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Background: Nurses play an essential role as frontline caregivers, particularly in recognizing and responding to patient deterioration. This study addresses nurses' self-leadership in the face of challenging situations such as patient deterioration, emphasizing the importance of self-leadership skills in navigating complex patient care scenarios. Delayed recognition of subtle changes in patient's conditions has been linked to adverse outcomes, necessitating a closer examination of the role of self-leadership in nursing practice. Objective: The objective of this research was to explore and understand the implications of self-leadership among nurses when confronted with challenging situations, specifically focusing on patient deterioration. Methods: A qualitative, exploratory, and descriptive research design was employed, utilizing focus group discussions (FGDs) with nurses from a private hospital in Pretoria, South Africa. Semistructured interview guide facilitated the FGDs, and data saturation was achieved after the eight sessions. The sample included nurses with various qualifications and shifts, offering diverse perspectives on self-leadership in patient care. Rigorous data collection and trustworthiness measures, including member checking and verbatim transcriptions, were employed to enhance the conformability of the study. Results: The findings revealed six overarching themes and 15 subthemes, demonstrating the interconnectedness of self-leadership and nursing practice. Themes included responsibility and autonomy, compassion and care, support and collaboration, learning from experience, teamwork, and appreciation and recognition. These themes explained how nurses actively engaged in self-observation, constructive thought patterns, and natural reward strategies to proactively address patient deterioration. Conclusion: The study underlines the significance of integrating self-leadership principles into nursing practice. Embracing self-leadership in nursing holds promise for improving patient outcomes and nurturing a resilient and competent nursing workforce. [ABSTRACT FROM AUTHOR]

Older adults are at high risk of experiencing injury, exacerbations of their chronic conditions, and death when evacuations are ordered because of hurricanes or natural disasters. The Homebound seniors residing in Galveston County are at a particularly high risk of morbidity and mortality during evacuations for hurricanes. This paper described the impact of a quality improvement intervention designed and implemented by nurse practitioners during the 2022 and 2023 hurricane season. The education program aimed at increasing the hurricane preparedness of the home-bound patients. Of these patients, 190 returned pre and post surveys. Interventions showed a 43% increase in patients having an evacuation plan in the event of a hurricane, 633% increase in STEAR registration, 16% increase in patients having access to emergency supplies, and 34% increase in patients having an emergency contact list with up-to-date medication list. All improvements on hurricane preparedness items were significant (p <.0001) except for the need for assistance in case of an evacuation. Our findings suggest a need for continuous hurricane preparedness education in the community to ensure safe evacuation, improve hurricane preparation, and increase the number of seniors who registered with the State of Texas Emergency Assistance Registry. [ABSTRACT FROM AUTHOR]

Artificial intelligence revolutionizes nursing informatics and healthcare by enhancing patient outcomes and healthcare access while streamlining nursing workflow. These advancements, while promising, have sparked debates on traditional nursing ethics like patient data handling and implicit bias. The key to unlocking the next frontier in holistic nursing care lies in nurses navigating the delicate balance between artificial intelligence and the core values of empathy and compassion. Mindful utilization of artificial intelligence coupled with an unwavering ethical commitment by nurses may transform the very essence of nursing. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was aimed to explore the trajectory of thoughts and feelings related to religiosity and spirituality using a holistic approach following attendance at group—Quran Recitation (QR) sessions among annual flood victims. Design: This is a qualitative study with an in-depth retrospective interview conducted data in 2019. Methods: The purposive sampling was applied to conduct face-to-face individual video-recorded semistructured interviews. Seventeen participants followed six QR chanting sessions in Bandung, Indonesia. Data were transcribed verbatim and analyzed using inductive analysis. Findings: After extracting evidence expressions of participants, the research team generated the central theme of "Holism of Religiosity and Spirituality," using three influential sub-themes, including obedience to God's will, growing a positive mindset through spirituality and life started to be delighting from nine categories. Conclusion: The relationship of body-mind concepts of holism through QR among flood sufferers was explored. The effect of QR chanting is beneficial to change awareness about the wisdom of spirituality. The holistic approach of religiosity and spirituality in nursing care is recommended to promote all service settings, especially community and disaster nursing in the Indonesian context. Future research is needed to develop QR chanting activities among multiethnic and socio-cultural groups as alternative therapy quantitatively. [ABSTRACT FROM AUTHOR]

Energy-based therapies (EBT) are increasingly being used as comfort measures for hospitalized patients. This article describes the background and process of implementing an EBT healing touch (HT) pilot program in an inpatient rehabilitation unit. The pilot built on knowledge gained in a preliminary EBT pilot in two hospital units to improve rehabilitation patient outcomes and gather additional information to support a fully funded, sustainable rehabilitation EBT program. Thirty-five percent of the rehabilitation patients received HT, most commonly for pain and anxiety, by experienced HT practitioners over the 9-month pilot period. Both HT practitioners' and patients' ratings showed that patients' level of pain and anxiety decreased by approximately two points after the HT experience. Documented patient comments confirmed their positive experience, including comments describing a reduction in anxiety and increased sense of calm. [ABSTRACT FROM AUTHOR]

Purpose of the study: The study aimed to develop and validate a holistically based follow-up pain assessment diary for patients with cancer pain in Sri Lanka. Design of the study: Mixed-method design adapted. Methods used: Developing a pain diary and testing its psychometric qualities were done in two phases. Comprehensive literature research and qualitative semistructured interviews with patients, clinical, and subject specialists created the pain diary items. Content, face, construct, criterion validity, and reliability were evaluated. Findings: The essential domains to be assessed were identified under six main categories; pain and related characteristics, physical, psychological, social, spiritual, and financial aspects. The average variance extracted from the subscales "Influence on daily life," "Gastric disturbances," and "Pain intensity" were 0.526, 0.562, and 0.696, respectively. The heterotrait–monotrait criterion values between subscales were from 0.691 to 0.44, which was lower than the threshold. Good to excellent correlation coefficients were demonstrated with the scores of reference tools. Cronbach's alpha was computed for each subscale and ranged from 0.75 to 0.92 and composite reliability from 0.921 to 0.826. Conclusions: Pain diary is a reliable and valid instrument for follow-up assessment of holistic pain experience enabling holistic nursing among patients with cancer pain in Sri Lanka. [ABSTRACT FROM AUTHOR]

The evolution of the role of the Professional Nurse Coach (NC) in recent years has been an empowering and innovative model for health and wellness for individuals, groups, communities, and populations. The relationships, requirements, and responsibilities of NC supervision to date, however, have not been fully examined. The aim of NC supervision is to provide feedback on the coaching process, and confidently guide the new NC to utilize creative problem-solving techniques and interventions. Themes emerge in supervision that can help expand competence and skills of coaching. Additionally, knowledge gaps may become apparent that would require further exploration or education. Articles on clinical supervision within the confines of nursing and other related disciplines do not highlight the challenges, responsibilities, or contractual obligations of the NC-Supervisor relationship. Without clear guidelines and identifiable themes within the supervisory experience, there are inconsistent parameters and confusion around supervision. This article will address the need for a consensus of a competency framework for NC clinical supervision and recommend a baseline strategy for guideline development. The article is relevant to the competencies associated with the ANA Standards of Professional Performance required for certification as an NC. [ABSTRACT FROM AUTHOR]

Introduction: Nurse-led primary care is a relatively rare model for primary care, but given nurses more holistic approach to medicine, can prove effective in both reducing costs and disparities in access and outcomes. The present study compares cost adjusted quality of care between a nurse-led primary care facility and the standard primary care. Design: To compare the cost adjusted quality of care between the standard primary care model and a nurse led primary care model the outcomes from a population of patients that visited each (control and experimental, respectively) are compared with respect to three complications of hypertension (stroke, heart attack, and coronary heart disease). Method: The number of three complications (stroke, heart attack, and coronary artery disease) from hypertension for the experimental population is estimated using time-to-event distributions estimated from the control population. Costs are estimated using the control population data. Results: It is found that the population that visited the nurse-led primary care facility had better cost adjusted outcomes than the population that visited the physician led facilities. We can attribute, at least, $3.7 million in costs not realized due to the quality of care provided by the nursing center. Conclusion: Nurse-led primary care is one way that the U.S. healthcare system could reduce costs while providing consistent quality of care. [ABSTRACT FROM AUTHOR]

Background: Palliative Care also encompasses the dimension of spiritual pain. Pastoral care workers and chaplains are specialists in the provision of spiritual care. Decreasing religious affiliation and increasing spiritual diversification in modern societies raise the question of the function of pastoral care. Aim: The goal of this study is to answer the question of what pastoral care workers can offer to dying residents in hospices and palliative care units. Design: A qualitative interview study was designed to explore the specific perspective of pastoral care workers in a multidisciplinary environment. The study is based on differentiation theory which is particularly well adjusted to reveal differences in perspectives in so called 'holistic' care settings. The reporting follows the COREQ guidelines. Setting: Problem centered interviews were conducted at five hospices and two palliative care units. Results: Eight pastoral care workers were interviewed (5 Catholic, 3 Protestant, mean age of 58 years). The analysis of the interviews revealed three major themes: (A) Self-positioning in relation to the organization, (B) Offering conversations to patients and relatives, (C) Performing religious rituals. Minor themes were: mediating conflicts between patients, relatives and staff, sensing moods in silence with patients and organizing workshops for staff. Conclusion: In modern hospice care, pastoral care workers routinely address the problem of making death more tangible and of answering the unanswerable question of what comes afterwards. Through this, they support dying residents in hospices and palliative care units in dealing with the inexplicability of death. [ABSTRACT FROM AUTHOR]

OBJECTIVE: A diverse physician workforce ensures equitable care. The holistic review of residency applications is one strategy to enhance physician diversity; however, little is known about current adoption and the factors that facilitate/impede the adoption of holistic recruitment practices (HRPs) by graduate medical education (GME) residency, and fellowship program directors (PDs). To describe the current state and explore, the barriers/facilitators to the adoption of HRPs at our institution. METHODS: We disseminated information about HRP within our program between 2021 and 2022. In May 2022, a survey of 73 GME PDs assessed current recruitment practices and self-reported barriers to holistic recruitment. Holistic Recruitment Scores (HRSs) reflecting the adoption of best practices were tabulated for each program and compared to identify predictors of adoption. RESULTS: 73/80 (92%) of PDs completed the survey. Programs whose PDs had higher academic rank, total number of trainees, and female trainees in the past 3 years had higher HRSs. Program size was directly correlated with HRS. Most (93%) PDs felt their current efforts were aligned to increase diversity and 58% felt there were no barriers to the adoption of holistic review. The most reported barriers were lack of time and knowledge/expertise in diversity, equity, and inclusion (DEI), both reported by 16 out of 73 PDs (22%). CONCLUSION: While most PDs implemented some HRP, institutional and departmental support of program directors through the commitment of resources (eg, staffing help and subject matter experts/coaches hiring) are crucial to overcome barriers. [ABSTRACT FROM AUTHOR]

Purpose : This study interpreted journaled experiences of registered nurses (RNs) who were working at the bedside early in the pandemic as they were simultaneously enrolled in a baccalaureate (RN-BSN) completion program. Design: This qualitative interpretive descriptive study used purposive sampling. Methods: Eighteen students participated in the journal assignment. Fifteen students consented to participate in journal analyses. Journals were de-identified and a code book was used to document the entirety of journal reflections to identify meaningful text, and, ultimately, assert thematic codes. Thorne's interpretive description guided analysis. Researchers coded four journals together to obtain trustworthiness and rigor. Each doctorally prepared researcher independently coded a subset of the remaining journals. Emerging significant statements and subthemes were discussed and verified as a team. Results : Researchers identified the essence of pandemic footprints as the following themes emerged: Physical Threats to Safety, Emotional Threats to Safety, Workplace Culture, Healing Energies, and Professional Identity. Conclusions : Compared to previously published research conducted at later points of the pandemic this study is unique. Study data captured nurses' expressed voices through journaling at the brink (March 2020) of what became a global reality. Results illuminated dichotomies that existed then, particularly in response to their own and others' safety and security, leaving profound imprints on their identities extending beyond care environments. [ABSTRACT FROM AUTHOR]

Aim: Cultural appreciation is found within the arts, psychology, counseling, health disciplines, and education. Currently, in the literature, there is not a strong link between cultural appreciation, nursing, and Indigenous people. The aim of this concept analysis is to analyze the concept of cultural appreciation for nurse educators, nurse researchers, and nurse leaders to apply to culturally appreciate Indigenous people within their geographical areas which can result in meeting their wholistic care needs. Design: This concept analysis of cultural appreciation uses Walker & Avant's (2019) approach to define cultural appreciation, antecedents, empirical referents, and consequences. Results: The antecedents of cultural appreciation are cultural appropriation, oppression, cultural prejudice, privilege, and lack of knowledge to integrate the wholistic health of Indigenous people into practice, education, and research. The defining attributes of cultural appreciation are awareness, knowledge acquisition, and desire. The consequence of cultural appreciation is wholistic care of Indigenous people as defined by their ways of knowing and being. Conclusion: The concept analysis of cultural appreciation integrates Indigenous wholistic health beliefs and ways of knowing and being that can advance holistic nursing knowledge for nurses, educators, and researchers. [ABSTRACT FROM AUTHOR]

Background: Psychoactive substance abuse can affect biological, psychological, social, and spiritual aspects, as well as the users' quality of life, and obliged to carry out medical and social rehabilitation. Purpose: The purpose of the study was to identify the effect of holistic rehabilitation programs on quality of life among drug abusers. Methods: Quasi-experimental with time series design. The sample of this study amounted to 54 people, taken by G-power, all participants who will take part in the rehabilitation program at the National Narcotics Board rehabilitation clinic. Rehabilitation interventions include health assessment, psychological assessments, health counseling, human immunodeficiency virus-related voluntary counseling and testing, addiction counseling, group therapy, family therapy, client and family monitoring, relapse prevention therapy, and postrehabilitation services. Interventions are provided for 10 weeks, and delivered by health professionals. Measurement of quality of life using World Health Organization Quality of Life—Brief Version (WHOQOL-BREF) MEAT 26 statements consisting of physical, psychological, environmental, and social relationship dimensions, with an alpha value of 0.8756. The data was analyzed with the Friedman test. Results: Holistic rehabilitation influences all dimensions quality of life of drug abusers with a P -value of <0.001. Conclusions: A holistic rehabilitation program improves the quality of life of drug abusers. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the effect of spiritual emotional freedom techniques (SEFTs) on pain intensity of advanced breast cancer patients. The study used a quasi-experiment design with one pre–posttest group. The sample was selected using a consecutive sampling technique with total of 45 respondents. The respondents were given SEFT intervention for 3 (three) days using set-up, tune-in, and tapping techniques. The evaluation was carried out on the third day after the intervention by measuring the pain intensity using Brief Pain Inventory (BPI). This research used Wilcoxon and ordinal logistic regression for data analysis. The results showed a difference in pain intensity before and after SEFT intervention in patients with advanced breast cancer with a p -value of.001 (p <.05) with a change in intensity from severe to mild pain. This study's novelty is that SEFT intervention can be used as a nonpharmacological therapy for pain management in patients with advanced breast cancer. The limitations are only limited to measuring the patient's pain and less analysis related to the patient's emotional and spiritual problems. The application of SEFT intervention is recommended as a nurse's independent intervention in the management of advanced breast cancer pain. [ABSTRACT FROM AUTHOR]

Purpose: This review aims to determine the effectiveness of the application of digital-based psychotherapy in overcoming the psychological problems of college students during the COVID-19 pandemic. Methods: Several databases consisting of EBSCO-Host CINAHL, PubMed, Scopus, Sage Journal, and Taylor and Francis were used in the search process and resulted in experimental studies focusing on the effectiveness of the application of digital-based psychotherapy during the COVID-19 pandemic timeline (2019–2022). Descriptive and exploratory analyses were performed based on the data set from the study. Results: A total of 12 articles were included in the review. The digital psychotherapy interventions found are diverse including websites, smartphone applications, and video conferencing with the types of therapies provided in the form of, Cognitive Therapy, Cognitive-Behavioral Therapy, Psychodynamic Therapy, and Mindfulness Therapy. Each intervention has a diverse duration and frequency adjusting to the type of therapy given. Digital psychotherapeutic interventions are effective in reducing mental health problems among college students during the COVID-19 pandemic. Conclusions: The use of digital psychotherapy can be used as a prevention and support service for students who experience psychological problems during the COVID-19 pandemic. The combination of the use of digital media with video conferencing can be considered to increase the effectiveness of this service. Nurses need to understand how the procedure for implementing digital-based psychotherapy is to improve the quality of mental care services as an effort to prevent and support students. More research is needed to find out the effectiveness of the use of digital psychotherapy services and how they impact the psychological well-being of students holistically. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is a crippling epidemic that is predicted to affect over 15 million people worldwide by the year 2050. Symptoms such as refusal to cooperate, impaired communication and cognition, and agitation and anxiety can play a large part in the difficulties that surround caring for an AD patient. There are medications that are marketed to treat AD symptoms, but many have harmful side effects. Holistic methods, such as music therapy, are gaining attention for their ease of implementation and limited side effects. Aim: The purpose of this project was to implement a music therapy intervention for people with AD in hospice and evaluate the levels of agitation experienced by the patient. Method: The study was conducted over a period of eight weeks. Music therapy was administered nightly for 20 minutes by caregivers and the Pittsburgh Agitation Scale was completed at the beginning of the study, at four weeks into the study, and at the completion of the study. Results: The intervention was found to be significant in reducing aberrant vocalization, motor agitation, aggressiveness, and resisting care. Conclusion: Based on the findings, music therapy may be useful as a holistic intervention for decreasing agitation in individuals with AD. [ABSTRACT FROM AUTHOR]

The primary goal of holistic nursing research is to develop and expand the knowledge base of holism and healing for nursing praxis. This article provides an overview of the process used to identify the research priorities for holistic nursing research over the next 3 to 5 years. A mixed method design using Appreciative Inquiry and surveys revealed five research priorities and the holistic philosophical foundation for these priorities. Additionally, new challenges in the environment, person, health, and nursing will undoubtedly emerge, requiring nurses to discern the research needs beyond 2026. This work seeks to inspire holistic nurses to consider research related to the American Holistic Nurses Association's five key research priorities. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of an abbreviated (4-week) and asynchronous, mindfulness-based intervention (MBI) on nurses' perceived stress and mindful attention and awareness. Design: An evidence-based quality improvement pilot program. Methods: The participants (n = 15 nurses) attended a 4-week, asynchronous MBI. The participants attended a 90-minute webinar on mindfulness as a prerequisite, followed by 4 weeks of guided meditation and informal mindfulness practice materials. The MBI was offered remotely with self-modulated practice. Participants also provided the number of days per week they participated in formal meditation practice. Project participants completed pre- and post-intervention questionnaires. Project instruments included the Mindful Attention Awareness Scale (MAAS) and the 10-item Perceived Stress Scale (PSS). Findings: 12 complete pre-and post-intervention surveys were analyzed. Significant improvements were noted in participant mean MAAS scores post-intervention (p =.004). Cumulative PSS scores also decreased post-intervention (p =.009). Conclusion: The 4-week MBI demonstrated a statistically significant impact on nurses' perceived stress and mindful attention and awareness. Additionally, this Doctor of Nursing Practice (DNP) student led program was offered in an asynchronous and remote format, which was received well by program participants and may be a practical option for future MBIs. [ABSTRACT FROM AUTHOR]

Children with medical complexity are an increasing population with frequent use of intensive care services within hospitals. As children's health improves, they are often transferred to a general unit before being discharged to home. This transition often leads to an acute decline in health, resulting in emergent interventions. Betty Neuman's systems model provides the foundation to guide prevention interventions on stress mitigation to promote stability. An evidence-based transition bundle of care may be a valuable tool to prevent stress at the time of transfer from the intensive care unit and prevent deterioration. [ABSTRACT FROM AUTHOR]

Dr. Barbara M. Dossey is an internationally recognized pioneer in the holistic nursing and nurse coaching movements. She is a Florence Nightingale scholar, nurse theorist, and national and international speaker and teacher on the role of holistic, integral, and integrative nursing and nurse coaching in the integrative healthcare paradigm. Her theory of integral nursing presents the science and art of nursing. Her coauthored theory of integrative nurse coaching, a middle-range theory, is a framework to guide integrative nurse coaches in nurse coaching practice, education, research, and healthcare policy. In this column, Dr. Dossey shares her scholarly journey of joy. [ABSTRACT FROM AUTHOR]

Purpose: Dhikr and prayer reduce pain and improve a patient's vital signs. However, the interactions among these require further clarification in patients undergoing appendectomy. This study aimed to assess the effects of the combination of dhikr and prayer on pain, pulse rate, respiratory rate, and oxygen saturation. Study design: Quasi-experimental design. Method: Pain, pulse, respiratory rate, and oxygen saturation were measured via clinical examination immediately after leaving the recovery room at 1 and 2 hr after surgery in both the experimental and control groups. In total, 88 eligible participants were allocated to two groups: participants who received both dhikr and prayer (n = 44), and those who received routine care without analgesic therapy (n = 44). The chi-square test, independent t test, and general equation model were employed. Results: Respondents showed a significant interaction between group and time to decrease in pain, pulse, respiratory rate, and improved oxygen saturation, except for pain within 1 hr. The differences in all outcome scores between the groups after 1 and 2 hr were statistically significant, except for oxygen saturation after 1 hr. Conclusion: The combination of dhikr and prayer effectively decreased pain and improved vital signs. This helped nurses implement this procedure by promoting an essential culture of spiritual care for appendectomy patients. [ABSTRACT FROM AUTHOR]

Background: Anxiety is a problem that most often occurs in the pre-operative coronary artery bypass graft surgery stage. The combination of prayer therapy with education is expected to be able to overcome anxiety. The combination of prayer and education therapy have been researched as a potential holistic intervention for reducing anxiety in coronary artery bypass graft surgery. Purpose: This study compares the effect of combination therapy with the golden standard of therapy in hospitals. Methods: A true-experimental design was used. Fifty participants were randomly assigned to two groups. Data were collected using a State-Trait Anxiety Inventory questionnaire from Spielberger. Findings: Most respondents were elderly, male, high school graduates in the treatment group, and bachelor graduates in the control group. Prayer therapy and education have an effect of 63.8% on reducing anxiety. An increase of 1 constant in the provision of prayer therapy and education can reduce anxiety by 0.772. Conclusions: The combination of prayer therapy and education becomes the holistic nursing modality that can reduce anxiety in pre-operative coronary artery bypass graft patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The gut microbiome has been well researched in the past few years and may be a target for treating mental illness. Trillions of bacteria in the digestive system work with the brain, immune function, and endocrine pathways. This gut microbiome ecosystem mediates the interaction between the human being and the environment making its inclusion in holistic nursing essential. Changes in normal balance of the gut microbiome occur with diet, antibiotics and other medications, stress, cancer treatment, geography and environment, and current illnesses. When the microbiome is challenged a "dysbiotic" state leads to inadequate production of needed neurotransmitters such as serotonin and dopamine. Research has shown links between the dysbiosis, and the inflammatory response system that are known to contribute to depression, anxiety, and schizophrenia. Understanding the role of the gut microbiome can be beneficial to holistic nurses, providing a new tool to prevent, treat, or reduce symptoms of mental illness and improve general immune function. This innocuous holistic approach to mental wellness is becoming an important evidenced-based approach. [ABSTRACT FROM AUTHOR]

Background: Health disparities between Native Americans and white Americans persist due to a variety of factors, including colonization, poverty, and racism. Racist interpersonal interactions between nurses and other healthcare providers and tribal members may also contribute to reluctance among Native Americans to engage with Western healthcare systems. Purpose: The purpose of this study was to better understand the healthcare experiences of members of a state-recognized Gulf Coast tribe. Methods: In partnership with a community advisory board, 31 semistructured interviews were conducted, transcribed, and analyzed utilizing a qualitative description approach. Results: All participants mentioned their preferences, views about, or experiences of using natural or traditional medicine approaches (referenced 65 times). Emergent themes include (a) preference for and use of traditional medicine; (b) resistance to western healthcare systems; (c) preference for holistic approaches to health; and (d) negative provider interpersonal interactions contributing to reluctance in seeking care. Conclusion: These findings suggest that integrating a holistic conceptualization of health and traditional medicine practices into Western healthcare settings would benefit Native Americans. [ABSTRACT FROM AUTHOR]

The purpose of this evidence-based project (EBP) was to determine if an evidence-based sleep health and wellness intervention improved sleep in veterans self-reporting a history of insomnia. Insomnia can negatively affect an individual's physical and psychological well-being, as well as increase health-care costs and decrease the overall quality of life. The intervention utilized a combination of insomnia treatments, delivered to two American Legion veteran participant groups: an Alabama American Legion Retreat and individuals at an American Legion Post site. The holistic-focused modalities used in this intervention included Cognitive Behavioral Therapy for Insomnia (CBT-I) techniques, sleep hygiene principles, and Complementary and Alternative Medicine (CAM) methods. The measurement tool, the Insomnia Severity Index (ISI), indicated statistically significant changes in the severity of participants' self-reported insomnia. Based upon the research evidence and results of the pre- and post-test ISI, a more permanent, ongoing sleep health and wellness intervention is feasible and would have numerous beneficial effects for the veteran's management of insomnia symptoms. Future efforts include implementing sleep hygiene, CAM interventions, and holistic nursing-supported education interventions at other sites and venues within the Alabama American Legion, as well as maintaining long-term community partnerships with veteran groups such as the Alabama American Legion. [ABSTRACT FROM AUTHOR]

This paper presents a middle-range theory of storytelling in nursing education. Both explanatory and predictive, the theory further develops the existing conceptual work on the topic of storytelling. It places storytelling as a pedagogical technique within the realm of holistic nursing theory and philosophy. Storytelling is seen as a manifestation of the process of integral interconnectedness. The theory suggests a mechanism by which storytelling, as mediated by narrative transportation and neuroplasticity, can be effective in promoting desirable outcomes for holistic nursing students, including the achievement of affective and cognitive educational objectives. The theory describes the relationship of storytelling to narrative transportation and neuroplasticity. Within the concept of storytelling, the Temporal Bidirectionality of Story and Experience and the Story Creation-Interpretation-Recreation Cycle of telling and listening are explained. This theory was developed using deductive reasoning combining existing nursing and non-nursing theories. Recommendations for research and application are included. [ABSTRACT FROM AUTHOR]

This study aimed to examine the effects of holistic nursing competence on work engagement, self-reflection and insight in nurses. This descriptive and cross-sectional study was conducted with 309 nurses working in Turkey. Data were collected using the "Descriptive Information Form", "Holistic Nursing Competence Scale (HNCS)", "Utrecht Work Engagement Scale (UWES)", and "Self-Reflection and Insight Scale (SRIS)". Pearson correlation analysis and multiple linear regression analysis were used to analyze the data. We found that the HNCS had a moderate positive relationship (r = 0.411, p < 0.05) with the UWES, and a weak positive relationship (r = 0.324, p < 0.05) with the SRIS. In the model established by multiple regression analysis, the effect of the HNCS, age, marital status, position, and performing the profession willingly on work engagement explained 33.7% of the variance. In another established model, the effect of the HNCS, gender, and having children on self-reflection and insight explained 11.5% of the variance. Our findings revealed the effect of holistic competence on nurses' positive attitudes about their work engagement and self-reflection in practice. We recommended developing awareness-based programs for nurses to increase their holistic nursing competence. [ABSTRACT FROM AUTHOR]

The experience of a radical remission from a terminal diagnosis is essentially life altering. The purpose of this self-report is to provide a basis for understanding this event and to provide practitioners a guide for supporting patients during the transition process. A conceptual model is presented that outlines the structure and changes that are influenced during the transition process. [ABSTRACT FROM AUTHOR]

Introduction: Ubuntu is an African philosophy that reflects holistic and comprehensive care among people in the community. Holistic nursing is a philosophy of caring that focuses on holistic healing and humanism. The purpose of the study was to explore the views of the South African final-year student nurses on the ability of Ubuntu to foster holistic nursing. Methods: An exploratory descriptive qualitative method was used. Eight focus group interviews were conducted with final-year student nurses at selected universities. Colaizzi seven steps process of data analysis was utilized. Results: One of the themes that emerged was that Ubuntu can be an instrument to foster holistic nursing Ubuntu and holistic nursing share many common attributes, hence, the teaching and learning of Ubuntu could foster the type of caring embodied by holistic nursing. Discussion: Ubuntu represents an important care philosophy that can foster holistic nursing, especially when the inner driving force of the nurses is primarily to care for patients. [ABSTRACT FROM AUTHOR]

Undiagnosed and untreated postpartum mental health disorders represent a silent health crisis. The aim of this paper was to develop a lexicon of metaphors women use to describe their postpartum mood and anxiety disorders to assist holistic nurses in recognizing as early as possible these struggling mothers. Mothers may not know the medical terminology to articulate their mental health problems and may turn to using metaphors. The metaphors included in this lexicon were obtained from the author's earlier qualitative studies of metaphors women used to describe their experiences of postpartum depression, postpartum panic disorder, and posttraumatic stress disorder due to traumatic childbirth. In this lexicon these metaphors are organized by these three mental health disorders and includes a table of definitions of each metaphor along with examples of the context of the metaphors represented by quotes from the mothers. Metaphors can be keys that open and unlock doors that stand between holistic nurses and their patients. Being attentive to metaphorical language women use to describe how they are feeling after giving birth can be an innovative approach holistic nurses can use to identify these vulnerable women and provide an opportunity to nurture and empower new mothers. [ABSTRACT FROM AUTHOR]

Aim: The aims of this sequential explanatory mixed method study were twofold 1. Firstly, to evaluate the implementation of a spiritual care subject in a nursing program. 2. Secondly, to examine undergraduate nursing students' perceptions of providing spiritual care within their holistic care practice. Background: Studies conducted internationally indicate many nurses feel inadequately prepared to provide holistic care inclusive of spiritual care due to insufficient spiritual care education. Design: Two phase, sequential explanatory mixed method design which comprised of a quantitative study followed by a qualitative study. Methods: The setting was an Australian faith-based university. Participants comprised of undergraduate nursing students who were enrolled in a spiritual care subject. Findings: Two study findings emerged: 1. Participants' knowledge and practice of spiritual care were transformed by the spiritual care subject, and 2. The spiritual care subject broadened perceptions of spiritual care so participants viewed themselves more equipped to provide spiritual care in their holistic care provision. Conclusion: The spiritual care subject had an affirmative influence on participants' perceptions of providing spiritual care within holistic care practice. The findings have implications for nurse educators to consider how spiritual care content can be included within undergraduate nursing curricula. [ABSTRACT FROM AUTHOR]

Purpose: To test the feasibility of recruiting dementia family caregivers to participate in the holistic intervention of mindfulness self-compassion (MSC) to decrease perceived distress. There are few studies focused on MSC for dementia caregivers. Design: An interdisciplinary approach (nursing and psychology) and uncontrolled experimental design tested a holistic intervention Mindfulness Self Compassion (MSC) as a coping strategy using the Stress Process framework. Findings: Twenty-four caregivers participated. Dementia caregivers' use of positive reappraisal increased with a mean difference of 2.53 (t = 2.10; SD = 5.23) (p =.049) indicating that family caregivers may have increased their use of positive reappraisal. MSC sessions impacted the caregivers ways of coping with increases in accepting responsibility [model: F(4, 13) 3.18, p-value 0.0499, R-sq = 49.5%, estimate: B = 1.11, t = 2.64, p-value = 0.02)] and impacted caregivers' ways of coping using distancing [model: F(4, 13) 1.47, p-value 0.2682, R-sq = 31.1%, estimate: B = 1.63, t = 2.19, p-value = 0.05)]. Conclusion: Satisfaction with MSC was high among caregivers. At the study's conclusion, caregivers appraised their caregiving non-judgmentally and reduced their negative thoughts of difficult situations. MSC as a holistic practice has the potential to shift caregivers' focus to positive appraisals and promote caregiver wellbeing. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore emergency care nurses' experiences of an intervention to increase compassion and empathy and reduce stress through individual mindfulness training delivered via workshops and a smartphone application. We also explored how the nurses felt about the practical and technical aspects of the intervention. Design: Qualitative interview study. Method: Individual interviews were conducted with eight of the 56 participants in the intervention study and used phenomenological analysis to illuminate how they made sense of their lived experiences of mindfulness training. Findings: Three themes illuminated the nurses' experiences: becoming aware, changing through mindfulness, and gaining the tools for mindfulness through workshops and the mobile application. The first two themes expressed personal experiences, whereas the third expressed experiences of the practical and technical aspects of the intervention. Most nurses found the mobile application easy to use and effective. Conclusions: Emergency care nurses can feel that the awareness and changes that come with mindfulness training benefit them, their colleagues, and the patients for whom they care. The findings also provide insights into the challenges of practicing mindfulness in a busy emergency care setting and into the practical aspects of using a smartphone application to train mindfulness. [ABSTRACT FROM AUTHOR]

Introduction: Being a teacher of nursing education can be challenging. Nursing theories can guide clinical nurses in their work, but is it possible to apply a nursing theory in the context of academic teaching? Purpose: To investigate if it is possible to apply Dossey's holistic nursing theory into the context of teaching the subject of nursing. Conclusion: This article proposes that Dosseys holistic nursing theory could be applied in the context of nursing education. [ABSTRACT FROM AUTHOR]

The collapse of the Champlain Towers South (CTS), a condominium in Miami, Florida, left a diverse group of survivors and healthcare clinicians tasked with finding ways of coping with the disaster. Within seconds, the CTS collapse became a global tragedy due to the coastal neighborhood's rich international mix of residents. Although this tragedy impacted communities across globe, a large population of Hispanic victims lived in CTS that were deeply affected. Culturally adaptive interventions and holistic healthcare for Hispanic individuals are highly relevant because Hispanic Americans represent one of the fastest growing demographic groups in the United States. To reach, engage, and address the needs of Hispanic victims, this article provides an overview of psychosocial factors that influence Hispanic victims with trauma and discusses holistic psychotherapeutic approaches in nursing care that can be applied to improve victims' well-being. Culture is an important consideration in health; therefore, this article highlights and operationalizes culturally tailored holistic nursing care that draws from the physical, mental, emotional, and spiritual dimensions of health and well-being that can be used in clinical settings with Hispanic clients who have experienced trauma. [ABSTRACT FROM AUTHOR]

The use of a concise standardized spiritual screening process to identify spiritual practices and needs of patients is essential for holistic nursing care. This interprofessional initiative resulted in the development of a spiritual screening tool that substantially increased Pastoral Services referrals to the patients who needed them and represents a significant opportunity in the delivery of holistic nursing care. Acute care settings may benefit from the adoption of a standardized chaplain referral process housed in the EMR and completed on the frontlines by trusted nursing staff providing patient and family centered care. This standardized spiritual screening process not only triggered essential services of Pastoral Services, but also helped identify and address important spiritual needs of hospitalized patients. The ability to design a tool responsive to the evolving, spiritual needs of patients can be challenging. Through collaboration with chaplains, nurses can be instrumental in creating instruments informed by available evidence in the empirical literature. Furthermore, engaging patients as a source of data during instrument design helps to ensure the content validity and practical usefulness of an instrument. Healthcare organizations might choose to implement and further evaluate/refine the new Spiritual Screening Tool and referral process developed as a result of this initiative. [ABSTRACT FROM AUTHOR]

An increasing proportion of new drugs approved for market worldwide are now high cost, specialty medicines. Pharmaceutical marketers face the challenge of convincing payers, prescribers, and patients that the cost and complexity of care associated with specialty medicines is worth the trouble, and now offer patient support programs, free of charge, to patients prescribed their drug. We conducted a secondary, qualitative, interpretive analysis of 24 interviews with leaders of patient groups and members of hospital formulary committees in Australia to describe the work of pharmaceutical company-employed or contracted nurses who provide support to patients prescribed specialty medicines, and to prompt discussion around the policy implications of relying on industry-funded nursing care within publicly funded health systems. Participants affirmed the value of specialist, holistic, person-centered nursing care, but perceived gaps within the public health system related to the availability and provision of nursing care for people living with chronic disease. Consequently, participants described the pharmaceutical industry as addressing health system gaps through sponsorship or direct provision of medication-related nursing care, but recognized that care was contingent on commercial interest. Participants highlighted a number of ethical and policy concerns stemming from industry-funded nursing care of people prescribed specialty medicines related to patient safety, continuity of care, inducement to prescribe, and health equity. This analysis suggests that outsourcing necessary medication-related care to pharmaceutical companies has implications for the health system and equitable, sustainable pharmaceutical policy that extend far beyond the care encounter. [ABSTRACT FROM AUTHOR]

Objective: To understand the process of building culturally competent compassion in nurses who care for vulnerable populations. Method: This is a qualitative study of a "single case study" type, developed with 18 nurses who worked in an emergency care unit in the city of Belo Horizonte, Brazil, between October 2020 and January 2021. Data collection was performed through individual online or one-to-one interviews, following a semi-structured script. Data were treated following thematic content analysis, proposed by Bardin. All ethical precepts were taken into account. Results: After data analysis, the following categories were created: a) Looking within: the recognition of cultural identity; b) Paths to be taken: from the gap to cultural knowledge; c) Attentive listening as essential nursing care; d) Culturally competent compassion as an infinite opportunity for growth. Final considerations: Culturally competent compassion is a subjective, complex, and essential construct in holistic nursing care. When implemented successfully, we gain a significant improvement in the quality of healthcare provided to patients and their families as well as a decrease in social inequality, and the protection of human rights. [ABSTRACT FROM AUTHOR]

The paper offers space for dialogue illustrating reflection as lived, exploring both my personal and professional experiences of grief and loss surrounding the death of my Dad from Covid −19. In my role as a nurse educator, I share understandings of reflection in facilitating learning and person centered practices with students. I illustrate my approach with two stories generating a narrative giving testimony to those who have died and highlighting the ensuing grief for those who have cared for older people during the pandemic. The first reflective story has been shared with students and snapshots of student responses during virtual sessions are incorporated. The second story shifts to a more personal focus reflecting personal knowing. Insights emerge bringing forth personal and professional knowing, about the art and science of holistic nursing. I explore the challenges in separating ourselves from personal knowledge and experience in reflective writing. I invite readers to take time to pause amidst a global healthcare pandemic to consider the potential of reflection to support nurses in recovering from suffering experienced during a pandemic. [ABSTRACT FROM AUTHOR]

The purpose of this quantitative, descriptive, exploratory study was to gauge the degree to which nurse practitioners (NPs) incorporate holistic nursing values in their care, with a special focus on shared decision-making (SDM), using the Nurse Practitioner Holistic Caring Instrument (NPHCI), an investigator-developed scale. A single open-ended question inviting free-text comment was also included, soliciting participants' views on the holistic attributes of their care. A convenience sample of NPs (n = 573) was recruited from a southeastern U.S. state Board of Nursing's (BON) publicly available list of licensed NPs. Results suggest that NPs do indeed perceive their care to be holistic, and that they routinely incorporate elements of SDM in their care. Highest scores were accorded to listening, taking time to talk to patients, knowledge of physical condition, soliciting patient input in care decisions, considering how other areas of a patient's life may affect their medical condition, and attention to "what matters most" to the patient. Age, gender, level of education, practice specialty, and location were also associated with inclusion of holistic care. Free-text responses revealed that NPs value holistic care and desire to practice holistically, but identify "lack of time" to incorporate or practice holistic care as a barrier. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including ethical dilemmas arising from new health technologies, integrative nursing in clinical settings, and the healing role of music.

Purpose: Currently, standards for transgender care guide surgical, hormonal, cosmetic and psychological care, yet do not include the domain of nursing care and nursing sensitive care outcomes. In response, the purpose of this project was to create a middle-range nursing theory to guide transgender nursing care. Methods: Rivera's Gender Affirming Nursing Care (GANC) Model was developed using a community informed iterative process, combining and modifying two existing theories. Each theory was evaluated, construct templates were created, modified, and expanded to create the proposed gender transcendent model. Face validity was established through expert and community review. Findings: Concepts identified include: Relationship (Join With), Knowledge (Learn With) and Engagement (Partner With). Action within the model is propelled by drivers, including ongoing learning, ongoing research, ongoing self-assessment, and leadership. The model operates within the recognized domains of nursing, to support gender affirming nursing care. Conclusions: The middle-range theory was tested and found to stimulate gender neutral thinking; however, the model would benefit from additional testing to determine impact on nursing and patient outcomes. The model allows the nurse, through self-reflection and other internal growth mechanisms, to identify personal implicit and explicit bias. It is through these actions and shifting paradigms that nurses develop a personal gender affirming nursing practice. [ABSTRACT FROM AUTHOR]

Human trafficking, also known as modern-day slavery, is a public health crisis and a growing worldwide crime exploiting approximately 40.3 million victims. A decade ago approximately 79% of human trafficking crimes were related to sexual exploitation and 18% were related to forced labor, but more recent reports show approximately 50% and 38%, respectively. Although sexual exploitation continues to make up the majority of human trafficking crimes, forced labor continues to grow at an alarming rate. The purpose of this paper is 2-fold. First, to empower healthcare providers and community volunteers serving potential victims of human trafficking in traditional and nontraditional settings with human trafficking identification training. This education should include the use of a validated human trafficking screening tool and the timely provision of resources. Second, to guide professional nurses in the holistic approach to caring for potential victims of human trafficking. The core values of holistic nursing practice and Watson's Theory of Human Caring are the pillars guiding mindful and authentic nursing care. Merging evidence-based practice with holistic care will boost victim identification and rescue. [ABSTRACT FROM AUTHOR]