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PubMed2004

Group medical visits for low-income women with chronic disease: a feasibility study.

BACKGROUND: Group medical visits (GMVs) have been proposed as a means of providing comprehensive primary care services to patients with chronic disease. We studied the feasibility of implementing a GMV model with low-income women in an innercity clinic setting. METHODS: The intervention consisted of six GMV sessions cofacilitated by a physician/nurse practitioner team. Participants included 28 women with at least one chronic disease diagnosis (71% Latina). Thematic analysis of open-ended interviews assessed participants' experiences in the GMV. Patient charts and provider logs provided information on health service utilization patterns and provider productivity. RESULTS: An average of 7 women attended each session, with 16 women attending three or more sessions. In open-ended interviews, the most commonly mentioned positive aspects of the GMV were personalized attention (77%), self-care education (69%), access to medication refills and examinations (69%), and advice from peers (62%). Negative aspects included insufficient personal attention (23%), logistical barriers (8%), and loss of confidentiality (4%). On average, patients required 20 minutes of physician time plus 21 minutes of nurse practitioner time per session. Medical record reviews revealed a significant decrease in urgent care visits (p < 0.05) during the 9 months of the intervention compared with a prior 9-month period. CONCLUSIONS: In this innercity clinic setting, the GMV model was well tolerated by patients, did not alter provider productivity, and may have encouraged participants to avoid more expensive urgent care services. The results of this pilot study suggest that GMVs represent a cost-effective ambulatory care alternative that is acceptable to low-income women with chronic disease.

California↗
PubMed2006

Overseas nurses' experiences of equal opportunities in the NHS in England.

PURPOSE: To explore the experiences of overseas black and minority ethnic nurses in the National Health Service (NHS) in the south of England. METHODS: Semi-structured in-depth interviews were conducted with 12 overseas black and minority ethnic nurses. All interviews were taped, transcribed verbatim and analysed using thematic analysis. All transcripts were read and re-read to elicit general themes. FINDINGS: Qualitative data analysis was undertaken using Van Manen framework and this enabled a number of themes to be identified that were part of overseas black and minority ethnic nurses' experience, however, two main themes would be discussed in this study. Firstly, unequal opportunities in career advancement and secondly, unequal opportunities for skill development and training. Both themes affected overseas nurses chances of promotion in the NHS. RESEARCH LIMITATION/IMPLICATIONS: The study has identified a notably gap in the implementation of equal opportunity policies and suggests that a more transparent implementation of such policies is needed in the NHS in the UK where this study was conducted. Additionally, more research is needed to determine whether overseas nurses in other areas experience similar problems. PRACTICAL IMPLICATIONS: The findings of this study could encourage managers to re-examine their equal opportunity policies in the light of these findings. Although this study has explored overseas nurses experiences, the findings cannot be generalised to the wider population. ORIGINALITY VALUE: The differences experienced by overseas nurses in relation to career opportunities and skill development and training.

Adult↗
PubMed2004

Families in home care--a resource or a burden? District nurses' beliefs.

BACKGROUND: Caring for families in home care is a growing part of Swedish district nurses' professional work. District nurses' facilitative and constraining beliefs about families guide the extent to which families are acknowledged and engaged in the care. AIMS AND OBJECTIVES: The aim of the study was to explore district nurses' beliefs about families in home care. DESIGN: Explorative, descriptive. METHODS: Five district nurses participated in focus group interviews on three separate occasions. Each interview lasted approximately 90 minutes, was audio taped and transcribed verbatim. A thematic content analysis was used for analyses of the data. RESULTS: The result revealed two underpinning beliefs held by the district nurses towards families in home care: families are a resource and Families are a burden. Families could be a resource for the patient, for the other family members as well as for the district nurses themselves. Families could be a resource for the patient both practically and emotionally by e.g. being present and listening. Being open in communication with other family members and district nurses was also considered as a resource. The district nurses considered families as a burden when they were experienced as demanding in various ways, for example, when family members did not act in a way that pleased the district nurses or when family members showed their suffering. CONCLUSIONS: This study highlight some facilitating and constraining beliefs held by district nurses: families can be both a resource and a burden. RELEVANCE TO CLINICAL PRACTICE: It is important that district nurses are aware of what beliefs they hold as their beliefs guide their actions towards the families.

Attitude of Health Personnel↗
PubMed2005

A life shaped by pain: women and endometriosis.

AIMS AND OBJECTIVES: The research aim was to explore women's perceptions of living with endometriosis, its effects on their lives and the strategies used to manage their disease. BACKGROUND: Symptomatic endometriosis significantly affects women's quality of life. Characteristically the condition causes severe pain and has a negative impact on the ability to work, on family relationships and self-esteem. There has been little discussion about women's experience of endometriosis in nursing literature. DESIGN: A qualitative research design informed by feminist research principles was chosen for this project. METHODS: Eighteen women agreed to take part in the research. The individual, audio taped interviews were semi-structured and interactive. The interviews were analysed using a thematic analysis approach. RESULTS: The dominant feature of data from the interviews was the experience of severe and chronic pain impacting on all aspects of life. Analysis related to pain resulted in four themes: manifestations of pain, the pain trajectory, intractable pain and controlling pain. CONCLUSION: The diagnostic process typically took 5-10 years indicating that primary health care practitioners need higher levels of 'suspicion' for this condition. Case studies and problem-based scenarios focusing on endometriosis in health professional education programmes would enhance diagnostic skills and knowledge development. No formal pain management follow up after diagnosis and treatment meant women actively sought information from other sources as they made major lifestyle changes in the areas of activity and nutrition. Pain management services specifically for women with endometriosis would provide much needed support with this neglected aspect of the disease. RELEVANCE TO CLINICAL PRACTICE: This is a fertile area for the development of the Nurse Practitioner role which, also drawing on the considerable collective expertise of women with endometriosis, could provide significant information and support for women as they manage this highly complex condition.

Activities of Daily Living↗
PubMed2006

An exploration of factors which constrain nurses from research participation.

AIM: The aim of this study was to explore practising nurses' views on factors which they perceived constrained them from research participation. BACKGROUND: Many studies reviewed in the literature have taken a quantitative approach and have concentrated on why nurses do not use research findings in their practice. Of these studies a few included constraints to research use. However, with the development of national research strategies for nursing and the drive for the profession to develop its own research base, there is a need to understand what constrains clinically practising nurses from taking up opportunities to either develop their own research or participate in research studies. DESIGN AND METHOD: Data were collected during June and July 2004 by means of two focus groups (n=7) followed by single interviews (n=7). Analysis was undertaken using a thematic approach aided by N-Vivo 2.0. RESULTS AND DISCUSSION: In this study, findings revealed six key themes perceived by nurses to constrain from research participation: 'Level of support nurses require to be research active', 'Nurses' attitudes to undertaking/participating in research', 'The extent of nurses knowledge about research', 'Skills to undertake research' and 'Level of educational preparation relating to undertaking/participating in research'. CONCLUSIONS: In this study, nurses were generally receptive to participating in research. However, they felt constrained because of lack of time, lack of peer support and limited knowledge and skills of the research process. RELEVANCE TO CLINICAL PRACTICE: What is already known on this topic: studies into nurses and research have predominantly taken a quantitative approach; many studies have aimed to elicit the extent of nurses' use of research findings. WHAT THIS STUDY ADDS: this study adds a qualitative perspective; although findings are not generalizable, they support quantitative study findings into this subject; identifies constraints that require to be overcome for practising nurses to actively get involved in research studies.

Attitude of Health Personnel↗
PubMed2005

The development of medical teachers: an enquiry into the learning histories of 10 experienced medical teachers.

AIM: The aim of the study was to explore the different ways in which doctors have learned to teach and train. INTRODUCTION: There is no coherent theory of medical teacher development. Doctors are experts in what they teach; most have had little or no training in how they teach. Research has mostly concentrated on the acquisition and improvement of pedagogical skills by attendance at formal, generally short courses. These may have limited impact. METHODS: We carried out semistructured interviews with 10 experienced medical teachers. A review of the literature had suggested areas to explore. Interviews were transcribed and coded and thematic analysis and grounded theory used as the framework for qualitative analysis. RESULTS: Four areas were identified as important in teacher development: acquisition of educational knowledge and skills; modelling and practice of teaching skills; encouragement and motivation of teachers, and constraints on teaching and learning. DISCUSSION: The results suggest a model for teacher development that begins with doctors as learners, learning to learn and watching teachers teach. They then start to teach, acquiring and practising skills, and subsequently move on to reflect on their teaching. They can be encouraged to teach but may also be prevented from teaching. CONCLUSIONS: This inductive study proposes a model for medical teacher development that attempts to explain how doctors learn to teach and train. More research is needed to clarify the findings. There are implications for faculty development.

Education, Medical↗
PubMed1996

[Situation of nursing students during their university courses appointed as crisis solvers].

The study approaches the situations lived by the students of the various semesters of nursing in that University context, that, can often render negative feelings to the students, which are appointed as crisis and the actions developed in coping with difficulties. The method of collect was based answer on questions opened in order that the same ones could answer freely. The analysis of the testimonies carried in a classifying form thematic. The study showed the difficulties of the students concerning themselves, with the colleagues, of structural and financial order, etc.

Adaptation, Psychological↗
PubMed2003

No time for dying: a study of the care of dying patients in two acute care Australian hospitals.

OBJECTIVES: Research was conducted in two teaching hospitals in Australia to collect data on the care of patients dying in the acute care setting. METHODOLOGY: Non-participant observation of the care of dying patients in medical wards was the primary method of data collection and selected staff were interviewed. Observers collected data on the type of care, who gave the care, and the time given to care. Thematic analysis was applied to both the observational and interview data. PARTICIPANTS: Patients selected were over the age of 18 years, with a terminal diagnosis and an estimated six days to live. RESULTS: Three major factors emerged from the data to form the context in which patients were cared for and died: 1) the organizational factor, 2) the environmental factor, and 3) the human factor. The presence or absence of family members influenced the amount of care given. If family members were not present, dying could be an isolating experience, with minimal care focused on routine hospital activities. CONCLUSION: This research indicated that the principles of palliative care are yet to be incorporated in the acute care hospital setting.

Adult↗
PubMedDate not supplied

[The health professionals' team, the patient with renal disease in hemodialysis, and interpersonal relations].

Comprehensive discussions in scientific literature on the relationship between health professionals teams and renal patients present some particularities regarding professional background and the health care provided. In this paper we have analyzed the kind of care health professionals provide and their interpersonal relationships from the point of view of patients undergoing hemodialysis. Interviews were made using a clinical-qualitative method, consisting of semistructured interviews with seven patients in a hemodialysis unit, who were chosen through an intentional sampling. The data selected were assessed on a thematic content analysis. We have found that patients wish the health care team would listen to their concerns more carefully, which go beyond physical aspects. The clinical care provided has proved to be more focused on biological aspects of patients and on mechanical procedures, showing a considerable degree of carelessness about how human relationships and technical competency differ.

Humans↗
PubMed2026

Qualitative evidence of service user experiences and perspectives on long-acting injectable buprenorphine for opioid treatment - a scoping review.

BACKGROUND: There is substantial literature on opioid treatment program (OTP) formulations and how they relate to the pharmacotherapy service user experience. As a newer formulation, less is known about service user experiences of long-acting injectable buprenorphine (LAIB). The aim of this scoping review is to map the qualitative evidence and gaps in the literature on service user experiences and perspectives of LAIB. METHODS: Our search strategy included Medline, Embase, PsycINFO, CINAHL, Scopus and Web Science, and citation chaining, from January 2016 to June 2025. Studies were included if reporting qualitative descriptions of LAIB service user experiences of treatment for opioid dependence, inclusive of qualitative, mixed methods (description of qualitative data only), case reports and English language. Articles were screened by two reviewers. A living experience first author led the analysis using inductive coding and thematic analysis, to produce a descriptive summary of synthesised findings alongside key study characteristics and quality appraisal, adhering to the Systematic reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) checklist. RESULTS: After screening 838 titles/abstracts and reviewing 150 full texts, 40 studies met the eligibility criteria. All were conducted in high income countries, principally the US (n=12); Australia (n=10); and England and Wales (n=9). We identified five themes: Navigating LAIB treatment; Embodied and relational effects of LAIB; Impact and role of the service provider; Narratives of harm reduction and recovery; Stigma and criminalisation. LAIB was commonly experienced as increasing convenience, stability and freedom from daily supervised dosing, enabling improved work, travel, privacy and social participation. Reduced clinic/dosing contact often lessened enacted stigma and treatment burden. However, experiences were heterogenous. Some participants described injection-site discomfort, uncertainty about dose adequacy, reduced flexibility once injected, and ambivalence about LAIB effects. There was inconsistency in LAIB service user reports on service connection, isolation and psychosocial support. Treatment experiences were strongly shaped by provider practices. CONCLUSIONS: Findings underscore the need for integrated, flexible, harm-reduction oriented and person-centred LAIB treatment models that prioritise choice, autonomy and therapeutic relationships to maximise benefit for service users. However, evidence of LAIB service user experiences is concentrated in high-income countries, and the absence of perspectives from low- and middle-income country settings represents a substantial gap in the evidence base.

LAIB↗
PubMed2006

Cultural context and impact of alcohol use in the Sundarban Delta, West Bengal, India.

Hazardous alcohol consumption is a worldwide problem with many locally distinctive features across cultures, but studies to guide policy in developing countries are notably lacking. This community study aimed to clarify local patterns of alcohol use in six villages of West Bengal, India. It considered the variety of local alcoholic preparations, who consumed them, when, and where. It sought to determine how social changes in the region influence changing patterns of acceptable and problem use of alcohol. Ethnographic methods included participant observation and focus group discussions. The qualitative data analysis of field notes and transcripts included a review of full texts and a computer-assisted analysis of thematically coded segments with reference to a structured agenda. We found that drinking is an integral feature of the cultural landscape. Locally brewed rice beer (handia), palm wine (tadi), distilled country liquor (chullu), and so-called Indian-made foreign liquor (IMFL) are consumed in these villages. Each is identified with particular segments of society and settings in these communities. Reported effects of problem drinking included social disturbances, family discord, and domestic violence. Increasing problem alcohol use was attributed by villagers to social changes resulting from development, which were otherwise valued, such as improved transportation and communications. In a field dominated by Western and urban studies, this research clarifies features of alcohol availability, use, and acceptance in a neglected rural area of India. It illustrates the limitations of western clinical models of dependence and the importance of clarifying sociocultural conditions that define locally acceptable and problem use.

Alcohol Drinking↗
PubMed2004

Experiences of adolescents with cystic fibrosis during their transition from paediatric to adult health care: a qualitative study of young Australian adults.

PURPOSE: Exploring the experiences of Australian adolescents with Cystic Fibrosis (CF) as they made the transition from paediatric to adult care. This often traumatic change of care was examined from the perspective of the two types of care, paediatric and adult, elements of a transition programme if available and psychosocial factors that may affect the transition. METHOD: Focused-in-depth interviews were conducted with six young adults with CF (19-34 years), asking them to describe their experiences during the transition period. RESULTS: Thematic analysis of the transcribed interviews indicated that the four main areas that affected the transition experiences of the participants were paediatric and adult health care, the elements included in the transition programme, and psychosocial factors. CONCLUSIONS: The relationship of the patient with their paediatric doctor, the doctor's attitude towards the transition and the delivery of age-appropriate care appeared to influence the experiences of adolescents as they changed to adult care. Successful elements of a transition programme, if it was offered, were the orientation tours, the provision of information and the presence of a familiar face at adult clinics. Transition experiences of individuals had potential effects on their psychological and physical well-being so that, in order to maximize quality of care, health professionals must be aware of factors which may improve transition experiences.

Adaptation, Psychological↗
PubMed1996

The introduction of case management on a rehabilitation floor.

An exchange for 1 day a week between a clinical nurse specialist and a lecturer gave rise to the opportunity to evaluate the introduction of case management on a newly created rehabilitation floor at an elderly care hospital. The aims of the study were to examine the feelings and concerns of new case managers, their conception of case management and their perceived educational needs. Qualitative research methods were employed to achieve the aims. Rigour was addressed, in part, through concurrent analysis of data with data collection, which encouraged probing of issues important to research participants. Thematic categories are presented under the headings: 'structure' and 'process'. The data collected revealed vividly that, as with any change, the people involved experienced anxieties and/or confusion over their new roles, but that some of the problems arose from the relocation of staff when the rehabilitation floor was established. Despite these difficulties, there was general enthusiasm for the potential of case management.

Aged↗
PubMed2004

Patients' experience of the diagnosis and treatment of skin cancer.

PURPOSE: This paper describes the experience of being diagnosed with skin cancer from the perspective of patients. BACKGROUND: Despite the number of people with newly-diagnosed skin cancer increasing each year, the psychological impact of receiving such a diagnosis has received little attention. Research in this area is sporadic and has predominantly focused on malignant melanoma and used a quantitative approach. METHOD: Sixteen patients were interviewed about their experiences of being diagnosed with malignant melanoma, basal cell carcinoma or squamous cell carcinoma. The interview transcripts were analysed using thematic content analysis. FINDINGS: Similar themes for the two non-melanoma forms of skin cancer patients emerged. Information and knowledge of skin cancer appeared as a key theme, and influenced experiences in a variety of different ways. Patients with malignant melanoma recounted similar experiences to those with basal cell carcinoma or squamous cell carcinoma. People with malignant melanoma, however, used a wider variety of strategies in order to cope with the diagnosis. Satisfaction with the care experienced by each of the three groups played a crucial role in minimizing the experience for the patients. CONCLUSIONS: Patients with skin cancer should not be conceived as a homogeneous group, but one in which there are a number of diagnoses which differ in prognosis, and so may result in a variety of different consequences and thus experiences for patients.

Adaptation, Psychological↗
PubMed2006

Perceptions of professionalism in medicine: a qualitative study.

PURPOSE: Current guidelines for medical undergraduate education require students to develop appropriate attitudes towards professionalism. As much of the literature defines professionalism in vague terms--altruism, humanism, excellence--few studies have operationalised medical professionalism. This study aims to describe the views and experiences individuals have about medical professionalism to provide a more comprehensive understanding of medical professionalism. METHODS: An interview study of medical educators, medical students, doctors, allied health professionals and lay professionals was employed to assess views and experiences of professionalism in medicine. Thematic content analysis was applied to the resulting transcripts; the data were managed by NUD*IST software. RESULTS: Twenty-three people participated. Two types of examples about professionalism were provided: conceptual (honest, trustworthy, competent); behavioural (communicating effectively, treating patients equally, working in teams). Seven themes were elicited from the data: compliance to values, patient access, doctor-patient relationship, demeanour, professional management, personal awareness and motivation. CONCLUSION: The study provided a description of views about medical professionalism. These data allowed for a more thorough conceptualisation which should be used to inform measures of medical professionalism in order to improve the validity of assessments of medical students' attitudes.

Attitude of Health Personnel↗
PubMed2004

The medical complaints and disciplinary process in New Zealand: doctors' suggestions for change.

AIM: To document New Zealand doctors' opinions about the complaints and disciplinary process, and to develop a proposal for change. METHOD: A cross-sectional survey of New Zealand doctors randomly selected to include vocationally registered general practitioners, vocationally registered hospital-based specialists, and general registrants. Qualitative (thematic) analysis of written responses was used to categorise doctors' ideas about the complaints system, and to develop a proposal for change RESULTS: 453 doctors responded to the survey. Respondents were aware of the complexity of medicine, the fallibility of doctors, and of tension between societal expectations of care and their ability to meet those expectations. They perceived a societal culture of blame, and indicated that complaints should provide an opportunity for learning (for both complainants and doctors to be heard), and for a satisfactory outcome to be achieved for both doctors and complainants. They indicated that complaints should be resolved rapidly, that frivolous and vexatious complaints should be identified early in the process, and that the role of the media should be minimised. They indicated that the complaints process should be transparent, with complaints tribunals using appropriate advisors and standards of judgment. The proposal for change was a single point of entry for all complaints. CONCLUSION: New Zealand doctors are aware of the nature of the practice of medicine, and the sociopolitical context of the delivery of care. They support the notion of a Complaints Tribunal providing a single point of entry for all complaints, and which uses a process that is transparently appropriate for both doctors and complainants.

Attitude of Health Personnel↗
PubMed2004

Clinical practice guidelines' development and use in New Zealand: an evolving process.

AIMS: This study explores the use of evidence-based guidelines by New Zealand general practitioners, and describes strategies developed to overcome identified barriers in the New Zealand setting. METHODS: In-depth, semi-structured interviews with a purposeful sample of New Zealand guideline stakeholders including policy makers and general practitioners. Data were analysed using inductive thematic analysis. Feedback of emergent themes to the New Zealand Guidelines Group (NZGG) and further collaboration resulted in strategies to overcome barriers to use, some of which have now been implemented. RESULTS: At the time of the research (2000/2001), general practitioners reported that they did not regularly use guidelines to support decision-making regarding patient care. Reasons given included guidelines formats not being recognisable or user-friendly, lack of general practitioner involvement in prioritisation and development processes, influence of stakeholders, and recommendations not being accessible or relevant. Policy and other interviewed stakeholders reported general acceptance of guidelines, however there were minimal interfaces between the NZGG and these organisations. CONCLUSIONS: Effective implementation of guidelines requires more than guidelines endorsement by policy stakeholders and passive dissemination strategies, but rather an understanding of the issues facing general practitioners and their attitudes to guideline use.

Attitude of Health Personnel↗
PubMed2026

Social Isolation and Loneliness Among Older Asian Immigrants Through the Lens of Sense of Coherence: Systematic Review of Qualitative Studies.

AIM: To explore the meaning older Asian immigrants attribute to social isolation and loneliness, their management strategies, utilisation of resources and impact on health. DESIGN: Systematic review of qualitative studies. DATA SOURCES: AgeLine, CINAHL, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science databases were searched in September 2024. METHODS: Inclusion criteria: participants were Asian immigrants to Western countries aged 65 and over, community-living and experiencing social isolation and loneliness. Antonovsky's Sense of Coherence was used to frame the thematic analysis. RESULTS: Ten papers were included and analysed deductively using elements of the sense of coherence framework: &#x2022; Comprehensibility: Social isolation and loneliness are viewed as multifaceted, influenced by cultural and environmental dislocation, language barriers, intergenerational conflicts, deteriorating health and mobility, and socioeconomic challenges. &#x2022; Manageability: included engaging in culture-specific community programs, family and ethnic community support and living within ethnic enclaves mitigated isolation and loneliness. &#x2022; Meaningfulness: Strong family ties, active community involvement, spirituality, volunteerism, and cultural practices fostered resilience. However, accepting the changing values of their new world, living independently, and carving their own niche provided meaning to their transformed reality. CONCLUSION: Older Asian immigrants experience social isolation and loneliness through a cultural lens, shaped by migration experiences, language barriers, and shifting family dynamics. Cultural roots, family ties, spirituality, community, acceptance, and independence enhance sense of coherence. Recognising the dynamic interplay between cultural identity, resilience, and adaptation is key to understanding their lived experience. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This review informs culturally sensitive interventions, guiding healthcare, community services, and policy to support social participation, mitigate loneliness through ethno-specific activities, and improve the quality of life for aging immigrant populations in Western countries. REPORTING METHOD: The review was undertaken and reported using the PRISMA guidelines. PATIENT OR PUBLIC INVOLVEMENT: None. PROTOCOL REGISTRATION: PROSPERO (CRD42023425752).

Humans↗