Liehr, Patricia

The decision to flee one’s homeland is a complex event that can have a life-long impact. The diaspora of the Cuban people has occurred throughout the United States since 1959. Their stories can shed light on the health challenge of leaving one’s homeland and can contribute to a body of knowledge that can inform nursing and health care. This study presents the qualitative findings from the stories of 13 participants who arrived in the U.S. from Cuba during the Mariel Boatlift of 1980. A story inquiry research design, grounded in the theoretical underpinnings of story theory (Smith & Liehr, 2014), was utilized to explore the dimensions of the health challenge of fleeing one’s homeland, turning points and movement to resolve. Deductive and inductive analysis of the health challenge of fleeing one’s homeland revealed the dimensions of trauma related to the pre-migration, migration, and post migration experience, associated losses, and stigma. The upheaval induced stress in the lives of the participants tested their ability to cope. Managing day-to-day and utilizing internal and external resources, the participants moved to resolve the challenge of fleeing their homeland over time. Many turning points shaped the direction of their experience over decades and contributed to their ability to find meaning by becoming self-sufficient, recreating home, and reconstructing a sense of self-identity. Their unique experiences and stories have provided a voice to empower future studies to expand nursing science, influence empathy and understanding through education, foster awareness in practice, and inspire the potential for policy change for the well-being of refugee populations.

Research has suggested positive effects of nature immersion––a state of being or an act of doing in natural space––for urban children who were otherwise at risk of emotional or behavioral problems. However, few studies have systematically investigated natural space qualities that predict child well-being at the clinical level. The purpose of this study was to increase understanding of natural space qualities as factors of urban child well-being. Explanatory mixed-methods were used.
Quantitative data (N = 174) included a survey and two parental-reports of child wellbeing.
Interviews provided qualitative data (N = 15). Data were analyzed using: Generalized Linear Model and Content Analysis. Both data streams were merged into a point of meta-inference that contributed to parental assessment of enhanced child well-being: 1) Parental valuing of nature connection (p < 0.001) as a soothing and safe resource and 2) Shorter and more frequent nature-child space-time immersion (p < 0.001). Integration of natural spaces into urban environments may be a costeffective and meaningful way to address urban child well-being.

Parents of children with developmental disabilities (DDs) often suffer from
psychological distress stemming from their children’s behavioral problems. One cause of
distress is their challenge to accept their children’s illnesses mindfully. A culturally
tailored and readily accessible mindfulness intervention may increase mindfulness and
reduce distress. Also, there were insufficient studies regarding culturally relevant
mindfulness trainings that have been conducted in Thailand. Therefore, a Brief Culturally
Tailored Thai Mindfulness intervention (BCTTMi) was developed, merging the work of
Jon Kabat-Zinn with Buddhist philosophy. The purpose of this study was to examine the
effects of the BCTTMi on stress, anxiety, and mindfulness in these parents.
An experimental waitlist control crossover design with the 2-weekend BCTTMi
was employed in 22 Thai parents and caregivers of children with DDs. They were all
Thais and Buddhists; more than half had practiced meditation. They completed three Thai-version questionnaires: (a) the Parenting Stress Index-Short Form-4th edition; (b) the
State Anxiety Inventory-Form-Y-1; and (c) the Mindfulness Assessment Scale, at three
measurements (baseline, posttest, and two-week follow-up). Repeated measure ANOVA
analyses were used to analyze data.
The findings showed that anxiety significantly decreased from baseline to
posttest, and mindfulness significantly increased with the BCTTMi. Nevertheless, stress
did not significantly reduce over time, and change between intervention and control
conditions did not differ for anxiety level. Moreover, there were no differences in any
outcomes from posttest to two-week follow-up.
In spite of Buddhist homogeneity of participants and sustained stress, mindfulness
increased, and anxiety decreased following the BCTTMi. These findings indicate the
feasibility of tailoring the mindfulness-based training to specific cultures and its
usefulness as an efficient option for parents and caregivers of children with DDs.
Further studies regarding the BCTTMi are warranted in broader populations and settings.

Workplace mistreatment (bullying, horizontal violence, and incivility) has been
shown to impact nurses’ work satisfaction, job turnover, and physical and mental health.
However, there are limited studies that examine its effect on patient outcomes. A
correlational descriptive study of 79 acute care nurses was used to test a social justice
model for examining the relationship between workplace mistreatment, quantified as
threats to dimensions of nurses’ well-being (health, personal security, reasoning, respect,
attachment, and self-determination), and nurses’ ability to provide quality patient care. In
addition, this study considered the moderating effect of caring work environment among
co-workers on nurses’ ability to provide quality patient care in the face of workplace
mistreatment. Stories of workplace mistreatment were collected anonymously and
analyzed for alignment with threats to six dimensions of well-being. Ability to provide
patient care was measured using the Healthcare Productivity Survey and a caring work
environment was measured via the Culture of Companionate Love scale. The results demonstrated that threats to all six dimensions of well-being described
by Powers and Faden (2006) were expressed in nurses’ stories of workplace
mistreatment. Furthermore, 87% reported a decrease in ability to provide patient care
after an incident of workplace mistreatment. Yet frequency of threatened dimensions did
not have a significant relationship with ability to provide patient care. Moreover, there
was a significant moderator effect of the caring work environment on the relationship
between number of threatened dimensions of well-being and ability to provide quality
patient care. Nurses in high caring environments loss less ability to provide care than
nurses in low caring environments when one to three dimensions of well-being were
threatened. However, this relationship reversed when four or more dimensions were
threatened. Implications include further research on the relationship between workplace
mistreatment and nurse well-being and changing practice to include fostering a caring
work environment in healthcare facilities.

The use of the telephone to speak to study participants about health-related issues is
useful when logistics make it difficult for participant and researcher to meet in person. However,
gaining the trust of the participant can be a challenge, partly due to fears of fraud and identity
theft. A spirit of openness and caring must come across the telephone lines between interviewer
and interviewee. Roach’s six C’s can be applied to convey a sense of caring, thereby relaxing the
participant and increasing their sense of safety to enhance the quantity and quality of health data
being collected. According to Roach, caring is manifested through six C’s – compassion,
competence, confidence, conscience, commitment, and comportment. Interviewers can be trained
through role playing and scripting using Roach’s caring model. Compassion is expressed by
being sensitive to the anxiety and apprehension they may feel toward receiving a call from a
stranger, who is asking about health-related issues. Competence is expressed by being able to
give the participant the information they need to have an understanding as to what they are
consenting. Confidence is achieved by ensuring the participant that the information they share
will be used appropriately and for the greater-good. Conscience is expressed by following ethical
research protocols, adhering to confidentiality, and respecting the relationship with the research
participant. Finally, interviewers manifest caring through comportment by identifying
themselves with their name, credentials, and institution; addressing the participant formally;
using language the participant can understand; and projecting caring through tone of voice.

The overall purpose of this mixed method study was to describe adolescents’
experiences of ease while enduring treatment for cancer. Specifically, the study used
avatar image-guided story-sharing (AIGSS) to explore adolescent sense-of-self,
experiences of feeling uneasy, descriptions of qualities of ease, and best places for
finding ease during treatment. The innovative research approach used in this study
incorporated avatar images representing ‘ease’ in typical environments. By testing a
developmentally relevant approach, AIGSS, to explore ease for adolescents enduring
cancer, this study addressed a pressing need for meaningful approaches to engage
adolescents in health-related dialogue about what matters most.
While 10 qualities captured adolescent ease (beauty, fun, safety, strength,
connectedness, calmness, rest, comfort, independence, and familiarity), connectedness,
strength, fun, rest, and safety were the most significant qualities of ease threaded
throughout stories. Two themes of self-reflected identity emerged: (a) valued personal
qualities (extrinsic/admired) and (b) infused unique demeanors. Three themes described adolescent uneasiness during cancer treatment: (a) persistent uncertainty, (b) fearful
anticipation, and (c) disrupted self. While home was most conducive for ease, personal
meaning was given to the hospital enabling finding ease.
This new knowledge is foundational for nurses who support adolescents during
cancer treatment. This research lays the groundwork to re-define ease as a relevant
outcome of quality nursing care, focusing on positive outcomes rather than catastrophic
ones such as infection and death. Advancing caring science with interactive participative
research enhanced communication with adolescents, having implications for both clinical
research and pediatric oncology nursing practice.

The growing older adult population, their age-related morbidities, and lifelimiting
chronic illnesses increase the demand for quality yet cost-effective end of life
(EOL) care. Losing a loved one creates emotional turmoil, heightened uneasiness, and
EOL uncertainties for family members. Understanding the complex needs of family
members and supportive actions deemed most significant to them can guide nurses to
enhance EOL care, encouraging palliation and peaceful death experiences. This study
used a qualitative descriptive exploratory design guided by story theory methodology to
explore the dimensions of the health challenge of losing a loved one who had been in an
acute care setting during the last three months of life, the approaches used to resolve this
health challenge, and turning points that prompted decisions about a loved one’s care
with 15 older adults residing in a Continuing Care Retirement Community (CCRC) in
Southeast Florida. Theoretical grounding for this study was Watson’s (1988, 2002)
theory of human caring and Smith and Liehr’s (2014) story theory. Older adults’ stories
were analyzed through theory-guided content analysis. Themes that describe the health challenge include moving from painful holding on to poignant letting go, uneasiness that
permeates everyday living and precious memories, patterns of disconnect that breed
discontent, and pervasive ambiguity that permeates perspectives about remaining time.
Approaches to resolve this challenge include active engagement enabling exceptional
care for loved ones, appreciating the rhythmic flow of everyday connecting and
separating to get by, and embracing reality as situated in one’s lifelong journey. Failure to
establish normalcy, coming to grips with abrupt health decline/demise, and recognition –
there’s nothing more to do – were the turning points identified by CCRC residents. Older
adults’ vivid recollections of losing a loved one and willingness to share EOL concerns as
well as recommendations regarding support of family members who are facing this
challenge serve as invaluable guidance for improving EOL care for dying patients and
their family members.

It is estimated that there will be a 20% shortage of full time equivalent registered
nurses (RN) by 2015. Retention of nurses is a priority in health care, so a better
understanding of factors that contribute to job satisfaction and intent to leave is needed.
One possible factor is the quality of the interpersonal relationships that occur among
managers, peers, and nurses. A negative quality would be acts of hostility or horizontal
violence, which is nurse-to-nurse aggression. This is theorized to be a result of oppressed
group behavior. These behaviors may influence job satisfaction and the intent to stay on
the job and in the profession.
The overall purpose of the study was to explore relationships between horizontal
violence, oppressed group behavior, job satisfaction and intent to leave a position or
nursing in the next 12 months. This pilot study examined factors that influence registered nurses ' job satisfaction
and intent to leave a position or nursing. Convenience sampling was used to obtain the
sample of registered nurses from a BSN completion program and a Novice Nurse
Initiative Program (n=99). Written stories of conflict between nurses were obtained and
analyzed with linguistic analysis and word count (LIWC) software and various
standardized instruments were used including the Nurses Workplace Behavior Scale
(NWBS), the Organizational Climate for Caring Scale (OCCS), the Peer Group Caring
Interaction Scale (PGCIS), The McCloskey/Mueller Satisfaction Scale (MMSS) and two
visual analogue scales (VAS).
Significant relationships were found between job satisfaction and intent to stay in
a position and nursing (p<.01), oppressed group behavior and intent to stay in nursing
(p<.01), oppressed group behavior and job satisfaction (p<.01). Manager and peer caring
behaviors were related to intent to stay in a position and nursing (p<.01). Using stepwise
multiple regression, both manager and peer caring behaviors were found to influence the
relationship between job satisfaction and intent to stay in a position or nursing.
The findings of this study suggest that the quality of interpersonal relationships
between managers, peers and nurses can influence job satisfaction and intent to stay in a
position or nursing.

The purpose of this study was to describe the sources of infant care informational
support systems that mothers residing in the Western North Carolina Appalachian region use and prefer in the postpartum period. In addition, the study explored the associations of the sources for informational social support on infant care with personal factors (age, socioeconomic status, parity, race, ethnicity, residence, marital status, education, access to Internet, access to cellular phone, prior attendance in childbirth classes, and other adult infant care assistance in the home) of the mothers.

The purpose of this study was to test the effect of the expressive writing and the expressive talking interventions on uncertainty and coping processes in Thai family members of patients in a coma, and to examine changes in positive emotion, negative emotion, and cognitive process word-use over three days. A quasi-experimental pretest-posttest, three group design was conducted with 45 Thai family members of patients in a coma who were in the intensive care units (ICU) at a hospital in Thailand. Three ICUs were randomly assigned into groups: the expressive writing, the expressive talking, and the control group. Participants of the expressive writing group (n = 15) were asked to write about their thoughts and feelings following standard guidance for expressive writing, those of the expressive talking group (n = 15) were interviewed with questions guided by the story path approach, whereas those of the control group (n = 15) did not receive any specific interventions. Participants completed the Thai version of the Mishel Uncertainty in Illness Scale-Family Member Form and the Thai version of the revised version of the Ways of Coping Scale before and after the interventions.