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Self-care requirements for activity and rest: an Orem nursing focus.

According to Orem's self-care deficit nursing theory, helping people to maintain a balance between activity and rest (a universal self-care requisite) is a legitimate concern of nursing. The meaning of activity and rest, the requirements and potential measures for meeting this self-care requisite, and factors that might influence the process are explored. Criteria for determining a need for nursing, guides for a nursing clinical assessment, and guides for nursing action are suggested as potential ways to assist persons to meet the action demands associated with this self-care requisite.

Activities of Daily Living↗

The lived experience of wanting to help another: research with Parse's method.

The phenomenon of wanting to help another is a universal human experience. Individuals reach out to others in order to fulfill personal commitments, to assist loved ones, or to meet professional obligations. The purpose of this research using Parse's method was to generate the structure of this experience as lived by nurses. Findings indicate that the lived experience of wanting to help another is directing nurturing intentions amidst uplifting affirmations with others while dissonant constraints unfold new possibilities. Findings are discussed in light of Parse's theory in order to expand the knowledge base of nursing. Similarities and differences with research findings on the experiences of nurturance and caring are presented. Implications for practice and further research are specified for nurses encountering persons who express their desire to help another.

Altruism↗

Satisfaction with support given and its association with subsequent health status.

OBJECTIVES: This study investigates health outcomes of older individuals who reported on their level of satisfaction with support given to family, friends, or community organizations. METHODS: A 3-year prospective cohort study of women aged 65 and older. RESULTS: Higher scores on the giving support scale predicted better lower-body function (Beta = .06; SE .02; p = .02) and less ADL difficulty (Beta = -.18; SE .04; p = .0001). The scale was also significantly associated with future hospitalization and death. Women in the lowest quartile were 28% more likely to be hospitalized (relative risk [RR] 1.28; 95% CI 1.00 - 1.65; p = .05) and 52% more likely to die (RR 1.52; 95% CI 1.03 - 2.26; p = .03) compared with those who scored in the highest quartile. CONCLUSIONS: Our results demonstrate that level of satisfaction with support given to family or friends or the community is associated with future health of the older person.

Aged↗

Construct analysis of four modes of being present.

The purpose of this construct analysis is to delineate the manner or modes of presence as used by nurses with their patients. The scope of the term presence encompasses four separate, distinct modes of presence. The term concept does not encompass the scope of the term. Therefore, the term construct is applied to demonstrate the differences in the four modes of being present. Model cases were extrapolated from personal experiences. Methods used in the construct development and construction include components of the Wilsonian method, an evolutionary view, and the hybrid model. Due to the breath and complexity of the interrelatedness of the four modes of being present, the author presents only a model case. To illustrate the attributes and consequences for the patient and the nurse in the interpersonal relationship for each of the four modes of being present, the author created models.

Empathy↗

Healing presence.

Since the introduction of presence as a concept in nursing literature in the early 1960s, nurse philosophers, theorists, and researchers have attempted to define and describe presence as it relates to nursing practice. Understanding of nursing presence and its link, if any, to nurse-patient interaction is basically subjective and intuitive. This article is based on the assumption that nursing presence fully understood may result in greater patient satisfaction and healing potential. A three-stage, hierarchical model culminating in healing presence is used to understand the nurse-patient dyad. The model is calibrated in terms of nursing maturity using Benner's novice nurse/expert nurse idea, Hanneman's expert nurse/nonexpert nurse view, Zaner's vivid-presence/copresence, and Doona, Chase, and Haggerty's nursing presence.

Communication↗

Nurturance. The spirit of holistic nursing.

In the theory of modeling and role modeling, the concept of nurturance is connected to holistic nursing practice. As nurturance is given and received within a context of unconditional acceptance, clients' needs are fulfilled and they can move toward a healthier state. An exploration of the literature revealed several defining attributes that clarify the definition of the concept as it is used by Erickson, Tomlin, and Swain. Model, borderline, related, and contrary cases further illustrate the meaning of nurturance and its relationship to holistic care. In addition, methods of measuring nurturance are discussed. An analysis of the concept brings an increased understanding of how nurses can care for clients in a manner that respects the uniqueness and value of each individual. The result is a client who experiences growth and renewal of of strength, allowing optimal healing to occur.

Education, Nursing↗

Restoring the patient's voice. The therapeutics of illness narratives.

Reflective and insightful autobiographical accounts of illness not only illuminate fundamental disruptions in selfhood and continuity of life that accompany illness, but authors of such accounts also maintain that narration is an important way to make sense of an illness episode, to restore personhood and connectedness, and to reclaim the illness experience from the medical meta-narrative. That witnessing and helping to order illness narratives can be a caring/healing nursing practice modality with significant healing potential is supported both by narrative theory and by nursing's theoretical and philosophical legacy. The challenge for the nurse guided by narrative ideas is to give primacy to the patient's voice, to listen for meaning rather than for facts, and to provide a relationship enabling the evolution of the patient's story.

Anecdotes as Topic↗

The ethics of caring: a basis for holistic care.

Interest in the concept of caring and the ethics of caring has grown as technology and depersonalization of health care delivery have increased. Major concepts of the ethics of caring are reviewed, with special focus on relating caring and virtue ethics. Assuming that caring is a virtue, it is concluded that ethically virtuous nurses must possess the caring attributes and demonstrate caring actions.

Empathy↗

The healing process of presence.

Therapeutic relationships help provide the milieu for the nurse and the patient to gain insights into the essence of disease and the nature of healing. In building a foundation on which to be in optimally responsive relationships, nurses at Riverside Methodist Hospitals in Columbus, Ohio, participate in a 2-day course that explores and names how we bring ourselves as gifts to others as well as to ourselves in the dynamic of therapeutic presence. The following article reviews the literature on presence, provides a course description and contents on presence, and assists nurses in incorporating principles of presence into nursing practice.

Empathy↗

Dimensions of culture care for substance-dependent African American women.

Substance abuse, now in epidemic proportions in many cultures, is of major concern nationally and transculturally. It is important for nurses and other health care providers working with an increasingly multiculturally diverse client population to understand the cultural implications of caring for clients with alcohol and drug dependence. The purpose of this ethnonursing research study was to discover meanings and expressions of care for substance-dependent African American women in the research context of an inner-city transitional home. A convenience sample of 12 key and 18 general participants was included in this study. The study was conceptualized within Leininger's culture care theory. Ethnonursing techniques of participant observation and focused in-depth interviews were used to collect data. Results included four universal care themes discovered in this study. Gender/cultural-specific care needs in relation to social structure, ethnohistory, and cultural context were discovered to influence the women's health/well-being as they moved through recovery.

Adaptation, Psychological↗

Mutual caring of elderly Korean couples.

The article described the experiences of elderly couples caring for each other using ethnographic methodology. Ten couples were interviewed in depth. The presence of a support system was found to be the primary requirement of elderly couples. Three taxonomies comprised the support system: (a) desire for respect in care, (b) desire for reliance, and (c) expectation. The close linkage and interaction of desire for care, desire for reliance, and expectations were confirmed. The findings suggested establishing a holistic support network for these elders.

Activities of Daily Living↗

Negotiating with helping systems: an example of grounded theory evolving through emergent fit.

A strength of substantive grounded theories is that they are modifiable. Yet, little attention is given in the research literature to the evolution of grounded theories through the process of emergent fit. In this article, emergent fit is discussed, and the evolution of the theoretical understanding of relationships with helping systems is provided as an example. In a feminist grounded-theory study of women's caring, emergent fit with existing inductive research on health care relationships resulted in a framework of negotiating, which includes four strategies: reframing responsibility, becoming an expert, harnessing resources, and taking on more. This explanatory model demonstrates how the use of emergent fit can avoid the generation of isolated theories and contribute to knowledge accumulation by producing a substantive theory with wider applicability.

Adaptation, Psychological↗

Music therapy with imminently dying hospice patients and their families: facilitating release near the time of death.

Hospice care seeks to address the diverse needs of terminally ill patients in a number of physical, psychosocial, and spiritual areas. Family members of the patient often are included in the care and services provided by the hospice team, and hospice clinicians face a special challenge when working with families of patients who are imminently dying. When loved ones are anticipating the patient's impending death, they may find it difficult to express feelings, thoughts, and last wishes. Music therapy is a service modality that can help to facilitate such communication between the family and the patient who is actively dying, while also providing a comforting presence. Music therapy as a way to ease communication and sharing between dying patients and their loved ones is discussed in this article. The ways in which music therapy can facilitate a means of release for both patients and family members in an acute care unit of a large US hospice organization are specifically described. Case descriptions illustrate how music therapy functioned to allow five patients and their families to both come together and let go near the time of death. Elements to consider when providing such services to imminently dying patients and their families are discussed.

Adaptation, Psychological↗

Choices about mortality.

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AIDS-Related Opportunistic Infections↗

Completing the hospice organizational model.

Hospices must be thought of as still being in their formative stages. We need not be satisfied with staffing arrangements and practices that, largely for reasons of expediency and the lack of other models, were inherited from other healthcare agencies or foisted on us by federal bureaucrats and third party payers. These external demands will be countered and features unique to hospices created only to the extent that all of us are clear about what we most need and want for ourselves as staff. That is how we created the patterns used in working with clients. Now let us use the same ingenuity in fashioning ways of working among ourselves.

Health Personnel↗