadership methods to lead teams placing the patient at the center of health care decision making and bring the essence of holism to the forefront of health care. Highlighted are methods for positive communication, inspiration, negotiation, and conflict resolution as tools the APHN could use to become a transformational leader. The purpose of this article is to discuss a framework for transformational leadership development and implementation to establish the holistic ideals of APHNs in the health care system.