Programs of Research
I have two active, but related programs of research:
A) The development and testing of emotional expression (story-telling) as a nursing intervention to facilitate meaning-making among Alzheimer Disease family caregivers to reduce caregiver burden; and
B) The identification of dispiritedness as a distinct subsyndromal form of depression and the use of meaning-making (narrative therapy) as a nursing intervention to facilitate inspiritedness among persons in later life experiencing dispiritedness.
Emotional Expression as an Intervention to Reduce Alzheimer Disease Family Caregiver Burden
Emotional expression has long been given a central role in the practice of nursing and psychology. The notion of having persons talk about their traumatic experiences is foundational to the practice of nurses engaged in counseling and psychotherapy. Therapists and researchers have long known that the expression of emotions is vital to mental health and physical health, while the inhibition of emotion has detrimental health effects.
James W. Pennebaker at the University of Texas has developed an extensive program of research testing the effectiveness of emotional expression in both healthy persons and in those persons who have experienced particular traumatic events. Numerous controlled studies testing emotional expression which involved asking participants to either write about or talk about a traumatic event for 20 minutes, once a day, for three days have reported overall improvements in psychological well-being, physical health, and general functioning including: decrease visits to a health clinic, report fewer illness related symptoms; decreased depression; and increased immune function.
Pennebaker postulates that the process of telling one's story, written or expressed verbally, is potentially a process of constructing a story into a meaningful and coherent whole which facilitates meaning-making. The transduction of a traumatic experience into a linguistic structure (story) promotes the assimilation and understanding of the event resulting in positive cognitive and physiological changes.
Currently, I am testing the emotional expression intervention with Alzheimer Disease family caregivers. The grant is funded by the National Institute of Nursing Research (1 R15 NR08213-01), the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Program Coordinated by the American Academy of Nursing, and the Gerontological Nursing Intervention Research Center at the University of Iowa. The abstract of the study is presented below:
ABSTRACT OF STUDY
The purpose of this study is to evaluate the effect of structured written emotional expression (SWEE) in decreasing the emotional and physiological burdens in family caregivers of persons with Alzheimer disease and related disorders (ADRD). SWEE is an intervention postulated to facilitate the making of meaning and involves asking participants to write for 20 minutes an account expressing their deepest thoughts and feelings about a stressful and traumatic experience. Negative consequences from the stress of ADRD caregiving are well documented in the research literature, with family caregivers being more stressed, burdened, and depressed than non-caregivers. The specific aims of this study are to: 1) determine the effect of SWEE on finding meaning (Finding Meaning Through Caregiving Scale); 2) determine the mediating effects of finding meaning on caregiver burden (Burden Interview), depression (CES-D), self reported physical symptoms (Pennebaker Inventory of Limbic Languidness), and salivary cortisol measured QID over two days; and 3) determine the effect of SWEE on caregiver burden, depression, self-reported physical symptoms, and salivary cortisol. Ninety caregivers will be randomly assigned to either an experimental or a comparison group. All caregivers will experience a total of three 20-minute writing sessions scheduled every other day. All outcome measures will be collected at pretest, 4th and 5th day post-test, and twice at one-month post intervention. Experimental group participants will be asked to write about their deepest thoughts and feeling related to the caregiving process while those caregivers in the comparison group will be asked to write about as non-emotional topics as possible. The researchers hypothesize that caregivers experiencing SWEE will report higher provisional finding meaning and that higher provisional meaning is positively associated with lower caregiver burden, decreased depression, decreased self-reported physical symptoms, and decreased salivary cortisol dysregulation. Given the negative health outcomes in family ADRD caregivers, an easily administered and low cost intervention that has an impact on improving the health outcomes is both significant and timely.
The Experience of Dispiritedness in Later Life
A second area of research concerns the experience of "dispiritedness in later life." From my experience of working with older persons diagnosed with Major Depression, I began to become aware that many elderly who are diagnosed as depressed do not fit the criteria established in the DSM-IV-TR manual. Rather, I have come to view depression more as a spectrum than as a category. The spectrum of depression ranges from subsyndromal depression to despair: sadness, dispiritedness, subsyndromal symptomatic depression, mild depressive disorder, chronic sorrow, depletion syndrome, Major Depression, and despair. My specific interest is in the identification and treatment of more mild syndromes of depression in later life that are under recognized and under treated. Without treatment, subsyndromal depressive syndromes may evolve into more severe experiences of depression.
Of particular interest is the experience of dispiritedness. Dispiritedness
describes a personal experience and does not have the connotation of a
diagnostic category, disease, mental illness, or abnormality. The phrase,
"my spirits are low" is a common expression reflecting the phenomenon
of dispiritedness. There are few references to dispiritedness in the health
literature. Jourard (1971), a existential-humanistic psychologist, described
"dispiritation" (p. 9) as a phenomenon related to, yet different
from, depression by emphasizing the subjectivity of dispiritedness.
Jourard further characterized dispiritedness as feelings of hopelessness,
purposelessness, meaninglessness, worthlessness, low self-esteem, and
isolation. Bugental and Bugental (1984), also existential-humanistic psychologists,
extended Jourard's work by identifying dispiritedness and defining it
as a "condition of blocked intentionality" (p. 50). Dispiritedness
is also viewed as a common human experience. Periods of being in low spirits
is a normal occurrence in the life process of human beings (Bugental,
1980). Bugental (1980) explained that "change is a common characteristic
of all living things and . . . our bodies are constantly flowing and evolving"
and believes that when "flow is interrupted to some extent, the person
experiences a drop in spirits" (p. 52). A "dysphoric, blue,
unhappy tone . . . a complaint of a lack of energy and inability to mobilize
oneself to act . . . a recurrent sense of blunted intention" is characteristic
of "low-spirited times" (Bugental, 1980, pp. 51-52).
In my dissertation work, I identified 10 themes that describe dispiritedness as a distinct phenomena in later life:
Dispiritedness is an:
1)
A resonating integral human experience in later life
2) Experiencing the ebb and flow of dissipating energy
3) Perception of an abyss of emptiness
4) Emerges amidst life's adversity
5) Feeling adrift in swirling chaos while out of rhythm with the world
6) Enduring adversity while wanting to relinquish the will to live
7) Moving aimlessly and apprehensively through a dense fog with uncertainty
8) Feeling detached, alone, and disconnected from the flow of life
9) Expressed as dwindling vitality and liveliness
10) Active involvement, connectedness, and maintaining hope propels inspiritedness.
Using the Unitary Field Pattern Portrait research method the 10 themes were synthesized together to create a following portrait of dispiritedness in later life:
Dispiritedness is experiencing the resonating ebb and flow of dissipating energy while perceiving of an abyss of emptiness amidst enduring adversity in later life. Dispiritedness embraces loneliness, disconnectedness, and feeling of being adrift in swirling chaos while out of rhythm with life's flow. Dispiritedness is expressing dwindling vitality, liveliness, and wanting to relinquish the will to live, yet, moving aimlessly and apprehensively through a dense fog with uncertainty. Active involvement, connectedness, and maintaining hope propels inspiritedness.
My particular interest is in developing and testing meaning-making interventions that are designed to facilitate the movement from dispiritedness toward inspiritedness.
Butcher,
H.K. (1996). A unitary field pattern portrait of dispiritedness in later
life. The Journal of Rogerian Nursing Science, 4, 41-58.
Scholarship Expanding the Science of Unitary Human Beings
In addition to the two programs of research described above, a significant amount of my scholarship is concerned with the development of research and practice methodologies specific to Rogers' Science of Unitary Human Beings. These efforts have lead to the development of the Unitary Field Pattern Portrait research method, and an expansion of the Rogerian Practice Model [Pattern Manifestation Knowing and Appreciation & Voluntary Mutual Patterning] to include a system of ethics intrinsic to the Rogerian Nursing Science. I've also developed a model of Rogerian Praxis that is a synthesis of the Rogerian practice and research models.
The Unitary Field Pattern Portrait Research Method
The Unitary Field Pattern Portrait Research Method (UFPP) was developed as a means to create a unitary understanding of the dynamic kaleidoscopic and symphonic pattern manifestations emerging from the pandimensional human/environment mutual process as a means to enhance understanding a a significant human experience related to well-being. The method is specific to Rogers Science of Human Beings and was derived from her postulates and principles. The steps of the method are listed below:
1. Initial Engagement is a passionate search for a research question of
central interest to understanding unitary phenomena associated with human
betterment and well being.
2. A priori Nursing Science identifies the Science of Unitary Human Beings
as the researcher's perspective. As in all research, the perspective of
the researcher guides all processes of the research method including the
interpretation of findings.
3. Immersion involves becoming steeped in the research topic. The researcher
may immerse in poetry, art, literature, music, dialogue with self and
other, research literature or any activity that enhances the integrality
of the researcher and the research topic.
4. Pattern manifestation knowing and appreciation, formally referred to
as pattern appraisal, includes participant selection, in-depth dialoguing,
and recording pattern manifestations. Participant selection is made using
intensive purposive sampling. Patterning manifestation knowing and appreciation
occurs in natural setting and involves using pandimensional modes of awareness
during in-depth dialoguing. The activities described earlier in the pattern
manifestation knowing and appreciation process in the practice method
are used in this research method. However, in the UFPP research method
the focus of pattern appreciation and knowing is on experiences, perceptions,
and expressions associated with the phenomena of concern. The researcher
maintains an informal conversational style while focusing on revealing
the rhythm, flow, and configurations of the pattern manifestations emerging
from the human/environmental mutual field process associated with the
research topic. The dialogue is taped and transcribed. The researcher
maintains observational, methodological, theoretical field notes, and
a reflexive journal. Any artifacts the participant wishes to share that
illuminates the meaning of the phenomenon may also be included. Artifacts
may include pictures, drawings, poetry, music, logs, diaries, letters,
notes, or journals.
5. Pattern profile construction is the process of creating a pattern profile
for each participant using creative pattern synthesis. All the information
collected for each participant is synthesized into a narrative statement
revealing the essence of the participant's description of the phenomena
of concern. The field pattern profile is in the language of the participant.
The participant's field pattern profile is shared with the participant
for verification and revision.
6. Mutual unitary field pattern profile construction is the process of
mutually sharing an emerging joint or shared profile with each successive
participant at the end of each participant's pattern manifestation knowing
and appreciation process. For example, at the end of the interview of
the fourth participant, a joint construction of the phenomenon is shared
with the participant for comment. The joint construction (mutual unitary
field pattern profile) at this phase would consist of a synthesis of the
profiles of the first three participants. After verification of the fourth
participant's pattern profile, the profile is folded into the emerging
mutual unitary field pattern profile. Pattern manifestation knowing and
appreciation continues until no new pattern manifestations to add to the
mutual unitary field pattern profile.
7. Unitary Field Pattern Portrait Construction is the process of identifying
emerging unitary themes from each participant's field pattern profile,
sorting the unitary themes into common categories, creating the resonating
unitary themes of human/environmental pattern manifestations through immersion
and crystallization, and synthesizing the resonating themes into a descriptive
portrait of the phenomenon. The unitary field pattern portrait is expressed
in the form of a vivid, rich, thick, alive, and accurate aesthetic rendition
of the universal patterns, qualities, features, and themes exemplifying
the essence of the dynamic kaleidoscopic and symphonic nature of the phenomenon
of concern.
8. Lastly, the unitary field pattern portrait is interpreted from the
perspective of the Science of Unitary Human Beings creating a theoretical
unitary field pattern portrait of the phenomenon. The purpose of theoretical
unitary field pattern portrait construction is to explicate the theoretical
structure of the phenomenon from the perspective of Rogers' Nursing Science.
The theoretical unitary field pattern portrait is expressed in the language
of Rogerian Science thereby lifting the unitary field pattern portrait
from the level of description to the level of unitary science. Scientific
rigor is maintained throughout of processes by using criteria of trustworthiness
and authenticity. The findings of the study are conveyed in a Unitary
Field Pattern Report.
Butcher, H.K. (2001). Nursing
Science in the New Millennium: Practice and Research within Rogers' Science
of Unitary Human Beings. In M. Parker (Ed). Nursing theories and nursing
practice.(pp. 205-226) Philadelphia: F.A. Davis.
Rogerian-Ethics
From an in-depth ethical analysis of Martha E. Rogers' life and her work, I uncovered a system of values and virtues inherent to the Science of Unitary Human Beings. Since values are inseparable from any work of science, the values intrinsic to the Science of Unitary Human Beings need to be explicitly and intentionally incorporated into any Rogerian research and practice model.
Butcher, H.K. (1999). Rogerian-ethics: An ethical inquiry into Rogers' life and science. Nursing Science Quarterly, 12, 111-118.
Rogerian-Praxis Model
Praxis is the integration of theory, practice, research, and action. Rogerian-Praxis is a nexus of self-reflection, theory, and research relevant to the world nurtured by actions that emerge from Rogerian Science for the purpose of enhancing knowing participation in change and promoting human betterment. The Rogerian-Praxis model shows how Rogers' philosophy describing a unitary cosmology-ontology-epistemology-ethics guides development of mid-range Rogerian research methods which in turn provide the basis for both the Unitary Field Pattern Portrait research method and the Rogerian Pattern-Based practice model. Both the research and practice models include the phases Pattern Manifestation Knowing and Appreciation & Voluntary Mutual Patterning.
Home Introduction Vitae Research Courses
The
University of Iowa College of Nursing
324 Nursing Building
Iowa City,
IA 52242
Ph: 319-335-7039
Fax: 319-335-9990
howard-butcher@uiowa.edu
