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Oncology Nursing Society. Unauthorized reproduction, in part or in whole, is strictly prohibited. For permission to photocopy, post online, reprint, adapt, or othenwise reuse any or all content from this article, e-mail [email protected] To purchase high-quality reprints, e-mail [email protected] Online Exclusive Article Preferences for Photographic Art Among Hospitalized Patients With Cancer Hazel Hanson, MSN, RN, ACNP-BC, OCN®, Kathtyn Schroeter, PhD, RN, CNOR, CNE, Andrew Hanson, MSN, RN, FNP-BC, CCRN, Kathryn Asmus, MSN, RN, OCN®, and Azure Grossman, BSN, RN, OCN® A lternative and complementary therapies may increase patient satisfaction, wellbeing, and outcomes and may be beneficial during extended stays. Music therapy, art therapy, massage therapy, meditation, and relaxation have helped many people v^ith cancer (American Cancer Society, 2012). Complementary therapies have been evaluated with the cancer population, but little is known about the specific impact of photography (Geue et al., 2010; Oncology Nursing Society, 2009). Many hospitals now provide patients with meditation rooms and healing gardens. Thoughtfully selected artwork, including photographs, paintings, prints, and sculptures, also are found on display throughout hospitals. Although many patients and visitors can take advantage of walking outside, patients with cancer, by virtue of their decreased white blood cell counts, often are prohibited the benefits of communing with nature. Photography, however, may be one way for patients to experience the benefits of nature. In addition, although fewer patients with cancer reqtiire hospitalization at the current study facility, those that do typically are hospitalized for extended stays. The researchers of the current study have noted that, during those stays, the patient’s quality of life (QOL) and experience of the hospital environment become vitally important. Nightingale (1860) wrote about the significance of the environment for its impact on physical health, mental health, and recovery. She recognized that to regain health, people need adequate ventilation, odor reduction, and windows for natural light and outdoor views. Nightingale (1860) believed that integrating the natural environment with views of the outdoors was a strategy to improve human comfort. More than 150 years later, the impact of the aesthetics of the hospital environment on patients and healing is still being explored. Photographic art is a form of aesthetics that may positively impact a patient’s hospital experience. The primary purpose of this descriptive Purpose/Objectives: To determine the preferences of patients with cancer for viewing photographic art in an inpatient hospital setting and to evaluate the impact of viewing photographic art. Design: Quantitative, exploratory, single-group, post-test descriptive design incorporating qualitative survey questions. Setting: An academic medical center in the midwestern United States. Sample: 80_men (n = 44) and women (n = 36) aged 19-85 years (X = 49) and hospitalized for cancer treatment. Methods: Participants viewed photographs via computers and then completed a five-instrument electronic survey. Main Research Variables: Fatigue, quality of life, performance status, perceptions of distraction and restoration, and content categories of photographs. Findings: Ninety-six percent of participants enjoyed looking at the study photographs. The photographs they preferred most often were lake sunset (76%), rocky river (66%), and autumn waterfall (66%). The most rejected photographs were amusement park (54%), farmer’s market vegetable table (51%), and kayakers (49%). The qualitative categories selected were landscape (28%), animals (15%), people (14%), entertainment (10%), imagery (10%), water (7%), spiritual (7%), flowers (6%), and landmark (3%). Some discrepancy between the quantitative and qualitative sections may be related to participants considering water to be a landscape. Conclusions: The hypothesis that patients’ preferences for a category of photographic art are affected by the psychophysical and psychological qualities of the photographs, as well as the patients’ moods and characteristics, was supported. Implications for Nursing: Nurses can play an active role in helping patients deal with the challenges of long hospital stays and life-threatening diagnoses through distraction and restoration interventions such as viewing photographic images of nature. Knowledge Translation: Nurses can use photographic imagery to provide a restorative intervention during the hospital experience. Photographic art can be used as a distraction from the hospital stay and the uncertainty of a cancer diagnosis. Having patients view photographs of nature is congruent with the core nursing values of promoting health, healing, and hope. Oncology Nursing Forum • Vol. 40, No. 4, July 2013 E337 study was to deternüne the preferences of patients with cancer for vievdng photographic art. The secondary aim of this study was to evaluate whether viewing photographic art is perceived by patients as being distracting, restorative, or both. Theoretical Framework Two theoretical frameworks. Nightingale’s (1860) and Han’s (1999), were used in this study design. Nightingale purported that nurses should manage their patients’ environments so as to assist nature in the overall reparative process. The nurse must construct environmental settings that are appropriate for the gradual restoration of the patient’s health and coordinate the external factors associated with the patient’s surroundings that can affect the patient’s life or physiologic processes (Nightingale, 1860). Han’s (1999) midrange theory. Integrated Landscape Assessment Theory, provided the current study with the foundation that identified and defined the constructs and concepts that were measured, as well as their relationships. Landscape assessment predicts “how attributes of environments relate to a wide range of cognitive, affective, and behavioral responses” (Wong, 1989, p. 6). Viewing high-quality aesthetic scenes evokes positive feelings, whereas viewing lowquality scenes evokes negative feelings. A person’s response to the scenes positively or negatively impacts his or her functioning and sense of well-being. Han’s (1999) theory explains the relationship among the physical qualities of photographs and people’s moods and preferences for specific photographs. Applied to this study, qualities of the photographs and the person’s mood determine his or her preference for types of photographs. Theoretical constructs include psychophysical factors (e.g., openness, depth, penetration), psychological factors (e.g., coherence, legibility, mystery, complexity), mood states (e.g., relaxed, anxious, fatigued, grouchy) and preferences for specific photographs (e.g., category, delivery method, viewing time). Literature Review The significance of viewing nature as a method to enhance healing was documented in a landmark study of two groups of hospitalized postoperative patients, one group with a window view of deciduous trees and the other group with a view of a brick wall (Ulrich, 1984). Findings indicated significantly shorter postoperative hospital stays and decreased pain levels in the group who viewed the trees. Ulrich and Gilpin (2003) recommended guidelines for selecting art for patients by arguing that viewing water, landscapes, flowers, and figurative art conveyed optimism and safety to patients. Kaplan (1995) also recommended inclusion of natural passages. Subject matter that portrays uncertainty, negativity, overcast scenes with ominous weather, or surreal qualities should be avoided (Hathom & Ulrich, 2001; Marberry, 1995; Ulrich, 1991). Photographs of nature have been associated with improved outcomes in patients undergoing short-term noxious procedures and treatments. Researchers studied the viewing of different forms of photography and the impact on pain associated with dressing changes (Miller, Hickman, & Lemasters, 1992), sigmoidoscopies (Lembo et al., 1998), and bronchoscopies (Diette, Lechtzin, Haponik, Devrotes, & Rubin, 2003). Changes in patient outcomes were attributed to distraction. Findings indicated an improvement in outcomes across all the studies ranging from decreased pain and discomfort, need for sedation, and side effects of therapy. Similar positive outcomes are noted in people receiving chemotherapy treatment who viewed scenes of nature via virtual reality (Schneider, Ellis, Coombs, Shonkwiler, & Folsom, 2003; Schneider & Hood, 2007). Women with breast cancer experienced a significant decrease in anxiety (Schneider et al., 2003). Participants with breast, colon, or lung cancer (men and women) enjoyed the experience and perceived the treatment as shorter, but no significant differences in symptom distress were observed (Schneider & Hood, 2007). Again, the authors postulated that the nature scenes improved participants’ outcomes because they were distracting. Other researchers believe the positive effects of viewing or being present in nature are restorative rather than distracting (Hartig, Korpela, Evans, & Gärling, 1997; Herzog, Black, Fountaine, & Knotts, 1997). Attention Restoration Theory (Kaplan, 1995, 2001; Kaplan & Kaplan, 1989) suggests one’s actual presence in or viewing of photographs of nature results in restoration from mental fatigue. Being present in nature and viewing photographs of nature is associated with positive health outcomes (Cimprich, 1993; Diette et al., 2003; Lembo et al, 1998; Miller et al., 1992; Schneider et al., 2003; Schneider & Hood, 2007). Explanations for these positive effects range from the satisfaction people experience being in a pleasant setting to an actual experience of restoration experienced when, without effort, a person who is fascinated by a picture experiences a sense of being somewhere else. In their effort to understand the restorative nature of photographic art, researchers had healthy individuals identify nature scenes they perceived as restorative (Feisten, 2009; Berman, Jonides, & Kaplan, 2008; Han, 2007; Herzog et al, 1997). Participants preferred nature rather than urban scenes (Berman et al., 2008; Herzog et al., 1997) or sports or entertainment scenes (Herzog et al., 1997) and chose photographs of tundra and coniferous forests over deserts and grasslands (Han, 2007). E338 Vol. 40, No. 4, July 2013 • Oncology Nursing Forum Patients valued art in their hospitalized rooms and preferred images of realistic art with nature content, including animals, water, flowers, and landscapes (Nanda, Eisen, & Baladandauthapani, 2008; Nanda, Ha thorn, & Neumann, 2007). Patients liked nature images offering a sense of familiarity, greenery, or environments in which they could envision themselves. In contrast, the students ranked abstract art and stylized nature significantly higher than the patients. Although positive effects have been observed, little is known about the best process to make photographic art available to hospitalized patients. Some gaps exist in the literature related to the therapeutic use of photographic art, including poor understanding of the mechanism for how photographic art works. Two mechanisms have been proposed. Photographic art works by distracting people from their current unpleasant or noxious situation or by relieving mental fatigue and restoring the person (Cimprich, 1993; Diette et al., 2003; Hartig et al., 1997; Herzog et al., 1997; Kaplan, 1995, 2001; Kaplan & Kaplan, 1989; Lembo et al., 1998; Miller et al., 1992; Schneider et al., 2003; Schneider & Hood, 2007). Another gap is the contradictory information that exists about the types of photographs people prefer and differences in preferences across ages, genders, and personal health states (Berman et al., 2008; Feisten, 2009; Han, 2007; Herzog et al., 1997; Nanda et al, 2007,2008). As a result of the literatiire analysis, the following research questions were identified. • How do patients like viewing the photographs? • What are patients’ general predispositions toward viewing photographic artwork? • What category of photographs and which specific photographs do patients prefer? • What category of photographs and which specific photographs do patients reject? • What types of delivery formats do patients prefer when viewing photographs? The authors hypothesized that patient preference for a category of photographic art (dependent variable) is affected by the psychophysical and psychological qualities of photographs and the patient’s mood and characteristics (e.g., age, gender, race or ethnicity, performance status, socioeconomic status [SES], QOL, fatigue). Methods The current study used a quantitative, exploratory, single-group, post-test descriptive design in addition to incorporating some qualitative survey questions for analysis. A convenience sample of 90 people hospitalized for treatment of cancer was recruited. Patients were eligible for this study if they were aged 18 years or older, admitted to the blood and marrow transplantation (BMT) or hematology/oncology services for at least 24 hours, medically stable, able to participate in the research as determined by the RN responsible for their care, English speaking, able to consent, and able to view the photographs on a computer screen. Setting The stiidy took place on the 12-bed BMT and 15-bed hematology/oncology inpatient units of the 450-bed Froedtert Hospital and the Medical College of Wisconsin, an academic medical center in the midwestern United States. All patient rooms for this study were single occupancy and located on the fourth floor of an eight-story wing of the hospital. Most of the rooms have an exterior window with a view of buildings and parking lots with land and trees in the distance. Six rooms on each unit face a courtyard, which contains shrubbery and trees along with a small fountain; however, trees and ñowers in the courtyard are visible only when standing or sitting in a chair next to the window. The rooms are painted beige; have healthcare information flyers, printed signs, or posters affixed to walls; and have a clock and 24-inch television mounted to the wall along with a DVD player. Neither the rooms nor hallways contained photographic art. During the patients’ stay, many kept greeting cards or pictures of family, friends, or pets on their window sills or bulletin boards. Because of their immunocompromised conditions, patients usually were confined to the vtnit except to leave for tests or procedures. The majority of patients admitted to both the BMT and hematology/oncology units have a diagnosis of leukemia, lymphoma, or multiple myeloma. The average length of stay for patients in these settings is 12.4 days for BMT and 6.8 days for hematology/oncology. The average number of patients admitted to the BMT and hematology/oncology units is 18 and 40 patients per month, respectively. Measures Several measures were used to collect and analyze data for this study. Demographic and descriptive information: Demographic and descriptive information that was collected included age, gender, diagnosis, number of days hospitalized, service, unit, race or ethnicity, and marital status. The number of days hospitalized was defined as the day of admission to the day the patient viewed the DVD that contained the photographs. That information was obtained from the unit census report. Performance status: The Eastern Cooperative Oncology Group (ECOG) Performance Status is a simple assessment tool used to measure physical functioning in patients with cancer. The ordinal scale is graded by healthcare providers (Oken et al, 1982). Patients receive a score ranging from 0 (fully active without restriction) to 5 (dead). Oncology Nursing Forum • Vol. 40, No. 4, July 2013 E339 Table 1. Participant Characteristics (N = 80) Characteristic Age (years) Length of stay (days) Characteristic Gender Male Female Marital status Married Single Divorced Widowed Live with significant other Separated Education 8th grade or less Some high school High school graduate or GFD Some college or two-year degree Four-year college graduate More than four-year college degree Race Caucasian African American Bi racial American Indian Asian Mexican Service Hematology Blood and marrow transplantation Diagnosis Leukemia Lymphoma Other Multiple myeloma ECOG score 0 1 2 3 X 49 7 SD 15.48 12.91 Range 19-85 1-107 n 44 36 51 14 7 6 1 1 2 1 14 30 19 14 72 3 2 1 1 1 54 26 27 23 19 11 47 23 3 7 FCOG—Eastern Cooperative Oncology Group Socioeconomic status: The Hollingshead (1975) Four-Factor Index of Social Status measures SES and was used as a variable predictive of health outcomes (Lawson & Boek, 1960). The Hollingshead measure is a well-researched tool that computes an individual’s SES based on education, occupation, and spouse’s education and occupation, if applicable (Cirino et al., 2002). Quality of life: Quality of life was assessed with the QOL Linear Analog Scale-Assessments (LASA), a simple tool measuring perceived level of functioning. The tool consists of five single-items, each targeting a specific domain of QOL (Brown et al., 2008). The domains include physical (e.g., fatigue, activity level), emotional (e.g., depression, anxiety, stress), spiritual (e.g., sense of meaning, relationship with God), intellectual (e.g., ability to think clearly and concentrate), and overall well-being. The 11-point linear scales range from 0 (as bad as it can be) to 10 (as good as it can be). When used with patients with cancer, the QOL LASA had a Cronbaeh alpha ranging from 0.83-0.88 (Locke et al., 2007). The results of this five-item scale are comparable with results of lengthier measures of QOL. Fatigue: As recommended by the Fatigue Guidelines Panel of the National Comprehensive Cancer Network ([NCCN], 2013) Oncology Practice Guidelines, a singleitem, numeric rating scale was used to measure general fatigue intensity during the past three days. The 11-point linear rating scale ranged from 0 (no fatigue) to 10 (worst fatigue imaginable). The simple tool is used in outpatient oncology settings and is predictive of poor outcomes (Butt et al., 2008). Visual Arts Research Survey: Based on the literature (Han, 2003,2007; Hartig et al., 1997; Kaplan & Kaplan, 1989; Ulrich & Gilpin, 2003), the researchers developed a survey to match the purpose of the study. The Visual Arts Research Survey contained 35 questions focusing on patient preferences for photographic art, mood state or emotional response, and distraction or restoration. Two open-ended questions were used to allow participants to express their preferences and to give any other comments regarding the overall study process. Participants were given two pages containing thumbnail images of all the photographs on the DVD and asked to select the images they would like to see in their hospital room and those they would not like to see. Photographs A DVD of 60 photographs was displayed on laptop computers for this study. The DVD used software allowing participants to control the length of time each photograph was displayed on the computer screen. The photographs used in this study were chosen from the personal collections of a freelance photographer and a nationally recognized photographer whose photographs have been used in previous research (Nanda et al., 2007). Han’s (2007) intricate selection criteria guided the research team in evaluating the selected photographs based on the following criteria: horizontal layout, high photographic quality, openness, variety, and complexity. Prior to making the final selection of photographs to be used in this study, a small group of people with cancer (patient advisory board) shared their thoughts on photographs. As a result of their comments, bright, cheerful colors and variety were considered in selecting the photographs. Categories for the photographs (e.g., landscapes, water, flowers, animals, landmarks, entertainment) were based on research findings and suggested guidelines for appropriate healthcare art (Nanda et al., 2008; Ulrich & Gilpin, 2003). E340 Vol. 40, No. 4, July 2013 • Oncology Nursing Forum Procedure Following approval from the Froedtert Hospital and the Medical College of Wisconsin’s institutional review board, participants were recruited via personal contact. Patients who met the eligibility requirements were invited to participate in the study by a member of the research team. RNs were used in this study as data collectors based on a previous request from the nursing staff to have more experience participating in nursing research activities. Data collectors who were RNs on the BMT or hematology/oncology units did not collect data on the unit on which they worked. Visitors were encouraged to leave the room during the study; however, visitors who remained in the room were requested to remain quiet, allowing participants the freedom to express their own thoughts and opinions. The data collector assisted the participant in unplugging or turning off the hospital phone, personal cell phone, television, personal computer, and/or radio to minimize interruptions. The data collector set up the study’s laptop computer on the participant’s bedside table and explained the procedure. Throughout the study, the data collector remained quiet in the room, timed the viewing of the DVD with a stop watch, and was available to assist with any unforeseen computer problems or participant questions. After participants viewed the 60 photographs, the data collector set up the computer for the participant to complete the Visual Arts Research Survey. The survey was conducted via a secure Internet survey site, Qualtrics^M. A three-digit identification number was assigned to each participant linking paper and electronic data. The data collector assisted the participant with the first six questions of the survey to ensure information was accurate and to assess the participant’s comfort level with the computerized survey. The data collector was permitted to assist the participant in reading questions aloud and explaining the computerized survey tool if the participant was unable to read or wanted assistance in using the computer. The paper survey results were transcribed by the data collector onto a recording sheet that included the participant identification number so that the data could be entered into a statistical program at a later date. Participants who had consented and been transferred to a different unit prior to completing the study were given the opportunity to complete the study on their new unit. The two open-ended questions were analyzed by a group of three research team members who individually grouped the participants’ responses into categories and then came together to compare categories. The group matched the participants’ responses to the categories in the study (landscape, water, flowers, animals, entertainment, and landmark) and also identified three miscellaneous categories: people, spiritual, and imagery. Results Results reflect both quantitative and qualitative data. A total of 146 patients hospitalized for treatment of cancer were eligible to participate in the study, but 66 did not participate because of refusal, increasing illness, or staffing limitations that impacted study follow-up. The final study sample was comprised of 80 adults aged 19-85 years (X = 49 years) (see Table 1). The majority (91%) of the participants had a performance status of 0-2, meaning they were ambulatory with limited ability to carry out work activities, whereas 9% of participants were classified as at least grade 3, meaning they were partially or completely confined to a bed or chair and had limited abilities for self-care. When evaluating their QOL, participants rated their spiritual and intellectual well-being during the past week the highest, with means of 8.75 (SD = 2.09) and 8.74 (SD = 1.81), respectively. Their physical well-being was rated the lowest, with a mean of 6.61 (SD = 2.28), and emotional and overall well-being were rated in the middle, with means of 7.76 (SD = 2.17) and 7.8 (SD = 2.03), respectively. Respondents rated their fatigue during the last three days at a mean of 5.39 (SD = 2.34). When asked to rate their emotional response to looking at the study photographs on a scale of 1 (not at all) to 10 (a great deal), the mean response to “grouchy” was 2.31 (SD – 2.33), whereas the mean responses to “happy” and “hopeful” were 6.63 (SD = 2.6) and 7.58 (SD = 2.32), respectively After looking at the study photographs, participants rated their perceptions of distraction and restoration (see Table 2). The vast majority of the participants (96%) Table 2. Participants’ Perceptions of Distraction and Restoration (N= 80) Variable SD Data Analysis Data from the secured Internet site were automatically extracted and transferred to SPSS®, version 17. Descriptive statistics were used, as well as qualitative analysis of specifically designed survey questions. Interested in the photographs 8.33 1.76 Thought the photographs were fascinating 8.3 1.72 Believe it is helpful for patients to look at photographs 8.29 1.79 Attention was pulled to viewing the photographs. 8.23 1.72 Photographs held their attention. 8.21 1.76 Photographs were a good distraction. 8.1 2.06 Note. Scores were on a scale ranging from 1 (not at all) to 10 (a great deal). Oncology Nursing Forum • Vol. 40, No. 4, July 2013 E341 a—amusement park; b—bridge over stream; c—decaying car; d—farmer’s market vegetable table; e—kayakers; f—lake sunset; g—rocky river; h—waterfall with backdrop of autumn trees Figure 1. Study Photographs Note. Photos courtesy of Bill Robertson (photos a, c, d, and e) and Jack Roper (photos b, f, g, and h). Used with permission. reported enjoying looking at the study photographs, with 39% (n = 31) choosing the highest ranking of 10 (a great deal). Seventy-five percent of participants reported they had photographs similar to those in the study in their home. When asked if they would like to have one of the study photographs in their hospital room or home, the mean scores were 8.21 (SD = 2.03) and 7.19 (SD = 2.98), respectively (scale ranging from of 1 [not at all] to 10 [a great deal]). The photographs that the participants selected most often were lake sunset (76%), rocky river (66%), and waterfall with backdrop of autumn trees (66%) (see Figure 1). The most rejected photographs were amusement park (54%), farmer’s market vegetable table (51%), and kayakers (49%). Of the 80 participants, 57 gave responses to the open-ended question “What other types of photos would you like to see in your hospital room?” That includes participants who responded with more than one category. The breakdown of categories is landscape (28%), animals (15%), people (14%), entertainment (10%), imagery (10%), water (7%), spiritual (7%), flowers (6%), and landmark (3%). Responses to the question asking for comments reflected participants’ opinions of the study process and the selection of the study photos, as well as relating aspects of the photos to their personal life situation. This population spent anywhere from a couple of days to a couple of months in the hospital and were facing life-threatening conditions and dealing with the uncertainty of their diagnosis. One participant stated, “Many of the photos had symbolic meaning to me in a very powerful way. The bridge over the stream was my favorite, symbolizing a means through an obstacle.” That comment reflects how the patient perceived the need to get through the obstacle of the disease and treatment. Another participant wrote, “I thought the picture with the decaying car was nice but it can be taken in a wrong way. I can see it as a piece where they are capturing the theme of time and death where everything in life has an end point. On a bad day, it would really ruin someone’s mood seeing the age of the car.” Other patients made comments related to photos in a hospital unit. “I would like to see some photos on this floor. When I go to other areas of the hospital and see the birch tree pictures, it makes for a more personal feeling rather than institutionalized,” one participant sad. Another stated, “I think photos in patients rooms would be a wonderful asset to their rooms.” Finally, one participant said, “I think photos would add a great deal to the hospital rooms . .. when I had my children, there was artwork on the walls in our rooms, and it was really nice.” These comments show the importance of the hospital environment to patients facing long hospitalizations. E342 Vol. 40, No. 4, July 2013 • Oncology Nursing Forum Another group of patients commented on their perception of fun and vacation. “I liked the carnival ride .. . the least,” one participant said. Another noted a lack of “people enjoying ‘their’ vacations.” As one participant explained, “I like the vacation pictures, but it was kind of sad … looking at them reminds me that I will not be going on vacation for a long time due to being sick.” Even so, other participants commented on the healing and distraction provided by the photos. “It was a nice break to see the photos,” one participant said. Another elaborated, “Photos, particularly sunsets, flowers, and soft scenes, can be helpful in reducing pain. They can be effective in the healing process.” That reflects the need these patients felt for a break from their daily routines related to treatment. The results support the hypothesis, indicating that patient preference for a category of photographic art is affected by the psychophysical and psychological qualities of photographs, as well as the patient’s mood and characteristics. Discussion When comparing the participants’ top answers, the write-in comments did not necessarily support the selections made in the quantitative section of the study. For example, of the top 10 photos chosen by participants to be in their hospital room (quantitative), half were in the water category and half were in the landscape category. In the open-ended question, 22 of 57 respondents said they would like landscape photographs in their room and only 6 respondents said water. Based on the categories selected for the study, the authors did not designate water as a landscape, but instead made it its own category. Some of the participants may consider water a landscape, which may explain the discrepancy between the quantitative and qualitative sections. Han’s (1999) Integrated Landscape Assessment Theory was supported in this study, as the findings related how the positive or negative responses of the participants to the various photographs impacted his or her sense of well-being. Han’s theory also illustrated the relationship between the photographs and the participants’ preferences for specific photographs, which was evident in both the qualitative narratives and the actual photograph preference data. Nightingale’s (1860) Environmental theory also is supported in the aspect of participants’ using elements in nature via the photographs from this study. A relationship between nursing practice and the environment can be seen when nurses can use select scenes from nature to create a more positively perceived healing environment for their patients. Limitations Patient acuity levels, such as patients being too sick to participate, impacted the overall number of participants. As a result, very little is known about what very ill patients would like. In addition, nurses who were trained to data collect were not consistently available, which impacted data collection and patient participation. Another limitation was related to the equipment, specifically the laptop computers and access to the Internet. At times, Internet access would falter during the participants’ viewing of the study materials, resulting in lengthening of participant time. However, no participants were eliminated, as they all chose to continue the survey. Finally, the Hollingshead (1975) tool was designed to assess participants’ SES; however, the categories on the forms appeared to confound the participants and, as a result, those data were negated. Implications for Nursing Practice and Research Nurses in general, and oncology nurses specifically, can play an active role in helping patients deal with the challenges of long hospital stays and hfe-threatening diagnoses through distraction and restoration interventions such as viewing photographic images of nature. Distraction and restoration can improve the hospital environment, which is consistent with Nightingale’s (1860) environmental theory. Having patients view photographs of natu

In this assignment, you will be creating a PowerPoint presentation based on the application of the functional health assessment of a movie character. To complete this assignment, choose a movie from the following list and identify a character from the movie on whom you would like to do a health assessment. If you wish to use a character from a movie not included on the following list, get the approval of your instructor.

Films: 1.Away From Her 2.Lorenzo’s Oil 3.Mask 4.My Sister’s Keeper 5.Philadelphia 6.Rain Man 7.Steel Magnolias 8.Stepmom 9.The Elephant Man 10.The Mighty 11.The Tic Code Directions:

1.Create a PowerPoint presentation of 10-12 slides using the template “Movie Character Presentation.” 2.Provide an introduction and background overview of the movie character (client). 3.Assess the client using the “Functional Health Pattern Assessment.” 4.Based on your “observations” and thoughts, document your assessment, providing examples from the movie. 5.Describe any observed or potential cultural, geographic, religious, ethnic, or spiritual considerations of this client. 6.Describe two normal health patterns of the client as well as two abnormal health patterns that you observe, and provide examples. 7.Develop an appropriate nursing diagnosis for the client based on your assessment. 8.Identify and describe three interventions for the client: health promotion, health prevention, and maintenance. 9.Identify at least two possible resources or community services to which you would refer this client and provide rationale for your choices. In addition to submitting the presentation to the instructor, post your assignment to the Movie Character Health Assessment Presentation Main Forum as directed by instructor. Respond to other students’ posts in a manner that initiates or contributes to discussion. Each person should make at least three substantive comments. While APA format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are not required to submit this assignment to Turnitin.

Where do you think nursing is in it’s struggle to be recognized as a discipline of knowledge? Support your beliefs on this question by using/discussing three of the characteristics of a discipline. Apply what you have come to know about a discipline to a nursing situation in your workplace/clinical practice area or through personal experience. Tell us the nursing situation, and describe how the characteristics of the discipline are lived in the situation. A nursing situation is defined as any event in which a nurse is engaged with another individual.

– Needs to be APA style

– Refer to the text book ‘Professional Nursing’ by Beth Black, chapters 3, 5, 6, & 8 and other credible articles.

A patient who is 48 hours post–mitral valve replacement surgery has become progressively more hypotensive, tachycardic, tachypneic, and restless over the past several hours. You suspect that the patient is going into shock.

a. Since this patient is at high risk for both cardiogenic and septic shock, how would you go about determining what type of shock (if any) is present? Support your approach.

b. What special challenges are associated with trying to treat septic shock in a patient with cardiovascular disease?

The ethos of scientism and postmodernism has exacerbated the perceived philosophical and cultural tension between science and religion. What is your perception of this tension? Use the lecture and the topic readings to support your response.

According to Rutherford (2008, para. 15), “Improved communication with other nurses, health care professionals, and administrators of the institution in which nurses work is a key benefit of using a standardized nursing language.” In this Discussion you consider the reasoning behind and the value of standardized codification.

To prepare

· Review the information in Nursing Informatics: Scope and Standards of Practice. Determine which set of terminologies are appropriate for your specialty or area of expertise.

· Reflect on the importance of continuity in terminology and coding systems.

· In the article, “Standardized Nursing Language: What Does It Mean for Nursing Practice?” the author recounts a visit to a local hospital to view its implementation of a new coding system. One of the nurses commented to her, “We document our care using standardized nursing languages but we don’t fully understand why we do” (Rutherford, 2008, para. 1). Consider how you would inform this nurse (and others like her) of the importance of standardized nursing terminologies.

· Reflect on the value of using a standard language in nursing practice. Consider if standardization can be limited to a specialty area or if one standard language is needed across all nursing practice. Then, identify examples of standardization in your own specialty or area of expertise. Conduct additional research using the Walden Library that supports your thoughts on standardization of nursing terminology.

Post an explanation of why nurses need to document care using standardized nursing languages and whether this standardization can be limited to specialty areas or if it should be across all nursing practice. Support your response using specific examples from your own specialty or area of expertise and using at least one additional resource from the Walden Library.

Link to Article:

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/StandardizedNursingLanguage.html

– Social Cognitive Theory

1. Describe the background of the theorist, description of the theory, assumptions of the theory, the application of the theory to nursing practice, and the compatibility of the theory to your personal philosophy of nursing.

– APA format.

– 500 words minimun.

– 3 References

– Free of Plagiarism assignment!

I need 1 comment per each post in APA with citation and 2 references per comment not older that 2013.

Post 1

For this week’s discussion, I chose the 5-year old girl with normal weight with obese parents. Unfortunately, this topic hits close to home as our youngest daughter is 4 ½ and both my husband and I have gained significant weight over the past few years and are in the obese category. Most children are able to self-regulate diet and balance what they eat with the amount of energy that they are expending. Parental influence at a young age can have a significant effect on the child’s ability to regulate on their own. Obesity places adults and children alike at a higher risk for hypertension and diabetes than those of normal weight. A child who has obese parents is at a higher risk of becoming obese due to unhealthy eating habits that are learned at home. Obesity is defined in the course text as BMI > 95th percentile for age and gender in children ages 2-18 (Ball, Dains, Flynn, Solomon and Stewart, 2015).

During the child’s health assessment the provider needs to be watchful for any signs of malnutrition as well as over-nutrition. In addition to standard screening using height, weight and BMI, additional nutritional screening should be performed. Below are three specific questions that could be utilized to further assess nutrition and risk for obesity. Can you describe to me all of the foods that the child has eaten in the past 24-48 hours? How many sugary drinks such as soda and juice, does the child drink each day? How many minutes/hours of screen time does your child have per day? Do you have a standard bedtime? How many hours of sleep does the child typically get per night?

Describing the foods that the child has eaten over 24-48 hours will provide a more accurate account of overall nutrition. Specifically asking about sugary drinks such as soda and juice can provide opportunity to discuss the health risks that can be associated with too much sugar intake. Specific questions related to amounts of fruits and vegetables are important as well. Determining if the child is receiving adequate nutrients from the food that they are eating is important. If there is concern that the child may not be receiving enough vitamins and minerals from food, it may be necessary to recommend a multi-vitamin to supplement what the child is missing from diet.

There are multiple studies that have shown that an increased amount of screen time can have devastating effects on children’s health. High volume of screen time whether that is from television, video games, computers or other hand-held devices can lead to increased risk of obesity as well as behavioral problems. Asking questions related to screen time also provides the opportunity to determine where the child eats most of their meals. Does the family eat together at the table? Do they eat while watching television? How often do they eat in the car or on the go due to busy schedules? These factors can be used to determine the risk of the normal weight child at age 5 becoming overweight or obese as they get older. These questions also provide an opportunity to educate parents on healthy eating habits that they can utilize as well to improve the overall health of the family.

Another important factor to determine overall health of the child is determining if the child is getting enough sleep each night. Children are in a period of rapid growth in early childhood and the body needs time to rest so that it can develop appropriately. Asking if the child has a standard bedtime and how many hours of sleep the child gets each night can help determine if the child is getting adequate sleep. In relation to screen time it is important to discuss bedtime habits that the child and parents may have as well. Does the child have their own bedroom? Or do they share with an older sibling or parent? Is there a television in the room? Video games in the room? There are many children whose parents will tell providers that their children are in bed by 8 pm each evening and while that may be a true statement, the child may not actually be going to sleep until much later due to television or other distractions present in the room. This again provides the opportunity to educate family members on the importance of a good night sleep for overall family health.

Strategies to encourage parents to be proactive about child’s health

In addition to the above strategies, maintaining a food dairy can be an excellent tool to determine over time whether there is adequate nutrition for both the child and parents. There are many tools that can be utilized to keep a food diary. A simple notebook and pen works well and with all of the technology available, there are multiple apps such as My Fitness Pal that can be used to track more than the type of food. They can help track calories, fat, cholesterol, sugar as well as exercise. These apps are only as good as the information that the user puts in them. “Parents influence a child’s weight through interactions that shape the development of child eating behaviors.” (Pietrobelli and Agosti, 2017). Parents can be educated on modeling good habits of eating such as eating at the table versus in the care or while watching television. Avoid using food as a reward that can lead to child becoming an emotional eater when they are older. (Pietrobelli and Agosti, 2017). Providing good habits that can be passed on to children can also decrease their risk of depression and eating disorders such as anorexia and bulimia.

Reference

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Pietrobelli, A., & Agosti, M. (2017). Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science. International Journal Of Environmental Research And Public Health, 14(12), doi:10.3390/ijerph14121491

Rub, G., Marderfeld, L., Poraz, I., Hartman, C., Amsel, S., Rosenbaum, I., & … Shamir, R. (2016). Validation of a Nutritional Screening Tool for Ambulatory Use in Pediatrics. Journal Of Pediatric Gastroenterology And Nutrition, 62(5), 771-775. doi:10.1097/MPG.0000000000001046

Watkins, F., & Jones, S. (2015). Reducing Adult Obesity in Childhood: Parental Influence on the Food Choices of Children. Health Education Journal, 74(4), 473-484

Post 2

Diagnostic Tests: Mammography

Mammography is an effective diagnostic test that can help practitioners identify breast cancer at an early stage (Jerome-D’Emilia & Chittams, 2015). Typically, a mammogram is a series of x-ray images capable of detecting tumors too small to be palpated as well as calcium microcalcifications that are associated with breast cancer growth (National Cancer Institute, 2016). Screening mammograms are performed routinely and diagnostic mammograms, specific targeted imaging, are used when changes are identified on screening exams or when visibility is compromised, for example with breast implants (National Cancer Institute, 2016).

It is important to evaluate the validity and reliability of important screening tests like mammography to ensure proper screening and early diagnosis and treatment in affected patients. This early detection allows for a greater array of treatment options and an improved overall prognosis (Jerome-D’Emilia & Chittams, 2015). The reliability and validity of the mammogram increases when used in accordance to recommendations, for instance, in patients over the age of 30, as younger women have increased breast density that affects the diagnostic value (Dains, Baumann, & Scheibel, 2016). In addition, for best results, it is important to adhere to regularly scheduled mammograms, typically done annually for women over the age of 40 (National Cancer Institute, 2016). The National Health Service Breast Screening Programme has developed national guidelines to standardize image assessments and screening programs (Hill & Robinson, 2015). The Breast Imaging Reporting and Database System provides radiologists a uniform way to describe and report findings from mammograms, which helps physicians to appropriately coordinate necessary plans of care (National Cancer Institute, 2016).

At times, mammogram imaging can lead to false-positive results, when radiologists identify abnormalities without the presence of cancer. This can result in over treatment with follow up diagnostic mammograms, ultrasounds, and biopsies to rule out findings (National Cancer Institute, 2016). Predictive values can change if screening is not done properly, and Taylor et al. describes breast positioning as being the most important factor in producing quality mammography images (2017). Ensuring that diagnostic tests provide valuable, accurate, and useful information is key to preventative health care services and early management and treatment of identified disease processes.

References

Jerome-D’Emilia, B., & Chittams, J. (2015). Validation of a cultural cancer screening scale for mammogram utilization in a sample of African American women. Cancer Nursing, 38(2), 83-88. Retrieved from

https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2015-07872-002&site=eds-live&scope=site

National Cancer Institute. (2016). Mammograms. Retrieved from https://www.cancer.gov/types/breast/mammograms-fact-sheet

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Hill, C., & Robinson, L. (2015). Mammography image assessment; validity and reliability of current scheme. Radiography, 21, 304-307. Retrieved from https://ezp.waldenulibrary.org/login

url=https://search.ebscohost.com/login.aspx?direct=true&db=edselp&AN=S1078817415000899&site=eds-live&scope=site

Taylor, K., Parashar, D., Bouverat, G., Poulos, A., Gullien, R., Stewart, E., & … Wallis, M. (2017). Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the

assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment. Radiography, 23(4), 343-349. Retrieved from https://ezp.waldenulibrary.org/login

url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=28965899&site=eds-live&scope=site