Adolescent Relatedness Through the Lens of Unitary Caring Theory.

Caring as a central focus within nursing has evolved into a relational ontology to guide practice and enhance well-being. Caring praxis has the potential to address the complexities of adolescent development and to allow for authentic engagement, breaking down the barriers of resistance to care. It is clear from the alarming statistics related to the prevalence of anxiety and depression in adolescents that teens are in distress. The authors in this article examine the construct of relatedness in adolescence through the lens of the theory of unitary caring and propose a trans-theoretical transdisciplinary model of relatedness that informs adolescent practice.

Introduction to decolonizing nursing.

The fact that racism and other forms of discrimination and injustice have persisted in our own nursing communities despite our rhetoric of caring and compassion can no longer be denied. This fact gave rise to a webinar in which the scholars represented in this issue of Nursing Philosophy appear. The webinar centered on the philosophy, phenomenology and scholarship of Indigenous nurses and nurses of color. The authors of the articles in this issue are giving us the precious gift of their ideas. All of us, white scholars and scholars of color, must come together to receive this gift, learn from their words and their insight, debate the ideas, honor the perspectives, and consider ways that we can move this discourse forward to create new possibilities for nursing, new possibilities to shape the future development of our discipline.

A Unitary Theory of Healing Through Touch.

Touch has been linked empirically to healing outcomes; therefore, developing theories about the dynamics between touch and healing is important for nursing. A practice-based theory is described within a Unitary Science perspective emerging from the findings of a qualitative descriptive study of the experiences of persons with advanced cancer receiving touch (massage and simple touch) during hospice care. Seventeen participants were interviewed. Through content analysis and retroductive constructivist theory development, healing through touch was described as a dynamic process cocreated by healer and healee, characterized by the simultaneous activities of sensing , reflecting , and connecting . Interpretation of findings from a unitary lens led to an overarching theme of touch as sanctuary and explication of theoretical alignment with the concepts of wholeness, awareness, and presence.

A Life in Nursing Science: A Dialogue With Dr. Marlaine C. Smith.

The year 2022 is Nursing Science Quarterly's 35th year in publication, and we are dialoging with nurse theorists. We hope to uncover influences and origins of their theoretical thinking and hear about their current projects related to nursing science. In this scholarly dialogue column, we dialogue with Dr. Marlaine C. Smith, nurse theorist, Professor Emeritus, Christine E. Lynn College of Nursing, Florida Atlantic University, and president of the Society of Rogerian Scholars. Her contribution to nursing science began with her own inquisitiveness, the influence of nursing faculty and mentors, and an academic career based steeped in leadership and nursing theory. Her middle-range theory of unitary caring synthesizes her work in the science of unitary human beings and caring science.

Chief Nursing Officer Perspectives on Nursing Theory-Guided Practice.

OBJECTIVE: The purpose of this study was to identify what guides nursing practice. BACKGROUND: Change occurred when the Magnet Recognition Program® no longer required a nursing theory. METHODS: This was a mixed-methods study to identify the process used to implement nursing theory-guided practice and the relationship to professional practice recognition. Deidentified quantitative data were collected from 36 chief nursing officers (CNOs). Seventeen CNOs participated in the qualitative interview. RESULTS: Thirteen CNOs were from a Magnet®-designated facility. Ten CNOs were on the Magnet journey, and 2 had no intent to seek Magnet recognition. Two CNOs were from a Pathway to Excellence®-designated facility. One CNO was on the Pathway to Excellence journey. The majority of respondents who were Magnet® recognized who participated in the survey used Watson's Theory of Human Caring. Themes were identified that share the benefits and strategies to integrate nursing-guided theory into nursing processes, structures, and outcomes. CONCLUSION: Findings will benefit CNOs as they make decisions related to pursuing Magnet status recognition.

Knowledge for Nursing Practice: Beyond Evidence Alone.

OBJECTIVE: For the past 30 years there has been a growing emphasis on evidence as the primary or exclusive basis for nursing practice. METHODS: Critical examination of literature related to evidence-based practice from the 1990s to the present. RESULTS: This review of the nursing literature from the 1990s to the present reveals that in the midst of the movement to promote evidence-based practice as the gold standard, there have been persistent expressions of concern. These concerns are (a) lack of alignment of evidence-based practice with nursing's disciplinary perspective; (b) wrongful privileging of empirical knowledge over other sources of knowledge; (c) underappreciation of the complexity of practice and practice wisdom;(d) possibilities of evidence-based practice thwarting innovation and creativity;(e) vulnerabilities of empirical evidence to be flawed, inconsistent, and influenced by competing interests; (f) situational realities that limit access to and critical appraisal of evidence that access to and critical appraisal of evidence is not feasible or practical; and (g) lack of relationship of evidence-based practice to theory. CONCLUSIONS: We call for a recalibrated practice epistemology that promotes a greater appreciation for the myriad sources of knowledge for nursing practice, and offer recommendations for international change in education, literature, scholarship, and public media.

Regenerating Nursing's Disciplinary Perspective.

As we approach the 50th anniversary of the first national symposium on nursing theory development, the need to clarify nursing's disciplinary perspective is just as relevant as it was 50 years ago. The purpose of this article is to regenerate the disciplinary perspective by analyzing the literature on the focus of the discipline of nursing, synthesizing the themes and suggesting areas of knowledge development for the discipline, and imagining ways to move forward in claiming, clarifying, and strengthening the discipline. The 4 themes identified were human wholeness, health/healing/well-being, human-environment-health relationship, and caring. Nine areas of inquiry generated from the disciplinary perspective were suggested.

Thoughts About Nursing Curricula: Dark Clouds and Bright Lights.

In this essay, several nurse scholars who are particularly concerned about the contemporary state of nursing science present their concerns about the inclusion of nursing conceptual models and theories in the curricula of nursing programs (dark clouds) and ways in which the concerns have been addressed (bright lights). This essay is the second of two essays that were catalyzed by Barrett's paper, "Again, What Is Nursing Science?" The first essay was published in the previous issue of Nursing Science Quarterly.

Thoughts About Advancement of the Discipline: Dark Clouds and Bright Lights.

In this essay, several nurse scholars who are particularly concerned about the contemporary state of nursing science present their specific concerns (dark clouds) about the advancement of our discipline and the ways in which the concerns have been addressed (bright lights). This essay is the first of two essays that were catalyzed by Barrett's paper, "Again, What Is Nursing Science?" The second essay will be published in the next issue Nursing Science Quarterly.

Support for caring and resiliency among successful nurse leaders.

Health care practice settings are replete with competing priorities for nurse leaders who are responsible to the staff, the organization, and the patients and their families. In the midst of the competing priorities, there is a mandate for successful nursing leadership that is patient centered. To support the continuance of nurse leader success and avoid discouragement and attrition, a caring and resilient model for leadership may be necessary. This article considers the practices of nurse leaders that support caring, resiliency, and, ultimately, their success. Successful navigation toward patient-centered solutions through the intentional and inextricably linked living caring and resiliency was enhanced with practices of self-care, accountability, and reflection. Within each of the 3 intentional practices, a primary process emerged that revealed how nurse leaders actualize their caring and resiliency. The practices and mutually supportive processes are discussed. Useful questions are provided to guide any nurse leader who is contemplating practices of self-care, accountability, and reflection for supporting caring and resiliency.

Holistic nurses' stories of healing of another.

The purpose of this study was to uncover the essence and meaning of healing through narrative accounts of holistic nurses, using a qualitative, descriptive design integrating narrative and story inquiry. Twenty-five stories were collected. Seven stories revealed personal healing and have been published in a prior article. Eighteen stories, the focus of this analysis, revealed healing of another. A hybrid method blending narrative and story guided the overall process for the study. Nine themes emerged describing healing of another within three story segments: The Call to Healing, The Experience of Healing, and Insights. The theme within The Call to the Healing Encounter was Drawn by Compassion to the Vulnerability and/or Suffering of Another. Five themes describe the Experience of Healing: Connection: Cocreating Relationships; Taking Risks and Dealing With Skeptical Colleagues; Use of Modalities and Actions as Tools in Developing Self as an Instrument of Healing; Profound, Ineffable Events; and Using Metaphor and Rituals to Describe Healing. Three themes describe Insights: Mutual Transformation, Change, and Reciprocity; Gratitude for the Healing Encounter; and Leaving a Legacy. The metastory, a reconstructed story created by the researchers, was the final phase of research synthesizing and demonstrating themes of healing of another. Results were compared to existing healing literature.

Holistic nurses' stories of personal healing.

The purpose of this study was to uncover the nature, experiences, and meaning of personal healing for holistic nurses through their narrative accounts. The study employed a qualitative descriptive design with methods of narrative and story inquiry. Participants were nurse attendees at an American Holistic Nurses' Association conference who volunteered for the study. They were invited to share a story about healing self or another. Twenty-five stories were collected; seven were about personal healing, and these are the focus of this analysis. Data were analyzed using a hybrid approach from narrative and story inquiry methods. Eleven themes were clustered under three story segments. The themes within the Call to the Healing Encounter are the following: recognition of the need to resolve a personal or health crisis, knowledge of or engagement in self-care practices, and reliance on intuitive knowing. Themes under the Experience of Healing are the following: connections; profound sensations, perceptions, and events; awareness of the reciprocal nature of healing; inner resolution: forgiveness, awakening, and acceptance; use of multiple holistic approaches; and witnessing manifestations of healing. The themes for Insights are the following: gratitude and appreciation and ongoing journey. A metastory synthesizing the themes is presented, and findings are related to existing literature on healing.

A prescription for disruptions in care: community building among nurses to address horizontal violence.

In the health care environment, threats exist that can impact a nurse's ability to provide safe, quality care. One of these threats is disruptive behavior among health care workers in which negative interactions adversely affect communication and collaboration. When this occurs among nurses, it is identified as horizontal violence. An underlying concept is power. When attempting to address these behaviors in the workplace, it is important that nurses recognize the context in which they occur so sustaining changes can be made. Community building among nurses may be an appropriate approach to give nurses the skills to make these changes.

Integrative review of research related to Margaret Newman's theory of health as expanding consciousness.

Since 1978 when Margaret Newman first introduced her theory of health as expanding consciousness, the theory has been widely expanded upon by Newman and nursing scholars around the world. This manuscript provides an integrative review of research related to the theory of health as expanding consciousness and analyzes strengths, limitations, and directions for the future. A consistent method of praxis within a unitary, participatory worldview was found. Health as expanding consciousness praxis provides a lens for guiding and interpreting meaning and has cross-cultural appeal and utility.

A nursing manifesto: an emancipatory call for knowledge development, conscience, and praxis.

The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto, written by three activist scholars whose objective was to promote emancipatory nursing research, practice, and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto. Our analysis yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto, its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscience-ness and intention seen in the framework of the Nursing Manifesto.

Perspectives on professional values among nurses in Taiwan.

AIM: The purpose of this study was to identify the most important contemporary professional nursing values for nursing clinicians and educators in Taiwan. BACKGROUND: Nursing values are constructed by members of political and social systems, including professional nursing organisations and educational institutions. Nurses' personal value systems shape the development of these professional values. An understanding of nurses' perceptions of professional values will enable the profession to examine consistencies with those reflected in existing and emerging educational and practice environments. DESIGN: A qualitative descriptive study was conducted using the focus-group discussion method. METHODS: A purposive sample of 300 registered nurses in Taiwan, consisting of 270 nursing clinicians and 30 faculty members, participated in 22 focus-group interviews. Data were analysed using a systematic process of content analysis. RESULTS: Six prominent values related to professional nursing were identified: (a) caring for clients with a humanistic spirit; (b) providing professionally competent and holistic care; (c) fostering growth and discovering the meaning of life; (d) experiencing the 'give-and-take' of caring for others; (e) receiving fair compensation; and (f) raising the public's awareness of health promotion. Four background contexts framed the way participants viewed the appropriation of these values: (a) appraising nursing values through multiple perspectives; (b) acquiring nursing values through self-realisation; (c) recognising nursing values through professional competency and humanistic concerns and (d) fulfilling nursing values through coexisting self-actualisation. A conceptual framework was developed to represent this phenomenon. CONCLUSION: The most important professional nursing values according to the perspectives of nurses in Taiwan were identified. These values reflect benefits to society, to nurses themselves and to the interdisciplinary team. RELEVANCE TO CLINICAL PRACTICE: Nurses' awareness of their own values and of how these values influence their behaviour is an essential component of humanistic nursing care. Nursing educators need to develop better strategies for reflection and integration of both personal and professional philosophies and values.

Providing massage therapy for people with advanced cancer: what to expect.

There is very little information in the literature to prepare massage therapists for what they might expect when they provide treatment to people with advanced cancer in hospice or palliative care. We report an analysis of a subset of data collected from a large multi-site clinical trial of the efficacy of massage therapy for people with advanced cancer. This is the first analysis of empirical data of patient presentation, massage treatment environment, and the characteristics of massage provided for this population.

Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial.

BACKGROUND: Small studies of variable quality suggest that massage therapy may relieve pain and other symptoms. OBJECTIVE: To evaluate the efficacy of massage for decreasing pain and symptom distress and improving quality of life among persons with advanced cancer. DESIGN: Multisite, randomized clinical trial. SETTING: Population-based Palliative Care Research Network. PATIENTS: 380 adults with advanced cancer who were experiencing moderate-to-severe pain; 90% were enrolled in hospice. INTERVENTION: Six 30-minute massage or simple-touch sessions over 2 weeks. MEASUREMENTS: Primary outcomes were immediate (Memorial Pain Assessment Card, 0- to 10-point scale) and sustained (Brief Pain Inventory [BPI], 0- to 10-point scale) change in pain. Secondary outcomes were immediate change in mood (Memorial Pain Assessment Card) and 60-second heart and respiratory rates and sustained change in quality of life (McGill Quality of Life Questionnaire, 0- to 10-point scale), symptom distress (Memorial Symptom Assessment Scale, 0- to 4-point scale), and analgesic medication use (parenteral morphine equivalents [mg/d]). Immediate outcomes were obtained just before and after each treatment session. Sustained outcomes were obtained at baseline and weekly for 3 weeks. RESULTS: 298 persons were included in the immediate outcome analysis and 348 in the sustained outcome analysis. A total of 82 persons did not receive any allocated study treatments (37 massage patients, 45 control participants). Both groups demonstrated immediate improvement in pain (massage, -1.87 points [95% CI, -2.07 to -1.67 points]; control, -0.97 point [CI, -1.18 to -0.76 points]) and mood (massage, 1.58 points [CI, 1.40 to 1.76 points]; control, 0.97 point [CI, 0.78 to 1.16 points]). Massage was superior for both immediate pain and mood (mean difference, 0.90 and 0.61 points, respectively; P < 0.001). No between-group mean differences occurred over time in sustained pain (BPI mean pain, 0.07 point [CI, -0.23 to 0.37 points]; BPI worst pain, -0.14 point [CI, -0.59 to 0.31 points]), quality of life (McGill Quality of Life Questionnaire overall, 0.08 point [CI, -0.37 to 0.53 points]), symptom distress (Memorial Symptom Assessment Scale global distress index, -0.002 point [CI, -0.12 to 0.12 points]), or analgesic medication use (parenteral morphine equivalents, -0.10 mg/d [CI, -0.25 to 0.05 mg/d]). LIMITATIONS: The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of a beneficial effect. The generalizability to all patients with advanced cancer is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive without a usual care control group. CONCLUSION: Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study groups, the potential benefits of attention and simple touch should also be considered in this patient population.

Holistic foundations of aromatherapy for nursing.

The purpose of this article is to describe a theoretical framework for the integration of aromatherapy in the practice in nursing. Five propositions derived from 3 theories comprising the framework are presented, and suggestions for the integration of aromatherapy in nursing practice and education are described.