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This paper aims to describe how healthcare providers perceived spirituality and spiritual care while caring for dying patients and their families in a hospice setting in Karachi, Pakistan. Using a qualitative interpretive description design, individual in-depth interviews were conducted among healthcare providers. Thematic analysis approach was used for data analysis. Spirituality and spiritual care were perceived as shared human connections, relating to each other, acts of compassion, showing mutual respect while maintaining dignity in care and empowering patients and families. Developing spiritual competency, self-awareness, training and education, and self-care strategies for healthcare providers are essential components promoting spiritual care in a hospice setting.

Purpose: This study explored the underlying process faith community nurses (FCNs) experience in developing their spiritual nursing practice. Design: A qualitative, exploratory design was used. Method: Data from interviews with six FCNs were generated and analyzed using Glaserian grounded theory. Findings: The basic social psychological process, cultivating the soul to become a channel of God, explains the steps these nurses take to achieve stages of presence. Going through these stages of presence, FCNs develop a foundation of God-related beliefs and values, presence with self, presence with God, presence with others, presence with God and others, and become a channel of God. Conclusions: Developing spiritual care competence in assessing and meeting clients’ spiritual needs is necessary to enhance person-centered practice, a vital aspect of holistic care. The model of presence can inform the development of spiritual care competencies and link to other nursing theories including Watson’s theory of caring and Benner’s novice to expert theory. Workplace support is needed for nurses to refine spiritual nursing care practices and integrate spiritual care into practice. Further research regarding the stages of presence could foster deeper understanding of how foundations of God-related values develop.

Family caregivers experience multiple transitions, resolutions, loss, and grief where their search for meaning becomes evident. Spirituality is an important dimension of palliative care, yet little attention has been given to this important aspect of spirituality especially among the family caregivers in a hospice setting. The study aimed to bring the hidden voices of family caregivers, their own spiritual experiences caring for their dying patients in a hospice setting, to guide and direct the care practices of health care professionals. An interpretive descriptive approach guided the study using a purposive sample of 18 family caregivers from a hospice in Karachi, Pakistan. Major themes were family love, attachment, and belongingness; honoring family values and dignity; acts of compassion and selfless service; and seeking God's kindness and grace. Spirituality enabled family caregivers to uncover meaningful engagement and provided strength and peace while serving a dying family member in challenging caregiving situations such as adversity and limited resources. They highly valued the love, respect, and honor of the family; showed compassion; believed in God's blessings; and experienced spiritual growth and self-transcendence. Spirituality was found to be a major resource of coping among family caregivers. Health care professionals need to integrate spirituality while developing family-centered interventions in hospice care.

Introduction: Data show that maternal stress triggered by exposure to a natural disaster before, during or just after pregnancy is associated with adverse pregnancy and newborn outcomes. In this paper, the first aim is to describe our efforts to test a simple, low-cost intervention to large numbers of women following a major natural disaster. The second aim is to outline the challenges faced and lessons learned during the execution of this natural disaster study.Methods: The setting was the May 2016 Fort McMurray Wood Buffalo wildfire in northern Alberta, Canada. Women who were pregnant or preconception at the time of the disaster were invited to participate via social media. This prospective cohort study included a randomized controlled trial to test the effectiveness of an expressive writing intervention on the levels of prenatal maternal stress and maternal, birth, and early childhood outcomes. At recruitment and at multiple timepoints postpartum, a battery of questionnaires was administered to evaluate objective and subjective stress exposure to the fire as well as maternal mental health, resilience and its contributing factors as well as infant developmental milestones. Qualitative content analysis of the expressive writing was conducted.Discussion: There is an increasing need to develop effective, wide-spread, rapid, and low-cost interventions to reduce prenatal maternal stress, increase resilience, and improve pregnancy outcomes following a natural disaster. Though analysis of data is ongoing, we highlight the strengths of this study which include strong community participation, rapid recruitment of eligible participants, low-cost intervention and data acquisition, and successful testing of the intervention. We acknowledge the challenges we encountered including the high rate of participant disqualifications or losses due to incomplete collection of online data; evacuation, dispersal, and inconsistent return to homes; and the high levels of stress accumulated post-disaster which led to inability to complete the study. Despite potential challenges, there remains a need for such research amid natural disasters.

Introduction: A new vision of resilience and well-being for Canadian military service members (SMs), Veterans and their families has been championed by the Canadian Armed Forces (CAF) and Veterans Affairs Canada (VAC). Operationalizing this vision, which aims to support those who serve/have served and their families as they navigate life during and post-service, requires the support of service providers (SPs). Training SPs to deliver complementary resilience-training programs Reaching In… Reaching Out (RIRO; for adults working with parents of young children) and Bounce Back and Thrive! (BBT; for parents of children aged 0–8 years of age) may support this vision.Objective: To assess the appropriateness of RIRO/BBT trainer training for SPs, and RIRO and BBT resilience-training for military populations and families.Methods: This qualitative descriptive study involved the delivery of RIRO/BBT trainer training to SPs (n = 20), followed by focus groups (n = 6) with SPs and organisational leaders (n = 4). Focus groups were recorded, and data were transcribed and thematically-analysed.Results: Several themes emerged: (1) RIRO/BBT trainer training enabled SPs to model resilience and deliver the resilience-training programs, (2) training was appropriate and adaptable for the CAF and SMs/CMFs, and (3) training could support the development of resilient communities.Discussion: RIRO/BBT trainer training and RIRO and BBT resilience-training programs use a holistic, integrated, experiential, and community approach to resilience-building and align with CAF and VAC initiatives. Once contextualised, such programs could support resilience-building in the military context.

The goal of this descriptive qualitative study was to examine the views of students about their experience and development as scholars during the first two years of an online cohort nursing doctoral program. A secondary goal was to seek the views of faculty members very involved in the program. Semi-structured interviews were conducted with 10 of the 13 students of the first two online cohorts and five faculty members. Four themes emerged from the data: adjusting to the program; the group as emotional and academic support; reflections on teaching and learning; and becoming a scholar. The findings suggest that the students were developing as scholars, and that the cohort model was a source of support for them. Similar to other PhD students, transition into doctoral education necessitated finding a new balance between other commitments and doctoral studies. Providing opportunities to engage with faculty outside of courses is important.

The preconception, pregnancy and immediate postpartum and newborn periods are times for mothers and their offspring when they are especially vulnerable to major stressors – those that are sudden and unexpected and those that are chronic. Their adverse effects can transcend generations. Stressors can include natural disasters or political stressors such as conflict and/or migration. Considerable evidence has accumulated demonstrating the adverse effects of natural disasters on pregnancy outcomes and developmental trajectories. However, beyond tracking outcomes, the time has arrived for gathering more information related to identifying mechanisms, predicting risk and developing stress-reducing and resilience-building interventions to improve outcomes. Further, we need to learn how to encapsulate both the quantitative and qualitative information available and share it with communities and authorities to mitigate the adverse developmental effects of future disasters, conflicts and migrations. This article briefly reviews prenatal maternal stress and identifies three contemporary situations (wildfire in Fort McMurray, Alberta, Canada; hurricane Harvey in Houston, USA and transgenerational and migrant stress in Pforzheim, Germany) where current studies are being established by Canadian investigators to test an intervention. The experiences from these efforts are related along with attempts to involve communities in the studies and share the new knowledge to plan for future disasters or tragedies.

Background: Family caregivers experience spiritual and existential concerns while caring for their terminally ill family members. Aim: To evaluate and synthesise studies on spirituality among family caregivers in palliative care. Design: An integrative literature review of peer-reviewed articles published between 2000 and 2016. Sample: Participants were family caregivers (parents, spouses, relatives or friends) caring for an adult (age>18 years) family member with a terminal illness in a palliative care setting. Results: Data from 26 published research papers were systematically analysed. Five themes were identified regarding spirituality and family caregiving: a close and meaningful connection, spirituality as a way of coping, spiritual needs and expressions among family caregivers, spirituality to transcend fears, and spirituality in family caregivers' decision-making. Implications for Practice: Nurses are encouraged to explore the spirituality and spiritual experiences of family caregivers to support their spiritual wellbeing while caring for their terminally ill family members.

Background: Limited skill in health literacy is a global issue. Variation in health literacy skills within societies is a source of health inequality unless health care providers apply health literacy practices to effectively communicate with all clients. Objective: This study examined Iranian registered nurses' knowledge of and experience with health literacy practices. Methods: This cross-sectional study provides a quantitative description of knowledge of and experience with health literacy practices. Using a rigorous process, we adapted the Health Literacy Knowledge and Experience Survey to collect data from the participants, who were 190 registered nurses working in Tehran, Iran. Key Results: Findings identify gaps in participants' knowledge and experience with health literacy practices. Knowledge deficits are most noticeable in standards to create written materials, screening tools to identify limited health literacy, and the Teach-Back strategies to determine people's understanding. Limited experience is prominent in using health literacy screening tools, evaluating written health information, and applying technologies to provide health information. Our multivariate analysis suggests participants who reported more interaction with health care professionals for personal reasons scored higher in knowledge of health literacy practices. Conclusions: This study indicated that registered nurses in Iran do not have adequate knowledge and experience regarding health literacy practices. Addressing this issue is fundamental to promoting health equity. Future investigations should identify both barriers and facilitators for nurses to apply health literacy practices. [ HLRP: Health Literacy Research and Practice . 2019;3(4):e268–e279.] Plain Language Summary: Health literacy practices enable health care professionals to offer understandable health information to all people and contribute to health equity. We surveyed 190 registered nurses in Iran to assess their knowledge of and experience with health literacy practices. The findings will be a guide to create interventions to improve registered nurses' knowledge of these practices and to use them to communicate clearly with clients.

Background Nurses are increasingly expected to provide care for older persons; however, there are too few nurse educators with expertise in older person care to ensure students graduate with the requisite competencies. Methods An integrative review, using Whittemore and Knafl's framework, was undertaken to identify and synthesise evidence about factors affecting nurse educators' knowledge, skills or attitudes about older persons and their care. Results Forty-four articles met the inclusion criteria. All but three papers originated in the USA. Content analysis yielded three central themes: external-level factors, employer-level factors and individual-level factors. Findings demonstrated that external funding from philanthropic organisations and government agencies supported many of the national, regional and site-specific initiatives, which were, in many cases, underpinned by professional regulatory frameworks. Negative attitudes of administrators and reduced budgets of educational institutions impeded the availability of such initiatives. Negative attitudes of individual educators towards older person care and the specialty of gerontology constrained their pursuit of such learning, as did their lack of awareness of current gerontology resources. Conclusions The lack of educators with gerontology knowledge, skills and requisite attitudes requires a focused effort from external and professional bodies, and from educational institutions to ensure the resources are available to enhance educator expertise in gerontology. Rigorous study addressing the factors influencing educators' knowledge, skills or attitudes towards older persons and their care is required. Implications for practice Addressing the lack of nurse educator expertise in gerontology could help to ensure new nurses have the required competencies to provide quality older person care.

Aims and objectives To identify the current state of knowledge about the use of the sit-to-stand intervention with older people and to identify implications for further research. Background Many older people experience mobility challenges which can negatively affect their well-being. Physical activities are vital to improving or maintaining mobility. Although there is evidence that mobility challenged older people benefit from the sit-to-stand intervention, there is a need to systematically examine the state of knowledge about this intervention. Design Scoping review using Arksey and O'Malley's methodological framework. Methods A systematic search of three databases was completed. Abstracts were evaluated for relevance using predetermined inclusion criteria. Studies that met the inclusion criteria had data extracted and were appraised for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues. Results Of 3,041 papers, six studies met the inclusion criteria. Publications provided a range of sit-to-stand interventions with durations varying from four weeks to six months. The frequency of each intervention fluctuated from three to seven times/week with a duration of 15-45 min. Different professionals prompted the activity. Three themes were identified the following: (a) sit-to-stand activity as an intervention; (b) generalisability of findings; and (c) sustainability. Conclusions Most of the studies reviewed indicated improvements in performance of the sit-to-stand activity and in motor function. However, issues with studies rigour do not allow us to make generalisations. Further research is needed to confirm the effectiveness of the intervention. Implications for practice Healthcare providers are expected to offer evidence-based patient care. This review details current knowledge about the sit-to-stand intervention with older people.

Introduction: The purpose of this scoping review is to identify measures of spiritual fitness that can be used in a military context. Methods: Two independent reviewers applied post-hoc inclusion and exclusion criteria for the identification of relevant articles, reviews, and assessments. Each reviewer independently recorded criteria met using a jointly developed form, considering relevant spiritual fitness screening and assessment tools based on clinical experience. When two reviewers were in disagreement, a third blinded reviewer was used to create consensus. Results: 35 assessments with psychometric properties were identified that could be administered by military chaplains, health care professionals, or military personnel (through self-reporting) to evaluate spiritual fitness over time among those in the military service. The assessments were compiled into a table to isolate differing properties of each assessment, including target population, length/time to complete, measurement of affective, behavioural, and cognitive aspects of spiritual fitness, psychometric properties, and example questions. Discussion: There is now an opportunity to further identify and evaluate spiritual fitness screening and assessment tools that will appropriately and effectively determine the spiritual fitness and resilience of individuals serving in the military as well as their families.

The worst disaster of natural origin in recent Canadian history occurred in May 2016 in the northern Alberta community of Fort McMurray Wood Buffalo (FMWB). Among the 88,000 people abruptly evacuated amidst a raging wildfire were approximately 1850 pregnant or pre-conception women. Based on the Allostatic Load and Preterm Birth Conceptual Framework (Olson et al., 2015) [1], a simple, cost-effective expressive writing intervention following Pennebaker's work (Pennebaker and Beall, 1986; Pennebaker et al., 2007) [2,3] was implemented in a primary study to help mitigate the negative effects of stress on a sample of these women and their unborn children. Journal writing served as an intervention in the primary study while the contents of the journal entries became the data analyzed in this qualitative study. This study utilized both inductive and deductive thematic analysis of journal entries completed by 54 women over four consecutive days (15 min/day). Deductive analysis followed a coding structure that was generated from two resilience scales. Themes that emerged during inductive analysis were also coded. The main themes that emerged described the women's challenging experiences: fears for themselves and their offspring, fire-related and past trauma, and relationship changes. Resilience characteristics and practices also emerged from the writings and mirrored those found in the literature: (a) post-traumatic growth, (b) adaptability, (c) emotional/social connectedness, (d) composure, and (e) reasoning. This paper highlights the challenging experiences of pregnant women exposed to a disaster and the resilience they demonstrated in the face of the tragedy.

Purpose – The purpose of this paper is to test a model linking physical therapy (PT) and occupational therapy (OT) practitioners’ perceptions of resonant leadership, structural empowerment and psychological empowerment to their experiences of spirit at work (SAW), job satisfaction and organizational commitment within the Canadian workplace. Design/methodology/approach – The authors tested the model using LISREL 8.80 and survey data from 101 OTs and 169 PTs, randomly selected by the Alberta professional licensing associations. Content analysis of responses to the open-ended comments section provided additional depth and insight. Findings – Analysis of results culminated in minor modifications to the original theoretical model, creating separate PT and OT models. Both models revealed a good fit with the observed data. Several SAW concepts accounted for moderate to large amounts of variance in both PT and OT models, indicating that SAW is a comprehensive workplace outcome. Research limitations/implications – Theory was derived from business and nursing research literature due to limited rehabilitation research literature. Discussion of OT results must consider the small sample size. This study is initial exploratory research. Practical implications – Each discipline-specific model provides professionals, health care leaders and policy makers with a rich body of information upon which to base beneficial workplace decisions. SAW will guide leaders in the holistic development and enrichment of the work environment. Originality/value – This research contributes to the substantive knowledge of the OT and PT disciplines, particularly in the areas of leadership, workplace structural organization and indicators of healthy work environments such as SAW, empowerment, job satisfaction and organizational commitment.

Despite mandates to provide spiritual care, confusion persists among nurses about spirituality, spiritual needs, and related roles. To discover how practicing nurses acquire knowledge for spiritual care, the authors chose a grounded theory design. They constantly compared and analyzed verbatim transcribed interview data to find the core variable, categories, and properties. Connection, manifesting as a state, act, or process, appeared throughout the data. Categories emerged as Needing Connection, Nurturing Connection, Learning Connection, and Living Connection. Nurses used a cyclical, intertwined, and progressive learning process of opening to, struggling with, and making connections between numerous discrete personal and professional experiences. Shifting attention between these interconnected experiences fueled knowledge acquisition. Whether referring to how nurses learn, what they do, or with whom, the theory Connecting Spiritually joined categories into a cumulative experiential learning process that explained how nurses learn to care for spiritual needs.

Aims. The aims of this paper are to add clarity to the discussion about paradigms for nursing research and to consider integrative strategies for the development of nursing knowledge. Background. Paradigms are sets of beliefs and practices, shared by communities of researchers, which regulate inquiry within disciplines. The various paradigms are characterized by ontological, epistemological and methodological differences in their approaches to conceptualizing and conducting research, and in their contribution towards disciplinary knowledge construction. Researchers may consider these differences so vast that one paradigm is incommensurable with another. Alternatively, researchers may ignore these differences and either unknowingly combine paradigms inappropriately or neglect to conduct needed research. To accomplish the task of developing nursing knowledge for use in practice, there is a need for a critical, integrated understanding of the paradigms used for nursing inquiry. Methods. We describe the evolution and influence of positivist, postpositivist, interpretive and critical theory research paradigms. Using integrative review, we compare and contrast the paradigms in terms of their philosophical underpinnings and scientific contribution. Findings. A pragmatic approach to theory development through synthesis of cumulative knowledge relevant to nursing practice is suggested. This requires that inquiry start with assessment of existing knowledge from disparate studies to identify key substantive content and gaps. Knowledge development in under-researched areas could be accomplished through integrative strategies that preserve theoretical integrity and strengthen research approaches associated with various philosophical perspectives. These strategies may include parallel studies within the same substantive domain using different paradigms; theoretical triangulation to combine findings from paradigmatically diverse studies; integrative reviews; and mixed method studies. Conclusion. Nurse scholars are urged to consider the benefits and limitations of inquiry within each paradigm, and the theoretical needs of the discipline.

Este é um estudo etnográfico enfocado, realizado com 10 mães de pré-adolescentes da OASE (Ordem Auxiliadora Senhoras Evangélicas) em Timbó, Santa Catarina, Brasil. O objetivo foi descrever variações em padrões dos fenômenos promoção de saúde, qualidade de vida e comportamento de risco a partir das perspectivas das mães, explorando como influenciam seus filhos, protegendo-os de comportamento de risco tais como álcool, fumo, outras drogas e violência. Utilizamos entrevista semi-estruturada, observação participante, diário de campo, genograma e fotografias. Os dados foram analisados segundo Bardin e os resultados agrupados em 4 categorias: mães encaram sua função como desafio; ser saudável como condição de qualidade de vida; impedimentos para atingir qualidade de vida; práticas de promoção à saúde para proteger filhos de comportamento de risco. O estudo evidenciou a crença das mães como participantes na promoção de saúde, o que poderá orientar a elaboração de políticas de saúde e encorajar mudanças de comportamento. This is a focused ethnography study of 10 preadolescents' mothers who participate in OASE (Help Group of Evangelic Women) in Timbó, Santa Catarina, Brazil. The purpose of the study was to describe variances in patterns of health promotion, quality of life and preadolescents' risk behavior from the mothers' perspective, exploring how they influence their children and protect them in terms of risk behavior such as alcohol, tobacco, other drugs and violence. Semistructured interviews, participant observation, field notes, genograms and photography were used for data collection. Data were analyzed according to Bardin and the results were grouped in 4 categories: mothers see their function as a challenge; being healthy as a condition for quality of life; obstacles to achieve quality of life; health promotion practices to protect preadolescents from risks. The study showed mothers see themselves as participants in health promotion, which can guide health policy makers and encourage behavioral changes. Estudio etnográfico enfocado, realizado con 10 madres de preadolescentes que participan en OASE (grupo de ayuda de mujeres evangélicas) en Timbó, SC/Brasil. El objetivo fue describir las variaciones sobre los patrones de promoción de la salud, calidad de vida y comportamiento de riesgo bajo las perspectivas de las madres, explorando como estas influyen en sus hijos y los protegen de comportamientos de riesgo como alcohol, cigarro, otras drogas y violencia. Se utilizaron: entrevista semiestructurada, observación participante, diario de campo, genograma y fotografías. Los datos fueron analizados con base en Bardin y los resultados formaron cuatro categorías: madres encaran su función como un desafío; ser saludable como condición de calidad de vida; impedimentos para alcanzar calidad de vida; prácticas de promoción de salud. El estudio evidenció la creencia de las madres como participantes en la promoción de la salud, lo que puede orientar la elaboración de políticas de salud y estimular cambios comportamentales.

Nurse educators must confront the issue of nursing students' personal safety in community health practice, provide the necessary knowledge and skills, and document their actions. Learning opportunities are required to assist students to recognize and evaluate risks, and prevent their consequences. Thematic analysis of interviews with 56 public health nurses in Alberta, Canada uncovered knowledge, skill, and attitudinal components of risk assessment. Categories under the theme framing personal risk in work environments and the sub-themes framing for action and framing for no action provided a conceptual framework for planning educational strategies. Based on how these nurses framed their personal risk, 4 educational strategies are presented: a checklist, small group learning activities, a template for Web-based courseware, and a problem-based learning scenario.

Canadian researchers have developed the Spirit At Work (SAW) tool for identifying the experiences of individuals who are passionate about and energized by their work. This article describes (a) what registered nurses perceive as contributing to their personal SAW; and (b) the relationships among resonant leadership, structural empowerment concepts, psychological empowerment concepts, SAW concepts, job satisfaction, organizational commitment, and the demographic variables of experience, education, and rank in the RN workplace. The theoretical model was tested using LISREL 8.80 and survey data from 147 randomly selected RNs. Engaging work was found to account for 63% of the explained variance in the model's endogenous variables. Spiritual connection had a causal effect on organizational commitment, while resonant leadership and individual empowerment had significant causal influence on SAW, job satisfaction, and organizational commitment. These results strengthen those of previous studies reporting workplace structures/processes/contributions leading to superior care environments. Future studies will clarify the role of SAW in the workplace.

Purpose: To demonstrate how a middle-range theory was developed and tested through research that examined relationships between nurse-expressed empathy and two patient outcomes: patient-perceived empathy and patient distress. Significance: Nurse-patient relationships are the basis for all nursing care and empathy is an important aspect of these relationships. Research is needed, however, to determine the patient outcomes that are related to the empathy of nurses. Organizing Framework: Orlando's (I 96 1, 1972) nursing model. Scope: 140 subjects, 70 staff RNs and 70 patients from hospital medical-surgical acute care units. Each nurse-subject completed two measures of nurse-expressed empathy and each patient-subject completed a measure of perceived empathy and two measures of distress. Findings: Negative relationships were found between nurse-expressed empathy and patient distress (r = -.71, p < .001), and between patient-perceived empathy and patient distress (r = -.71, p < .007). A moderate positive relationship was found between nurse-expressed empathy and patient-perceived empathy (r = .35 to .47, p < .05). Conclusions: A model can be tested when propositions theoretically linked to the model are empirically tested. This study's findings demonstrated support for relationships proposed in Orlando's model.

It is increasingly important that nursing care be associated with measurable patient outcomes. A correlational study examined relationships between nurse-expressed empathy and two patient outcomes: patient perceived empathy and patient distress. Subjects (N = 140) were randomly selected from RNs and patients on medical and surgical units in two urban, acute care hospitals. Nurse-subjects (N = 70) completed two measures of nurse-expressed empathy: the Behavioral Test of Interpersonal Skills and the Staff-Patient Interaction Response Scale. Patient-subjects (N = 70) completed the Profile of Mood States, the Multiple Affect Adjective Checklist, and the Barrett-Lennard Relationship Inventory. Findings indicated a negative relationship (r = .71, p < .001) between a set of empathy variables and a set of patient distress variables and a positive relationship between nurse-expressed and patient perceived empathy (r = .37-.47, p < .05). This study is one of the first to link behavioral measures of nurse empathy to patient outcomes.

The purpose of this exploratory study was to gain insight into students' perceptions of learning to nurse families using a team approach. A sample of 112 thirdyear baccalaureate nursing students provided data from clinical journals and responses to a teacher-developed questionnaire regarding number of home visits made with a partner, the extent to which partners shared responsibility for the nursing care of two families, perceived benefits and disadvantages of teamwork, roles assumed by team members, perceived outcomes of the team approach, and suggestions for revision of the approach. The degree to which students shared responsibility was moderate and positive perceptions of teamwork were significantly correlated with the degree of sharing of nursing activities. Using Spradle/s qualitative method of domain analysis, interpretation of data from students' clinical journals revealed subjective aspects of the experience that appeared to influence teamwork practices and attitudes. Results suggest that the shared assignment approach offers students a unique opportunity to learn about the realities of collaborative nursing practice.

Clarification of conceptualizations of empathy Background. If understanding our clients needs, emotions, and circumstances is fundamental to nursing practice, and empathy is the foundation of that understanding, then a conceptualization of empathy that can be used by nurses is of utmost importance to the profession. In 1992, Morse, Anderson, Bottorff, Yonge, O’Brien, Solberg and McIlveen analysed the concept of empathy in the psychological and nursing literature, and suggested the conceptualization of empathy was incomplete. Since that time, nurse authors have continued to publish conceptualizations and research on empathy. Purpose. The purpose of our analysis was to describe empathy as presented in the nursing literature between 1992 and 2000. Method. A concept clarification methodology of concept analysis was used because of the many definitions, the rich descriptions, and the application of empathy as a research variable in the reviewed literature. Findings. Five conceptualizations of empathy were revealed: empathy as human trait, empathy as a professional state, empathy as a communication process, empathy as caring, and empathy as a special relationship. Conclusions. The literature reviewed contained evidence that the concept is developing more depth and breadth. Nurse authors are approaching empathy from a variety of perspectives, time frames, measurements, and outcomes. While all are important to the development of the concept, further enrichment of the conceptual work on empathy is needed before a fully mature concept emerges that is fully useful in nursing practice, research, and education.

This study investigated the effects of a training module on the active listening skills of non-degree registered nurses. Active listening skills were defined as understanding what another person is saying and feeling and then communicating this understanding of his thoughts and feelings back to him. The sample consisted of 26 postdiploma RNs registered in the first year of a baccalaureate degree nursing program. Pretraining and posttraining data were collected when subjects verbally responded to two portions of the Behavioral Test of Interpersonal Skills for Health Professionals (BTIS). Subjects were audiotaped while responding and tapes were scored using BTIS guidelines. Paired t-tests were used to determine differences between pretraining and posttraining scores. Active listening scores increased significantly (p_< .0005) while attempts to suppress or discount speakers' feelings decreased significantly (2