Journal of Holistic Nursing

The purpose of this article is to introduce a unique tai chi form that has been successfully implemented in two large randomized clinical trials. The intervention is composed of a series of tai chi movements chosen for their particular meanings, thus adding a cognitive component to the practice of a moving meditation. Over the last decade, the intervention has continued to evolve as it has been used in different populations. Most recently, medical qigong has been integrated to strengthen its potential impact on a variety of biobehavioral measures associated with cardiometabolic risk in women. Following an appraisal of the authors’ process as well as the philosophy, practice, and research of tai chi and qigong, the authors share the story of their intervention to contribute to the evolving research of these safe, well-received, low-cost, and beneficial practices.

Purpose: Self-transcendence, the ability to expand personal boundaries in multiple ways, has been found to provide well-being. The purpose of this study was to examine the dimensionality of the Norwegian version of the Self-Transcendence Scale, which comprises 15 items. Background: Reed’s empirical nursing theory of self-transcendence provided the theoretical framework; self-transcendence includes an interpersonal, intrapersonal, transpersonal, and temporal dimension. Design: Cross-sectional data were obtained from a sample of 202 cognitively intact elderly patients in 44 Norwegian nursing homes. Results: Exploratory factor analysis revealed two and four internally consistent dimensions of self-transcendence, explaining 35.3% (two factors) and 50.7% (four factors) of the variance, respectively. Confirmatory factor analysis indicated that the hypothesized two- and four-factor models fitted better than the one-factor model (cx², root mean square error of approximation, standardized root mean square residual, normed fit index, nonnormed fit index, comparative fit index, goodness-of-fit index, and adjusted goodness-of-fit index). Conclusions: The findings indicate self-transcendence as a multifactorial construct; at present, we conclude that the two-factor model might be the most accurate and reasonable measure of self-transcendence. Implications: This research generates insights in the application of the widely used Self-Transcendence Scale by investigating its psychometric properties by applying a confirmatory factor analysis. It also generates new research-questions on the associations between self-transcendence and well-being.

Purpose: This exploratory study investigated nursing students’ perceptions and attitudes about spirituality and spiritual care in practice. Study Design: A qualitative interpretative approach was used to investigate the research question. Method: In-depth interviews were conducted with 16 final-year preregistration nursing students from 3 different educational institutions offering a degree or diploma program in Singapore. Data were analyzed using the Miles and Huberman’s method of thematic analysis. Findings: Thematic analysis identified three themes: (a) students’ perceptions of spirituality, (b) spiritual care, and (c) factors influencing spiritual care in practice. Conclusions: The study informed that though young, spirituality matters to the nursing students. Accordingly, nursing is perceived to play an integral role in spiritual care. Enabling factors need to be systematically addressed both in the education and practice arenas before the perennial issue of disconnect between development and implementation of spirituality in practice can be bridged.

Purpose: To investigate whether a mindfulness-based stress reduction program for cancer (MBSR-C) improved psychological and physical symptoms, quality of life (QOL), and stress markers among advanced-stage cancer patients and caregivers. Design: A pilot within-subject design was used. Method: Patients previously diagnosed with advanced-stage breast, colon, lung, or prostate cancer and on treatment were recruited from the Moffitt Cancer Center and Research Institute. Twenty-six patient–caregiver dyads completed a modified 6-week, self-study MBSR-C program based on the Kabat–Zinn model. Psychological and physical symptoms and QOL were compared pre– and post–MBSR-C sessions. Salivary cortisol and interleukin-6 were assessed pre– and post–MBSR-C session at 1, 3, and 6 weeks. Findings: Following the 6-week MBSR program, patients showed improvements in stress and anxiety (p < .05); caregivers’ psychological and QOL also improved but were not statistically significant. Both patients and caregivers had decreases in cortisol at Weeks 1 and 3 (p < .05) but not at Week 6. Similar to cortisol levels at Week 6, salivary interleukin-6 levels were lower overall (before/after an MBSR-C session), compared with Week 1 for patients and caregivers. Conclusions: MBSR-C may be a beneficial intervention for reducing stress, anxiety, cortisol levels, and symptoms in advanced-stage cancer patients and may also benefit caregivers.

Purpose: To describe the beliefs and attitudes about self-identity and pain medication in a sample of Mexican American women with chronic pain living in the El Paso, Texas, area. The findings are drawn from a larger qualitative study of 15 women describing the expression and communication of chronic pain symptoms, pain-related cultural beliefs, decision making, and treatment preferences of chronic pain. Methods: Participants who had chronic pain syndromes for at least 1 year were recruited from a pain clinic and fibromyalgia support group. In-depth, open-ended interviews, fieldwork, and participant observation were used to gather information using a focused clinical ethnographic approach. Interviews were audiotaped and transcribed verbatim. Findings: A shared central theme was controlling the use of pain medications to control perceived negative associations with pain medication. The negative associations resulted in women rejecting use of medication to preserve their legitimate identity. This perception can be destructive and can lead to poor pain control. Conclusion: Providing patients with anticipatory guidance about common barriers to taking pain medication may allow medication use consistent with improved pain control.

Objective: Examine how wellness in six dimensions (occupational, social, intellectual, physical, emotional, and spiritual) protects cognition in aging adults. Background: cognitive impairment increases with age. Baby boomers represent a significant percent of the population at risk for cognitive impairment. Cognitive impairment has a negative impact on nursing resources, health care finances, patient mortality, and quality of life. Wellness and prevention is one focus of Institute of Medicine’s vision for the future of nursing. Method: Literature was retrieved from Cumulative Index to Nursing and Allied Health Literature and MEDLINE. Research that examined the affect of wellness in each of the six dimensions on cognition in older adults was included. Results: One or more of the following may protect cognition in aging: midlife occupation complexity, marriage, social networks, formal education, intellectual activities, physical activity, healthy nutrition, motivational ability, purpose in life, and spirituality. Conclusion: Wellness in one or more of the six dimensions may protect cognition in aging. The cognitive protective benefits may increase when wellness in more than one dimension is demonstrated. High wellness in one dimension may protect cognition by compensating for low wellness in another dimension. The interconnectedness of each of the dimensions signifies the importance of evaluating older adults holistically. Wellness throughout the life span may result in improved cognition in aging. Application: Future research is needed to examine the relationship between the six dimensions of wellness and cognition, and to determine if one dimension of wellness is a significant predictor of cognitive health in aging adults.

The purposes of this pilot study were to determine the feasibility of using a Healing Touch (HT) intervention with noncommunity-dwelling older adults experiencing persistent pain and to determine an HT protocol. Data were collected at multiple time points from 20 noncommunity-dwelling older adults experiencing pain. Residents were assigned to the HT group that included techniques specific for pain or a Presence Care group. Outcome variables included measures for pain, activities of daily living, and quality of life. The pain measures showed decreases that were not statistically significant for both groups. The measure for activities of daily living showed a non–statistically significant improvement over time for the HT group. Quality of life decreased for the HT group and improved for the Presence Care group although not significantly. The practitioners were able to complete all seven of the 30- minute HT sessions. The findings indicated that both groups showed some improvement in their pain scores with other measures being variable. HT is a feasible intervention for the elderly with pain. Overall, the findings highlight the complex nature of pain in older adults.