Effectiveness of mental health website intervention on stress and depression for women with recurrent miscarriage: A randomized controlled trial.

We aimed to investigate the effect of a mental health website intervention on perceived stress, depression, sleep quality, and social support in women with recurrent miscarriage (RM). Performing a randomized controlled trial, the participants in the experimental group (n = 31) received a 12-week mental health website intervention; the participants in the control group (n = 31) received RM standard medical care only. The paired t-tests results for the mean posttest scores for depression (p = .023) and perceived stress (p = .041) in the experimental group showed a significant decrease, but did not in the control group.

Outcomes of a walking exercise intervention in postpartum women with disordered sleep.

AIM: Good sleep quality is essential to physical and mental-health-related quality of life. The purpose of this study was to evaluate the effects of a walking exercise in relieving sleep quality, fatigue, and depression in new mothers during the postpartum period. METHODS: This quasi-experimental study was conducted at a teaching hospital in southern Taiwan. One hundred and four eligible postpartum women with poor sleep quality (Postpartum Sleep Quality Scale; PSQS score ≧16) were assigned to either the experimental group (n = 50) or the control group (n = 54) according to their individual preferences. The participants in the experimental group participated in a 12-week stride walking exercise intervention. The control group did not receive any exercise intervention. The PSQS, Postpartum Fatigue Scale, and Edinburgh Postnatal Depression Scale were used to assess outcomes. RESULTS: Repeated measures ANOVA demonstrated that the experimental group participants perceived milder physical symptoms associated with sleep inefficiency at 4-week posttest (F = 7.25, p < 0.01) than their control group peers. However, no significant differences were found between two groups in terms of either fatigue or depression at 4-week and 12-week posttest. CONCLUSION: Significant improvement in the physical symptoms associated with sleep inefficiency was observed. The findings may be used to encourage postpartum women with disordered sleep to incorporate 20-30 min of stride walking into their regular routine to improve sleep quality.

Stress, anxiety and depression perceived by couples with recurrent miscarriage.

AIM: Recurrent miscarriage is considered a major life event. The main purposes of this study were to compare the differences in stress, anxiety, social support, sleep quality and depressive symptoms in couples experiencing recurrent miscarriage compared to peers who experience full-term normal childbirth in southern Taiwan. METHODS: Convenience sampling and snowball sampling were used respectively to recruit 78 couples with and 80 couples without recurrent miscarriage from October 2014 to July 2015. Five structured questionnaires including Perceived Stress Scale, State- Anxiety Inventory, Interpersonal Support Evaluation List, Pittsburgh Sleep Quality Index and Edinburgh Depression Scale were administered. RESULTS: Women who experienced recurrent miscarriage perceived significantly higher levels of stress, anxiety and depressive symptoms than their husbands. Women in the recurrent miscarriage group reported significantly greater depressive symptoms than women of the other group. A stepwise multiple regression analysis indicated key predictors of depressive symptoms among women of childbearing age, accounting for 62.9% of the variance, were anxiety, stress, social support and history of recurrent miscarriage. CONCLUSION: Women with recurrent miscarriage suffer mild to moderate depressive symptoms and a greater incidence of depression than their peers who experienced normal childbirth. Health professionals can use the knowledge gained from these findings to evaluate women with recurrent miscarriage for stress, anxiety and depressive symptoms and develop supportive interventions.

The clinically crucial predictors of depression in women with systemic autoimmune diseases.

The researchers' aim of this study was to identify and quantify the useful, clinically crucial predictors of depression in Taiwanese women with systemic autoimmune diseases (SADs). We used a cross-sectional method. A total of 241 Taiwanese women with SADs between 21 and 85 years of age participated in the study. Analysis revealed that the strongest predictors of depression in participants were: perceived stress, fatigue, mental health, physical health, chronic-disease-related comorbidities, self-perceived SAD severity, and social support. The model used in the present study explained 70.9% of the variance in the depression.

Music intervention for pain and anxiety management of the primiparous women during labour: A systematic review and meta-analysis.

AIMS: To determine the effect of music on the management of pain and anxiety in primiparous women during labour. BACKGROUND: Music is cost-effective intervention in clinical practice to reduce pain, stress, and anxiety. However, a systematic review with meta-analysis for investigating its effects during labour is still lacking. DESIGN: A systematic review with meta-analysis. DATA SOURCES: MEDLINE, EMBASE, and CINAHL databases. REVIEW METHODS: Randomized controlled trials or quasi-experimental trials concerning the effects of music among primiparous women who were expected to give normal spontaneous delivery were searched and screened up to 31 July 2017. The recruited trials for this review were compliant with the standards of the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: A total of 392 primiparous pregnant women (197 in the music intervention group and 195 in the routine care group) from five studies were included in this review. Music as an intervention seemed to lower the pain scores for primiparous women during labour, but the effect was not statistically significant. However, there was a significant benefit of music intervention compared with routine care for primiparous women during labour. In the sensitivity analysis, music intervention showed significant effect on the improvement of pain and anxiety for primiparous women during labour. CONCLUSION: Music intervention may be an effective intervention for the management of pain and anxiety for primiparous women during labour.

Risk factors associated with newly psychiatric disorder in spinal cord injury: A retrospective cohort study.

AIM AND OBJECTIVES: To predict the risk factors related to newly diagnosed psychiatric disorders resulting from spinal cord injuries (SCIs). BACKGROUND: SCIs are a common result of devastating accidents; they can have an essential negative impact on the psychological health of those so afflicted. Psychiatric disorders commonly occur worldwide and are often associated with pain and disability; however, few studies have investigated the risk factors of psychiatric disorders among persons with SCIs. DESIGN: A retrospective cohort study design with data obtained from the Taiwan Health Insurance Research Database (THIRD). THIRD involves the claims data on recipients recorded in the Taiwan National Health Insurance (TNHI), which was set up in 1995 and covers about 99% of the 23 million persons in Taiwan. METHODS: We used THIRD to predict the risk factors related to newly diagnosed psychiatric disorders among victims of spinal cord injury. RESULTS: The majority of persons with SCI were men (51.2%), and their average age was 52.8 years. All 5,828 newly diagnosed psychiatric disorders were included from 1997-2009 in 64,907 SCI in the THIRD data set. These results demonstrated notable differences in hazard risk (HR); the injured persons were inspected for the level of SCI, age, hypertension and chronic obstructive pulmonary disease (HR: 1.637, 95% CI: 1.452-1.844, p < .0001; HR: 1.005, 95% CI: 1.002-1.009, p = .0019; HR: 0.724, 95% CI: 0.642-0.816; HR: 1.267, 95% CI: 1.105-1.454, p = .0007; HR: 1.368, 95% CI: 1.183-1.582, p < .0001, respectively); the persons with SCI exhibited significant independent associations with psychiatric disorders. CONCLUSIONS: The results revealed that the level of SCI, female gender and age, respectively, affects the incidence of newly diagnosed psychiatric disorder related to SCI. RELEVANCE TO CLINICAL PRACTICE: This study showed that psychiatric disorders may be associated with the development of SCI, and that this risk was more predominant in females with SCI. Our results are of direct clinical relevance as they are meant to assist clinical assessment, counselling, guidance of symptomatic monitoring and early clinical intervention.

Effects of an intervention with drinking chamomile tea on sleep quality and depression in sleep disturbed postnatal women: a randomized controlled trial.

AIM: The purpose of this study was to evaluate the effects of chamomile tea on sleep quality, fatigue and depression in postpartum women. BACKGROUND: Sleep quality is a significant issue for postnatal women. Chamomile is widely used as a folk remedy for its presumed sedative-hypnotic effects. DESIGN: A pretest-post-test randomized controlled trial was used. METHODS: A total of 80 Taiwanese postnatal women with poor sleep quality (Postpartum Sleep Quality Scale; PSQS score ≧16) were recruited from November 2012-August 2013. They were systematically assigned, with a random start, to either the experimental group (n = 40) or the control group (n = 40). The participants in the experimental group were instructed to drink chamomile tea for a period of 2 weeks. The participants in the control group received regular postpartum care only. The PSQS, Edinburgh Postnatal Depression Scale, and Postpartum Fatigue Scale were used to assess outcomes. Two-sample t-tests were used to examine the mean differences in outcome variables between the two groups. RESULTS: Compared with the control group, the experimental group demonstrated significantly lower scores of physical-symptoms-related sleep inefficiency (t = -2·482, P = 0·015) and the symptoms of depression (t = -2·372, P = 0·020). However, the scores for all three instruments were similar for both groups at 4-week post-test, suggesting that the positive effects of chamomile tea were limited to the immediate term. CONCLUSION: Chamomile tea may be recommended to postpartum women as a supplementary approach to alleviating depression and sleep quality problems.

Effects of music listening on stress, anxiety, and sleep quality for sleep-disturbed pregnant women.

Prenatal sleep disturbance has been associated with undesirable birthing outcomes. To determine the effectiveness of listening to music at home in improving sleep quality, 121 Taiwanese pregnant women with poor sleep quality (Pittsburgh Sleep Quality Index [PSQI] score > 5) were systematically assigned, with a random start to music listening (n = 61) or control (n = 60) group. Participants in the music listening group self-regulated listening to music in addition to receiving general prenatal care similar to that in the control group for 2 weeks. The PSQI and State-Anxiety Inventory were used to assess outcomes. ANCOVA analyses were used with the pretest scores as covariates and showed significant improvement in sleep quality, stress, and anxiety in the music listening group compared with the control group. The most frequently used music genre by participants in the experimental group was lullabies, followed by classical music and crystal baby music. This study supported the theory that 2-week music listening interventions may reduce stress, anxiety, and yield better sleep quality for sleep-disturbed pregnant women. The analysis of participants' journals also implied that the expectant mothers' choices of musical genres may correlate more with perceived prenatal benefits or the desire to interact with their unborn child.

Effects of Lavender Tea on Fatigue, Depression, and Maternal-Infant Attachment in Sleep-Disturbed Postnatal Women.

BACKGROUND: Lavender inhalation aromatherapy is widely believed to impart a hypnotic effect, act as a mood stabilizer, and enhance the positive feelings of mothers toward their infants. However, research into these and other potential therapeutic effects of lavender tea has been limited. AIMS: This study was conducted in Taiwan to evaluate the effectiveness of lavender tea in relieving sleep quality, fatigue, and depression; and in improving maternal-infant attachment during the early postpartum period. METHODS: A total of 80 Taiwanese postnatal women with poor sleep quality (Postpartum Sleep Quality Scale; PSQS score ≥16) and with no history of allergy to herbal teas, foods, or medicines were assigned systematically to either the experimental group (n = 40) or the control group (n = 40). The participants in the experimental group were instructed to drink one cup of lavender tea after spending time to appreciate and smell the aroma each day for a period of 2 weeks, whereas their control group peers received regular postpartum care only. The PSQS, Edinburgh Postnatal Depression Scale, Postpartum Fatigue Scale, and Postpartum Bonding Questionnaire were used to assess outcomes. RESULTS: ANCOVA analyses using education level and pretest scores as covariates showed that experimental group participants perceived less fatigue (F = 6.281, p = .014) and depression (F = 4.731, p = .033) and showed greater bonding with their infant (F = 4.022, p = .049) compared with the control group. However, the scores for all four instruments were similar for both groups at the 4-week posttest, suggesting that the positive effects of lavender tea were limited to the immediate term. LINKING EVIDENCE TO ACTION: Healthcare researchers assume accountability for integrating research results into clinical practice. The findings in this study can gain greater attention among healthcare practitioners and encourage the correct and positive use of herbal therapy in postpartum health care.

Postpartum women's sleep quality and its predictors in Taiwan.

PURPOSE: The purpose of this study was to explore postpartum women's sleep quality and its predictors in Taiwan. DESIGN: Cross-sectional design. METHODS: Postpartum women (N = 327) were recruited during their postnatal check-ups in Taiwan. Data were collected from October 2008 to July 2009 using a demographic form, the Pittsburgh Sleep Quality Index (PSQI), Physical Symptoms Checklist, Perceived Stress Scale, and Postpartum Social Support Scale. Descriptive statistics, Pearson's correlation, and stepwise multiple regression analysis were used to analyze data. RESULTS: Most participants (87.5%) reported poor sleep quality (PSQI > 5). Postpartum sleep quality was predicted by postpartum physical symptoms, frequency of nighttime awakening, co-sleeper disturbance, marital satisfaction, perceived stress, and baby sleep status, which explained 29.9% of the total variance. CONCLUSIONS: Most postpartum women did not sleep well due to physical discomfort, perceived stress, co-sleeper disturbance, and marital dissatisfaction. CLINICAL RELEVANCE: Evaluation of sleep quality should be a routine part of postnatal check-ups. Information on women's sleep problems, marital satisfaction, stress, co-sleepers, and baby sleep status can be used to individualize intervention protocols for sleep-disturbed women.

Effectiveness of a stretching exercise program on low back pain and exercise self-efficacy among nurses in Taiwan: a randomized clinical trial.

The purpose of this study was to examine the effectiveness of a stretching exercise program (SEP) on low back pain (LBP) and exercise self-efficacy among nurses in Taiwan. A total of 127 nurses, who had been experiencing LBP for longer than 6 months and had LBP with pain scores greater than 4 on the Visual Analogue Scale for Pain (VASP), were randomly assigned to an experimental group and a control group. The experimental group (n = 64) followed an SEP, whereas the control group (n = 63) was directed to perform usual activities for 50 minutes per time, three times a week. Data were collected at four time points: at baseline, and 2, 4, and 6 months after the intervention. During the 6-month follow-up, the experimental group had significantly lower VASP scores than did the control group at the second, fourth, and sixth months. In addition, the experimental group showed significantly higher exercise self-efficacy than did the control group at the fourth and sixth months. A total of 81% of the participants in the experimental group reported a moderate to high level of LBP relief. The findings can be used to enhance self-care capabilities with SEP for nurses that experience LBP or are vulnerable to such work-related pain. SEP is an effective and safe nonpharmacological intervention for the management of LBP.

Taiwanese women's process of recovery from stillbirth: a qualitative descriptive study.

The purpose of this qualitative descriptive study was to portray the recovery process of Taiwanese women after stillbirth. Data were generated through individual in-depth interviews with 21 women selected using purposeful sampling. Three stages in an emotional journey of recovery were suffering from silent grief, searching for a way out, and achieving peace of mind and mental stability. Throughout their journey, the women's overarching concern was where the deceased child had gone and whether it was well. Together these stages composed A pathway to peace of mind, a mental journey on which women struggled to spiritually connect with the lost baby and finally sought a personal pathway to emotional peace. Findings can inform healthcare providers in providing culturally sensitive care for Taiwanese women to facilitate healing after a stillbirth.

The effectiveness of visual art on environment in nursing home.

PURPOSE: This Taiwan study investigated the effect of a visual art-based friendly environment on nursing home residents' satisfaction with their living environment. DESIGN: A pre-experimental design was used. Thirty-three residents in a nursing home were recruited in a one-group pre- and post-test study. METHODS: The four-floor living environment was integrated using visual art, reminiscence, and gardening based on the local culture and history. Each floor was given a different theme, one that was familiar to most of the residents on the floor. The Satisfaction with Living Environment at Nursing Home Scale (SLE-NHS) was developed to measure outcomes. FINDINGS: Of the 33 participants recruited, 27 (81.8%) were women and 6 (18.2%) were men. Their mean age was 79.24 ± 7.40 years, and 48.5% were severely dependent in activities of daily living. The SLE-NHS showed adequate reliability and validity. Its three domains were generated and defined using factor analysis. After the visual art-based intervention, the score on the "recalling old memories" subscale was significantly higher (t = -13.32, p < .001). However, there were no significant score changes on the "convenience" and "pretty and pleasurable" subscales. In general, the participants were satisfied with the redesigned environment and felt happy in the sunny rooms. CONCLUSIONS: Visual art in a nursing home is a novel method for representing the local culture and stressing the spiritual value of the elderly residents who helped create it. Older adults' aesthetic activities through visual art, including reminiscence and local culture, may enrich their spirits in later life. CLINICAL RELEVANCE: Older adults' aesthetic activities through visual art have been shown to improve their satisfaction with their living environment. The SLE-NHS is a useful tool for evaluating their satisfaction.

Maternal-foetal attachment during early pregnancy in Taiwanese women pregnant by in vitro fertilization.

AIM: The aim of this study was to investigate maternal-foetal attachment at 9, 12 and 20 weeks gestation and to identify factors that influenced maternal-foetal attachment in Taiwanese women who conceived by in vitro fertilization. BACKGROUND: Development of maternal-foetal attachment is an important part of taking on the maternal role. However, evidence about maternal-foetal attachment after assisted conception is inconclusive. DESIGN: A longitudinal design with repeated measures. METHODS: A prospective, longitudinal design with repeated measures was used. Over an 18-month period in 2006-2008, a convenience sample of 160 women who conceived after undergoing successful in vitro fertilization were recruited from a major infertility care centre in Taiwan. Data were collected by self-reported measures, including: (1) Maternal-Foetal Attachment Scale; (2) Symptoms Checklist; (3) Pregnancy-related Anxiety Scale; (4) Social Support Apgar; (5) Chinese childbearing attitude Questionnaire; and (6) Awareness of Foetus Scale. The selected instruments to measure each variable were administered to participants at 9, 12 and 20 weeks gestation. RESULTS: Maternal-foetal attachment increased as pregnancy progressed from 9 to 20 weeks gestation. General linear mixed model showed predictors of maternal-foetal attachment included Chinese childbearing attitude, awareness of the foetus, and social support. CONCLUSION: Health provider awareness of cultural influences on the development of early maternal-foetal attachment of women pregnant by in vitro fertilization is needed. Prenatal education in early pregnancy might incorporate more information about foetal development to allow the mother to visualize her unborn child. Providing social support for women who were conceived by in vitro fertilization is beneficial to the development of maternal-foetal attachment.

Effects of Yoga for Coping with Premenstrual Symptoms in Taiwan-A Cluster Randomized Study.

Home-based yoga practice has not been approved as a method for alleviating premenstrual symptoms in Taiwan. This study was a cluster randomized trial. A total of 128 women self-reporting at least one premenstrual symptom were enrolled in the study, of which there were 65 participants in the experimental group and 63 participants in the control group. Women in the yoga group were provided with a yoga DVD program (30 min) to practice for three menstrual months, at least three times a week. All participants were given the Daily Record of Severity of Problems (DRSP) form to measure premenstrual symptoms. After the yoga exercise intervention, the yoga group had statistically significantly fewer and/or less severe premenstrual depressive symptoms, physical symptoms, and anger/irritability. Other disturbances and the impairment of daily routine, hobbies/social activities, and relationships also occurred significantly less often in the yoga group. The study found that yoga is useful to relieve premenstrual symptoms. Moreover, home-based yoga practice is more pertinent in the pandemic era. The strengths and drawbacks of the study are discussed and further study is recommended.

Atypical work schedules are associated with poor sleep quality and mental health in Taiwan female nurses.

PURPOSE: To investigate the effects of shift work schedules on sleep quality and mental health in female nurses in south Taiwan. METHODS: This study recruited 1,360 female registered nurses in the Kaohsiung area for the first survey, and among them, 769 nurses had a rotation shift schedule. Among the 769 rotation shift work nurses, 407 completed another second survey 6-10 months later. Data collection included demographic variables, work status, shift work schedule, sleep quality (Pittsburgh Sleep Quality Index), and mental health (Chinese Health Questionnaire-12). RESULTS: Nurses on rotation shift had the poor sleep quality and mental health compared to nurses on day shift. The nurses on rotation shift had a relatively higher OR of reporting poor sleep quality and poor mental health (OR, 2.26; 95% CI, 1.57-3.28; and OR, 1.91; 95% CI, 1.39-2.63, respectively). Additionally, rotation shift nurses who had ≥2 days off after their most recent night shifts showed significantly improved sleep quality and mental health (PSQI decreased of 1.23 and CHQ-12 decreased of 0.86, respectively). Comparison of sleep quality between the first and second surveys showed aggravated sleep quality only in nurses who had an increased frequency of night shifts. CONCLUSION: Female nurses who have a rotation shift work schedule tend to experience poor sleep quality and mental health, but their sleep quality and mental health improve if they have ≥2 days off after their most recent night shifts. This empirical information is useful for optimizing work schedules for nurses.

Effects of a relaxation training programme on immediate and prolonged stress responses in women with preterm labour.

AIM: This paper is a report of an experimental study of the effects of relaxation-training programme on immediate and prolonged stress responses in women with preterm labour. BACKGROUND: Hospitalized pregnant women with preterm labour experience developmental and situational stress. However, few studies have been performed on stress management in such women. METHODS: An experimental pretest and repeated post-test design was used to compare the outcomes for two groups in northern Taiwan from December 2008, to May 2010. A total of 129 women were randomly assigned to an experimental (n = 68) or control (n = 61) group. The experimental group participants were instructed to listen daily to a 13-minute relaxation programme. Measurements involved the stress visual analogue scale, finger temperatures, State Trait Anxiety Inventory, Perceived Stress Scale and Pregnancy-related Anxiety. Two-way analysis of variance and hierarchical linear modelling were used to analyse the group differences. RESULTS: Compared with those in the control group, participants in the experimental group showed immediate improvements in the stress visual analogue scale scores and finger temperatures. The State Trait Anxiety Inventory-State subscale score for the experimental group was significantly lower than that for the control group (P = 0·03). However, no statistically significant differences for the Perceived Stress Scale and Pregnancy-related Anxiety scores were found between the experimental group and the control group. CONCLUSIONS: The relaxation-training programme could improve the stress responses of women with preterm labour.

[A "dialogue" between the aesthetics of nursing and philosophy].

Nursing aesthetics belong to the broader school of aesthetics, a branch of philosophy, as well as the nursing arts, an element of professional nursing. The philosophy of aesthetics recognizes the connection between an author and appreciators and identifies both substantive and abstract aesthetic experiences in interpersonal communication through the fine arts. Nursing aesthetics values the meaningful moments of patients, is sensitive to the influences of different circumstances and situations, and appreciates the unique qualities of humanness. Nursing aesthetics is emancipatory knowledge and involves empirical, ethical and personal knowing. The article is based on a search of OvidSP and Chinese Electronic Periodical Services (CEPS) database references using key words including aesthetic, aesthetics, art of nursing, or nursing aesthetics as well as a review of books related to aesthetics, knowledge construction, and nursing aesthetics. Authors determined definitions as defined by nursing experts and the applications thereof in clinical practice. This article aimed to illustrate that the ultimate concern of philosophy is "goodness" and that the foundation of caring behaviors is "love". In practice, nursing aesthetics is expressed through empathy, appreciation, inspiration and the therapeutic use of the self. Through aesthetic knowing and enhanced perceptual sensibility and reflection, nurses can transform intuitive knowing into art-acts and ultimately enhance nursing care quality.

Development and validation of the paediatric cancer coping scale.

AIM: The purpose of this study was to develop and test the psychometric properties of the paediatric cancer coping scale in children with cancer. BACKGROUND: Coping is a mediator between stressful events and adaptation. However, existing tools cannot be used to assess and understand coping strategies in children with cancer in Taiwan. METHODS: A total of 229 children with cancer were recruited from three medical centres in Taiwan in 2008-2009. Internal consistency and test-retest reliability were estimated by Cronbach's alpha and intra-class correlation coefficient respectively. The factor structure was determined by exploratory factor analysis and confirmatory factor analysis. Pearson's correlation coefficient was employed to test the convergent and discriminate validity. RESULTS: The paediatric cancer coping scale demonstrated internal consistency (α = 0·91) and a 2-week test-retest reliability (intra-class correlation coefficient = 0·86). Its construct validity was confirmed by factor analysis, which extracted and defined three categories of coping strategies: cognitive coping, problem-oriented coping and defensive coping; these three factors explained 40% of the total variance with factor loadings ranging from 0·31 to 0·71. Convergent and discriminate validities were demonstrated by significant correlations among the coping, resilience and anxiety subscales. CONCLUSIONS: The paediatric cancer coping scale is a reliable and valid scale to measure and examine coping strategies in children with cancer.

[Using alternative therapies in treating sleep disturbance].

Sleep disturbance is a common health problem among adults, and enhancing sleep quality is an issue of significant importance to healthcare providers. As sleep quality worsens into insomnia, individuals may seek assistance from medication. However, sedative hypnotic drugs pose potentially adverse effects. Also, most medical treatments (e.g., positive pressure assistant ventilators) represent invasive interventions that must be prescribed by physicians. Non-pharmacological alternative therapies are commonly recommended and adopted by community nurses. Alternative therapies for sleep disturbance included exercise, cognitive behavior therapy, multiple strategies, music, and acupressure. In general, moderately intensive walking exercise is the intervention most recommended by professionals to help patients deal with sleep disturbance. Therefore, it is suggested that future researchers devise sleep quality promotion strategies that are suitable for home practice in order to apply the findings and spirit of research already done in this area.