HOLISTIC NURSING RESEARCH

MAYBELLE B. ANIMAS

A systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge about all nursing practice that has

healing the whole person as its goal

Holistic Nursing Research

Evidence-based Practice

The current mandate to use the best evidence in our clinical decisions is

driven by the goal of achieving effective patient outcomes and making a positive difference in

the lives of our patient.

Evidence-based Practice

Two strategies:

• Research utilization

• Evidence-based practice

Evidence-based Practice

Two strategies:

• Research utilization– Using research in practice in a way that

resembles how it was done in the original research study.

Evidence-based Practice

Two strategies:

• Evidence-based practice– Careful deliberation use of the best

available evidence for making decisions about patient care.

Evidence-based Practice

Meta-analysisstatistical technique that establishes

an overall estimate of the therapeutic effectiveness of an

intervention by combining the results of many experiments related to that

intervention.

Evidence-based Practice

Meta-analysisstatistical technique that establishes

an overall estimate of the therapeutic effectiveness of an

intervention by combining the results of many experiments related to that

intervention.

Selection of studies :

The search strategy returned a total of 7671 hits. After eliminating irrelevant and duplicate studies, 740 studies remained.

Conclusion

There is consistent and conclusive evidence that massage therapy is generally safe.

Conclusion

There is consistent and conclusive evidence that massage therapy is generally safe.

Need to Conduct Holistic Research

• Research provides the direction for selecting interventions with proved effectiveness.

• Research determine the effectiveness of our interventions on patient outcomes.

• Research investigates the outcome of healing on individuals

Research

Method

Quantitative Research

• Systematic formal, objective process in which numerical data are used to obtain information about the world.

• Systematic, subjective form of research that is used to describe life experiences and give them meaning.

AbstractThis study explored the experiences of parents of children with cerebral palsy undergoing surgery as they describe them from a lived experience perspective. When children undergo surgical procedures, they have to stay at hospital for a long time, which represents a great challenge for the children as well as their parents. 

AbstractParents experienced demanding challenges as they entered the hospital, in a situation that meant both familiarity and unfamiliarity. Judgments about how to care for the child relied on what they normally did. Sitting bedside for hours and days, thoughts about the legitimacy of letting their child go through the suffering surgery were tormenting the parents. They felt vulnerable and very much dependent on health care workers’ competence and at the same time doubting them in seeing and taking care of their child's specific needs.

Methodology

 We collected data by using open-ended interviews with 12 parents of 9 children and analyzed these data in accordance with Max van Manen's methodological themes, a method that is both descriptive and interpretive.

Enhancing Holistic Research

Triangulationuse of multiple research techniques

to collect and evaluate data on a specific topic in order to converge on a complete representation of reality

and confirm the credibility of the research findings.

Triangulation

Data Source Triangulation-strengthens the rigor of the research by using several sources of data to assess a single clinical phenomenon

Example:

In a large capital city, three different nongovernmental organizations (NGOs) run comprehensive prevention projects for hotel-based sex workers. Each programme works in a different part of the city where there are multiple hotels that rent space to sex workers and their clients. The projects are generally similar, but the dynamics in each community are slightly different. Triangulating performance data from across these three projects e.g. frequency of contact with sex workers, percentage of sex acts including proper use of a condom, reduction in prevalence of sexually transmitted infection among sex workers will provide a much clearer picture of the overall situation than simply reviewing the data from one programme and attempting to extrapolate broader lessons from those data.

Triangulation

Methodologic Triangulation-Combining multiple methods to gather data, such as documents, interviews, observations, questionnaires or surveys, when conducting primary research, at different times and in different places

ABSTRACT

The study wishes to explore the lived experiences of nurses caring for a patient with a Do-Not-Resuscitate (DNR) order in the year 2010 among tertiary hospitals in Cebu City, Philippines in the year 2010. Moreover, the study probes if there was a change in the quality of nursing care after the order was consented, the reasons for it as well as the true feelings of the nurses and the possible consequences of it towards their personal and professional roles.

Methods

The design is a phenomenological study which was done through a triangulation -the formation of a primary, focus and narrator groups respectively. Data gathering was done through a narrative accounts of informal interviews, an audio-video recording, a checklist, and through validation groups through patient accompanying and other nurses which are not a part of any of the groups stated

Results and Discussion

There were varying degrees of views that nurses have why they changed their views after the Do-Not-Resuscitate Order and the two most common reasons were, they donot want to place more burden on the sacrificing and struggling patient while the other was although these patients have limited time to leave, they still deserve the full rights of being cared for justly. Out from these responses, the common themes formulated out of the responses are patient attachment, conflicting roles, hopelessness, perceived incompetence, conscience and idealism and work exhaustion which need to be addressed and given emphasis.

Conclusions

It was found out in the study that nurses do have a change in the way they view their patient’s after their relatives consented to a Do-Not-Resuscitate. But these changes do not merely mean tardiness or the lack of motivation but with a very humanitarian reason of not imposing and preventing the risk of adding additional burden towards the agonizing and suffering patient. They believed that the more they give not that essential yet exhausting interventions might shorten the patients living hours.

It is further concluded that changes in the quality of care happen intentionally for the reason of giving the allotted time into other patients who have greater chances of survival and not a the same order as the former is.

Triangulation

Theory triangulation:-Using more than one theoretical approach (theory) to interpret and support data

HERE’S MORE!

BackgroundLanguage development is one of the most significant processes of early childhood development. Children with delayed speech development are more at risk of acquiring other cognitive, social-emotional, and school-related problems. Music therapy appears to facilitate speech development in children, even within a short period of time. The aim of this pilot study is to explore the effects of music therapy in children with delayed speech development.

Methods

A total of 18 children aged 3.5 to 6 years with delayed speech development took part in this observational study in which music therapy and no treatment were compared to demonstrate effectiveness. Individual music therapy was provided on an outpatient basis. An ABAB reversal design with alternations between music therapy and no treatment with an interval of approximately eight weeks between the blocks was chosen. Before and after each study period, a speech development test, a non-verbal intelligence test for children, and music therapy assessment scales were used to evaluate the speech development of the children.

ResultsCompared to the baseline, we found a positive development in the study group after receiving music therapy. Both phonological capacity and the children's understanding of speech increased under treatment, as well as their cognitive structures, action patterns, and level of intelligence. Throughout the study period, developmental age converged with their biological age. Ratings according to the Nordoff-Robbins scales showed clinically significant changes in the children, namely in the areas of client-therapist relationship and communication.

Conclusions• This study suggests that music therapy may have

a measurable effect on the speech development of children through the treatment's interactions with fundamental aspects of speech development, including the ability to form and maintain relationships and prosodic abilities. Thus, music therapy may provide a basic and supportive therapy for children with delayed speech development. Further studies should be conducted to investigate the mechanisms of these interactions in greater depth.

Conclusions• This study suggests that music therapy may have

a measurable effect on the speech development of children through the treatment's interactions with fundamental aspects of speech development, including the ability to form and maintain relationships and prosodic abilities. Thus, music therapy may provide a basic and supportive therapy for children with delayed speech development. Further studies should be conducted to investigate the mechanisms of these interactions in greater depth.

• Background• Dance therapy or dance movement therapy is

defined as “the psychotherapeutic use of movement as a process which furthers the emotional, social, cognitive, and physical integration of the individual.” It may be of value for people with developmental, medical, social, physical, or psychological impairments. Dance therapy can be practiced in mental health rehabilitation units, nursing homes, and day care centers and incorporated into disease prevention and health promotion programs.

ObjectiveTo evaluate the effects of dance therapy for

people with schizophrenia or schizophrenia-like illnesses compared with standard care and other interventions.

• Search MethodsWe searched the Cochrane Schizophrenia Group

Trials Register (July 2007), inspected references of all identified studies (included and excluded), and contacted first authors for additional data.

Selection CriteriaWe included all randomized controlled trials

comparing dance therapy and related approaches with standard care or other psychosocial interventions for people with schizophrenia.

• Data Collection and Analysis• We reliably selected, quality assessed, and

extracted data. We excluded data where more than 30% of participants were lost to follow-up. For continuous outcomes, we calculated a weighted mean difference (WMD); for binary outcomes, we calculated a fixed-effect risk ratio (RR) and their 95% confidence intervals (CIs).

• Results• We included one single blind study (total n=45) of

reasonable quality (tables 1 and  and22).1It compared dance therapy plus routine care with routine care alone. Most people tolerated the treatment package, but about 40% were lost in each group by 4 months (RR = 0.68, 95% CI = 0.31 to 1.51). Positive and Negative Syndrome Scale (PANSS) average endpoint total scores were similar in each group (WMD = −0.50, 95% CI = −11.8 to 10.8) as were the positive subscores (WMD = 2.50, 95% CI = −0.67 to 5.67). At the end of treatment, significantly more people in the dance therapy group had a greater than 20% reduction in PANSS negative symptom score (RR = 0.62, 95% CI = 0.39 to 0.97) (figure 1), and overall average negative endpoint scores were lower (WMD = −4.40, 95% CI = −8.15 to 0.65). There was no difference in satisfaction score (average Client's Assessment of Treatment Scale score, WMD = 0.40, 95% CI = −0.78 to 1.58), and quality-of-life data were also equivocal (average Manchester Short Assessment of Quality of Life score, WMD = 0.00, 95% CI = −0.48 to 0.48).

• AUTHORS' CONCLUSIONS:• There is no evidence to support - or refute - the

use of dance therapy in this group of people. This therapy remains unproven and those with schizophrenia, their carers, trialists and funders of research may wish to encourage future work to increase high quality evidence in this area