Smith, Marlaine

Although there appears to be heightened awareness of the alarming rise in adolescent mental health concerns, treatment initiation and adherence to traditional therapies remains low. Nurses are at the forefront of exploring innovative youth-friendly therapeutic options that engage adolescents who otherwise may be reluctant to care. Human-animal interactions (HAIs) are alternative approaches where animals are integrated as therapeutic partners to help break down barriers, build trust, uncover meaning, and foster transformation. Equine-assisted learning (EAL), a type of HAI, was the focus of this research. This study explored the lived experience of adolescents who participated in an equine-assisted learning program guided through the lens of the theory of unitary caring and the hermeneutic-phenomenological unitary-caring research method. Eleven participants between the ages of 11-19 were interviewed. The outcomes of improved self-confidence, better mood, healthier relationships, and an optimistic outlook were supported by the literature. Six essences evolved from the narratives: troubled by turbulent connections; embracing uncertainty and vulnerability; awakening to the shared human-horse condition; attuning as one; engaging harmonically; and cultivating peace and joy. These essences, blended with the theory of unitary caring, led to the discovery of the antecedents of transformational change defined in the conceptual representation of the Unitary Caring Relatedness Model. These findings contribute to nursing and HAI literature and suggest a model that may be implemented in adolescent practice.

Adverse childhood experiences (ACEs), involving abuse, neglect, and violence exposure, have been connected to undesirable physical and mental health consequences across the life span. With regards to the range of factors that moderates the impact of ACEs on life course health, resilience is suggested as a quality that can lead to better health and quality of life outcomes. The purpose of the study was to examine the relationship between adult-reported ACEs, resilience, and mental and physical health in Saudi Arabia. The study was a predictive/correlational design. A total of 328 participants completed the online questionnaire through (Qualtrics). The independent variables were ACEs and resilience while the dependent variable was physical and mental health. The variables were measured by: 1) The ACE International Questionnaire (ACE-IQ). 2) The Physical and Mental Health Checklist. 3) The Connor-Davidson Resilience Scale -25 (CD-RISC-25). Descriptive statics showed that 97% of participants were medically diagnosed with some health illnesses and they were under the age of 45 years old.

The purpose of this quasi-experimental study was to investigate the effects of equine-assisted psychotherapy (EAP) on mindfulness, self-reflection, insight, and psychological well-being in an adult veteran population with mental health concerns. Specific aims were (1) to determine the effect of EAP on mindfulness, self-reflection, insight, and psychological well-being in veterans with psychiatric diagnoses or mental health concerns; and (2) to describe the relationship of the sociodemographic characteristics (age, ethnicity, gender, education level, income, and deployment history) to mindfulness, self-reflection, insight, and psychological well-being of adult veterans with mental health concerns engaged in EAP. Smith’s (1999) theory of unitary caring provided the guiding theoretical and conceptual framework for the study.
A convenience sampling design was used to recruit 18 participants from a South Florida therapeutic riding center and an online veterans’ forum. The sample consisted of adult veterans ages 18 years and older who had mental health concerns and/or diagnoses. Assignment to the EAP group (n=9) was determined by the therapy center director based on session days and times and participant availability. The comparison group (n=9) received their treatment as usual.

The global agenda for gender equality recognizes unpaid domestic caregiving in the home as the largest barrier to gender equality. The purpose of this constructivist grounded theory study was to explore the social process of caregiving in fathers and identify the patterns that influence caregiving in fathers. Recruited from multiple community settings, thirty-five fathers participated in intensive interviews with the investigator. Guided by the Swanson’s (2013) Theory of Caring and using iterative categorization during data analysis, this study proposed the action-based Caregiving in Fathers Theory. The three main themes of the theory are Reinventing the Kitchen Table, Creating a Home and Being More than The Commander. Fathers identified the barriers of exhaustion, preoccupation, social culture, and controlling forces. Fathers identified the passages of love, expectations, support, and lifestyle. For fathers, gender equality in society begins with accepting fathers as proficient, competent, and primary caregivers. The results of this study can be utilized by healthcare professionals, educators, and other disciplines to understand the social process of caregiving in fathers. Future research could explore the role of sex or related phenomenon, such as disability, on caregiving.

One in three American older adults fall every year, making falls the leading cause
of nonfatal injury treated in the emergency department (Centers for Disease Control and
Prevention [CDC], 2013). Fall-related injuries cost the United States healthcare system
nearly $30 billion a year and result in 27,000 deaths per year (Burns, Stevens, & Lee,
2016). The risk of falls increases with age, occurring more often in women than man.
Age-related muscle weakness and functional decline contribute to fall risk. Age-related
changes in neuroendocrine hormone production and shifts in circadian rhythms promote
sleep disorders, affecting nearly two-thirds of older adults. Poor sleep quality over time
leads to drowsiness and impaired attention span and judgment. The purpose of this
secondary analysis of a previously collected data set was to describe the relationships
among frailty, subjective sleep quality, and falls in community-dwelling older adults.
This secondary analysis also sought to determine the extent to which frailty and
subjective sleep quality predict risk of future falls among community-dwelling older adults. Correlational analyses were performed to determine the nature and significance of
the relationship between sleep quality and falls, frailty and falls, and sleep quality and
frailty. A multiple regression analysis was performed to determine if sleep quality and
frailty combined could predict falls. Frailty was found to account for a small variance in
fall risk. However, sleep quality was not significantly related to falls nor was sleep
quality predictive of falls. Risk for falls should be assessed at every clinical encounter
and efforts to promote restful sleep should be addressed at least annually to reduce the
risks of falls, functional decline, and sleep disorders among older adults in the
community.

The purpose of this study was to investigate the process used by Haitians and Haitian Americans who must make healthcare decisions for a terminally ill family member. There is a large population of Haitians and Haitian Americans in South Florida and there has been no research regarding their decision-making process about end-of-life healthcare. The study design was descriptive, applying constructivist grounded theory methodology. Data were collected using semi-structured, face-to-face qualitative interviews. Data analysis and collection occurred simultaneously. Participants (n=12) were purposefully recruited, with 11 from a single, faith-based community. The findings resulted in six concepts: (1) imminent or actual death, (2) disrupted unity, (3) managing disrupted unity, (4) consequences, (5) restoring unity, and (6) creating memories you can live with. These six concepts, elaborated by an additional 17 dimensions, were incorporated into a process model relating to the cultural value of communal unity to the end-of-life decision-making process. The implications of this study include a need to improve the congruence between the nursing care provided at this vulnerable time and the cultural values of this population. Successful access to this population through the structure of the faith-based community points the way to increasing access to appropriate end-of-life healthcare. Practice implications informed by caring science include the importance of nurses’ coming to know the family and listening to the unique care needs.