Mary P. Bennett

Humor and Laughter May Influence Health: III. Laughter and Health Outcomes

This is part three of a four-part series reviewing the evidence on how humor influences physiological and psychological well-being. The first article included basic background information, definitions and a review of the theoretical underpinnings for this area of research. The second article discussed use of humor as a complementary therapy within various clinical samples, as well as evidence concerning how a sense of humor influences physiological and psychological wellbeing. This third article examines how laughter influences health outcomes; including muscle tension, cardio-respiratory functioning and various stress physiology measures.

Design and Testing of the Use of a Complementary and Alternative Therapies Survey in Women With Breast Cancer

PURPOSE/OBJECTIVES To design and test a reliable and valid instrument to determine the frequency of use of complementary and alternative medicine (CAM) therapies among women diagnosed with breast cancer. DESIGN A descriptive cross-sectional survey. SETTING Women were recruited from the southeastern area and a rural midwestern area of the United States. SAMPLE 105 predominantly Caucasian women (mean= 59 years of age) with a diagnosis of breast cancer. METHODS The Use of Complementary and Alternative Therapies Survey was designed with a content validity index, and reliability was determined with the coefficient alpha. Exploratory factor analysis using a principal components analysis identified primary components (factors) embedded within the survey. Frequency of CAM therapy use was calculated for 33 individual therapies listed on the survey and among three survey-defined subscales of CAM therapies (i.e., diet and nutritional supplements, stress-reducing techniques, and traditional and ethnic medicines). MAIN RESEARCH VARIABLES Psychometric properties of an instrument to assess frequency of use of CAM among women with breast cancer. FINDINGS The reported prevalence of use of the individual CAM therapies varied considerably. The coefficient alpha estimate for the total survey was 0.86. Estimates for the individual hypothesized subscales were 0.67 for diet and nutritional supplements, 0.79 for stress-reducing techniques, and 0.80 for traditional and ethnic medicines. The principal components analysis resulted in a two-factor solution with nine items that loaded heavily and uniquely on a factor conceptualized as stress and anxiety reduction and six items that loaded heavily and uniquely on a factor conceptualized as dietary and physical manipulation. The remaining five items (vitamins and minerals, prayer and spiritual healing, massage, reflexology, and aromatherapy) indicated moderate loadings on factors one and two and, thus, were interpreted as equivocal items. CONCLUSIONS Preliminary data indicated that the instrument is reliable and valid. Additional work is needed to improve the range of items and to test the instrument with other populations. IMPLICATIONS FOR NURSING Use of CAM by women with breast cancer is believed to be increasing. However, limited data exist on the frequency and predictors of its use in this patient population; therefore, reliable and valid instruments are needed to determine use. If nurses can determine which CAM therapies women are employing, nurses can educate patients with breast cancer on the safe use of these therapies.

Humor and Laughter May Influence Health IV. Humor and Immune Function

This is the final article in a four part series reviewing the influence of humor and laughter on physiological and psychological well-being. This final article reviews the evidence for the effect of sense of humor, exposure to a humor stimulus and laughter on various immune system components, with a focus on the effects of laughter on natural killer cell cytotoxicity.

Humor and Laughter May Influence Health: II. Complementary Therapies and Humor in a Clinical Population

Our results support a connection between sense of humor and self-reported physical health, however, it is difficult to determine the relationship to any specific disease process. Whereas relationships between sense of humor and self-reported measures of physical well-being appear to be supported, more research is required to determine interrelationships between sense of humor and well-being.

Immune responses to guided imagery during breast cancer treatment.

Background: The use of relaxation and guided imagery to reduce stress and improve immune function has great potential benefits for patients with breast cancer. Methods: This pilot study used a pretest—posttest experimental design with 28 breast cancer patients, aged 25 to 75 years, with the diagnosis of stage 0, 1, or 2 breast cancer. The experimental group received a relaxation and guided imagery intervention and the control group received standard care. The effects of the intervention on immune function were measured by natural killer (NK) cell cytotoxicity and IL-2—activated NK cell activity prior to surgery and 4 weeks postsurgery. NK cell activity was measured using a 15-hr incubation chromium release assay. Cytotoxicity of NK cells was measured against chromium-labeled K-562 target cells. IL-2 was used to enhance reactivity of NK cells against tumor cells. After incubation for 15 hr, cytotoxicity was measured through the release of radioactive chromium. Results: Significant differences between groups were found at 4 weeks postsurgery. T-tests showed increased NK cell cytotoxicity for the intervention group at 100:1, 50:1, and 25:1 effector cell: target cell ratios (E:T) (p < .01 to p < .05) and increased activation for IL-2 at 100:1, 50:1, 25:1, and 12.5:1 (E:T) (p < .01 to p < .05) for the intervention group as compared to the control group. Discussion: These findings suggest that a relaxation intervention such as guided imagery could have an effect on NK cell cytotoxicity and NK cell cytotoxicity after activation with IL-2 in patients undergoing surgery for breast cancer.

Psychoneuroimmunology and Immune System Link for Stress, Depression, Health Behaviors, and Breast Cancer:

This article reviews the literature on psychoneuroimmunology and its theoretical underpinnings. It also reviews research related to the immune-system-link of stress, chronic stress, depression and health behaviors to breast cancer. Although the relationship between psychological characteristics and the immune system have been documented repeatedly, the significance of these effects has not been demonstrated in many studies empirically. The question whether the use of alternative therapies contributes to decreasing the progression of the diseased is often asked. Research in the area of psychoneuroimmunology can provide the answer to this question.

Preadmission Predictors of Student Success in a Baccalaureate of Science in Nursing Program

Introduction Few studies have examined the best use of admission data to differentiate between successful and unsuccessful students in a nursing program. Methods Using data from 341 students admitted over a 3-year period, the authors attempted to determine which factors best predicted student success in a baccalaureate of science in nursing, or BSN, program. These factors were used to develop an admission formula that was tested retroactively to determine its ability to differentiate between successful and unsuccessful students. The authors defined student success as passing all nursing courses on the first attempt with a grade of C or above, completing the program on time, and passing the National Council Licensure Examination on the first attempt. Logistic regression for prediction of the probability of success found that the following three variables accounted for 76% of the variance: preprogram grade point average, or GPA, science GPA, and scores on the Health Educational Systems Incorporated Admission Assessment anatomy and physiology subscale. The formula derived was validated by retrospective analysis to determine effect of using this model to select students for admission. Results Use of this model would have eliminated 40.9% of the unsuccessful students and retained 84% of the successful students. Conclusion The formula derived from this study is now being used to select students for the BSN program. In the future, graduation rates obtained by using this formula will be compared to the graduation rates obtained by the prior rational admission process.

Nursing Care at the End of Life: 25 Years After the Passage of the Patient Self-determination Act

This article compares the aggressiveness of nursing behavioral intentions in the care of the end-of-life patient between 1989 and 2014. Using a comparison design, the effects of patient age, presence of a do-not-resuscitate order, and nursing unit norms on the aggressiveness of nursing behavioral intentions were documented in 1989 and again in 2014. The results were compared for significant changes over time. Based on the results of this study, it appears that there has been a significant increase in aggressiveness of nursing behavioral intentions in the care of the end-of-life patient, even if the patient has a do-not-resuscitate order and is attempting to refuse certain nursing or medical procedures. This study has implications for increased teaching on end-of-life care, quality of life, and rights of patients to self-determination during the end of life.

I Can Do This – Collaboration on a Global Nursing Assignment to Increase the Self-Efficacy of Pre-nursing Students for Research Skills

Abstract This study asked whether pre-nursing students who took Nursing 102 (the Introduction to Professional Nursing class), which included information literacy instruction by a health sciences librarian and writing assistance from peer tutors, felt better prepared in basic research skills and had a more global understanding of nursing than they did before they took the class. In Nursing 102, instruction in the skills needed to prepare an American Psychological Association (APA) paper and group presentations on an assigned country were used to increase pre-nursing students’ self-efficacy in basic computer and library skills as well as global health awareness. In cooperation with the instructors, the health sciences librarian presented a one-hour session to each class on using the library website and searching in CINAHL. Later, students met the librarian by appointment in small groups. Peer tutors at the campus writing center helped students refine and edit their writing. A computer self-efficacy scale and comments from students, faculty, and the librarian assessed results. Of the potential participants, 209 of 301 enrolled in Nursing 102 between fall 2011 and spring 2013 completed a pretest and posttest. Results of a paired t-test indicated the average score on the computer self-efficacy test increased from 34.80 to 40.30, and the change was statistically significant at the p ≤ .05 level. The instructors and librarian noted subjective improvements in the retrieval and use of scholarly resources by students. The introduction to research skills and the global nursing assignment in Nursing 102, with participation of classroom faculty, the health sciences librarian, and the campus writing center peer tutors, appeared to help increase pre-nursing students’ self-efficacy for basic computer and library skills, their retrieval of scholarly sources, and their understanding of global health systems.

Immune function and health outcomes in women with depression

This research reports immune function and health outcomes in women with depression, as compared with a non-depressed control group. Using Psychoneuroimmunolgy theory and a descriptive comparison design, scores on the Beck Depression Inventory (BDI) were used to divide 40 non-hospitalized Caucasian women between the ages of 18 and 65 years into either the control or depression comparison group. Women with depression were found to report significantly more incidences of illness over the previous two months and they were found to have significantly more indicators of illness at the time of the exam as compared to the controls. However, contrary to what has been documented in some earlier studies of depression, women with depression were not found to have significantly different immune function measures as compared to the control group. There was also no significant correlation between scores on the BDI and natural killer cell cytotoxicity in this study. While these findings support a connection between depression and both increased self-report of illness and increased signs and symptoms of minor illness or inflammation on physical exam, this study was not able to document that these effects were related to decreased immune function, as measured by natural killer cell activity or white blood cell counts.