A review of the power as knowing participation in change literature

Barrett's Power Theory: Re-Conceptualizing the Pediatric Organ Donation Experience With Letter Writing

Pediatric organ donation is often a time of reported turbulence and isolation for both families involved. Communication through letter writing is a way for those families to connect and heal, if they choose to participate. Barrett's Power as Knowing in Participation in Change Theory, with its accompanying health patterning, is applicable to this experience by facilitating awareness, choices, freedom to act intentionally, and involvement in the change process related to the pediatric organ donation process. Two families' experiences connected through organ donation and letter writing, as conceptualized through the lens of Barrett's Power Theory, supported future use of patterning of knowing participation in change for families.

Music Listening as Coping Behavior: From Reactive Response to Sense-Making

Coping is a survival mechanism of living organisms. It is not merely reactive, but also involves making sense of the environment by rendering sensory information into percepts that have meaning in the context of an organism's cognitions. Music listening, on the other hand, is a complex task that embraces sensory, physiological, behavioral, and cognitive levels of processing. Being both a dispositional process that relies on our evolutionary toolkit for coping with the world and a more elaborated skill for sense-making, it goes beyond primitive action-reaction couplings by the introduction of higher-order intermediary variables between sensory input and effector reactions. Consideration of music-listening from the perspective of coping treats music as a sound environment and listening as a process that involves exploration of this environment as well as interactions with the sounds. Several issues are considered in this regard such as the conception of music as a possible stressor, the role of adaptive listening, the relation between coping and reward, the importance of self-regulation strategies in the selection of music, and the instrumental meaning of music in the sense that it can be used to modify the internal and external environment of the listener.

Patient Engagement in Breast Cancer Survivorship Care

BACKGROUND

Patient engagement (PE) is a key factor for early-stage breast cancer survivors during survivorship, yet little is known about what factors may contribute to PE.

OBJECTIVES

The aims of this study were to describe the relationship between sociodemographic factors, survivorship variables, and PE and explore how variations in these variables might contribute to PE in breast cancer survivors.

METHODS

A cross-sectional, web-based self-report national survey was conducted to assess sociodemographic factors and survivorship variables: health-related quality of life (HRQOL) as measured by 7-item Functional Assessment of Cancer Therapy-General, fear of cancer recurrence, cancer health literacy, and 2 measures of PE (Patient Activation and Knowing Participation in Change) in breast cancer survivors. One open-ended question assessed additional survivorship concerns. Data were analyzed via bivariate associations and backward linear regression modeling in SPSS.

RESULTS

The sample (N = 303), equally dispersed across the United States, was predominantly middle-aged (mean, 50.70 [SD, 14.01]), white, non-Hispanic women. Knowing Participation in Change and Patient Activation regression models indicate HRQOL was significantly associated with PE (P ≤ .001), whereas findings related to fear of cancer recurrence lacked significance. In the Knowing Participation in Change regression model, HRQOL, social support, and level of education were all significantly associated with PE (P ≤ .001).

CONCLUSIONS

Breast cancer survivors with higher HRQOL, greater social support, and higher levels of education were more likely to have higher levels of PE.

IMPLICATIONS FOR PRACTICE

Findings may provide insight as to which survivors may be ready to engage in SC and those who may need more specific tailoring of resources and support.

Building to Make a Difference: Advanced Practice Nurses’ Experience of Power

Power is necessary for nurses to affect change in patient care and to move the nursing profession forward. Despite the evolving body of nursing research on power, there have been no studies that have investigated the nature of advanced practice nurses’ (APNs’) power. The purpose of this study was to explore the APNs’ lived experience of power. Interpretive phenomenology guided the method and analysis. Eight APNs employed in a single Canadian tertiary care teaching health-care organization engaged in in-depth interviews. The overarching theme, building to make a difference, reflected the APNs’ perception of power in their practice, which involved a passion to facilitate change in practice to improve patient care. Building to make a difference involved three themes: building on, building with, and building for. The APNs experienced more power—a process they described as power creep—when they used soft power that was shared with others to affect positive change in health care. These findings contribute to our understanding of how power is perceived and manifested in the APN role, thus further enabling organizations to create working conditions to support the APNs’ endeavors to empower others.

From equity to power: Critical Success Factors for Twinning between midwives, a Delphi study

AIMS

To gain consensus for Critical Success Factors associated with Twinning in Midwifery.

BACKGROUND

International publications identify midwifery as important for improving maternity care worldwide. Midwifery is a team effort where midwives play a key role. Yet their power to take on this role is often lacking. Twinning has garnered potential to develop power in professionals, however, its success varies because implementation is not always optimal. Critical Success Factors have demonstrated positive results in the managerial context and can be helpful to build effective Twinning relationships.

DESIGN

We approached 56 midwife Twinning experts from 19 countries to participate in three Delphi rounds between 2016 - 2017.

METHODS

In round 1, experts gave input through an open ended questionnaire and this was analysed to formulate Critical Success Factors statements that were scored on a 1-7 Likert scale aiming to gain consensus in rounds 2 and 3. These statements were operationalized for practical use such as a check list in planning, monitoring and evaluation in the field.

FINDINGS

Thirty-three experts from 14 countries took part in all three Delphi rounds, producing 58 initial statements. This resulted in 25 Critical Success Factors covering issues of management, communication, commitment and values, most focus on equity.

CONCLUSION

The Critical Success Factors formulated represent the necessary ingredients for successful Twinning by providing a practical implementation framework and promote further research into the effect of Twinning. Findings show that making equity explicit in Twinning may contribute towards the power of midwives to take on their identified key role.

Essential Oils and Gastroparesis: Power for Transforming Health, Hope, and Quality of Life

This study explored how essential oils for persons with gastroparesis symptoms affect the quality of life. Gastroparesis is a chronic delayed gastric motility disorder characterized by postprandial fullness, early satiety, nausea, vomiting, abdominal discomfort, bloating, depression, and anxiety. The aim of this study was to determine how essential oils support digestion and eliminate inflammation in the body as evidenced by self-reporting a decrease in symptoms, thereby improving quality of life. A qualitative descriptive methodology using Barrette's Theory of Power as Knowing Participation in Change thematic framework was used. Three main themes were extracted from the data: awareness of quality of life possibilities, freedom to make choices, and transforming health and hope. The constitutive theme that was synthesized became essential oils transform health, hope, and increase quality-of-life possibilities.

Patterning of Pain and Power With Guided Imagery

Using Martha Rogers’ science of unitary human beings, changes in pain and power among 42 patients were examined in relation to the use of a guided imagery modality. Participants were randomly assigned to treatment and control groups and repeated measures MANCOVA was used to detect differences in pain and power over a 4-day period of time. The treatment group’s pain decreased during the last 2 days of the study. No differences in power emerged. Guided imagery appeared to have potential as a useful nursing modality for chronic pain sufferers.

Personalised care planning for adults with chronic or long-term health conditions

BACKGROUND

Personalised care planning is a collaborative process used in chronic condition management in which patients and clinicians identify and discuss problems caused by or related to the patient's condition, and develop a plan for tackling these. In essence it is a conversation, or series of conversations, in which they jointly agree goals and actions for managing the patient's condition.

OBJECTIVES

To assess the effects of personalised care planning for adults with long-term health conditions compared to usual care (i.e. forms of care in which active involvement of patients in treatment and management decisions is not explicitly attempted or achieved).

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ProQuest, clinicaltrials.gov and WHO International Clinical Trials Registry Platform to July 2013.

SELECTION CRITERIA

We included randomised controlled trials and cluster-randomised trials involving adults with long-term conditions where the intervention included collaborative (between individual patients and clinicians) goal setting and action planning. We excluded studies where there was little or no opportunity for the patient to have meaningful influence on goal selection, choice of treatment or support package, or both.

DATA COLLECTION AND ANALYSIS

Two of three review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes were effects on physical health, psychological health, subjective health status, and capabilities for self management. Secondary outcomes included effects on health-related behaviours, resource use and costs, and type of intervention. A patient advisory group of people with experience of living with long-term conditions advised on various aspects of the review, including the protocol, selection of outcome measures and emerging findings.

MAIN RESULTS

We included 19 studies involving a total of 10,856 participants. Twelve of these studies focused on diabetes, three on mental health, one on heart failure, one on end-stage renal disease, one on asthma, and one on various chronic conditions. All 19 studies included components that were intended to support behaviour change among patients, involving either face-to-face or telephone support. All but three of the personalised care planning interventions took place in primary care or community settings; the remaining three were located in hospital clinics. There was some concern about risk of bias for each of the included studies in respect of one or more criteria, usually due to inadequate or unclear descriptions of research methods. Physical healthNine studies measured glycated haemoglobin (HbA1c), giving a combined mean difference (MD) between intervention and control of -0.24% (95% confidence interval (CI) -0.35 to -0.14), a small positive effect in favour of personalised care planning compared to usual care (moderate quality evidence).Six studies measured systolic blood pressure, a combined mean difference of -2.64 mm/Hg (95% CI -4.47 to -0.82) favouring personalised care (moderate quality evidence). The pooled results from four studies showed no significant effect on diastolic blood pressure, MD -0.71 mm/Hg (95% CI -2.26 to 0.84).We found no evidence of an effect on cholesterol (LDL-C), standardised mean difference (SMD) 0.01 (95% CI -0.09 to 0.11) (five studies) or body mass index, MD -0.11 (95% CI -0.35 to 0.13) (four studies).A single study of people with asthma reported that personalised care planning led to improvements in lung function and asthma control. Psychological healthSix studies measured depression. We were able to pool results from five of these, giving an SMD of -0.36 (95% CI -0.52 to -0.20), a small effect in favour of personalised care (moderate quality evidence). The remaining study found greater improvement in the control group than the intervention group.Four other studies used a variety of psychological measures that were conceptually different so could not be pooled. Of these, three found greater improvement for the personalised care group than the usual care group and one was too small to detect differences in outcomes. Subjective health statusTen studies used various patient-reported measures of health status (or health-related quality of life), including both generic health status measures and condition-specific ones. We were able to pool data from three studies that used the SF-36 or SF-12, but found no effect on the physical component summary score SMD 0.16 (95% CI -0.05 to 0.38) or the mental component summary score SMD 0.07 (95% CI -0.15 to 0.28) (moderate quality evidence). Of the three other studies that measured generic health status, two found improvements related to personalised care and one did not.Four studies measured condition-specific health status. The combined results showed no difference between the intervention and control groups, SMD -0.01 (95% CI -0.11 to 0.10) (moderate quality evidence). Self-management capabilitiesNine studies looked at the effect of personalised care on self-management capabilities using a variety of outcome measures, but they focused primarily on self efficacy. We were able to pool results from five studies that measured self efficacy, giving a small positive result in favour of personalised care planning: SMD 0.25 (95% CI 0.07 to 0.43) (moderate quality evidence).A further five studies measured other attributes that contribute to self-management capabilities. The results from these were mixed: two studies found evidence of an effect on patient activation, one found an effect on empowerment, and one found improvements in perceived interpersonal support. Other outcomesPooled data from five studies on exercise levels showed no effect due to personalised care planning, but there was a positive effect on people's self-reported ability to carry out self-care activities: SMD 0.35 (95% CI 0.17 to 0.52).We found no evidence of adverse effects due to personalised care planning.The effects of personalised care planning were greater when more stages of the care planning cycle were completed, when contacts between patients and health professionals were more frequent, and when the patient's usual clinician was involved in the process.

AUTHORS' CONCLUSIONS

Personalised care planning leads to improvements in certain indicators of physical and psychological health status, and people's capability to self-manage their condition when compared to usual care. The effects are not large, but they appear greater when the intervention is more comprehensive, more intensive, and better integrated into routine care.

Rasch Analysis of the Power as Knowing Participation in Change Tool--the Brazilian version

OBJECTIVES

the objective of this study was to evaluate the items contained in the Brazilian version of the Power as Knowing Participation in Change Tool (PKPCT).

METHOD

investigation of the psychometric properties of the mentioned questionnaire through Rasch analysis.

RESULTS

the data from 952 nursing assistants and 627 baccalaureate nurses were analyzed (average age 44.1 (SD=9.5); 13.0% men). The subscales Choices, Awareness, Freedom and Involvement were tested separately and presented unidimensionality; the categories of the responses given to the items were compiled from 7 to 3 levels and the items fit the model well, except for the following/leading item, in which the infit and outfit values were above 1.4; this item has also presented Differential Item Functioning (DIF) according to the participant's role. The reliability of the items was of 0.99 and the reliability of the participants ranged from 0.80 to 0.84 in the subscales. Items with extremely high levels of difficulty were not identified.

CONCLUSIONS

the PKPCT should not be viewed as unidimensional, items with extremely high levels of difficulty in the scale need to be created and the differential functioning of some items has to be further investigated.

An alternate HIV preventive strategy: sex scripts in media for women of color

New cases of HIV/AIDS among women of color in the United States highlight the continuing need for the public and private sectors to develop alternate preventive strategies. The author discusses the conceptual basis for using television sex scripts to incorporate women of color relational needs (trust, romance, sexual pressure) to promote HIV risk-reduction messages through a process of association with the television storyline. Sex scripts are a source of implicit knowledge about how to behave in situations that involve sexual intimacy. The article suggests that sexual scripts prevention messages build on the agency of women through the use of power theory-that is supporting woman's self-power by participating in sexual behavioral change. Implications for sexual equality in media programming are discussed.

Randomized control trial of the Health Empowerment Intervention: feasibility and impact

BACKGROUND

Older adults prefer to stay in their homes for as long as possible but are often unaware of the resources in their community to help them to remain in their home. Access to resources may be important among older adults, representing a critical area for intervention.

OBJECTIVES

The study aim was to evaluate the feasibility of the Health Empowerment Intervention (HEI) and to explore the impact of the HEI on the theoretical mediating variables of health empowerment and purposeful participation in goal attainment and the outcome variable of well-being with homebound older adults.

METHOD

Fifty-nine eligible homebound older adults were randomly assigned to the intervention group or the comparison group. The HEI consisted of 6 weekly visits, whereas the comparison group received a weekly newsletter for 6 weeks. Participants were measured at baseline, after the 6-week protocol, and at 12 weeks. Data were analyzed using descriptive statistics, t test, chi, and analysis of covariance.

RESULTS

There was a significant difference between groups in education. The participants in the intervention found the sessions to be helpful in recognizing resources. In addition, participants in the intervention group had significantly higher scores in the mediator purposeful participation in goal attainment, F(2, 83) = 3.71, p = .03. There was no significant main effect for the mediator health empowerment; however, the intervention group increased in the subscale personal growth from baseline to 12 weeks, F(1, 83) = 3.88, p = .05.

DISCUSSION

This randomized control trial provided initial support for the hypothesis that homebound older adults receiving the HEI would find the intervention acceptable and have significantly improved health empowerment, purposeful participation in goal attainment, and well-being than an attentional comparison group receiving a weekly newsletter.

Power as knowing participation in change: what's new and what's next

The theory of power as knowing participation in change was derived from Rogers' science of unitary human beings. Following testing and research of the theory and measurement instrument, a practice methodology was developed and the health patterning practice model was initiated. Further developments of the theory are presented and future speculations are proposed.

Effectiveness of nursing intervention for adult patients experiencing chronic pain: a systematic review

OBJECTIVES

To determine the best available evidence regarding the effectiveness of nursing interventions for adult patients experiencing chronic pain.

TYPES OF STUDIES

Randomized Controlled Trials (RCT) and Quasi-Randomized Controlled Trials.

TYPES OF PARTICIPANTS

Participants were adults, aged at least 18 years, suffering from chronic pain (lasting for longer than six months). Pain of oncological origin and patients admitted in a hospital, were excluded.

TYPES OF INTERVENTIONS

Non pharmacological nursing interventions for chronic pain.

TYPES OF OUTCOME MEASURES

The primary outcome measure was chronic pain, and secondary outcome measures were: disability, depression, dependence and health related quality of life.

SEARCH STRATEGY

All studies, published and unpublished, in English and Spanish, carried out between January 1997 and December 2007 were retrieved..

SELECTION OF STUDIES

The methodological quality of included articles was assessed by two independent reviewers using appropriate critical appraisal tools from the Joanna Briggs Institute.

DATA EXTRACTION AND ANALYSIS

Data were independently extracted by two reviewers, using the standardised data extraction tool from the Joanna Briggs Institute.A meta-analysis was not possible as the trials were heterogeneous in their interventions, characteristics of the populations, intervention duration measurement instruments and outcomes measures.

RESULTS

1,666 references were identified that fit the aim of the review. 92 articles were retrieved, of which 13 were chosen to be critically appraised for their methodological quality. In the end, eight controlled trials were included.The main results were:Other outcome measures showed an improvement in the quality of life (sensorial stimulation and guided imagery), in depression, disability and empowerment (music therapy) and physical functioning (program of psycho-education).The main limitations of this review were: excluding studies were the professional performing the interventions were not detailed or the intervention was not carried out by a nurse and that the search strategy was limited up to 2007.

IMPLICATIONS FOR PRACTICE

Listening to music, a cognitive-behavioural treatment programme, magnetic therapy, sensorial stimulation, a psychoeducation programme and guided imagery are nursing interventions that helps to reduce the chronic pain in adults and may be used as contributory to the pharmacological treatment. Short exercises for increasing endurance does not reduce pain.

IMPLICATIONS FOR RESEARCH

For future reviews we do not recommend the inclusion of different interventions for the reduction of chronic pain, due to the great number and variability of intervention, but the development of a SR on specific interventions.

Power, Right, and Truth

Power has historically been viewed from a position of dominance and authority. Using this lens leads one to a destiny wherein one individual or society has power over another. The power over approach is a hierarchical view, one that leads to someone else being oppressed, and one wherein the prevailing hegemony continues. If a different lens is used, wherein power does not reside within a position, but rather, within a person and within a relationship bounded by knowledge, a new destiny of power to and power of is created. These two approaches to power are examined and clinical power is offered as a lens that culminates in the understanding of power as a right and as truth imbedded with awareness and relationships.

Quality of Life in Contemporary Nursing Theory

A critical appraisal of the concept, quality of life, as used in nursing theories, is presented in a historically situated context. This approach to concept analysis was selected to illuminate the subjective, contextual, and fluid nature of the concept. Based on this review, quality of life is defined as an intangible, subjective perception of one's lived experience. From a review of Peplau's, Rogers', Leininger's, King's, and Parse's conceptualizations of quality of life, it is concluded that it may be viable to replace health with quality of life as a metaparadigm concept for nursing.

Nurses' perception of power regarding their clinical role

This article reports on a study on nurses' perception of power regarding their clinical role before and after implementation of a nursing diagnosis classification. Sixty clinical nurses (average age = 37.2 ± 7.0 years) from a Brazilian teaching hospital answered the Power as Knowing Participation in Change Tool (PKPCT) before and after the implementation of a diagnosis classification. PKPCT has four domains and provides total and partial scores. Reliability coefficients ranged from 0.88 to 0.98. Total scores were not statistically different between assessments (p=0.21), although scores in the "Involvement in Creating Change" domain were higher in the second assessment (p=0.04). Further studies providing sound evidence regarding the impact of nursing classification systems on nurses' power perception are needed to guide decisions on teaching and clinical practice.

Soap opera video on handheld computers to reduce young urban women's HIV sex risk

The purpose of this study was to develop a soap opera video, A Story about Toni, Mike, and Valerie, designed to communicate HIV risk reduction themes. The study evaluated viewing the video and responding to audio computer assisted self-interview (ACASI) on a handheld computer. The sample was 76 predominately African American women, aged 18-29, in sexual relationships with men. Data were collected in urban neighborhoods in the northeastern United States. A pretest-posttest control group design with systematic assignment indicated statistically significant reduction in expectations to engage in unprotected sex in the experimental group. The handheld computer was found to be acceptable to view the near feature length video and complete ACASI. To date, no study has reported on use of video and ACASI on a handheld device to reduce HIV risk. The significance is the potential to stream health promotion videos to personal devices, such as cell phones.

Research diversity from the perspective of the Science of Unitary Human Beings

This column presents an overview of Rogerian nursing science-based research. In Rogers' own words, she fostered the development of nursing science with a diversity of methods. She encouraged both qualitative and quantitative approaches and the development of new research methods and tools. Her only caveat was that theoretical conceptualization and research method must match.

The Relation of Power and Well-Being in Korean Adults

The researchers examined the relation of power and well-being in a sample of 881 men and women living in South Korea. Rogers' science of unitary human beings, Barrett's theory of power, and Gueldner's theoretical perspective of well-being served as the theoretical rationale. The hypothesis was supported by a significant positive correlation between power and well-being (r = .52, p < .001). Reliabilities by Cronbach's alpha were .96 for the Power as Knowing Participation in Change Tool and .84 for the Well-Being Picture Scale. Well-being can be facilitated by enhancing person's power as knowing participation in change.

A telephone-delivered empowerment intervention with patients diagnosed with heart failure

BACKGROUND

Heart failure (HF) is a major public health problem. Case management by nurses using telephone follow-up has been suggested as a convenient and effective mechanism to promote the self-management of HF. Similarly, a patient empowerment approach to the management of chronic disease has been suggested as one that may nurture self-management in individuals with chronic illness.

OBJECTIVE

The purpose of this study was to examine the effects of a telephone-delivered empowerment intervention (EI) on clinically and theoretically relevant outcomes in patients with HF, including purposeful participation in goal attainment, self-management of HF, and perception of functional health. The EI was guided by Rogers' Science of Unitary Human Beings person-environment process.

METHODS

A convenience sample of men and women aged 21 years and older with a clinical diagnosis of HF was obtained from a metropolitan hospital located in the southwestern United States. The participants were randomly assigned to the control group (n = 45) or EI group (n = 45). All participants received standardized HF patient education; the intervention group also received an EI delivered through telephone follow-up calls from a registered nurse. Repeated-measures analysis of variance was used to evaluate intervention effects.

RESULTS

The telephone-delivered EI facilitated self-management of HF through self-care activities in EI group members.

CONCLUSION

The knowledge gained from this study provides a beginning understanding of strategies to enhance health care providers' ability to facilitate self-management of HF among patients diagnosed with HF.

Breaking the silence: nurses' understandings of change in clinical practice

AIM

This paper reports a study exploring critical care nurses' understandings of change in their practice.

BACKGROUND

In contemporary nursing literature, change in clinical nursing practice is generally understood to be a rational process, synonymous with progress. It is seen as invariably contested, and hence difficult to achieve. It is represented as occurring infrequently. This literature effectively silences clinicians as this discourse of change does not recognize or incorporate their views or practices.

METHODS

This study was informed by a Foucauldian poststructuralist framework. The participants were 12 critical care nurses who engaged in three individual in-depth, focused interviews. The transcripts were deconstructed to reveal participants' discourses of change and the implications of these discourses for nursing work. The data were generated between 1996 and 1998 as part of a study whose in-depth analysis was completed in 2003.

FINDINGS

Change was revealed as a highly complex phenomenon, closely intertwined with understandings of clinical nursing work. Participants showed difficulty in identifying or recalling clinical changes. Several dichotomies shaped their understandings of change, including change/stasis, formal/informal and dramatic/subtle. Their experiences of change frequently conflicted with prevailing dominant understandings, but they did not openly challenge them. Rather, they employed dichotomies, such as abstract/concrete and other/self, to enable them to work with these conflicts. As a result, they engaged in practices such as naming other nurses as 'irrational'.

CONCLUSION

The data provide new understandings of change in clinical nursing practice, some of which challenge many widely held views (for example, that such change is a rare occurrence). It is argued that a lack of open challenge by clinical nurses contributes to their silencing, promotes disharmony amongst nurses and, hence, works against a collaborative approach to decisions about clinical practice.

Predictors of self-rated health in patients with chronic nonmalignant pain

Self-rated health (SRH) is an important outcome measure that has been found to accurately predict mortality, morbidity, function, and psychologic well-being. Chronic nonmalignant pain presents with a pattern that includes low levels of power and high levels of pain, depression, and disability. Differences in SRH may be related to variations within this pattern. The purpose of this analysis was to identify determinants of SRH and test their ability to predict SRH in patients with chronic nonmalignant pain. SRH was measured by response to a single three-option age-comparative question. The Power as Knowing Participation in Change Tool, McGill Pain Questionnaire Short Form, Center for Epidemiological Studies Depression Scale, and Pain Disability Index were used to measure independent variables. Multivariate analysis of variance revealed significant differences (p = .001) between SRH categories on the combined dependent variable. Analysis of variance conducted as a follow-up identified significant differences for power (p < .001) and depression (p = .003), but not for pain or pain-related disability; and discriminant analysis found that power and depression correctly classified patients with 75% accuracy. Findings suggest pain interventions designed to improve mood and provide opportunities for knowing participation may have a greater impact on overall health than those that target only pain and disability.

Effect of music on power, pain, depression and disability

AIM

This paper reports a study testing the effect of music on power, pain, depression and disability, and comparing the effects of researcher-provided music (standard music) with subject-preferred music (patterning music).

BACKGROUND

Chronic non-malignant pain is characterized by pain that persists in spite of traditional interventions. Previous studies have found music to be effective in decreasing pain and anxiety related to postoperative, procedural and cancer pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non-malignant pain has not been investigated.

METHOD

A randomized controlled clinical trial was carried out with a convenience sample of 60 African American and Caucasian people aged 21-65 years with chronic non-malignant pain. They were randomly assigned to a standard music group (n = 22), patterning music group (n = 18) or control group (n = 20). Pain was measured with the McGill Pain Questionnaire short form; depression was measured with the Center for Epidemiology Studies Depression scale; disability was measured with the Pain Disability Index; and power was measured with the Power as Knowing Participation in Change Tool (version II).

RESULTS

The music groups had more power and less pain, depression and disability than the control group, but there were no statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported.

CONCLUSION

Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of power.

Patient-perceived usefulness of online electronic medical records: employing grounded theory in the development of information and communication technologies for use by patients living with chronic illness

OBJECTIVE

Patient use of online electronic medical records (EMR) holds the potential to improve health outcomes. The purpose of this study is to discover how patients living with chronic inflammatory bowel disease (IBD) value Internet-based patient access to electronic patient records.

DESIGN

This was a qualitative, exploratory, descriptive study using in-depth interviews and focus groups of a total of 12 patients with IBD of at least one-year duration at University Health Network, a tertiary care center in Toronto, Ontario.

RESULTS

Four themes have been elucidated that comprise a theoretical framework of patient-perceived information and communication technology usefulness: promotion of a sense of illness ownership, of patient-driven communication, of personalized support, and of mutual trust.

CONCLUSIONS

For patients with chronic IBD, simply providing access to electronic medical records has little usefulness on its own. Useful technology for patients with IBD is multifaceted, self-care promoting, and integrated into the patient's already existing health and psychosocial support infrastructure. The four identified themes can serve as focal points for the evaluation of information technology designed for patient use, thus providing a patient-centered framework for developers seeking to adapt existing EMR systems to patient access and use for the purposes of improving health care quality and health outcomes. Further studies in other populations are needed to enhance generalizability of the emergent theory.

Relationships of Contextual and Relational Factors to Health Empowerment in Women

The purpose of this study was to determine the relationships of contextual and relational factors to health empowerment in women with children. This study used a descriptive, correlational design to answer the basic research question: “What contextual and relational factors explain health empowerment in women?” The theoretical framework of health empowerment was based upon a synthesis of social and developmental perspectives and guided by a Rogerian view of the person-environment process. The analytic approach included bivariate correlations and a series of multiple regressions to identify factors explaining health empowerment. The contextual (demographic) and relational (social and professional support) factors explained 38% of the variance in health empowerment measured as knowing participation in change. For health empowerment, measured as lifestyle behaviors, the contextual and relational factors explained 43% of the variance. The results of this study offer partial empirical support for theoretical relationships. Findings provide a basis to generate additional nursing research focusing on the continuous mutual process of human beings and the environment, leading to theory-based interventions.

Feasibility of Studying the Effects of Using NANDA, NIC, and NOC on Nursesʼ Power and Childrenʼs Outcomes

This was a pilot study with a pretest and posttest design to test the feasibility of conducting large-scale studies of the effects of using computer-based terms from NANDA, NIC, and NOC on nurses' power to help children and children's health outcomes. Four hypotheses were tested with data from 12 public health nurses in school settings and 220 schoolchildren. Group A comprised six nurses who used SNAP Health Center (SNAP 98) software to record health visits with 117 children. Group B comprised six nurses who used the same software and NANDA, NIC, and NOC with 103 children. After use of the software, the power of the 12 nurses to help children significantly increased. For the 220 children, the number of coping strategies significantly increased but there were no changes in the other health outcomes. The hypotheses indicating that Group B nurses and children would have more positive changes than Group A were not supported. Positive and negative elements for large-scale studies were identified.

The Effectiveness of Feminist Pedagogy in Empowering a Community of Learners

The purpose of this study was to determine whether a pedagogy grounded in feminist ideals has the potential to empower students to make changes consistent with those ideals in their personal and professional lives. In Phase I, qualitative data were collected through e-mail questionnaires from students in two nursing schools, one in Canada and one in the United States. Findings were used to identify an appropriate tool to measure the empowering influence of feminist pedagogy. In Phase 2, a pretest-posttest design used Barrett's Power as Knowing Participation in Change Tool (PKPCT) to measure student empowerment. A clinical setting was added in a third baccalaureate nursing program. A total of 218 students participated in seven course offerings-four classroom and three clinical. One hundred one matched pairs were obtained, for an overall response rate of 46%. Repeated measures ANOVA revealed that overall empowerment scores, as measured by the PKPCT, and classroom empowerment (CE), as measured by the addition of a variable (i.e., the ability to contribute in class), increased significantly from pretest to posttest. Interaction between Sites 1 and 2 was also significant. Regression analysis indicated posttest CE scores added to pretest PKPCT and CE scores provided a strong model to predict overall empowerment scores, measured by the PKPCT at Time 2 (R2 = .703). Despite limitations related to loss of follow up and low response rates at one site, the results of this study supported both hypotheses: that empowerment would increase over the course of the class in which feminist pedagogical principles were used, and that classroom empowerment is likely to extend beyond the classroom to personal and work environments.

Nurses' self-relation--becoming theoretically competent: the SAUC model for confirming nursing

The purpose of this study was to acquire an understanding of how nurses' self-relation (view of themselves as nurses) was influenced in connection with implementation of a nursing theory, the sympathy-acceptance-understanding-competence model for confirming nursing. This model was developed by Gustafsson and Pörn. Twenty-two nurses' written statements evaluating mentoring during the six-month implementation process in elder care, were analyzed hermeneutically with the hypothetic-deductive method. An action-theoretic and confirmatory approach was used for facilitating theoretically specified hypotheses. The nurses increased their ability to describe nursing theoretically and gained a foundation of common nursing values. The results provided an understanding of how nurses' self-relation was strengthened by becoming theoretically competent.

The nurse theorists: 21st century updates--Martha E. Rogers. Interview by Jacqueline Fawcett

This edited transcript of an interview with Rogerian scholars Elizabeth Ann Manhart Barrett, Violet M. Malinski, and John R. Phillips presents their thoughts about the contributions of Martha E. Rogers’ science of unitary human beings to the current state of the discipline of nursing and the emergence of the unitary perspective in nursing and other sciences, as well as the implications of the science of unitary human beings for nursing research, education, administration, and practice.

Power and self-perceived health in blind diabetic and nondiabetic individuals

AIMS

The aims of this study were: (1) to explore perceptions of power in blind individuals and relate presence or absence of power to self-perceived health and (2) to compare self-perceived health in blind individuals with that of the general population.

BACKGROUND

The theoretical framework of this study was Barrett's Power theory, which is based on The Rogerian nursing theory. Power is defined as being aware of what one is choosing to do, feeling free to doing it, and do it intentionally.

METHODS

Thirty-nine blind subjects at three adjacent ophthalmology centres agreed to participate in the study. Of those 23 had become blind because of late complications of diabetes. Power was explored during semi-structured interviews and self-perceived health was measured with the Swedish health-related quality of life questionnaire. Data on socio-economic, rehabilitative and diabetes-related variables were also collected.

FINDINGS

Power was experienced by 19 of the 39 respondents and was more frequently found in nondiabetic subjects than in diabetic subjects. Those experiencing power reported a better emotional and general health compared with individuals lacking power. The perception of having power was not significantly related to any other of the studied variables. When compared with age- and gender-matched controls from the general population, nondiabetic blind subjects scored higher in positive feelings and lower in physical functioning. In contrast diabetic subjects experienced poorer general health, less satisfaction with physical health and more negative feelings, but they reported that they did not experience limitation as a result of these emotions.

CONCLUSION

One way of improving health in diabetic blind individuals could be to increase the subject's perception of power.

Changes in hope and power in lung cancer patients who exercise

Using Rogers' science of unitary human beings, changes in hope and power among 104 lung cancer patients were examined in relation to participation in a preoperative exercise program. Participants were randomly assigned to exercise or no-exercise and a repeated measures ANOVA was employed. The exercise group's power increased while the no-exercise group's power decreased. No differences in hope emerged. Positive correlations between hope and power were observed. Findings suggest that exercise is a form of knowing participation in change and illustrate a relation between one's ability to envision a better future and one's potential to actualize options through choice.

Methodological ponderings related to the power as knowing participation in change tool

Based on 15 years of research using the Power as Knowing Participation in Change Tool, the authors summarize tool development, including reliability and validity, and discuss specific methodological issues and insights. These include clarity of instructions and complexity of language used in the PKPCT along with response set, norms, and sensitivity of the instrument to detect differences between groups. Problems of linear measurement are discussed along with the appropriateness of both qualitative and quantitative methods of studying power from the view of the science of unitary human beings. Recommendations for further psychometric studies of power are proposed.