The effect of healing touch on the pain and mobility of persons with osteoarthritis: a feasibility study.

The aims of this pilot study were to investigate the effects of Healing Touch (HT) on the pain level, joint function, mobility, and depression in persons with osteoarthritis (OA) of the knee joint(s). A randomized controlled trial using a repeated measures design was used. Cognitively intact persons (institutionalized and community) with a diagnosis of OA of the knee joint(s) received either HT sessions three times per week for 6 weeks (n = 12) or weekly friendly visits (FV) (n = 7). The HT sessions were delivered by a team of two nurses certified as HT practitioners and the FV was conducted by a nurse. All subjects continued to receive their standard care including the methods they had been using to relieve their joint pain. The two groups were similar regarding demographic variables, number of knees affected, co-morbidities, pain medications used and outcome variables at baseline. Two pain outcome measures (intensity and life interference) produced significant interaction effects. Two joint outcome measures (extension and extensor lag) also produced significant interaction effects. Furthermore, the HT group demonstrated significant improvements in 9 of the 12 outcome variables (75%) while no significant improvements occurred in the FV group. The HT group exhibited sustained effects (3 weeks post treatments) in three outcome variables. The reduction in joint pain and improvement in joint function suggest that biofield therapies could be effective non-pharmacological adjuncts to treatment of OA.

Slowing progression of early stages of AD with alternative therapies: a feasibility study.

This pilot study identified the feasibility and efficacy of the effect of combining healing touch (HT) and body talk cortices (BTC) on the progression of Alzheimer's disease (AD). Both HT and BTC elicit the relaxation response and support cognitive function from two different perspectives. A two-group, repeated measures design was used. Subjects (n = 22), 65 or older with early stage (less than four) AD, residing in the community (n = 2) or in care agencies (n = 20), were assigned to either the HT-BTC group (n = 12) or the control group (n = 10) randomized by residence. The treatment group received, 6 months of weekly HT and performed the BTC technique daily. The usual medical regimen for all subjects was continued. The control group had no additional interventions. Both groups were assessed at baseline, 3 and 6 months. The groups did not differ significantly at baseline on cognitive reserve, age, gender, and ethnicity, nor on the outcome variables (cognitive function, mood, & depression). Adherence (76%) to the BTC protocol, the major feasibility problem, related to memory deficits. Significant interactions occurred regarding cognitive function and mood. Significant improvements in cognitive function (p = .008), mood (p = .001), and depression (p = .028) were observed in the treatment group which is not the usual course of AD. A decline in cognitive function occurred in the control group typical of AD's usual course. Although the number of subjects in this pilot study was small, and there were feasibility challenges with recruitment and adherence, important trends were noted suggesting areas for future study.

Experiences of Implementing Rooming-in Practice for First-Time Mothers in a Postpartum Care Center.

Introduction: Practices promoted by the Baby-Friendly Hospital Initiative have become a part of the current mainstream postpartum infant care. However, adherence to rooming-in practice by health-care facilities is lower than that of other steps under this initiative. Objective: The aim of this study was to investigate the experiences in implementing the rooming-in policy among first-time mothers at a postpartum center. Methods: The present study is a qualitative research conducted using the descriptive phenomenological method. This study was performed at a postpartum care center in Southern Taiwan between August 2018 and December 2018. Semi-structured interviews were conducted with 20 postpartum mothers during their postpartum care center stay. Results: Based on interview data, this study identified three main themes about implementing full-time rooming-in experiences: (a) against the rule of taking plenty of rest during the postpartum period, (b) negative experiences and myths regarding implementing rooming-in experience, and (c) postpartum care centers service content affect first-time mothers' willingness to implement rooming-in. Conclusions: In postpartum care centers, first-time mothers' willingness to implement full-time rooming-in significantly decreases due to the effects of the "doing-the-month" culture, postpartum physical recovery status, stress of the rooming-in experience, myths regarding rooming-in practice, trusting professional neonate care services more than own care, and attitude toward payment for services.

Critical Thinking Disposition and Influencing Factors Among New Graduate Nurses.

BACKGROUND: Critical thinking disposition is important to facilitate professional judgment for novice nurses. The goals of this study were to describe critical thinking disposition among newly graduated nurses and to examine the factors that impact the development of critical thinking disposition. METHOD: This study employed a cross-sectional research design. RESULTS: The mean critical thinking score was 244.11 (SD = 44.70), with the highest mean scores earned on the inquisitiveness subscale (M = 38.46, SD = 7.10). The lowest subscale scores were for systematicity (M = 34.81, SD = 5.54), truth seeking (M = 33.12, SD = 6.42), and self-confidence (M = 29.26, SD = 6.90). Critical thinking dispositions were significantly associated with teaching strategies during the educational period, problem-based learning courses, and length of exposure to problem-based learning. CONCLUSION: Findings provide information to understand the disposition toward critical thinking in novice nurses and can serve as a reference in efforts to improve novice nurses' critical thinking skills. [J Contin Educ Nurs. 2023;54(5):233-240.].

Clinical features and outcomes of 98 children and adults with dense deposit disease.

BACKGROUND: Dense deposit disease (DDD) is an ultra-rare renal disease. METHODS: In the study reported here, 98 patients and their families participated in a descriptive patient-centered survey using an online research format. Reports were completed by patients (38%) or their parents (62%). Age at diagnosis ranged from 1.9 to 38.9 years (mean 14 years). RESULTS: The majority of patients presented with proteinuria and hematuria; 50% had hypertension and edema. Steroids were commonly prescribed, although their use was not evidence-based. One-half of the patients with DDD for 10 years progressed to end-stage renal disease (ESRD), with young females having the greatest risk for renal failure. Of first allografts, 45% failed within 5 years, most frequently due to recurrent disease (70%). Type 1 diabetes (T1D) was present in over 16% of families, which represents a 116-fold increase in incidence compared with the general population (p < 0.001). CONCLUSIONS: Based on these findings, we suggest that initiatives are needed to explore the high incidence of T1D in family members of DDD patients and the greater risk for progression to ESRD in young females with DDD. These efforts must be supported by sufficient numbers of patients to establish evidence-based practice guidelines for disease management. An international collaborative research survey should be implemented to encourage broad access and participation.

Pain in dementia: recognition and treatment.

The presentation and management of pain in older adults with dementia are highly complicated. This article addresses assessment challenges and nonpharmacological and pharmacological management strategies related to pain in those with dementia. Vigilant monitoring of comfort level and the effective use of multidimensional pain management strategies could substantially increase quality of life for older adults with dementia.

Rooming-In and Breastfeeding Duration in First-Time Mothers in a Modern Postpartum Care Center.

Uncertainty concerning the associations between rooming-in and breastfeeding duration remains at postpartum care centers. This cross-sectional study investigated the associations between the rooming-in policy and continual exclusive breastfeeding among first-time mothers at a postpartum center. Of the 160 participants, only 12.5% (n = 20) implemented full rooming-in. At 3-month follow-up, 85% (n = 17) of those individuals were exclusively breastfeeding. At the same time point, no participant practicing partial rooming-in (n = 140) was exclusively breastfeeding. The generalized estimating equation analysis indicated that full (24 h) rooming-in was statistically associated with continual exclusive breastfeeding 1 month postpartum (odds ratio (OR) = 0.90, p < 0.001) and 3 months postpartum (OR = 0.73, p < 0.001). Significant factors associated with a first-time mother's willingness to practice full rooming-in included vaginal delivery, a prenatal decision to practice breastfeeding, and undergoing prenatal classes on both rooming-in and breastfeeding. Success with continual exclusive breastfeeding in the postpartum period is dependent on full rooming-in. The findings serve as a reference for promoting exclusive breastfeeding for the first 6 months, as recommended by the World Health Organization.

Effects of a Web-based course on nursing skills and knowledge learning.

The purpose of the study was to assess the effectiveness of supplementing traditional classroom teaching with Web-based learning design when teaching intramuscular injection nursing skills. Four clusters of nursing students at a junior college in eastern Taiwan were randomly assigned to experimental and control groups. A total of 147 students (80 in the experimental group, 67 in the control group) completed the study. All participants received the same classroom lectures and skill demonstration. The experimental group interacted using a Web-based course and were able to view the content on demand. The students and instructor interacted via a chatroom, the bulletin board, and e-mail. Participants in the experimental group had significantly higher scores on both intramuscular injection knowledge and skill learning. A Web-based design can be an effective supplementing learning tool for teaching nursing knowledge and skills.

An evaluation process for an electronic bar code medication administration information system in an acute care unit.

The purpose of this case study is to present an evaluation process and recommendations for addressing the gaps found with the implementation of a new bar code medication administration (BCMA) technology in a busy acute care hospital unit. The case study analyzes workflow procedures associated with administration of medications in an inpatient labor and delivery care unit before and one year after implementation of BCMA technology. The comparison reveals a twofold increase in workflow procedures for nursing staff because of the new technology. System gaps are identified from a nursing user's perspective, and recommendations are offered to close those gaps.

[Factors related to falls among the community-dwelling elderly].

The purpose of this study was to investigate falls among community elderly and the factors related thereto. The cross-sectional method was utilized in this study. A sample of 118 subjects aged 65 and over completed structured questionnaires and balance tests. Forty participants (34%) had fallen once or more in the past. Multivariate logistic regression showed that incidents of falls were significantly related to general perceived health status (OR=0.938, 95% confidence interval [CI]=0.900-0.997), one legged stance with eyes closed (OR=0.788, 95% CI=0.626-0.933), and mobility (OR=1.184, 95% CI=1.026-1.367). Falling is a major health risk for older adults. Health professionals can therefore develop fall preventive programs with a focus on monitoring perceived health status, dynamic balance, and mobility ability, and interventions that are associated with these factors.

A descriptive study of individuals with membranoproliferative glomerulonephritis.

OBJECTIVE: Membranoproliferative Glomerulonephritis (MPGN) is one of a group of glomerulonephritides that often begins in childhood and progresses to renal failure. The purpose of this paper is to describe the initial results of a patient-driven database on individuals with MPGN. SAMPLE/SETTING: Patients with MPGN Types I, II, and III and their family members were recruited to this survey study. DESIGN: A population survey design was used. METHODS: A survey was developed for this study that obtained information from the individual with MPGN or a guardian on: patient information, family/patient health history, history of PGN, medications, course of MPGN, history of dialysis, and history of transplant. Surveys were completed either on-line or in paper format. RESULTS: Fifty-nine individuals who are primarily white (80%) and female (61%) with MPGN Type II (52%) participated in this study. The average age of onset of MPGN in this sample was 12 years. Ten (71%) of the total 14 patients with onset of less than 10y ears of age were female. Among these 10 female, 8 (80%) were diagnosed with MPGN II and developed end stage renal disease. CONCLUSION: Health screenings for blood pressure, urinary dipstick for both proteinuria and hematuria play important roles in early detection for MPGN. Nurses must provide emotional and information support to this population.

Case Report: Energy Field Changes Approaching and During the Death Experience.

BACKGROUND: This case report, addressing the aspect of the art of nursing devoted to end-of-life care, discusses subtle energy changes identified in the literature and observed in 3 case studies during the dying process. Biofield changes were noted during 3 case studies using assessment procedures of hand scan and penduling. Comparisons were made with near-death experiences reported in the literature and reports of care providers regarding subtle energy changes observed during their care of the terminally ill as they moved through the dying process. CASE SUMMARY: Consistent with reports in the literature, patterns of changes in the biofield observed during the dying process included the biofield decreasing in size and intensity from the feet upward, and chakras closing or reducing activity, from the root to the crown as the person moved closer to death. The energy field moved up and outward from the crown with death. CONCLUSION: Knowledge of these energetic patterns may provide guidance to hospice and palliative care providers, and identify supportive activities for the family of the dying as they interact with the transition of death.

Knowledge discovery: Detecting elderly patients with impaired mobility.

Immobility is an important health concern for the elderly patients and healthcare providers who care for the elderly. The purpose of this study was to test a knowledge discovery method to detect elderly patients with impaired mobility in a large clinical dataset. The research method applied an exploratory design and a data mining classification method (cost sensitive Decision Tree J48 from WEKA) to classify patients. Important factors were identified by the Feature Selection method. The Decision Tree algorithm classified patients in the dataset with 65% sensitivity and 72% specificity for a reduced model. The results were evaluated by 10-fold cross validation. Examples of decision rules were also extracted. The study can be applied to classify different health problems in different populations and serves as a foundation for the development of healthcare decision support systems.

The Use of Intercessory Prayer to Reduce Disruptive Behaviors of Patients With Dementia: A Pilot Feasibility Study.

A prospective longitudinal design was used to identify the feasibility, and preliminary efficacy of 12 weeks of intercessory prayer to reduce the disruptive behaviors of six late-stage dementia patients. One group of Catholic nuns offered the Lord's Prayer for assigned patients twice a day. Intercessory prayer for the entire subject group was also offered, by a second group of nuns, via a Latria (modality) called "Perpetual Adoration." Disruptions were documented from 3 weeks preintervention to 3 weeks postintervention. Consents were received for two thirds of invited patients. Retention was reduced by the death of two patients. Fidelity, assessed by retrospective report, was maintained throughout the study. Use of off-label antipsychotic medications was reduced or discontinued in four patients during the trial. The repeated measures analysis of variance, while indicative of a trend, did not reach a level of significance, likely due to small sample size. However, the average effect on behavior resulted in a reduction of disruptive incidents, for the group, in approximately 27 behavior categories/week. This study suggests that it is feasible to improve the life quality of patients in the terminal phase of their illness through prayer reducing their need to respond to life in a disturbed manner.

Effects of Healing Touch and Relaxation Therapy on Adult Patients Undergoing Hematopoietic Stem Cell Transplant: A Feasibility Pilot Study.

BACKGROUND: Stem cell transplant (SCT), considered the current standard of care for adults with advanced cancers, can lead to substantial deconditioning and diminished well-being. Attending to life quality of SCT recipients is now viewed as essential. OBJECTIVE: The objective of this study was to identify the feasibility and preliminary efficacy of healing touch (HT) and relaxation therapy (RT) with patients undergoing SCT. METHODS: A randomized prospective design compared 13 SCT patients who received HT daily while hospitalized to 13 similar SCT patients who received daily RT. The clinical outcomes of the 2 groups were also compared with retrospective clinical data of 20 patients who received SCT during the same year. RESULTS: The mean age of participants was 57 years, with 54% receiving autologous and 46% receiving allogeneic transplants. All patients assigned to the HT group completed the protocol. Only 60% of the relaxation group completed the intervention. Both interventions produced improvement in psychosocial measures and a shorter hospital length of stay (LOS) than the historical group. Differential results for LOS were related to the type of transplant received. The LOS differences were not statistically significant but could be clinically significant. CONCLUSIONS: Healing touch was a better tolerated modality by this population. Future research is needed to validate the LOS advantage of the HT and RT interventions, explore the differences in effect found with different transplant types, and identify patients who can tolerate RT. IMPLICATIONS FOR PRACTICE: The LOS reduction could result in decreased cost. Second, mood and function improvements support quality of life during SCT treatment.

Nursing interventions classification in systematized nomenclature of medicine clinical terms: a cross-mapping validation.

The Systemized Nomenclature of Medical Clinical Terms, or SNOMED-CT, was developed to create a comprehensive clinical healthcare reference terminology. Standardized nursing language concepts and terminologies recognized by the American Nurses Association have been added to SNOMED-CT and include the NANDA's Taxonomy II, NIC, NOC, the Omaha System, and CCC. The relationship link between terminologies and SNOMED-CT is provided in a mapping table, which identifies the source terminology. The purpose of this study is to examine the validity of the cross-mapping between the source system (NIC) and the target system (SNOMED-CT) using the methodology developed by Lu and colleagues to detect misassigned concepts. Knowledge representation concepts in the NIC and SNOMED-CT systems were compared using expert human judgment. Of 514 NIC concepts, 14 (2.7%) were identified as misassigned in SNOMED-CT. Two inappropriate representations of concepts were discovered in NIC. Results and recommendations were given to NIC and to SNOMED-CT.

Nursing outcomes classification in the systematized nomenclature of medicine clinical terms: a cross-mapping validation.

The Systematized Nomenclature of Medicine Clinical Terms is a reference terminology that can be used to cross-map standardized healthcare languages across healthcare disciplines. It is important to ensure that the knowledge represented in individual source systems has been preserved during the process of cross-mapping to the target system. The purpose of this study was to validate the cross-mapping between the Nursing Outcomes Classification and the Systematized Nomenclature of Medicine Clinical Terms. The methodology to detect incorrectly assigned (mis-assigned) concepts from the source system to the target system was developed by the authors. The methodology compared knowledge representations of Nursing Outcomes Classification concepts in both systems by using human expert judgments. Each concept's meaning is defined by both the structures and definitions in the concept model. Sixteen (4.8%) mis-assigned Nursing Outcomes Classification concepts in the Systematized Nomenclature of Medicine Clinical Terms, and one inconsistent concept representation in the Nursing Outcomes Classification were found. Results and recommendations were given to both the Nursing Outcomes Classification and Systematized Nomenclature of Medicine Clinical Terms developers for consideration of future system improvements.

Standardized nursing language in the systematized nomenclature of medicine clinical terms: A cross-mapping validation method.

Many standardized healthcare languages have been mapped to the Systematized Nomenclature of Medicine Clinical Terms known as SNOMED CT, which was developed by the College of American Pathologists. This study describes a methodology for detecting misassigned concepts from source systems to SNOMED CT and presents the results of applying this methodology to a subset of concepts from two standardized nursing languages, the Nursing Interventions Classification and the Nursing Outcomes Classification. The methodology is based on comparing the knowledge representations of a set of nursing concepts between source systems (nursing languages) and SNOMED CT. If any nursing concept differs in knowledge representation in the target system compared with the source system, editorial misassignment of the concept was declared and recommendations for target system developers were made. In a total of 75 nursing concepts used to test this method, five misassigned concepts(6.6%) were found in SNOMED CT. This method can be used to validate other healthcare languages.