Mary Gunther

Social Context of Rural Women with HIV/AIDS

The South has more AIDS cases than any other region of the US, with most new diagnoses among African American women (56%). In a previous study, a peer counseling intervention for rural women with HIV/AIDS was developed and tested. The purpose of this analysis was to describe, from the peer counselors’ perspective, the predominant concerns of the women, contextualized by living in isolated, impoverished circumstances in the rural Deep South. Following home visits, peer counselors recorded a description of the encounter. A multidisciplinary qualitative research group extracted, coded, and thematized the chief concerns and context of the womens lives. Findings provide a vivid portrait of HIV-infected women experiencing deeply troubling psychological and physiological symptoms of HIV/AIDS against the contextual ground of poverty and isolation. Themes include: (1) struggle/effort; (2) stigma/hiding; (3) loss/depression; and (4) independence/ dependence. These women lived in extremely difficult life circumstances that reflected not only a devastating chronic illness, but a life of poverty and abuse. Appropriate care for HIV-infected women living in the rural Deep South will need to address the whole context of their lives.

Cranial Electrotherapy Stimulation for the Treatment of Depression

More prevalent in women than men, clinical depression affects approximately 15 million American adults in a given year. Psychopharmaceutical therapy accompanied by psychotherapy and wellness interventions (e.g., nutrition, exercise, counseling) is effective in 80% of diagnosed cases. A lesser known adjunctive therapy is that of cranial electrotherapy stimulation (CES). The major hypothesis for the use of CES in depression is that it may reset the brain to pre-stress homeostasis levels. It is conjectured that the pulsed electrical currents emitted by cranial electrical stimulators affect changes in the limbic system, the reticular activating system, and/or the hypothalamus that result in neurotransmitter secretion and downstream hormone production. While evidence is good for applied research, basic research about the mechanisms of action for CES remains in its infancy. A review of the literature provides an overview of current research findings and implications for clinical mental health practice.

Increasing Nursing Treatment for Pediatric Procedural Pain

Procedural pain management is an underused practice in children. Despite the availability of efficacious treatments, many nurses do not provide adequate analgesia for painful interventions. Complementary therapies and nonpharmacologic interventions are additionally essential to managing pain. Owing to the increasing awareness of inadequate nursing utilization of pharmacologic measures for procedural pain, this paper focuses only on analgesic treatments. The aim of this review was to examine how varying degrees of quality improvement affect nursing utilization of treatments for routine pediatric procedural pain. A comprehensive search of databases including Cinahl, Medline/Pubmed, Web of Science, Google Scholar, Psycinfo, and Cochrane Library was performed. Sixty-two peer-reviewed research articles were examined. Ten articles focusing on quality improvement in pediatric pain management published in English from 2001 to 2011 were included. Three themes emerged: 1) increasing nursing knowledge; 2) nursing empowerment; and 3) protocol implementation. Research critique was completed with the use of guidelines and recommendations from Creswell (2009) and Garrard (2011). The literature reveals that nurses still think that pediatric pain management is essential. Quality improvement increases nursing utilization of procedural pain treatments. Although increasing nursing knowledge improves pediatric pain management, it appears that nursing empowerment and protocol implementation increase nursing compliance more than just education alone. Nurses providing pain management can enhance their individual practice with quality improvement measures that may increase nursing adherence to institutional and nationally recommended pediatric procedural pain management guidelines.

Sleep and HIV Disease

Although not the fatal illness it once was, HIV/AIDS remains a life-threatening illness. The worldwide prevalence of HIV/AIDS at the end of 2010 was estimated to be 34 million, which includes 3.4 million children who are less than 15 years of age. The incidence of HIV infection decreased from 3.1 million in 2001 to 2.7 million in 2010. The annual number of deaths worldwide is steadily declining since peaking in 2005 at 2.2 million.

Sleep Disorders and Sleep Promotion in Nursing Practice

Winner of a 2011 American Journal of Nursing Book-ofthe-Year award and holder of four stars from Doody’s Book Reviews, this manual compiles chapters from 28 leading experts on the subject of sleep ranging from physiology of normal sleep through recommendations for future research. The stated purpose of the book is to not only provide a reference for nurse educators and practitioners, but also “to integrate the science of sleep into nursing practice, education, and research” (p. xi). The resulting text holds the distinction of being the most comprehensive evidence-based resource available to educate nurses about their role in addressing sleep disorders encountered in every day practice. Viewing sleep as a biobehavioral phenomenon present throughout the lifespan, the book is designed for educators, practitioners, and researchers. Both editors are well-established sleep researchers with extensive experience in different nursing clinical specialties: Redecker in primary and acute care and McEnany in mental health. Nancy Redeker, Professor and Associate Dean of Scholarly Affairs at Yale University School of Nursing, focuses on sleep disorders among adults who have chronic medical conditions, primarily cardiovascular. In addition to having served as President of Eastern Nursing Research Society, she is currently editor of Heart & Lung, The Journal of Acute & Critical Care. McEnany, Professor of nursing at the University of Massachusetts Lowell, concentrates both his clinical practice and research in the area of adult mental health. With a strong interest in psychobiology and psychopharmacology, he maintains a private practice as well as teaching in the undergraduate and graduate nursing programs. An associate editor for Issues in Mental Health Nursing, he continues his work related to the role of sleep in schizophrenia and depression. Both are federally funded researchers in their specialty areas. Offering a compilation of sleep knowledge from eminent nurse scientists, this manual contains critical empirical information about sleep including gender, age, racial and cultural differences; psycho-physiological mechanisms; and individual and societal consequential costs of disorders. The nurse’s role in care of patients across the lifespan and in various settings is explored by multiple nurse experts who provide specific sleep promotion strategies for use in the everyday practice of educators, care providers, and employers. In addition, the authors provide information about numerous web-based resources.

The Mindful Therapist: A Clinician's Guide to Mindsight and Neural Integration

Currently a clinical professor of psychiatry at the UCLA School of Medicine with training in pediatrics and child, adolescent, and adult psychiatry, Dr. Siegel is a recognized expert in the interplay between human relationships and biologic processes. Educated at Harvard Medical School, he completed a National Institute of Mental Health Fellowship at UCLA studying family interactions with an emphasis on how attachment influences behavior. He is the Executive Director of the Mindsight Institute, a Co-Director of the Mindful Awareness Research Center at UCLA, and a practicing psychotherapist. His previous publications address such topics as interpersonal neurobiology and the cultivation of well-being. This latest publication explores the clinician’s personal development. A product of two decades of studying the connections between the physical and psychological facets of human interaction, Siegel’s theory characterizes mindfulness as an intentional awareness of moment-to-moment experience involving caring acceptance, conscious recognition of possibilities, and compassion, culminating in psychological and interpersonal change. The central organizing theme of this book is the premise that integration (synthesis of the differentiated elements of mind and brain necessary for relational experiences) is “at the heart of well-being” (p. 30). Expanding on earlier work that identified the domains of integration, The Mindful Therapist is presented as a primer “about the objective science and subjective art of mindful being” (p. xix) within the domain of consciousness. The book is organized using the acronym PART. A discussion of Presence, Attunement, and Resonance leads into an interpretive analysis of Trust, Truth, Tripod (openness, objectivity, observation), Triception (interdependence), Tracking (information flow), Traits, Trauma (resolution), Transition, Training, Transformation, Tranquility, and Transpiration (awareness). Each chapter includes a definition of the featured concept, an explanation of relevant neural circuitry, discussion of integration, and practical exercises for development of mindsight (perceptual) skills. An appendix provides explanation of basic terminology and foundational proposals required to appreciate the phenomena of mindsight and mindfulness. This well-researched book concludes with a list of suggested readings. Writing in an informal conversational tone, Siegel provides understandable descriptions of the physiological and mental processes that fuse together to make us who we are. Through discussion of awareness, balance, empathy, and resilience Siegel examines what it means to be a therapist rather than describing what therapists do. As Siegel admits, mindfulness is not “a common or necessarily scientifically or philosophically sanctioned move to define the mind” (p. 25). Nevertheless, the theory is both rooted in neuroscience and harmonious with the tenets of evidence-based holistic practice. Whether or not the suggested exercises reconfigure the clinician’s neural circuitry, they will heighten awareness of the subjective self while increasing the capacity to be present in the moment with clients.

Deferred Empathy: A Construct with Implications for the Mental Health of Older Adults

Deferred empathy occurs when an experience provokes a memory that after reflection allows people to say, “Now I understand.” Heretofore, the concept was explored only in quantitative research; therefore, the purpose of this phenomenological study was to elicit a more detailed description of the construct of deferred empathy. For most of the participants (n = 20) triggering events involved personal challenges such as loss, loss of control, or interpersonal conflict that reminded them of, and changed, their perception of earlier relationships. Development of empathy involved reflection on past and present events, making choices, changing expectations, and learning acceptance. The process resulted in appreciative understanding of others as well as personal benefits. Findings have implications for mental health promotion in older adults in which life review promotes gerotranscendence.