Howard K. Butcher

The Experience of Caring for a Family Member with Alzheimer’s Disease

The purpose of this phenomenological study was to describe the experience of caring for a family member with Alzheimer’s disease or related disorder (ADRD) living at home among a diverse sample of 103 family caregivers. The study involved secondary analysis of in-depth transcribed interview data using van Kaam’s rigorous four phase, 12-step psychophenomenological method. A total of 2,115 descriptive expressions were categorized into 38 preliminary structural elements. Eight essential structural elements emerged from an analysis of the preliminary structural elements. The eight elements were then synthesized to form the following synthetic structural definition: Caring for a family member living at home with ADRD was experienced as “being immersed in caregiving; enduring stress and frustration; suffering through the losses; integrating ADRD into our lives and preserving integrity; gathering support; moving with continuous change; and finding meaning and joy.”

Exasperations as Blessings: Meaning-Making and the Caregiving Experience

This study examines the process of how caregivers can shape the frustrations and exasperations of caring for a family member with Alzheimers disease into blessings. Heideggers hermeneutic phenomenological perspective is used to interpret a caregivers narrative, in which she describes caring for her husband with Alzheimers disease. The interpretive analysis focuses specifically on how the caregiver finds meaning in the caregiving process. The analysis reveals that the caregiver constructs meaning by emphasizing particular aspects of her experiences, including cherished memories, creating a happy life by living life intensely, and counting her blessings. While some caregivers naturally find such meaning, this study suggests that reading the narratives of others as well as writing about ones own thoughts and feelings can facilitate this meaning-making process. Structured written emotional expression, in particular, fosters meaning-making, diminishes psychological distress, improves immune function, and promotes health and well-being.

A Toolkit for Ethical and Culturally Sensitive Research: An Application with Indigenous Communities

Given the complex historical context of research with indigenous communities, there is an ethical imperative to ensure cultural sensitivity in research with these populations. Despite this need, there is a lack of practical guidance based on empirical results to conduct culturally sensitive research. The purpose of this qualitative inquiry is twofold. First, Part 1 identifies strategies for culturally sensitive research with indigenous communities in the USA. Second, Part 2 applies culturally sensitive strategies to a specific research setting with an indigenous community. Part 1 uses a qualitative descriptive study with 13 indigenous and non-indigenous researchers to identify strategies for cultural sensitivity in research. Part 2 applies identified strategies to a rigorous critical ethnography with indigenous communities. Emergent themes from Part 1 include the impact of history, relational research, incorporating cultural sensitivity and strengths, demonstrating patience, and negotiating multiple perspectives. These themes inform a researchers toolkit for cultural sensitivity, which is applied to a localized setting in Part 2. Cultural sensitivity enhances the quality and usefulness of research, which is better able to address the pressing problems experienced by some indigenous communities.

Illuminating the Lived Experiences of Research with Indigenous Communities

The historical exploitation experienced by indigenous people in the United States has left a number of negative legacies, including distrust toward research. This distrust poses a barrier to progress made through culturally sensitive research. Given the complex history of research with indigenous groups, the purpose of this descriptive phenomenological study was to illuminate the lived experiences of both indigenous and non-indigenous researchers conducting culturally competent research with indigenous people. Interviews from 13 social science research experts revealed 6 underlying themes about their research with indigenous people, including respect and commitment, mutual trust, affirmation, harmony among multiple worldviews, responsibility, and spiritual/personal growth.

Portraits of Caregivers of End-Stage Dementia Patients Receiving Hospice Care

The purpose of this study was to investigate how caregivers respond to the end stages of dementia with the assistance from hospice. Data were collected from 27 family caregivers over the course of 10 months, with each caregiver being interviewed up to 4 times during the time that the patient received hospice care. Chart review data were also collected. Four distinct caregiver portraits emerged: (a) disengaged, (b) questioning, (c) all-consumed, and (d) reconciled. Caregivers in each portrait differed in how they responded to the impending death of the care recipient, the disease progression, and hospice care. Recognizing the differences in the ways that caregivers respond to the final stages of the disease will assist hospice and other providers in best meeting the needs of the caregivers.

The Caregivers’ Story: Home Caregiving for Persons with Dementia

This study identified the salient issues of caregiving for family members of persons with dementia using computer-assisted content analysis followed by factor analysis. Differences in responses between caregivers in two treatment groups were also noted. Caregivers (N = 226) were interviewed on three occasions over 12 months. They consistently identified the following themes of caregiving in order of significance: (a) making meaning of the experience; (b) defining the caregiver role; (c) identifying specific caregiving strategies; (d) dealing with change, unpredictability, and vulnerability; (e) evaluating past and future decisions and quality of care; and (f) finding help and support. This representation of the caregiving experience is useful to home care nurses by providing a framework to address issues most important to caregivers and upon which therapeutic interventions can be developed.

Evidence-Based Practice Guideline: Changing the Practice of Physical Restraint Use in Acute Care.

Physical restraints continue to be used in acute care settings, despite the challenges and calls to reduce this practice. The current guideline on restraint use is updated with evidence that includes critical care settings and issues related to restraint use in acute care units. Nurses play a significant role in the use of restraints. Factors such as nurses knowledge and patient characteristics combined with the culture and resources in health care facilities influence the practice of physical restraint use. Nurses can identify patients at high risk for restraint use; assess the potential causes of unsafe behaviors; and target interventions in the areas of physiological, psychological, and environmental approaches to address those unsafe behaviors. Members of the interdisciplinary team can provide additional consultation, and institutions can provide resources and education and implement monitoring processes and quality improvement practices to help reduce the practice of physical restraint use. [Journal of Gerontological Nursing, 42(2), 17-26.].

Reenvisioning Gerontological Mental Health Nursing Education: A Commentary

Reenvisioning gerontological mental health nursing begins with reinterpreting the meaning of aging and radically transforming the curriculum of the subspecialty. The commentary suggests 11 specific recommendations that expand on Morris and Mentes’s article as a way of reenvisioning and rerooting gerontological mental health nursing. Among the recommendations are renaming the subspecialty “gerontological mental health nursing” as a means to more appropriately reflect the multidisciplinary focus and mental health perspective, placing an equal emphasis on positive aspects of healthy aging, developing a standardized model curriculum, increasing the number of programs offering specialization in gerontological mental health nursing, and reinvigorating continuing education about gerontological mental health care for currently practicing nurses.

Human Energy Field: A Concept Analysis

The human energy field (HEF) as a phenomenon of interest across disciplines has gained increased attention over the 20th and 21st centuries. However, a concern has arisen that there is a lack of evidence to support the concept of the HEF as a phenomenon of interest to professional nurses and nursing practice. Using Chinn and Kramer’s method of creating conceptual meaning, a concept analysis was conducted for the purpose of developing a conceptual definition of HEF. A systematic review of the literature using the CINAHL database yielded a total of 81 articles and text sources that were determined to be relevant to the concept analysis. The HEF is defined as a luminous field of energy that comprises a person, extends beyond the physical body, and is in a continuous mutual process with the environmental energy field. It is a vital energy that is a continuous whole and is recognized by its unique pattern; it is dynamic, creative, nonlinear, unpredictable, and flows in lower and higher frequencies. The balanced HEF is characterized by flow, rhythm, symmetry, and gentle vibration.

Holistic Nurses’ Use of Energy-Based Caring Modalities

As part of a study of a larger study of self-identified holistic nurses, researchers asked nurses to describe practice situations where energy-based modalities (EBMs) were used. Four hundred and twenty-four nurses responded by writing free-text responses on an online survey tool. The participants were highly educated and very experienced with 42% holding graduate degrees and 77% having over 21 years of practice. Conventional content analysis revealed four themes: EMBs are 1) caring modalities used to treat a wide range of identified nursing concerns; 2) implemented across the life span and to facilitate life transitions; 3) support care for the treatment of specific medical conditions; and 4) Use of EBMs transcend labels of ‘conditions’ and are used within a holistic framework. The fourth theme reveals a shared vision of nursing work such that the modality becomes secondary and the need to address the ‘whole’ at an energetic level emerges as the primary focus of holistic nursing.