Professor and Director of PhD Program Christine E. Lynn College of Nursing
Florida Atlantic University
BS Biology: Lebanon Valley College
BSN Thomas Jefferson University
MScN University of Toronto
PhD University of South Carolina
Post-Doc-John A. Hartford Foundation Building Academic Geriatric Nursing
Nursing Interventions Classification (NIC
Nursing Theory Guided Research, Practice, and Education
Unitary Caring Nursing Science
Rogers Science of Unitary Human Beings
Dispiritedness and Mild Depression in Later Life
Testing Written Emotional Expression to enhance Meaning-Making
Howard K. Butcher SAGE Publications
Awe is an emotion involving a feeling of being in the presence of something vast that transcends one’s current understanding of the world and is associated with creating a sense of wonder and curiosity. The author explores how awe experiences can have a role in igniting and sustaining research endeavors, and how nurse researchers can cultivate everyday awe experiences as sources of inspiration when engaged in the art of nurse sciencing.
Yamileth Castaño Mora, Beatriz Elena Arias López, and Howard K. Butcher SAGE Publications
Narrating or storytelling is a fundamental practice for human survival and a means for finding meaning in experiences and for enhancing self-understanding. The use of story has been present in nursing since its origins. Biographical narrative has rarely been used as a research method in nursing, and there are no examples conceptualizing biographical narrative research methods within a unitary science perspective. The purpose of this paper is to describe one specific narrative methodological approach—the biographical narrative research method—and to link the method to the science of unitary human beings as a means of creating a unitary understanding of the storied nature of human-health experiences.
Howard Karl Butcher SAGE Publications
The purpose of this narrative review of labyrinth walking research literature was to identify its experiences and potential health benefits and to conceptualize the labyrinth walking experience within Smith’s (2020) unitary caring theory. A total of 29 research studies from a 2022 annotated bibliography of 160 publications on labyrinth related research were selected for analysis. The findings coalesced around four themes. Labyrinth walking is an experience of irenic requiescence; expanding awareness; transforming potentials; and connecting to the beyond. A process of interpretive theorizing was used to interpret each theme from the perspective of the concepts within the theory of unitary caring.
Ana Caroline da Costa, Ana Paula da Conceição, Howard Karl Butcher, and Rita de Cassia Gengo e Silva Butcher FapUNIFESP (SciELO)
Objetivo: investigar los factores que influyen en la alfabetización en salud de los pacientes con enfermedad arterial coronaria. Método: estudio transversal, que incluyó 122 pacientes con enfermedades coronarias (60,7% del sexo masculino; 62,07±8,8 años); se evaluó la alfabetización en salud y el conocimiento específico sobre la enfermedad mediante entrevistas con los participantes, utilizando el Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Los datos fueron descritos por medidas de tendencia central y frecuencias. Los factores que influyen en la alfabetización en salud se determinaron mediante un modelo de regresión lineal. El nivel de significación adoptado fue del 5%. El estudio fue aprobado por el Comité de Ética e Investigación. Resultados: la edad y la hipertensión mostraron una relación inversa y significativa con la alfabetización en salud. Por otro lado, un mayor nivel educativo y tener empleo se asociaron con puntajes más altos en el instrumento de alfabetización en salud. El conocimiento específico sobre la enfermedad no influyó en la alfabetización en salud. Las variables del modelo de regresión explicaron el 55,3% de alfabetización inadecuada. Conclusión: en el presente estudio, se concluyó que el conocimiento sobre la enfermedad no influye en la alfabetización en salud, pero los profesionales deben considerar los factores sociodemográficos y clínicos para planificar las intervenciones.
Ana Caroline da Costa, Ana Paula da Conceição, Howard Karl Butcher, and Rita de Cassia Gengo e Silva Butcher FapUNIFESP (SciELO)
Objective: to investigate the factors that exert an influence on health literacy in patients with coronary artery disease. Methods: a crosssectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee. Results: age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy. Conclusion: this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.
Howard Karl Butcher SAGE Publications
While community-based participatory research (CBPR) and other related participatory action research approaches are increasingly being used in nursing research, few of these studies are conceptualized within an extant nursing framework. Instead, CBPR is typically only grounded in socio-ecological and social justice frameworks. However, knowledge is developed in a discipline through research that is conceptualized within the discipline’s conceptual systems, frameworks, or theories. This article begins with an explication of the processes and theoretical foundations of CBPR and concludes by offering Falk-Rafael’s Critical Caring Theory (CCT) as an ideal theory for reframing CBPR within a nursing science perspective.
Howard K. Butcher SAGE Publications
All phenomenological research, including descriptive phenomenological methods, are theory based. The knowledge in a discipline is built using discipline-specific methods. The purpose of this article is to develop and describe the processes of a mode of inquiry specific to caring in nursing theories housed within the unitary caring paradigm. Morgan’s practical framework examining ontological-epistemological-methodological linkages was used to develop the unitary-caring hermeneutic phenomenological research method The method is specific to conducting hermeneutic phenomenological research within Watson’s unitary caring science and Smith’s theory of unitary caring. The method includes a process of linking and interpreting themes generated from the textual analysis of participant descriptions of the caring phenomena to concepts in the specific unitary caring theory that informs the researcher’s a priori theoretical perspective to develop a theoretical understanding of the experience and contribute to the development of unitary caring nursing science.
Seham Alselami and Howard K. Butcher SAGE Publications
The aim of this study was to gain a deeper understanding of the experience of Saudi informal family caregivers of hospitalized patients who have experienced a stroke. In-depth, face-to-face, semistructured interviews of five family caregivers using open-ended questions were conducted in a major hospital in Saudi Arabia. The interviews were recorded, transcribed verbatim, and analyzed using the unitary-caring hermeneutic phenomenological research method. Data analysis revealed six major essences that were synthesized into one statement reflecting the essence of caring for a family member with a stroke in Saudi Arabia: Living with the uncertainty of ambiguity amid feeling distressed with worries and fears replete with unfulfilled desires while yearning for compassionate caring and overcoming uncertainties through connections and faith honoring abiding commitments. As a means to transform the findings into theory and language of the nursing discipline, the essences were then interpreted within the theory of unitary caring.
Kasorn Muijeen, Rangsiman Soonthornchaiya, and Howard K. Butcher Bentham Science Publishers Ltd.
Background: Depression is an illness with widespread incidence and has shown an annual increase, while depression relapse is also rising continually due to multiple causes. In Thailand, although many studies have been conducted to prevent depression incidence and relapse, there is little known about the meaning of depression relapse in adult Thai patients. An exploration of the direct experiences of adult Thai patients seems a suitable way to gather data for a care system development. Objectives: The purpose of this study is to describe the perceptions of adult Thai patients concerning their experience of depression relapse and its management among adult patients with depressive disorder in the Thai context. Methods: This research is a qualitative study using the directed content analysis approach. In-depth interviews with 20 adult Thai patients with depression that had direct experience with depression relapse were the participants used in this study. The interviews allowed the participants to talk about their experiences with depression relapse and how they managed depressive symptoms; the interviews lasted approximately 60 minutes. Results: Two themes emerged from the study. First, the experience of depression relapse is the feeling pulled away from happiness. Second, managing depression relapse. Conclusion: Depression relapse among adult Thai patients with depressive disorder is an experience causing patients to feel that they are losing their happiness again. Care and management of depression relapse by each patient differ, despite being in the same social contexts. Therefore, depression relapse risk assessment is important in the care of each patient in order to design more effective care.
Pilar Lozano, Howard K. Butcher, Cecilia Serrano, Aurelio Carrasco, Carolina Lagares, Pilar Lusilla, and Cristina O'Ferral Wiley
INTRODUCTION Low adherence to treatment is a common problem in the care of patients with severe mental illnesses. Motivational interviewing is a directive, client-centered counseling therapeutic approach designed to elicit behavior change by helping clients to explore and resolve ambivalence. Nurses use motivational interviewing, although it has not been defined from a nursing perspective nor with nursing language. Thus, nursing research on the use of these techniques is being carried out, supported by their effectiveness in many health problems. The development of motivational interviewing as a standardized nursing intervention for inclusion in the Nursing Interventions Classification (NIC) may promote its use by mental health nurses in their daily work and thus improve the quality of care. OBJECTIVES To validate a proposed motivational interviewing nursing intervention for inclusion in the NIC. MATERIALS AND METHODS We followed the validation methodology of the NIC of the Iowa and the Intervention Normalization for Nursing Practice projects. The study comprised theoretical (scientific and expert validation) and empirical (terminological and clinical validation) phases. RESULTS There is ample evidence supporting the efficiency of the motivational interviewing to improve the therapeutic adherence of people with severe mental illness. The group of experts agreed on the label name "motivational interviewing" for the NIC based on the modified model by Miller & Röllnick (2015), which includes 28 associated activities through the phases of engaging, focusing, evoking, and planning. Development of the NANDA International and the Nursing Outcomes Classification nursing language was completed. Knowledge and drug attitude improved in the motivational intervention group. CONCLUSIONS We validated the nursing intervention motivational interviewing for inclusion in the NIC that will help improve therapeutic adherence. The intervention may be used for other behavioral changes.
Mayra Cristina Luz Pádua Guimarães, Juliana Chaves Coelho, Giovanio Vieira da Silva, Luciano Ferreira Drager, Rita de Cassia Gengo e Silva Butcher, Howard K Butcher, and Angela Maria Geraldo Pierin Informa UK Limited
Objective To evaluate and identify variables associated with the control of hypertension and adherence to antihypertensive drug treatment in a group of patients with hypertension monitored in a specialized, highly complex outpatient service. Methods A prospective, cross-sectional study was carried out in the hypertension unit of a tertiary teaching hospital. Patients diagnosed with hypertensive aged 18 years and over and accompanied for at least six months were included in the study. Patients with secondary hypertension and pregnant women were excluded. The sample consisted of 253 patients. Adherence/concordance to antihypertensive treatment was assessed using the Morisky Green Levine Scale. Blood pressure control was set for values less than 140/90 mmHg. Variables with p≤0.20 in univariate analysis were included in multiple logistic regression. The level of significance adopted was p ≤0.05. Results Most of patients were white, married and women, with a mean age of 65 (13.3) years old, low income, and education levels. Blood pressure control and adherence were observed in 69.2% and 90.1% of the patients, respectively. Variables that were independently associated with blood pressure control were (OR, odds ratio; CI, 95% confidence interval): married marital status (OR 2.3; CI 1.34–4.28), use of calcium channel blockers (OR 0.4; CI 0.19–0.92) and number of prescribed antihypertensive drugs (OR 0.78; CI 0.66–0.92). Adherence was not associated with any of the variables studied. Conclusion There was a high frequency of patients with satisfactory adherence to antihypertensive drug treatment. Blood pressure control was less frequent and was associated with social and treatment-related factors.
Alba Lúcia Bottura Leite de Barros, Viviane Martins da Silva, Rosimere Ferreira Santana, Agueda Maria Ruiz Zimmer Cavalcante, Allyne Fortes Vitor, Amália de Fatima Lucena, Anamaria Alves Napoleão, Camila Takao Lopes, Cândida Caniçali Primo, Elenice Valentim Carmona,et al. FapUNIFESP (SciELO)
ABSTRACT Objective: to describe the theoretical construction process of nursing process support documents in COVID-19 care scenarios. Methods: an experience report of the joint activity of the Brazilian Nursing Process Research Network (Rede de Pesquisa em Processo de Enfermagem) composed of Higher Education and Health Institution researchers in Brazil. Results: five instruments were organized collectively, involving the elements of nursing practice (nursing diagnoses, outcomes and interventions) in assistance for community; for patients (with suspected or mild, moderate, and critical COVID-19 and residents in Nursing Homes); for nursing workers’ health support, also subsidizing registration and documentation during the COVID-19 pandemic. Final considerations: valuing the phenomena manifested by families/communities, patients and health professionals is essential for early detection, intervention, and prevention of diseases.
M. Lindell Joseph, Heather Bair, Michele Williams, Diane L. Huber, Sue Moorhead, Kirsten Hanrahan, Howard Butcher, and Nai-Ching Chi Elsevier BV
BACKGROUND An innovation scholarly interest group used the Jobs to Be Done Theory from the business literature to provide insight into the solution-focused progress that nurses are trying to make in challenging situations. PURPOSE This article presents a theoretical framework for understanding the progress nurses are trying to make through health care innovations across both practice and academic environments. METHOD This was a qualitative descriptive study using directed content analysis. We used the Jobs to Be Done Theory to guide the development of the semistructured questionnaire and the interpretation of findings. FINDINGS A theoretical framework of nursing innovations was derived to summarize and visually display the pathways and linkages of challenges, innovations, and impact domains of nursing innovations. Situations and opportunities arise within the context of interconnectedness and can lead to health care innovations in care delivery, patient care interventions, role transitions, research and translational methods, communication and collaboration, technology and data, teaching methods, and processes to improve care. DISCUSSION This theoretical framework offers insight into the dynamic interactions of academic-practice partnerships for innovation. Workplace situations are interconnected and can result in needed innovations designed to impact care delivery.
Joel Olayiwola Faronbi, Howard K. Butcher, and Adenike Ayobola Olaogun SLACK, Inc.
Family members play key roles in the care of older adults with chronic illness. However, little is known about the negative consequences of caregiving in Sub-Sahara Africa. The current study examined the influence of caregivers' burden and coping ability on the health-related quality of life of caregivers of older adults with chronic illness. An exploratory sequential mixed methods study was conducted among 16 family members. Findings showed that caregivers experienced severe burden, coped moderately with the burden, and had poor quality of life. Furthermore, directed content analysis of the in-depth interviews uncovered six major themes: (a) Being Pulled in Opposite Directions, (b) Experiencing Poor Health, (c) Receiving Support From Family and Friends, (d) Turning to God for Help, (e) Seeking Relief for Aching Bodies, and (f) Seeking Remedies for Sleeplessness. The current findings may have implications for designing programs that aim to improve the well-being of caregivers. [Journal of Gerontological Nursing, 45(1), 39-46.].
Howard K. Butcher and Todd N. Ingram SLACK, Inc.
Suicide is a tragic, traumatic loss, and one of the most emotionally devastating events families, friends, and communities experience. Suicide claims more than 800,000 lives every year, and some of the highest rates of suicide in the United States and globally are among older adults. The purpose of this evidence-based guideline is to help health care providers recognize those at risk for suicide and recommend appropriate and effective secondary suicide prevention interventions. The information in this guideline is intended for health care providers who work in a variety of settings, including hospitals, nursing homes, rehabilitation centers, out-patient clinics, mental health clinics, home health care, and other long-term care facilities. Assessment and preventive treatment strategies were derived by exhaustive literature review and synthesis of the current evidence on secondary prevention of late-life suicide across practice settings. [Journal of Gerontological Nursing, 44(11), 20-32.].
Noreen Frisch, Howard K. Butcher, Diana Campbell, and Dickon Weir-Hughes SAGE Publications
As part of a study of a larger study of self-identified holistic nurses, researchers asked nurses to describe practice situations where energy-based modalities (EBMs) were used. Four hundred and twenty-four nurses responded by writing free-text responses on an online survey tool. The participants were highly educated and very experienced with 42% holding graduate degrees and 77% having over 21 years of practice. Conventional content analysis revealed four themes: EMBs are 1) caring modalities used to treat a wide range of identified nursing concerns; 2) implemented across the life span and to facilitate life transitions; 3) support care for the treatment of specific medical conditions; and 4) Use of EBMs transcend labels of ‘conditions’ and are used within a holistic framework. The fourth theme reveals a shared vision of nursing work such that the modality becomes secondary and the need to address the ‘whole’ at an energetic level emerges as the primary focus of holistic nursing.
Jeanette M. Daly and Howard K. Butcher SLACK, Inc.
Elder abuse occurs in all practice settings and presents in various forms. The purpose of the current evidence-based practice guideline is to facilitate health care professionals' assessment of older adults in domestic and institutional settings who are at risk for elder abuse, and to recommend interventions to reduce the incidence of mistreatment. Limited research has been conducted on interventions to prevent or reduce elder abuse. Research is available on the prevalence of elder abuse and indicators of individuals who may be more susceptible to harm. The current article summarizes prevalence and risk factors for elder abuse, instruments available to assess individuals at risk for or victims of abuse, and potential interventions to prevent or reduce elder abuse. [Journal of Gerontological Nursing, 44(7), 21-30.].
Patricia Finch Guthrie, Shelley Rayborn, and Howard K. Butcher SLACK, Inc.
Delirium is a common cause of morbidity and mortality in hospitalized older adults often superimposed on dementia. Older patients with delirium are more likely than other populations to develop hospital-acquired infections, pressure ulcers, and immobility and nutritional issues, as well as to have increased health care costs, longer hospital stays, and long-term care following discharge. Interventions that prevent or mitigate the effects of delirium while promoting recovery are essential for caring for hospitalized older patients. This article is a summary of an evidence-based guideline that includes a framework for addressing delirium that focuses on predisposing and precipitating factors for delirium. In addition, the guideline includes evidence-based assessment and intervention principles, along with a review of reliable and valid assessment instruments. The guideline also identifies measurable outcomes for managing delirium and a quality improvement approach for improving outcomes. [Journal of Gerontological Nursing, 44(2), 14-24.].
Deborah Shields, Ann Fuller, Marci Resnicoff, Howard K. Butcher, and Noreen Frisch SAGE Publications
The human energy field (HEF) as a phenomenon of interest across disciplines has gained increased attention over the 20th and 21st centuries. However, a concern has arisen that there is a lack of evidence to support the concept of the HEF as a phenomenon of interest to professional nurses and nursing practice. Using Chinn and Kramer’s method of creating conceptual meaning, a concept analysis was conducted for the purpose of developing a conceptual definition of HEF. A systematic review of the literature using the CINAHL database yielded a total of 81 articles and text sources that were determined to be relevant to the concept analysis. The HEF is defined as a luminous field of energy that comprises a person, extends beyond the physical body, and is in a continuous mutual process with the environmental energy field. It is a vital energy that is a continuous whole and is recognized by its unique pattern; it is dynamic, creative, nonlinear, unpredictable, and flows in lower and higher frequencies. The balanced HEF is characterized by flow, rhythm, symmetry, and gentle vibration.
Cheryl Kruschke and Howard K. Butcher SLACK, Inc.
Falls are a major cause of injury and death annually for millions of individuals 65 and older. Older adults are at risk for falls for a variety of reasons regardless of where they live. Falls are defined as any sudden drop from one surface to a lower surface. The purpose of this fall prevention evidence-based practice guideline is to describe strategies that can identify individuals at risk for falls. A 10-step protocol including screening for falls, comprehensive fall assessment, gait and balance screening when necessary, and an individualized fall intervention program addressing specific fall risks is presented. Reassessing fall risk and fall prevention programs will ensure a proactive approach to reducing falls in the aging population. [Journal of Gerontological Nursing, 43(11), 15-21.].
Renan Alves Silva, Geórgia Alcântara Alencar Melo, Joselany Áfio Caetano, Marcos Venícios Oliveira Lopes, Howard Karl Butcher, and Viviane Martins da Silva FapUNIFESP (SciELO)
RESUMO Objetivo Analisar a acurácia do diagnóstico “Disposição para melhora da Esperança” em pacientes renais crônicos. Método Estudo transversal com 62 pacientes em clínica de hemodiálise entre agosto a novembro de 2015. Utilizou-se a Escala de Esperança de Herth para a construção das definições das características definidoras da North American Nursing Diagnosis Association International. Analisaram-se medidas de sensibilidade, especificidade, valor preditivo, razão de verossimilhança e odds ratio das características definidoras do diagnóstico. Resultados 82,22% apresentaram o diagnóstico. Verificou-se que as características definidoras “Expressa desejo de intensificar a coerência entre expectativas e desejos” e “Expressa o desejo de reforçar a resolução de problemas para alcançar as metas” aumentou em onze e cinco vezes, respectivamente, a chance de possuírem o diagnóstico. Conclusão “Expressa desejo de intensificar a coerência entre expectativas e desejos” e “Expressa o desejo de reforçar a resolução de problemas para alcançar as metas” apresentaram boas medidas de acurácia.
Paul Arnstein, Keela A. Herr, and Howard K. Butcher SLACK, Inc.
More individuals develop and endure constant or recurring pain in older adulthood. Although 40% of these individuals receive no treatment, many evidence-based treatments are available. Accurate assessment of pain, its impact on functioning, and preventing treatment-related harms lay the foundation of safe, effective pain control. Analgesic agents are often necessary, but require a delicate balance to prevent under-treatment, the unnecessary abandonment of therapy, or exposure to potentially serious adverse effects. Nondrug therapies must be better integrated into the treatment plan to ensure overall safety. Evidence-based approaches help older adults thrive and survive longer despite living with persistent pain. [Journal of Gerontological Nursing, 43(7), 20-31.].
Renan Silva, , Álissan Lima, Natália Barreto, Anna Viana, Howard Butcher, Viviane Martins, , , ,et al. Universidad de Antioquia
OBJECTIVES To identify and analyze the concept of the powerlessness in individuals with stroke, according to the NANDA-I Taxonomy. METHODS Concept analysis from online access of four databases using the descriptors: impotence; helplessness, learned; Stroke, depression in languages: Portuguese, English and Spanish. RESULTS The critical attributes of the feeling of powerlessness are: fragility, helplessness, lack of control, and power to achieve the proposed results for recovery and adaptation. Eleven new antecedents were found. It is recommended to reformulate three antecedents present in the taxonomy. Fourteen consequent were found. It is suggested to amend three consequential from the review. CONCLUSIONS With the analysis, a more complete concept of the powerlessness was elaborated allowing clarifying the critical attributes that, in turn, will help the rehabilitating nurse to recognize the signs and symptoms and to strengthen mechanisms of tolerance and resistance to stress.
Howard K. Butcher, Jean K. Gordon, Ji Woon Ko, Yelena Perkhounkova, Jun Young Cho, Andrew Rinner, and Susan Lutgendorf SAGE Publications
This study tested the effect of written emotional expression on the ability to find meaning in caregiving and the effects of finding meaning on emotional state and psychological burden in 91 dementia family caregivers. In a pretest–posttest design, participants were randomly assigned to either an experimental or a comparison group. Experimental caregivers (n = 57) wrote about their deepest thoughts and feelings about caring for a family member with dementia, whereas those in the comparison group (n = 34) wrote about nonemotional topics. Results showed enhanced meaning-making abilities in experimental participants relative to comparison participants, particularly for those who used more positive emotion words. Improved meaning-making ability was in turn associated with psychological benefits at posttest, but experimental participants did not show significantly more benefit than comparison participants. We explore the mediating roles of the meaning-making process as well as some of the background characteristics of the individual caregivers and their caregiving environments.