Barbara J. Leonard

Complementary therapies and healing practices: faculty/student beliefs and attitudes and the implications for nursing education

The purpose of this study was to describe the knowledge and attitudes of nursing faculty and students (BSN and MS) regarding complementary/alternative therapies (C/AT) and their integration into nursing practice. Implications for curricular and faculty development were also identified. A cross-sectional survey (n = 170) of graduating BSN students (n = 73) and MS and PhD students (n = 47) and faculty (n = 50) was conducted in a university-based nursing program. The self-administered questionnaire contained 134 forced choice items. Questions assessed attitudes and knowledge about training in, personal use of, perceived barriers to, and intent to integrate C/AT into clinical practice. Over 95 percent of the students and faculty agreed that clinical care should integrate the best of conventional and C/AT practices. Few had received formal C/AT education; the highest number had received some education about massage, music, prayer/spiritual healing, and therapeutic/healing touch. They desired more education but not necessarily the skills to perform these therapies themselves. Faculty and students expressed positive attitudes about incorporating C/AT into curricula and nursing practice. Current knowledge lags behind interest, however, suggesting a situation ripe for change. The most important perceived barrier to incorporation was lack of evidence. Curricular change is needed to fully integrate C/AT in nursing programs at all levels; faculty development and nursing research is needed to facilitate these changes.

Home care for medically fragile children: impact on family health and well-being.

The health status of 48 families providing home care for their medically fragile children was studied. Mothers, as the primary caregivers, experienced a greater decline in their physical health than did fathers or siblings. When the financial burden of providing care was greater and when the relationship with care providers was more strained, families had more physical illness symptoms. Who provided home care services for the medically fragile child influenced the psychosocial impact on the family. Care provided by home health aides was associated with greater negative impact, whereas care from professional nurses reduced the negative impact. The trend toward home care for medically fragile children has been accelerating; this study points to the importance of studying the impact on the family of this kind of care. Policy implications regarding the amount and quality of services and payment for them are discussed.

Adolescents With Type 1 Diabetes: Family Functioning and Metabolic Control

Families play central roles in the care of their adolescents with chronic illnesses. This study examined the relationship between family functioning and metabolic control in adolescents with Type 1 diabetes. The McMaster Family Assessment Device (FAD) measured family functioning; the Youth Self-Report Form (YSR) measured adolescent behavior. Older adolescents reported increased family dysfunction. Adolescents who reported family dysfunction on affective responsiveness had HbA 1c levels greater than 9. Older adolescents, males, and adolescents who reported a greater number of behavior problems were significantly more likely to have HbA 1c levels greater than 9. Considered together, older age and greater attention problems were most significantly associated with higher HbA 1c levels. These findings suggest the importance of the relationship between the adolescent’s perception of family functioning and metabolic control in the adolescents with Type 1 diabetes.

Self-management development in children and adolescents with diabetes: the role of maternal self-efficacy and conflict.

The overall purpose of this study was to investigate maternal self-efficacy and its relationship to maternal perception of the childs self-management of diabetes. The influence of conflict between mother and child was also examined. One hundred and four mothers of children, ages 8 to 17 years, who were attending summer diabetes camp, were asked to rate their own and their childs abilities to manage the childs diabetes. Overall, the mothers expressed a high degree of self-efficacy in managing their childs diabetes and perceived their children as average or above in managing their own diabetes when compared with agemates with diabetes. Furthermore, mothers level of self-efficacy was significantly positively related to their perceptions of their childs self-management. In addition, almost one third (30%) of the mothers reported experiencing interpersonal conflict regarding how much responsibility the child should assume in managing their own diabetes. Mothers who rated their childs level of independence as low were three times more likely to report experiencing conflict. In the vast majority of cases, the child was the primary source of conflict. When hierarchical logistic regression was used to multivariately model childrens independence, conflict with the child remained a significant predictor, above and beyond background, demographic, and important conceptual variables, including self-efficacy.

Awareness: The Heart of Cultural Competence

Cultural competency in critical care is providing care to patients and their families that is compatible with their values and the traditions of their faiths. This requires awareness of ones own values and those of the healthcare system. The nurse must also become aware of the cultural and spiritual values of patients and families. Although knowledge of many cultures is impossible, willingness to learn about, respect, and work with persons from different backgrounds is critical to providing culturally competent care. This article discusses elements essential for increasing cultural competency.

EXTENDED HOSPITALIZATION OF MEDICALLY STABLE CHILDREN DEPENDENT ON TECHNOLOGY: A FOCUS ON MUTABLE FAMILY FACTORS

This study identified three factors that influenced extended hospital stay in medically stable children dependent on medical technology. A retrospective review of 50 charts in a level II nursery was conducted. Bivariate analysis identified factors contributing to extended stay: parental factors, societal factors, health care factors, and presence of disease. Multiple regression explained 98% of the variance in extended length of stay. Family factors accounted for 19.6%, nonfamily factors accounted for 42.5%, and the two sets of factors together accounted for an additional 35.9%. Family-related issues with a high potential for change were identified. Pediatric providers should develop family intervention strategies that identify the most appropriate level of care that both advocates in the best interest of the child and family and contains the rising cost of health care.

Pediatric Nurse Educator Shortage: Implications for the Nursing Care of Children

Maternal and child health (MCH) nurses are vital to caring for the nations infants, children, and adolescents. A shortage of pediatric nursing educators has important consequences for the preparation of the next generation of MCH nurses. A Web-based survey of administrators and pediatric nursing faculty from U.S. schools of nursing with baccalaureate and advanced degree programs was conducted to assess perceptions of a pediatric nursing faculty shortage, and implications and solutions to such a shortage. Deans (n = 191) and pediatric faculty (n = 237) from schools of nursing responded to the survey. Institutions are representative of the 660 schools of nursing across the United States. Fifty percent of deans and 70% of pediatric nursing faculty members reported a shortage of pediatric nursing faculty. Large, public institutions (total school student enrollment over 15,000) expressed the most concern. The educational impact of the reported shortage included increased faculty workload, difficulty getting appropriate clinical practice settings, elimination of acute care clinical experiences, and reduction in pediatric content in curricula. Expected retirements of the current workforce (76% were over 45 years of age) without an increase in replacements will deepen the shortage in the coming decade. Pediatric faculty members focused on the need for competitive salaries (particularly compared to clinical salaries) and active mentoring programs as important factors in recruitment and retention of new faculty. Recommendations for stemming the decline in availability of pediatric nursing faculty are provided.

Incorporating Alternative and Complementary Health Practices Within University-Based Nursing Education:

The University of Minnesota School of Nursing aims to fully incorporate comple mentary and alternative health philosophy and healing practices into its baccalau reate, masters and doctoral programs. A planning process (1998-99) included School of Nursing faculty, administrators, and representatives of the universitys Center for Spirituality and Healing. A comprehensive course of action was devel oped that included strengthening didactic and experiential learning, offering indi vidualized plans of clinical study in a variety of modalities, improving access to an interdisciplinary graduate minor in Complementary Therapies and Healing Practic es, and encouraging faculty research initiatives and continuing education in CAM.

Graduate Nursing Education: Developmental Disabilities and Special Health Care Needs

As children and adults with developmental disabilities and special health care needs are integrated into home, school, and community life, nurses are being required to provide leadership, advocacy, and training in community settings to a much greater extent than in the past. To assess the school and community need for formal graduate preparation for nurses who work with individuals with developmental disabilities and/or special health care needs, 25 nurses in leadership positions representing urban and rural health agencies throughout Minnesota took part in a 5-hour focus group discussion. Analysis of data summarized from this process shows five features of the recommended curriculum necessary for advanced practitioners in this specialty area: (a) discipline-specific core competencies, (b) discipline-specific specialty competencies, (c) genetic competencies not specific to nursing but necessary to function in nursing roles, (d) interdisciplinary and intradisciplinary learning experiences, and (e) clinical experiences with preceptors. The authors recommend the development of interdisciplinary graduate programs designed to prepare nurses to assume leadership roles in school health, public health, home health care, and systems management that will affect public policy and, ultimately, promote change in the systems charged with responsibility to serve this population.

Influence of an Experiential Education Session on Nursing Students’ Confidence Levels in Performing Selected Complementary Therapy Skills

Efforts are under way in many nursing education programs across the United States to incorporate content into curricula on complementary/alternative therapies (CAT). Many of these efforts focus on didactic presentation of content. There is an absence of nursing programs that provide students with opportunities to actually experience and practice CAT skills; little is known about how these hands-on learning experiences affect confidence in applying selected CAT skills in beginning nursing practice. This article highlights efforts at the University of Minnesota School of Nursing to integrate practice and experience in selected CAT skills (music, hand massage, imagery, breathing/ mindfulness, reflexology) into an existing senior undergraduate clinical skills laboratory course. Students (n= 86) who participated in the class reported significant increases in their confidence levels after the experiential sessions for all of the CAT skills practiced. Directions for future curriculum integration efforts are discussed as well as opportunities for expansion of CAT skills experiences.