A Mindfulness-Based Intervention for Acute Care Nursing Staff: A Pilot Study.

Purpose:The purpose of this study was to determine if a mindfulness-based smartphone application, used for 5 minutes a day for 30 days, could address burnout among acute care nursing staff. Methods: A pretest-posttest design with a midpoint evaluation was utilized. The sample included 31 nursing staff from cardiovascular acute care units. The Copenhagen Burnout Inventory, Cognitive and Affective Mindfulness Scale-Revised, Perceived Stress Scale, and Brief Resilience Scale were used to measure the impact of the intervention on participants. Findings: In a repeated measures analysis, there were no statistically significant changes in scores on the Brief Resilience Scale across the three timeframes (F = 0.64, df = 1.42, p = .49). There were significant reductions over time for perceived stress (F = 10.56, df = 1.74, p = .002) and personal burnout (F = 11.8, df = 1.10, p = .007), and increased scores on mindfulness (F = 4.76, df = 1.57, p = .039). Conclusions: The utilization of a mindfulness-based smartphone application may promote the health and well-being of cardiovascular nurses in acute care units. Mindfulness-based smartphone apps should be considered as a method of self-care, along with other holistic approaches to improve well-being.

Chairside Yoga Therapy Alleviates Symptoms in Patients Concurrently Receiving Outpatient Cancer Infusions: A Promising Feasibility Study.

Purpose: To evaluate effectiveness of chairside yoga therapy on perceptions of fatigue, pain, nausea, anxiety, and distress among oncology patients concurrently receiving outpatient cancer infusion therapy. Design: This prospective pilot study used pre-/post-survey design in convenience sample of cancer patients in outpatient setting. Methods: Researchers developed and administered the Outpatient Cancer Symptom Assessment Scale (OCSAS) comprised of cancer- or treatment-related symptoms commonly reported in the oncology population (nausea, pain, fatigue, anxiety, and distress). Following IRB approval, symptoms were rated using Likert scale of 0 (not present) to 10 (severe) before and after chairside yoga therapy delivered concurrently with outpatient infusions. Qualitative data was collected related to patients' overall infusion experience. Findings: Participants (n = 82) reported positive patient experiences and statistically less pain (p < 0.001), fatigue (p < 0.001), anxiety (p < 0.001), and distress (p < 0.001) following the yoga intervention compared to baseline. Nausea was not significantly impacted by the yoga intervention. Conclusions: Yoga therapy received concurrently during outpatient cancer infusion is consistent with a holistic and integrative approach to care for the oncology population. Yoga therapy offers promise for reducing symptoms which negatively impact quality of life, including pain, fatigue, anxiety, and distress. Qualitative data suggests patients' overall infusion experience was enhanced with yoga therapy.

The Impact of Robotic Companion Pets on Depression and Loneliness for Older Adults with Dementia During the COVID-19 Pandemic.

Purpose: Differences in depression and loneliness, during the COVID-19 pandemic, for older adults with mild to moderate dementia living in residential care after interacting with a robotic companion dog or cat were explored. Experiences of family members and professional caregivers were also examined. Design: This study used a mixed research design with pre- and post-questionnaires on depression and loneliness. Method: Quantitative data exploring the impact of companion pets on depression and loneliness were collected from participants pre-intervention and at 3- and 6-week intervals. Qualitative data were collected during the 6-week study period, permitting researchers to explore the impact of robotic companion pets on participants, family members, and professional caregivers. Findings: Results indicated depression (χ2F(2) = 21.29, p < 0.001) and loneliness (χ2F(2) = 21.11, p < 0.001) improved. Moreover, participants were engaged with their companion pet, providing meaningful, activity and positive experiences. Conclusions: Robotic companion pet therapy, a holistic, nonpharmacologic animal-assisted therapy (AAT), changed the AAT landscape at the study site and provided an alternative option to live pet therapy during COVID-19. Participant interactions with their robotic companion pets enhanced their well-being and quality of life, especially during stringent COVID-19 restrictions and social isolation.

Older Adults Diagnosed With Schizophrenia in Long-term Care Facilities: Life Course Theory for Holistic Nursing Research and Practice.

Older adults diagnosed with schizophrenia (OADWS) often enter long-term care facilities with unique challenges related to trauma and stress experienced throughout their life course. Health care workers often report that when they work with this population, they feel unprepared due to limited training. In this article, life course theory is presented as a lens for holistic nursing research and as a way for nurses to adapt interventions already used with cognitively impaired older adults (e.g., those diagnosed with Alzheimer's disease) for OADWS in long-term care. It is hoped that these ideas will facilitate discussion of ways to inform training for holistic long-term care of OADWS. Holistic principles of nursing addressed with life course theory as a lens include the following: (a) accounting for strengths and challenges; (b) honoring experiences, values, and health beliefs; (c) viewing interrelationships with the environment; and (d) nurturing of peace, wholeness, and healing.

Essential Oil Use With Breast Imaging A Pilot Study.

Purpose: To examine the following variables related to essential oil use: familiarity, enjoyment, influence on relaxation, intention for future use, and acceptance among women undergoing breast-imaging procedures. Design: A descriptive, exploratory study. Method: An investigator-designed questionnaire was used to gather demographic information and study variables (N = 51). Data on age and scheduled procedure were collected. Data collected on essential oils included choice, anxiety, acceptance, familiarity, relaxation response, enjoyment with use, and intention to use in the future. Acceptance of essential oils was derived from the prompt included on the questionnaire "please tell us the reason you accepted the Essential Oil today." Findings: Enjoyment with essential oils was high 97.9% (n = 48), 76% (n = 38) were familiar with their use, a majority 94% (n = 48) of participants experienced some degree of relaxation following their use, and 94% (n = 46) would continue their use in the future. Acceptance of essential oils was based largely on familiarity with their use. Conclusions: A majority of participants in this study enjoyed essential oils, were familiar with their use, experienced relaxation following use, and intended to use them in the future when undergoing breast-imaging procedures.

Holistic Nursing in Practice: Mindfulness-Based Yoga as an Intervention to Manage Stress and Burnout.

PURPOSE: Effects of a mindfulness-based (MB) yoga practice on stress, burnout, and indicators of well-being among nurses and health care professionals (HCPs). DESIGN: A randomized controlled trial, 80 HCPs assigned to either MB yoga intervention or control group. METHOD: The MB yoga intervention group (n = 41) attended weekly yoga classes and practiced yoga independently. The control group (n = 39) did not receive the yoga intervention. Study participants completed pre- and postintervention questionnaires, instruments included (a) Perceived Stress Scale; (b) Maslach Burnout Inventory; (c) Vitality subscale of the Medical Outcomes Study Short Form-36; (d) Global Sleep Quality item, (e) Mindfulness Awareness Survey, and (f) subscale of the Brief Serenity Scale. Diurnal salivary cortisol and blood pressure were assessed pre and postintervention. RESULTS: Significant improvements (p < .01) noted in MB yoga compared with control for self-reported factors, including stress (Perceived Stress Scale), burnout (Maslach Burnout Inventory), vitality (Medical Outcomes Study Short Form-36), sleep (GSQ), serenity/inner haven (IH), and mindfulness (Mindfulness Awareness Survey). Diurnal cortisol slopes and blood pressure were not significantly improved. CONCLUSION: The MB yoga intervention had a statistically significant effect on the health and well-being of nurses and HCPs, most specifically for measures of stress; perceived stress, burnout, vitality, sleep quality, serenity, and mindfulness.

Effects of Reiki on Pain and Anxiety in Women Hospitalized for Obstetrical- and Gynecological-Related Conditions.

Purpose: To determine the effect of Reiki on pain and anxiety in women in antepartum, intrapartum, postpartum, gynecology, and gyn/oncology, settings. Method: This exploratory, comparative study used a Likert-type scale of 0 to 10 to measure pain and anxiety, and a survey asking about lingering effects of treatment. Results: Mean pain scores after Reiki significantly decreased from 3.24 to 1.52 (n = 203; z = -11.67, p < .001). Mean anxiety scores after Reiki significantly decreased from 3.56 to 1.28 (n = 195; z = -11.42, p < .001). Women were asked if the effects lingered for any length of time post-Reiki treatment, and 91 of 101 responded affirmatively that decreased pain and/or anxiety continued. Conclusion: Findings from this study confirm the positive and lingering effects of Reiki in women hospitalized for obstetrical and gynecological conditions.

Episodic Memory in Later Life: Benefits of Prayer and Meditation.

Purpose: To examine the effects of prayer and meditation on the episodic memory of older adults. Design: Secondary analysis of Health and Retirement Study (HRS). Method: Drawing from a subsample of HRS (n = 1,135), this study utilized generalized estimating equation regression models to examine the effects of meditation and prayer on changes in episodic memory of older adults over time. Findings: Findings show a statistically significant positive effect of the use of prayer (0.50, p < .05) on episodic memory score at baseline. We also observed a slight gain in episodic memory over time for older adults who used prayer (0.04, p = .05). Meditation was not found to have a statistically significant effect on changes in memory in later life. Conclusion: This study illustrates the benefits of prayer in preserving memory and provides much needed empirical basis for community-level interventions to enhance memory in later life.

Spiritual Care in Holistic Nursing Education: A Spirituality and Health Elective Rooted in T.R.U.S.T. and Contemplative Education.

Research to date demonstrates that spiritual care as an integral part of holistic nursing can be hampered if nurses experience insufficient preparation or organizational cultures that fail to prioritize spiritual well-being. In response, the author has developed a three-credit spirituality and health elective in an undergraduate nursing program to help participants address spiritual needs and mobilize spiritual strengths within themselves, patients, and workplaces. Using the T.R.U.S.T. Model for Inclusive Spiritual Care as its framework, the six-unit course draws on contemplative education practices in hopes of preparing a critical mass of nurses with the ability and confidence to foster safe, relevant spiritual care and promote a holistic, patient-centered health care culture. Course participants regularly demonstrate and report deeper self-awareness, skills development, and confidence in relation to spiritual care; the course also has been positively evaluated and fully subscribed over its seven offerings to date, validating its effectiveness in relation to short-term outcomes. Research is needed to evaluate its long-term effectiveness in helping alumni integrate spiritual care into their holistic practice and workplace culture.

How People Forgive: A Systematic Review of Nurse-Authored Qualitative Research.

Purpose: The aim of this systematic review of qualitative forgiveness studies by nurse authors is to contribute to the body of holistic nursing knowledge by discovering answers to the following research questions: (a) where/how does a person get the power to forgive? and (b) what are the people who forgive like? Method: We conducted a systematic search of the English language, peer-reviewed literature for nurse-authored, primary qualitative research that answered our research questions. A total of 188 potential studies were found, and 11 studies met the inclusion criteria. Results: Study participants used interpersonal, intrapersonal, and transpersonal sources of power to forgive, including prayer, meditation, and support from family, friends, and nurses. The findings also revealed the cognitive, emotional, and spiritual traits of forgiving people, including being faith oriented, empathetic, and understanding the meaning of forgiveness as letting go of negative emotions. The findings confirm activities listed under "Forgiveness Facilitation" (2018) in Nursing Interventions Classification (NIC) and suggest additions. Conclusion: This literature review adds to nursing knowledge by synthesizing the findings of the review in a way that provides guidance to nurses to help facilitate forgiveness with patients who want that.

The Emergency Resiliency Initiative: A Pilot Mindfulness Intervention Program.

Purpose: To assess the feasibility of a pilot mindfulness intervention program, the Emergency Resiliency Initiative (ERI), as well as to investigate changes in burnout scores and key drivers to burnout among registered nurses (RNs) and patient care technicians (PCTs) in a Level 1 trauma center emergency department (ED). Design: A mixed methods pre/post study with data collection points before and after the 3-month intervention. Method: Three mindfulness educational/experiential sessions were delivered once a month at staff meetings with topic themes of Introduction to Mindfulness, Practical Applications of Mindfulness, and Cultivating Compassion. Participants were asked to complete a minimum of two weekly 5-minute meditations. Burnout scores were assessed using the Maslach Burnout Inventory at preintervention (baseline) and postintervention. Findings: From the pre- (n = 35) to post- (n = 26) intervention period there was a significant increase in personal accomplishment scores (p = .01) and decrease in emotional exhaustion scores (p = .03) for RNs and PCTs combined. Qualitative interviews revealed five burnout-related themes: (a) prioritization distress, (b) change fatigue, (c) self-protection through superficiality, (d) intentional response, and (e) community amid chaos. Conclusion: The ERI was a feasible and acceptable program associated with improvements in burnout scores. Qualitative interviews revealed the positive impacts of mindfulness on ED clinician resiliency and identified future opportunities to address burnout from a holistic perspective.

A Qualitative Study of a Compassion, Presence, and Resilience Training for Oncology Interprofessional Teams.

The well-being of health care providers may be challenged by their work, with evidence that oncology health care providers are a high-risk group for burnout. The present qualitative pilot study evaluated a mindfulness-based group intervention, referred to as Compassion, Presence, and Resilience Training (CPR-T), for oncology interprofessional teams. The purpose of this study was to elucidate the subjective experience of oncology health care providers receiving CPR-T and their perceptions of its benefits, risks, or challenges. The CPR-T was delivered to providers from two oncology teams in a large cancer center in Canada. Ten of these providers participated in semistructured interviews 1 to 5 months after completing the CPR-T. The interview transcripts were coded using a thematic analysis strategy. Five benefits of the CPR-T were identified: learning to pause, acquiring a working definition of stress and self-care, becoming fully present, building self-compassion, and receiving organizational acknowledgment and recognition of stress. In addition, two participant-identified challenges were recognized: sharing vulnerability within interprofessional teams and committing to a sitting meditation practice. These findings demonstrate positive transformations as a result of the CPR-T, as well as important challenges, and have important implications for holistic health care practice in oncology. Further research is necessary to validate the findings of this explorative study.

Reducing Psychological Stress in Peripartum Women With Heart Rate Variability Biofeedback: A Systematic Review.

Peripartum women are exposed to a variety of stressors that have adverse health consequences for the maternal-child dyad (e.g., impaired bonding). To combat these adverse health consequences, heart rate variability biofeedback (HRVBF) may be implemented by holistic nurses to aid peripartum women experiencing a high level of stress. A systematic review was completed using the guidelines established in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. To be included in the review, studies had to meet the following criteria: (a) published scientific articles, (b) studies published in English, (c) experimental, quasi-experimental, or case reports, (d) use of HRVBF as the main treatment, (e) use of psychological stress as a dependent variable, and (f) studies published until December 2017. The major findings of this review can be described as follows: (a) HRVBF and psychological stress in peripartum women are related concepts, (b) peripartum women who completed HRVBF report a reduction in stress compared with participants who did not receive HRVBF, and (c) there is currently no information on the effectiveness of HRVBF on psychological stress in the first and early second trimester of pregnancy. Overall, this systematic review of the literature provides objective evidence that HRVBF may be a potential beneficial adjuvant treatment for stress management in peripartum women.

Distress Tolerance Intervention for Improving Self-Management of Chronic Conditions: A Systematic Review.

BACKGROUND: The inability to tolerate distress can negatively influence effective self-management (SM) of chronic conditions by interfering with the ability to focus on illness needs and impairing problem-solving and prioritizing capabilities, as well as engagement in SM activities. Interventions to increase distress tolerance offer a holistic approach to chronic disease SM and may enhance the individual's ability to apply SM skills and resources to improve quality of life and overall health. The purpose of this systematic review was to deepen understanding of the relationships among distress tolerance and goal-oriented problem-solving as an aspect of chronic disease SM. METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations were used to develop a search strategy, selection criteria, screening, and identification and extraction procedures. PubMed, CINAHL, PsychInfo, and Scopus were searched from 2006 to December 2017 using the following search terms: distress tolerance, chronic conditions, self-management. RESULTS: Across the 11 studies included in the literature review, there was a high level of heterogeneity in the use of subjective and objective measures to assess distress tolerance, and only one study included instruments to measure goal-oriented problem-solving, the target of distress tolerance interventions that are assumed to influence the selected health outcome. CONCLUSION: Further research is needed on the efficacy of distress tolerance interventions for improving SM of chronic conditions. Theory-driven interventions that explicate the precise goal-oriented problem-solving and SM behaviors that are expected to change as a result of the distress tolerance intervention will provide insight on the efficacy of the intervention and help close the theory-practice gap.

Evaluation of a Web-Based Holistic Stress Reduction Pilot Program Among Nurse-Midwives.

PURPOSE: Work-related stress among midwives results in secondary traumatic stress, posttraumatic stress disorder, and job attrition. The purpose of this pilot project was to evaluate the effectiveness of a holistic, web-based program using holistic modalities for stress reduction and improved coping among certified nurse-midwives. DESIGN AND METHOD: A convenience sample of 10 midwives participated in a web-based holistic stress reduction intervention using yoga, mindfulness-based stress reduction, and meditation for four days each week over 4 weeks. Participants completed pre- and postintervention questionnaires (Perceived Stress Scale [PSS] and the Coping Self-Efficacy Scale [CSES]) for evaluation of effectiveness. FINDINGS: The PSS means showed improvement in midwives' stress (16.4-12.3). The CSES means showed improvement in coping (174.8-214.5). Improvement was shown in each subscale of the CSES ("uses problem-focused coping": 19.2%; "stops unpleasant thoughts and emotions": 20.3%; and "gets support from family and friends": 16.6%). CONCLUSION: Findings suggest the potential for stress reduction and improved coping skills after using holistic techniques in a web-based format within a cohort of nurse-midwives. Further research of web-based, holistic intervention for stress reduction among midwives is warranted.

A Practice-Based Theory of Healing Through Therapeutic Touch: Advancing Holistic Nursing Practice.

For nearly 50 years, Therapeutic Touch (TT) has contributed to advancing holistic nursing practice and has been recognized as a uniquely human approach to healing. This narrative explores the development of a practice-based theory of healing through TT, which occurred between 2010 and 2016. Through the in-depth self-inquiry of participatory reflective dialogue in concert with constant narrative analysis, TT practitioners revealed the meaning of healing within the context of their TT practice. As the community of TT experts participated in an iterative process of small group and community dialogues with analysis and synthesis of emerging themes, the assumptions and concepts central to a theory of healing emerged, were clarified and verified. Exemplars of practice illustrate the concepts. A model of the theory of healing illuminates the movement and relationship among concepts and evolved over time. Feedback from nursing and inter-professional practitioners indicate that the theory of healing, while situated within the context of TT, may be useful in advancing holistic nursing practice, informing healing and caring approaches, stimulating research and education, and contributing to future transformations in health care.

The Emotional Freedom Technique: Finally, a Unifying Theory for the Practice of Holistic Nursing, or Too Good to Be True?

The Emotional Freedom Technique (EFT) is defined and described as a clinical procedure for the relief of psychological and physical distress that patients often bring to the attention of nurses. Frequently referred to as "tapping," this technique combines the cognitive reprocessing benefits of exposure and acceptance therapy with the energetic disturbance releases associated with acupuncture and other energy therapies. More than 60 research articles in peer-reviewed journals report a staggering 98% efficacy rate with the use of this procedure from psychological distress (posttraumatic stress disorder, phobias, anxiety, depression, etc.) to physical conditions (asthma, fibromyalgia, pain, seizure disorders, etc.) to performance issues (athletic, academic). Perhaps because of this, this technique has encountered a fair degree of skepticism within the health care community. Easily taught as a self-help aid that patients can administer to themselves, EFT becomes an efficacious tool in the hands of nurses who are seeking whole person approaches for the healing of a wide variety of psychological and physical conditions. A conceptual framework, mechanisms of action, evidence of safety, literature review, and case studies are also included.

Try-It-On: Experiential Learning of Holistic Stress Management in a Graduate Nursing Curriculum.

The aim of this article is to relate how nursing students in a graduate curriculum can learn, personally practice, and prepare to disseminate stress management strategies to patients. Advanced practice nurses often provide care for patients experiencing stress-related disorders while concurrently trying to manage their own high levels of stress. Through the innovative Try-It-On teaching-learning strategy, graduate students experimented with holistic stress management approaches, with the intention of sharing with patients what worked effectively. Student comments on course evaluations were positive regarding Try-It-On. In the pilot trial of a quantitative survey to expand the evaluation of the strategy, students who trialed holistic stress management techniques reported satisfaction, engagement, perceived relevance, and intention to trial techniques with patients in future clinical courses. Modeling role modeling theory and the Kirkpatrick evaluation model guided the project, which filled gaps in current knowledge about experiential learning in graduate nursing programs.

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.

An Initial Study Using Healing Touch for Women Undergoing a Breast Biopsy.

AIM: To determine if a noninvasive complementary therapy, Healing Touch, would benefit women undergoing diagnostic procedures for the determination of breast cancer. Women often experience high levels of fear and anxiety during this diagnostic period. STUDY DESIGN: A randomized controlled pilot study. METHOD: An out-patient clinic specializing in breast care management was used. Seventy-three women age 18 to 85 years old participated, with 31 in the control group of standard care and 42 in the intervention group receiving Healing Touch, a noninvasive energy therapy. A specific technique, magnetic clearing, was provided by a practitioner for 15 minutes prior to the biopsy procedure. Both the State-Trait Anxiety Inventory and the Coping Resources Inventory were used preprocedurally and the following day to assess changes. RESULTS: A mixed analysis of variance indicated that State Anxiety for the Healing Touch group showed a statistically significant reduction of anxiety that was sustained into the following day, F(2, 142) = 10.94, p < .001. For Trait Anxiety, there was a significant change pre-and postintervention to the day after, F(2, 142) = 5.15, p < .007. The Coping Resources Inventory had significant changes in two subcategories, Emotional, F(2, 142) = 6.10, p = .003, and the Spiritual/Philosophical, F(2, 142) = 6.10, p < .001, in the Healing Touch group. CONCLUSION: Healing Touch may have benefit in reducing anxiety from diagnostic breast procedures.