Howard K. Butcher; RN; PhD, FAAN
@fau.edu
Professor and Director of PhD Program Christine E. Lynn College of Nursing
Florida Atlantic University
EDUCATION
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
Capacity
RESEARCH INTERESTS
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
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Rangsiman Soonthornchaiya, Howard K. Butcher, and Rattiya Thong-on
SAGE Publications
The purpose of this study was to describe the perceptions of mental health applications in smartphones use among Thai older adults within the context of Locsin’s theory of technological competency as caring in nursing. Participants were 24 older adults living in the community. Two focus groups and semistructured interviews that were tape-recorded were used. Each focus group took 2 to 3 hours with 20-minute break times. Data were transcribed and analyzed using theory-directed thematic analysis. Five major themes emerged: (1) Knowledge about mental health transforms ways of caring for self; (2) Using smartphone enhances relationships with others; (3) Resistance-acceptance of using technology moment to moment; (4) Using technology presents challenges; and (5) Desire for technology to be user friendly. Each theme was linked and interpreted from the perspective of concepts in Locsin’s theory. The findings can help to develop the content and functions of mental health applications in smartphones.
Andra S. Opalinski, Laurie A. Martinez, Howard Butcher, Tara Bertulfo, Daphnee Stewart, and Rita Gengo
SLACK, Inc.
Background There are no detailed, step-by-step descriptions of a process for conducting rigorous literature reviews for Doctor of Nursing Practice (DNP) projects. Method After a search for a theory-guided literature review (TGLR) process for practice projects resulted in no established process, authors created a methodology by review of PRISMA guidelines, nursing theory experts' feedback, and a Think-Aloud process. Results A 10-step formal process for conducting a TGLR to support practice change was established. Conclusion The aims of developing this methodology include providing a formal process for DNP students to apply nursing theories to guide literature reviews and building nursing knowledge from a nursing disciplinary perspective to support practice change projects. [ J Nurs Educ . 2025;64(5):279–285.]
Howard K. Butcher
SAGE Publications
The author critiques the current American Association of Colleges of Nursing definition of nursing scholarship for its lack of emphasis on building discipline-specific knowledge. The author defines nursing scholarship as scholarly activities and formal investigations designed to generate, synthesize, translate, apply, and disseminate discipline-specific knowledge that advances nursing’s societal commitments and responsibilities in promoting human health, human betterment, and wellbecoming. Nursing scholarship guided by disciplinary thinking consists of scholarship that is (a) informed by nursing philosophy; (b) framed within nursing’s metaparadigm concepts; (c) situated within a nursing paradigm; (d) conceptualized within a nursing conceptual framework or nursing midrange theory; and (e) focused on, depending on one’s paradigmatic and theoretical perspective, developing and testing concepts in nursing classification systems.
Precious Chibuike Chukwuere, Howard K. Butcher, and Emmerentia Du Plessis
SAGE Publications
Purpose: This paper grounds the DREAM model, a practice-based framework developed from research on caring presence, aimed at enhancing holistic nursing care through being fully present and engaged with the patient, within Watson's Transpersonal Theory of Human Caring and the Unitary Caring Science worldview. The DREAM model was subsequently operationalized as a framework for providing care to adolescents with mental health conditions using the Nursing Interventions Classification (NIC). Design/Methods: The key concepts in the DREAM: D edication; R espect through relationship; E nvironment; A rt of nursing; and M otivation were linked to and conceptualized within concepts in Watson's Transpersonal Theory of Human Caring to demonstrate how the DREAM model can be philosophically grounded and practically operationalized within a caring science perspective. The model was then operationalized by linking the key concepts to five priority NIC interventions. Findings: The findings underscore how evidence-based nursing actions can enhance caring presence and relational engagement in healthcare, particularly in adolescent mental health care, creating a synthesis of caring theory with NIC. Conclusion: Through the grounding of the DREAM model in Watson’s theory and its operationalization using the NIC, the authors invite a new discourse on advancing adolescent mental health care.
Marcos Venícios de Oliveira Lopes, Viviane Martins da Silva, Cheryl Wagner, Karen Dunn Lopez, Leslie Arends, Mary Clarke, Alba Lúcia Bottura Leite de Barros, and Howard Karl Butcher
SAGE Publications
Background: The Nursing Interventions Classification (NIC) is a comprehensive, researched-based classification of 614 interventions whose responses can be influenced by a complex range of physiological, psychological, social and cultural conditions which present a challenge to establishing a specific level of evidence when findings are from studies using varied research contexts and methods. Aims: To develop criteria for establishing evidence levels for interventions included in the NIC according to research designs commonly used in nursing. Methods: A Design Science Research (DSR) approach was developed in four stages: (a) problem awareness, (b) solution suggestion, (c) artefact development, and (d) conclusion with presentation of the solution. Results: Six criteria were established to determine the quality information produced by each paper: level of analysis, study design, temporality, unit of analysis, information capture strategy, and comparison strategy. An evidence level classification for the NIC based on the accumulation of qualified information identified for an intervention was established in relation to the four levels, each with four sublevels. Conclusions: This study develops criteria and a classification system to assess evidence levels for the NIC, enhancing knowledge on the reliability and effectiveness of interventions in clinical practice and patient care.
Laurie A. Martinez, Andra S. Opalinski, and Howard K. Butcher
SAGE Publications
The major aim of this study was to understand the experience of resilience in adolescents and young adults within the context of a unitary caring science and to generate insights into ways to cultivate resilience in adolescents and young adults who have experienced adversity. Four major essences emerged and were synthesized into one statement. Maintaining hope and optimism for a promising future is acknowledging awareness and acceptance and experiencing connectedness while embracing power in the situation. The essences were interpreted within a theory of unitary caring.
Howard K. Butcher
SAGE Publications
The purpose of this article is to reintroduce and describe the processes and phases of heuristic inquiry and to illustrate how the method can advance nursing science. Heuristic inquiry is a rigorous, systematic, phenomenologically orientated research method developed by Clark Moustakas for investigating, discovering, and understanding the nature and meaning of living experiences. Heuristic inquiry invites the inclusion of the researcher’s autobiographical living of experience being investigated honoring the personal experiences of the phenomenon from self and each participant in the research study. The author proposes that heuristic inquiry be used in nursing science by including a theoretical interpretive process connecting the thematic essences of the nursing conceptual framework guiding the study. Nursing theory-guided heuristic research advances the study of caring for persons experiencing human-environmental-health transitions to enhance human betterment and wellbecoming.
Howard K. Butcher
SAGE Publications
The identification and interpretation of metaphor is useful to hermeneutic research. Metaphor is a way of conceiving one concept in terms of another and serves as a function of understanding. The author explores the rise of hermeneutics research and its relevance to nurse artsciencing. Metaphors are a creative strategy hermeneutic researchers can use to analyze and interpret data, and serve as a powerful strategy to represent complex realities, illuminate unnoticed aspects of a phenomenon, and provide depth of meaning to the understanding of human experiences.
Howard K. Butcher
SAGE Publications
Research aimed at generating new knowledge is the heart of the scholarship of discovery. The author of this paper explores how original research ideas can be generated for formal investigations and artsciencing. Curiosity and creativity are presented as “seeds” for originating ideas, and seven patterns (adjacent possible, liquid networks, the slow hunch, serendipity, error, exaptation, and platforms) are described as synergistic potentiators for geminating original research ideas.
Seham Alselami, Howard K. Butcher, and Joy Longo
Ovid Technologies (Wolters Kluwer Health)
Uncertainty is a universal experience of family caregivers caring for persons with a stroke and affects caregivers' readiness to care for their family members with a stroke. Guided by the unitary caring theory and unitary-caring hermeneutic-phenomenological research method, this study was conducted among 15 family caregivers of persons in the hospital who have survived strokes through in-depth semi-structured interviews. Five essences emerged from the analysis: living in a dark reality; yearning for professional support; enduring a life full of tribulations; attempting resolution; and creating new patterns of living. Each of the 5 essences was interpreted from Smith's unitary caring theory perspective.
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)
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.
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.
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.].