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PubMed1999

Breast cancer screening and African American women: fear, fatalism, and silence.

PURPOSE/OBJECTIVES: To explore the beliefs, attitudes, and practices related to breast cancer and breast cancer screening among low- and middle-income African American women. DESIGN: Qualitative study using focus group methodology. SAMPLE/SETTING: 26 African American women, age 40-65, selected from three employment groups, recruited from a community-based center and a local teacher's union in a moderate-sized urban area. METHODS: Three 90-minute focus group discussions exploring breast cancer beliefs, attitudes, and practices were audiotaped, transcribed verbatim, and analyzed using thematic context analysis techniques. FINDINGS: When breast cancer was discussed, fear was the predominant feeling expressed in all groups. This fear was a primary reason not to engage in breast cancer screening. Unemployed women and service workers emphasized the role of violence in causing breast cancer, whereas teachers discussed injury and sex as causing breast cancer. All participants stressed that breast cancer is seldom discussed within the African American community. Teachers added that this secrecy within the African American community leads to breast cancer being viewed as a white woman's disease. CONCLUSIONS: Despite initiatives promoting breast cancer awareness. African American women still hold misconceptions regarding the etiology of breast cancer and fatalistic perspectives regarding breast cancer outcomes, perhaps because breast cancer is discussed infrequently. Because pain, fear, and fatalism were discussed in all groups, future research should address the influence of these factors to increase screening behaviors. IMPLICATIONS FOR NURSING PRACTICE: Because unemployed women, service workers, and teachers differed in their beliefs about breast cancer and breast cancer screening, nurses must be mindful of the need to tailor Interventions to address the needs of both low- and middle-income African American women.

Adult↗
PubMed2002

Chronic illness care as a balancing act. A qualitative study.

OBJECTIVE: Current health care reforms aim to assist general practitioners in providing chronic illness care. This study investigates GPs' models of care including their role and responsibilities and their delivery of care models. METHODS: Sixteen GPs, as key informants representing diverse backgrounds, were interviewed about their general chronic illness care and responses to case vignettes. Thematic analysis was based upon the categorizing of GP interviews. RESULTS: The key responsibility in GP models of care was to address the presenting problem and to manage disease and treatment. Models encompassed providing preventive and psychosocial care; and care coordination, but in relation to need as time permitted. Experience and education, rather than reforms and incentives shaped care models. While patient-centredness was a universal theme, gender and location influenced its implementation. Care delivery was an individualized balance of patient needs with other pressures over a series of consultations. DISCUSSION: General practitioners balance models of care with organisational and resource constraints in everyday consultations. Consistent common models of care are subjected to a wide range of influences and translated into varied modes of service delivery and presumably patient outcomes. CONCLUSION: Reforms to improve outcomes for people with chronic illness must address GP care models and adaptive balancing of needs and resources and recognise internal and external constraints that encroach upon patient centred comprehensive care. Policymakers need to research and consult in order that reforms can realistically facilitate care.

Adult↗
PubMed2001

The development of reflective learning in the context of health counselling and health promotion during nurse education.

AIMS AND BACKGROUND: The purpose of this follow-up study was to describe the development of reflective learning of 16 student nurses in the context of health counselling and promotion during clinical training of a 3-year nursing education programme in two Finnish polytechnics. The first aim was to analyse the levels of reflectivity in the student nurses' reflections on their videotaped counselling situations. The second aim was to explore the qualitative features of the reflective health counselling learning process in the context of health promotion. The theoretical background of the study was based on a transformative learning theory. METHODS: The data consisted of stimulated recall interviews with 16 student nurses conducted once a year between 1998 and 2000. The data were analysed using categorization and thematic analysis. FINDINGS: The findings of the study showed that half of the students in the research group reached the level of critical consciousness during their nursing education. The others remained at the level of consciousness. Two students who represented thoughtful action without reflection in the first study year were able to reach reflection and even critical reflection later during their education. The meaning schemas of counselling developed and were enriched when the students moved into the higher stages of reflection. There were features of an empowerment approach to health promotion only in the meaning schemas and perspectives of critical reflectors. CONCLUSIONS: These results may indicate that the empowerment approach to health promotion within the modern health promoting role of nurses requires critical reflection. Therefore, effective methods and evaluation tools of reflective learning are needed to support learning from practice via critical reflection.

Adolescent↗
PubMed1999

[Modular nursing system in pediatric ambulatory care according to nursing insurance legislation XI].

UNLABELLED: In the compulsory nursing insurance according to German legislation, the assessed degree of disablement in children is dependent on their daily quantitative need for nursing care with respect to 19 distinctive items belonging to the four sectors "personal hygiene", "mobility", "nutrition", and "household duties", that exceeds normal age-dependent requirements. In ambulatory nursing, exactly that care is given to the clients. OBJECTIVE: Are there typical combinations of items scoring positively, delivering the basis for a simplified billing schedule? DESIGN AND METHODS: 4500 records from the expert assessment of children < 18 years underwent a hierarchical cluster analysis (SPSS, Ward's method). RESULTS: The resulting dendrogram revealed distinct relationships between items. The items clustered into 4 main groups. Each cluster comprised items with a common thematic relationship (A = household duties, B = mobility, C = personal hygiene, D = nutrition/leaving one's home--scoring positively may indicate extra severe disablement). CONCLUSION: Remarkably enough, the resulting four clusters are very similar to the four sectors as defined by legislation (see above), although each single item is assessed independently. Our results are similar to that found in adults (Michel et al., 1998). Here we deliver the statistical basis for a modularised system of ambulatory paediatric nursing care, or its costing.

Activities of Daily Living↗
PubMed2005

Patient experiences following cardiothoracic surgery: an interview study.

BACKGROUND: Numerous studies have investigated patient outcomes of cardiac surgery, including some examining health-related quality of life. While these studies have provided some insight into patients' physical function, social abilities and perceived quality of life, studies examining the experiences of individuals recovering from cardiac surgery have received only limited investigation. AIMS: This paper presents a thematic analysis of interviews conducted with patients recovering from cardiothoracic surgery, about their memories and experiences of hospital and recovery post-hospital discharge. METHODS: Using an exploratory qualitative approach, eight participants were interviewed 6 months following their surgery. Transcripts of interviews were examined using a content analysis approach, with open coding of text and categorising of similar concepts into themes. FINDINGS: Participants reported varying degrees of pain and physical dysfunction during their recovery from surgery and some had still not returned to optimal function. Seven themes emerged from the data: impressions of ICU; comfort/discomfort; being sick/getting better; companionship/isolation; hope/hopelessness; acceptance/apprehension; and life changes. A number of the themes were constructed as a continuum, with participants often demonstrating a range of views or experiences. Many had little or no memory of their stay in the intensive care unit, although others had vivid recollections. Their impressions of hospital were mostly positive, although many experienced fear, apprehension, and mood disturbances at some time during their recovery. Most participants recalled being sick, reaching a turning point, and then getting better. Many participants reported a change in life view since their recovery from surgery. CONCLUSIONS: Attention to specific areas of patient orientation, education and support was identified to facilitate realistic expectations of recovery. In addition, some form of systematic follow-up that focuses on patient recovery in terms of both physical and psychological function is important.

Adaptation, Physiological↗
PubMed2003

Searching for autonomy.

OBJECTIVE: to gain an understanding of what midwives understand by the term 'autonomy',and to discover whether they consider themselves and their colleagues to be autonomous in practice. PARTICIPANTS: a snowball sample of 27 midwives working in five National Health Service (NHS) trusts within the south west of England, based in both hospitals and in the community. METHOD: within a qualitative research design, semi-structured interviews with participants were tape-recorded and transcribed verbatim, and analysed using thematic content analysis. FINDINGS: most participants did not fully understand the implications of professional autonomy, particularly in terms of interprofessional collaboration and control of their own practice. There were mixed views among respondents about whether they practised autonomously. Although good relationships with medical personnel were found to facilitate midwifery autonomy, the ongoing dominance of the medical profession was still perceived as a major barrier to autonomy. Many participants did not feel that their midwifery education had equipped them for professional autonomy, although midwives educated by the direct-entry route were perceived to be more capable of exercising autonomy in practice than were nurse-trained midwives. Some participants expressed doubts about the possibility of genuine midwifery autonomy within the present system, while others felt that many midwives do not support their own or other midwives' professional autonomy. IMPLICATIONS FOR PRACTICE: midwives need to initiate major change at a collective level, or to consider the creation of obstetric nursing posts, both to afford women the choice of genuinely autonomous midwifery care and to alleviate the stresses of practising within a system that requires the accountability and responsibility of midwifery autonomy, yet neither recognises nor supports it.

Attitude of Health Personnel↗
PubMed1998

Student experiences of nursing health promotion practice in hospital settings.

It has become evident that the current approaches to health care are inadequate for the changing needs of the world. Health promotion has gained recognition as a preferred option and many nursing programmes throughout the world have reoriented their curricula to incorporate this approach. This paper describes a study that was conducted to explicate student experiences of the practice of health promotion. Twenty-four students participated in the study; qualitative methods, narrative accounts and reflective journals were used to collect the data and the data was analysed using van Manen's recommendations for thematic analysis. Three major themes emerged: the centrality of caring; empowerment--power, participation and partnerships; and the primacy of people. Student narratives are used to illustrate the themes.

Attitude of Health Personnel↗
PubMedDate not supplied

An investigation of patient satisfaction following discharge after total hip replacement surgery.

PURPOSE: To investigate patient expectations of and satisfaction with in-hospital discharge planning after total hip-joint replacement surgery in early and late discharge patient groups. DESIGN: A qualitative study describing patients' experience of discharge planning. SAMPLE: Thirty-three consecutive patients requiring primary total hip-joint replacement from two metropolitan hospitals. METHODS: Participants completed in-depth, semistructured interviews on the day of discharge from the hospital and again 4 to 8 weeks later. Thematic analysis of the transcripts was made after comparing data from early and late discharge groups. FINDINGS: Attendance at preassessment clinic was facilitated acceptable satisfaction levels for patients in both early and late discharge groups. Although that written information provided was timely, restricted opportunity for dialogue with health professionals limited patient knowledge and understanding of recovery. CONCLUSIONS: Multidisciplinary teams in orthopaedic practice face the challenge of finding better ways to coordinate care and ensure people undergoing total hip-joint replacement therapy surgery have individualized care. A nurse mentor-coach could be one way to ensure patients' education needs in this area are met. IMPLICATIONS FOR NURSING RESEARCH: Future studies could investigate nurses' work in discharge planning and identify any influence that their holistic approach to care could bring to a collaborative discharge process.

Activities of Daily Living↗
PubMedDate not supplied

"Dissed" by dating violence.

PROBLEM: This study describes the impact of the experience of dating violence on the daily lives of college women. METHODS: Qualitative content analysis was used to analyze transcribed responses from an open-ended question about the impact of dating violence. FINDINGS: Eight thematic categories emerged: emotional distress, distrust and using extra precautions, disconnected and distant in relationships, self-discontentment, disclaiming the experience, feeling disenfranchised, life disruption, and turning a situation from disempowering to empowering. CONCLUSIONS: Understanding the perspective of dating violence victims assists the advanced practice psychiatric nurse (APPN) with planning effective care. Routine screening about past and present experiences of violence must occur with all young women. Providers must be knowledgeable about available resources for victims.

Adolescent↗
PubMed2003

Access to intensive care unit beds for neurosurgery patients: a qualitative case study.

OBJECTIVES: The purpose of this study was to describe the process used to decide which patients are admitted to the intensive care unit (ICU) at a hospital with special focus on access for neurosurgery patients, and evaluate it using "accountability for reasonableness". METHODS: Qualitative case study methodology was used. Data were collected from documents, interviews with key informants, and observations. The data were subjected to thematic analysis and evaluated using the four conditions of "accountability for reasonableness" (relevance, publicity, appeals, enforcement) to identify good practices and opportunities for improvement. RESULTS: ICU admissions were based on the referring physician's assessment of the medical need of the patient for an ICU bed. Non-medical criteria (for example, family wishes) also influenced admission decisions. Although there was an ICU bed allocation policy, patient need always superceded the bed allocation policy. ICU admission guidelines were not used. Admission decisions and reasons were disseminated to the ICU charge nurse, the bed coordinator, the ICU resident, the intensivist, and the requesting physician/surgeon by word of mouth and by written documentation in the patient's chart, but not to the patient or family. Appeals occurred informally, through negotiations between clinicians. Enforcement of relevance, publicity, and appeals was felt to be either non-existent or deficient. CONCLUSIONS: Conducting a case study of priority setting decisions for patients requiring ICU beds, with a special focus on neurosurgical patients, and applying the ethical framework "accountability for reasonableness" can help critical care units improve the fairness of their priority setting.

Decision Making↗
PubMedDate not supplied

Practice nurses and their 'lived experience' of clinical supervision.

Increased workload in primary care and the advent of primary care groups means that practice nurses (PNs) are experiencing a profusion of changes. As a result, PNs have taken on board many new skills, and this has increased the demands and stresses made upon them. Accordingly, this study investigated 17 PNs' lived experiences of clinical supervision following a 4-day training programme. It adopted a hermeneutic, phenomenological method. Data were collected by means of semistructured interviews within a series of focus groups. The data from the focus groups underwent a thematic analysis, which induced an emerging theory comprising five key themes: (1) providing support (2) nurturing and growth (3) enhancing and enriching practice (4) encountering a new experience, and (5) engaging in intellectually challenging and demanding work. The findings indicated that the central theme of the PNs' experience of clinical supervision was that of 'providing support', in that, without the presence and application of support, the effectiveness of the other themes appears to be diminished. The findings additionally indicated a range of issues, discussed under the headings: practice, education, policy, and further research.

Attitude of Health Personnel↗
PubMedDate not supplied

Prostate cancer treatment decisions: a focus group exploration.

PURPOSE/OBJECTIVES: To explore the decision-making process as retrospectively described by patients with prostate cancer and their spouses and to test the feasibility of a larger scale prospective examination of decision making in this same population. DESIGN: A qualitative study using focus group methodology. SAMPLE/SETTING: Twelve patients with prostate cancer and six spouses were recruited purposefully from a newly organized prostate cancer support group in an urban North Carolina community. METHODS: Using an interview guide, an experienced facilitator conducted two 90-minute focus groups. Sessions were audiotaped, transcribed verbatim, and analyzed using thematic content analysis techniques. MAIN RESEARCH VARIABLES: Decision making, prostate cancer treatment, spousal participation. FINDINGS: Six themes were derived from the data: (a) Finding Out, (b) Prostate Specific Antigen Talk, (c) (Getting the Story, (d) Who Decides, (e) Treatment Options, and (f) Looking Back. The data corroborated American Cancer Society findings that national cancer resources are not being used effectively by this population and reinforced the need for a multidisciplinary approach to the management of prostate cancer. CONCLUSIONS: Additional prospective studies are needed to explore the decision process from a family perspective. Studies focusing on the unique needs of older patients with prostate cancer and their spouses also are needed. IMPLICATIONS FOR NURSING PRACTICE: Nurses must assess informal information sources and work toward a more comprehensive presentation of treatment options. Misconceptions about surgery and radiotherapy hamper informed decision making. Nurses are in a unique position to educate families regarding prostate cancer treatment options.

Aged↗
PubMed2005

Methodological triangulation showed the poorest quality of life in the youngest people following treatment of coronary artery disease: a longitudinal study.

The purpose of the longitudinal study was to describe, explain and understand the subjective health related quality of life (HRQoL) and life course of people (N=280) with coronary artery disease (CAD) during the period following the onset of the disease, the process of therapy and the period of rehabilitation. Methodological triangulation was used in this research. The significance of the results obtained with quantitative and qualitative methods was evaluated by means of meta-analysis. A longitudinal quantitative study was undertaken through the year after the treatments (medication, balloon angioplasty or bypass surgery), and 19 persons attended thematic interviews 1 year after the treatments carried out in their homes. The results of quantitative analysis showed that the male and female CAD patients in the youngest age group had the poorest HRQoL. Although, the patients average HRQoL improved on the dimensions of pain, energy and mobility, it deteriorated on the dimensions of social isolation, sleep and emotional reactions. From the viewpoint of methodological triangulation, the most significant finding was that the qualitative approach provided an explanation for the poor psychosocial HRQoL obtained by the quantitative approach, showing the crucial factor to be age and age-related aspects of the life situation. Interviews and the method of phenomenological psychology helped to gain insight into the informants' situational experience of HROoL and life course, which was not detectable with a questionnaire.

Activities of Daily Living↗
PubMed2002

Whole-system evaluation research of a scheme to support inner city recruitment and retention of GPs.

BACKGROUND: The GP Assistant/Research Associate scheme developed in the Guy's, King's and St Thomas' School of Medicine, London, aims to attract and recruit young GPs (GP Assistants) and develop their commitment to work in local inner city practices. Continuing professional development for both young and established GPs is a key feature of the scheme. OBJECTIVES: The objectives of the whole-system evaluation research were to explore the perspectives of 34 stakeholders in the academic department, the practices and the PCGs, and to investigate the experiences of 19 GP Assistants who have participated in the scheme. METHODS: Qualitative methods included semi-structured interviews, non-participant observations in the practices, audio-taped meetings and personal journals. Data collection also included reviewing documentation of the scheme, i.e. the previous quantitative evaluation report, publications and e-mails. The multi-method approach enabled individual, group and team perspectives of the scheme and triangulation of the data through comparing dialogue with observations and documentary evidence. Thematic analysis was undertaken to elicit the complex experiences of the GP Assistants. RESULTS: Wide-ranging findings included enthusiastic support for the continuation of the scheme. The GP Assistants' personal and professional development was clearly evident from the themes 'eye opener', new knowledge, managing multiple roles, feeling vulnerable, time constraints and empowering processes. Seven of the GP Assistants have become partners and ten chose to remain working in local practices. Significant challenges for managing and leading the scheme were apparent. Greater co-operation and collaborative working between the academic department and the practices is required. CONCLUSION: The scheme provides a highly valued visible means of support for GPs and could act as a model for a career pathway aimed at enhancing recruitment and retention of GPs. The scheme is also at the forefront of national initiatives aimed at supporting single-handed practices and helping GPs with their continuing professional development. An integrated approach to change, education, research and development is advocated to enable recruitment and retention of GPs, their academic development, and to underpin the evolution of PCTs as learning organizations.

Adult↗
PubMed2001

The desi ways: traditional health practices of South Asian women in Canada.

Although many South Asian immigrants have made their homes in Canada, little research has examined health behaviors in this population and fewer studies have examined the use of traditional health practices. As part of a larger study on health-seeking patterns of South Asian women living in Western Canada, an analysis was done on the use of traditional health practices. Using critical ethnographic methods, data were collected through face-to-face individual interviews (n = 50), focus group discussions (n = 12), and community meetings with a cross section of women in the South Asian community. Interviews were conducted in the language of each participant's choice. Thematic analysis was done on the transcribed interviews. Women's descriptions of traditional health practices varied and consisted of home remedies, dietary regimens, prayers, rituals, and consultation with hakims, veds, babajis, pundits, homeopaths, and jyotshis. Choosing to use traditional health practices was influenced by family members, the nature and severity of problems, beliefs and prior experiences, and the feasibility of using these practices. Traditional health practices were used on a daily or episodic basis. Women rarely used traditional health practices exclusively. Traditional health practices were used for small problems or when conventional medicines did not work. For women to meet their health needs, health care providers must be culturally sensitive and respect women's choices to use traditional health practices.

Attitude↗
PubMed2006

Building social capital in first-time parents through a group-parenting program: a questionnaire survey.

BACKGROUND: Parents who are connected into strong family and community networks are said to have high social capital enabling them to provide a positive context where their children's social, emotional and educational needs are met. OBJECTIVES: To identify parent satisfaction with, strengths and weaknesses of, opportunities to build social capital, and the impact of a two-course pilot health and relationship focused Parenting Education Program-PEPE, designed for first-time parents, on the core work of the well-child nurse/health visitor. DESIGN: Retrospective descriptive survey using postal questionnaires. SETTING: Twelve pilot parenting courses facilitated across five regions of New Zealand. PARTICIPANTS: All parents (n = 105) and clinical nursing staff (n = 12) involved in the pilot parenting courses were invited to participate. Overall response rate was 82%. METHODS: Questionnaires developed by investigators were mailed to the eligible population. Numerical data was analysed using PC-SAS. Narrative data was subjected to thematic content analysis. RESULTS: Attendance at both parenting courses positively correlated with an increase in measures of social capital: development of strong social networks (82% Your New Baby course respondents: 95% CI, 75-89, and 98% Your Growing Baby course respondents: 95% CI, 96-100), and positive relationships with others (93% Your New Baby course respondents: 95% CI, 88-98, and 86% Your Growing Baby course respondents: 95% CI, 83-89). Increased confidence in respondent's parenting ability was also identified (96% Your New Baby course respondents: 95% CI, 92-100; 96% Your Growing Baby course respondents: 95% CI 93-99). CONCLUSIONS: The PEPE programme was well accepted by first-time parents leading to significant improvements in development of social capital and parenting confidence. Well-child health nurses are in a prime position to foster social capital and help rebuild communities within which they work to enhance parenting outcomes.

Adolescent↗
PubMed2002

A framework for the role of Registered Nurses in the specialty practice of rehabilitation nursing in Australia.

AIM OF THE STUDY: This study sought to explore systematically the role of Registered Nurses working in rehabilitation in Australia. BACKGROUND: Rehabilitation has been identified as an important aspect of health care. However, evidence of a comprehensive investigation of the nurses' role in rehabilitation cannot be found. From Australia, in particular, no research has been published in this area. METHODS: This study used a qualitative approach by engaging 13 nurses in one-to-one interviews and a further 21 in focus group discussions. Thematic analysis was conducted on the interview and focus group data. FINDINGS: Seven domains of practice were identified and are suggested as a framework for the specialty practice of rehabilitation nursing. They capture the 'how' and 'what' of rehabilitation nursing practice. Central to this practice is a rehabilitative approach to patient care, teaching and coaching, and continual assessment. The nurses explained in detail how these aspects of rehabilitation nursing differentiate their practice from that of their acute care colleagues. CONCLUSION: The rehabilitative approach is one of a variety of approaches to nursing care, but should not be seen as the exclusive domain of rehabilitation nurses. Rehabilitation belongs in every nurse's toolkit.

Adult↗