Inez Tuck

The experience of caring for an adult child with schizophrenia

The experience of caring for an adult child with schizophrenia was explored using phenomenological methodology. Nine parents who were the primary caretakers of an adult child with schizophrenia participated in qualitative interviews. The resulting transcripts were analyzed to discover the structure of the lived experience. The study revealed that the diagnosis of schizophrenia in a child is experienced by the parent as a destructive force that interrupts and radically transforms the normative family life trajectory. This grief-filled experience involves both the loss of an imagined, idealized child and a transformation of the physically present child into a needy stranger. Implications are discussed and applied to community-based, family-centered mental health care. Importantly, the revealed dissatisfaction with initial mental health evaluations suggests that modification of current practices could produce significant benefits.

A randomized clinical trial of alternative stress management interventions in persons with HIV infection.

Research in psychoneuroimmunology suggests that immunosuppression associated with perceived stress may contribute to disease progression in persons with HIV infection. While stress management interventions may enhance immune function, few alternative approaches have yet been tested. This randomized clinical trial was conducted to test effects of three 10-week stress management approaches--cognitive-behavioral relaxation training (RLXN), focused tai chi training (TCHI), and spiritual growth groups (SPRT)--in comparison to a wait-listed control group (CTRL) among 252 individuals with HIV infection. Using repeated measures mixed modeling, the authors found that in comparison to the CTRL group, (a) both the RLXN and TCHI groups used less emotion-focused coping, and (b) all treatment groups had augmented lymphocyte proliferative function. Despite modest effects of the interventions on psychosocial functioning, robust findings of improved immune function have important clinical implications, particularly for persons with immune-mediated illnesses.

Spirituality and Spiritual Care Provided by Parish Nurses

The high level of religious participation in the United States provides a venue for parish nursing, a holistic nursing specialty that emphasizes the relationship between spirituality and health. This descriptive study measured two aspects of spirituality (spiritual perspective and spiritual well-being) in a national sample of parish nurses and described variables related to their practice. Furthermore, it qualitatively examined the provision of spiritual care to clients in this parish nurse sample. Parish nurses scored high in spiritual perspective and spiritual well-being and reported an emphasis on health promotion and education in their activities. Three views of spiritual interventions (ideal, general, and specific) were reported. Types of spiritual interventions typically fell into one of four categories: religious, interactional, relational, and professional.

Spirituality and Stress Management in Healthy Adults

The purposes of this longitudinal, descriptive pilot study were to (a) test the acceptability and feasibility of a 6-week spiritual intervention; (b) determine the relationship between spirituality and stress; (c) explore the effects of the intervention on measures of perceived stress, spiritual perspective, and spiritual well-being; and (d) explore the meaning of spirituality. The sample consisted of 27 community-dwelling adults. Six categories emerged from the qualitative data as descriptors of the meaning and significance of spirituality. The survey data indicated that there were significant negative correlations between perceived stress and spiritual well-being at three time intervals, a significant decline in the levels of perceived stress, and a significant increase in spiritual perspective from the pretest to the 6-week follow-up. There were no significant changes in spiritual well-being. The intervention proved effective in reducing stress in this healthy adult sample.

Exploring Parish Nursing from an Ethnographic Perspective

Purpose: This study examined a parish program as an evolving nursing specialty. Design: This is an ethnographic study of a parish nursing program in a southeastern U.S. city that included interviews with key informants, participant observations, and document analysis. Data were content analyzed. Findings and results: Findings indicate positive perceptions of the parish nursing program. Cultural themes include the process of discovery, commitment to the parish nurse and program, and fit with values and missions. Taxonomies of parish nurse attributes, actions, offerings, roles, and entrance requirements were derived. Discussion and conclusion: Parish nursing offers nurses the opportunity to bridge physical, social, emotional, and spiritual lives into one caregiving experience. Implications for practice: Findings provide clinical guidance for parish nurses.

Spiritual Interventions Provided by Mental Health Nurses

This descriptive qualitative study explored the spiritual nursing interventions provided by mental health nurses. Fifty mental health nurses responded to open-ended interrogative statements to report on nursing interventions in three situations that supported the spiritual needs of patients and families. Their responses were grouped into four categories, nurses being with the client, doing for the client, encouraging the client to look inward, and encouraging the client to look outward. Being with was demonstrated through the presence of the nurse. Doing for included interventions performed on the clients behalf and included the nurse using time, people, and space to provide care. Clients were encouraged to look inward for strength and look outward for people and objects that could be resources for them. A serendipitous finding was that mental health nurses were able to describe the ideal spiritual interventions but reportedfewer instances of actually having intervened.

An exploration of the meaning of spirituality voiced by persons living with HIV disease and healthy adults.

Spirituality has been documented in several studies as having a positive effect on chronic disease progression and as being efficacious in improving quality of life and well being. In many studies, researchers have used predetermined definitions of spirituality and have proscribed the variable by the selection of measures. This study examines the meaning of spirituality as voiced by participants in two ongoing intervention studies, a sample of healthy adults and a sample of persons living with HIV disease. The findings resulted in six themes for each sample. Exhaustive statements were written depicting the summary relationships of themes. The findings support spirituality as an essential human dimension.

MILIEU THERAPY: A REVIEW OF DEVELOPMENT OF THIS CONCEPT AND ITS IMPLICATIONS FOR PSYCHIATRIC NURSING

Milieu therapy has long existed as an effective treatment modality for the mentally ill. It has also been a significant aspect of psychiatric-mental health nursing practice for several decades. This article reviews the history of milieu therapy and the role that psychiatric-mental health nursing staffs have in its implementation. The authors suggest strategies for milieu management and future implications for milieu therapy.

Forgiveness, flourishing, and resilience: the influences of expressions of spirituality on mental health recovery.

The relationships of spirituality, religion, and health have been the subject of research in a variety of disciplines over the past two decades. Findings have varied: Some findings appear to have strong evidence of relationships while other findings are deemed inconclusive. A few studies have distinguished between religion and spirituality, but most investigators have treated the two as one concept with no clear lines of distinction between them. This theoretical study, focusing on the topic of spirituality, explores several related concepts, including forgiveness, flourishing, and resilience, as a basis for developing approaches to facilitate recovery in mental health clients using spiritual interventions.

Psychoneuroimmunology-Based Stress Management during Adjuvant Chemotherapy for Early Breast Cancer

Objective. In a randomized trial of women with early stage breast cancer undergoing adjuvant chemotherapy, two stress management interventions, tai chi training and spiritual growth groups, were compared to a usual care control group, to evaluate psychosocial functioning, quality of life (QOL), and biological markers thought to reflect cancer- and treatment-specific mechanisms. Method. The sample consisted of 145 women aged 27–75 years; 75% were Caucasian and 25% African American. A total of 109 participants completed the study, yielding a 75% retention rate. Grounded in a psychoneuroimmunology framework, the overarching hypothesis was that both interventions would reduce perceived stress, enhance QOL and psychosocial functioning, normalize levels of stress-related neuroendocrine mediators, and attenuate immunosuppression. Results. While interesting patterns were seen across the sample and over time, the interventions had no appreciable effects when delivered during the period of chemotherapy. Conclusions. Findings highlight the complex nature of biobehavioral interventions in relation to treatment trajectories and potential outcomes. Psychosocial interventions like these may lack sufficient power to overcome the psychosocial or physiological stress experienced during the chemotherapy treatment period. It may be that interventions requiring less activity and/or group attendance would have enhanced therapeutic effects, and more active interventions need to be tested prior to and following recovery from chemotherapy.