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PubMed1998

Meaningful work in supportive environments: experiences with the recovery process.

OBJECTIVE: This ethnographic study examined what makes work meaningful for persons with persistent mental illness and how this meaningfulness relates to their recovery. METHOD: Twelve persons between 32 and 58 years of age who had been involved an average of 19 years with a formal mental health system participated in in-depth interviews and a focus group. Thematic analysis and case studies were understood in the context of the investigator's 15 months of participant observation of 35 persons with psychiatric disabilities working at an affirmative business. RESULTS: The meaning of work varied with participants perception of their illness and their self-concept. Changes in their self-efficacy and self-concept were driven by their participation in work activities to operate the affirmative business. CONCLUSION: Findings suggest that therapists could potentially facilitate these changes in clients' sense of self-efficacy and self-concept by helping them make connections with meaningful occupations and contributions to organizations in the community and to experience challenges and successes in the context of meaningful work.

Activities of Daily Living↗
PubMed2006

The role of the breast care nurse during treatment for early breast cancer: the patient's perspective.

INTRODUCTION: Women who are diagnosed with breast cancer require the support of a range of people during their treatment. Although the role of the breast care nurse in providing support has recently been investigated in several Australian studies the patients' perspective on the role of the breast care nurse in Australian hospitals has not previously been described in detail. The aim of this paper is to explore patients' perspectives on the role of the breast care nurse. METHODS: In-depth interviews were conducted with 18 women who had completed treatment for early breast cancer. The women were asked to describe their experiences from the time of diagnosis through to treatment completion. Thematic analysis was used to analyse the data. FINDINGS: Breast cancer patients repeatedly emphasised the importance of the role of their breast care nurses throughout their experience of breast cancer. The support that breast care nurses provided incorporated the following components: communication, rapport and an awareness of the women's needs, availability, reassurance and practical information. CONCLUSION: This study provides an understanding of women's perspectives on the role of breast care nurses and confirms that breast care nurses play an important support role during the experience of early breast cancer. Oncology clinics should focus on ensuring that all women who are diagnosed with breast cancer have adequate access to the support that breast care nurses are able to provide.

Adult↗
PubMedDate not supplied

Pre-operative fasting for elective surgical patients.

AIM: To explore the knowledge, past experience, perceptions and opinions of nurses working in surgical units at a local hospital with regard to pre-operative fasting times. METHOD: A qualitative research design, using a grounded theory approach, was adopted. Semi-structured interviews were undertaken with a sample of 15 staff nurses employed within five surgical units in one hospital. FINDINGS: After thematic analysis, three core categories emerged from the data: knowledge, practice and systems. Nurses stated that there were significant barriers to an individual approach to pre-operative fasting within the organisation. These included lack of knowledge and skills, limited autonomy with regard to changing practice, and an operating room system that contributed to patients being fasted for a longer period than necessary. CONCLUSION: Further research is required on how long patients should be fasted before theatre. In addition, all healthcare professionals require education pertaining to best practice, and organisations should have in place clear policies and guidelines to prevent variances in fasting procedures.

Attitude of Health Personnel↗
PubMed2002

The nursing contribution to qualitative research in palliative care 1990-1999: a critical evaluation.

BACKGROUND: Qualitative research plays an important part in providing evidence for practice in nursing, and is gaining greater acceptance within medicine. However, questions remain about what criteria are most appropriate for evaluating qualitative research. To date, little systematic evaluation of qualitative research in palliative care has been conducted. AIMS: This paper is based on a larger study in which we conducted a critical review of qualitative research in palliative care from nursing, medicine, specialist palliative care, sociology, death studies, medical anthropology, and gerontology journals published between 1990 and 1999. The aim of this paper is to present an account of the strengths and weaknesses of qualitative palliative care research in nursing, using data from this review. METHODS: In the larger study, 138 papers from 50 journals were reviewed critically using a tool developed to assess both content and quality; in one part of this tool reviewers recorded open-ended comments on the strengths and weaknesses of each paper. In this paper, we present a thematic analysis of reviewers' comments on a subgroup of 67 nursing papers from the main review, together with an analysis of comments on 29 papers from a comparison group of death studies, medical anthropology, and sociology journals. Patterns of positive and negative evaluation are identified and used to generate an account of strengths and weaknesses in qualitative palliative care research in nursing. FINDINGS: Over 40% of the subgroup of papers from nursing journals received positive comments on topic and quality of writing; around 30% received positive comments on contribution to understanding, practical value, and conceptual or theoretical issues. Less than 20% received positive comments on other critical dimensions. Over 40% of nursing papers received negative comments on the link between data, analysis, and findings, other aspects of method and theoretical and conceptual issues. A higher proportion of papers in the comparison group received positive comments on conceptual and theoretical issues and contribution to understanding. CONCLUSIONS: Nearly half the nursing papers reviewed were judged to be well written or to have a well-chosen topic. However, more than 40% of papers drew negative comments about key methods-related issues. Arguably therefore efforts to improve the quality of research evidence should focus on this area.

Data Collection↗
PubMed2003

"Vanished twin": an exploration of women's experiences.

BACKGROUND: Evidence suggests that in identified twin pregnancies 30 percent become a "vanished twin," that is, when two gestation sacs are identified at early ultrasound but subsequently only one fetus is seen. This study explored the thoughts, feelings, and hospital experiences of women who have a vanished twin. METHOD: The study was conducted in a large teaching hospital in northwest England from April to June 2001. The experiences of 9 women were explored through 4 focus groups and an individual interview. Nulliparous and multiparous groups were separated for homogeneity. The study's philosophical approach was based on constructivism, and the thematic analysis used a feminist interpretation to search for patterns of meanings from the women's words. RESULTS: The women wanted to be cared for in a humanistic manner, and they felt that acknowledgement of the vanished twin by the professional was important. The findings highlighted the need for better information giving to improve communication between caregivers and women. Multiparas were more prepared than nulliparas to ask for the attention that they wanted. CONCLUSIONS: Despite the small number of study participants, results suggest that maternity caregivers should be sensitive to the feelings and individual nature of a woman who has experienced a vanished twin. Humanistic approaches to communication and improved methods of information based on the development of an information sheet are advised.

Adult↗
PubMedDate not supplied

Reciprocity for patients with head and neck cancer participating in an instrument development project.

PURPOSE/OBJECTIVES: To examine reciprocity (i.e., a mutual exchange of benefit) in study participation via a thematic analysis of field notes on study participation from a parent psychometric study. DESIGN: Qualitative. SETTING: Head and neck surgery clinic in an urban tertiary hospital. SAMPLE: Seven patients with head and neck cancer recruited to participate in an instrument development project. METHODS: Symbolic interactionism was employed to frame the examination of field notes from observations and interactions with patients, as well as participant notes accompanying returned retest questionnaires. Analysis relied on the constant comparative technique at the levels of open and axial coding. MAIN RESEARCH VARIABLES: Participation in an instrument development project. FINDINGS: Four content themes emerged in the analysis: Willingness to Help, Reassurance That the Deficits Patients Experience Are Common, Participation Provides Social Contact, and Confirmation of Clinically Significant Findings. A process theme, Unveiling the Experience, integrated the content themes in relation to participation itself. The role of the study nurse appears to be pivotal in this process. CONCLUSIONS: A notion of reciprocity in research participation is apparent. The role of the study nurse is an important element in the process of reciprocity. This role should be explored to enhance study participation. IMPLICATIONS FOR NURSING: Implications, particularly for clinical trial nurses, include recasting the benefits of participating in research, better addressing preparation for patients scheduled to receive treatment for head and neck cancer, and exploring and enhancing the role of the study nurse.

Clinical Nursing Research↗
PubMed2005

An educational framework for triage nursing based on gatekeeping, timekeeping and decision-making processes.

INTRODUCTION: The role of the triage nurse has emerged in response to growing community demand for a more accessible and efficient emergency department (ED) service. The focus of triage research has been on measuring outcomes and improving the delivery of emergency care. This has meant that the context of care, and triage processes and practices have remained concealed. Thus, little evidence about the role and ways to prepare nurses for this role is available. The aim of this study was to provide insight and understanding needed to educate and support the triage nursing role in Australian EDs. METHODS: A 12-month ethnographic study of triage nursing practice was conducted in Sydney metropolitan EDs. Data were then collected from participant observation in four EDs and interviews with 10 triage nurses. Analysis used standard content and thematic analysis techniques. FINDINGS: Findings reveal that notions of timeliness, efficiency and equity are embedded in a culture of ED care. This sustains a particular cadence of care to which triage nurses are culturally oriented. Triage nurses maintain, negotiate and restore this cadence of emergency care by using gatekeeping, timekeeping and decision-making processes. CONCLUSION: The comprehensive study of triage nursing has led to the development of an educational framework based on the processes of gatekeeping, timekeeping and decision-making.

Anthropology, Cultural↗
PubMed2005

The impact of research governance in healthcare and higher education organizations.

AIM: This paper reports a study exploring the impact and implementation of research governance in the North West region of England. BACKGROUND: In 2001, the UK Government launched a framework to ensure the governance of research within the National Health Service. Whilst this framework was undoubtedly geared towards improving the standards and practice of research, concerns have been raised in the academic literature about the potentially negative impact on future research. METHODS: A mixed method approach, using questionnaires (n = 350), semi-structured interviews and focus groups with a volunteer sample, was used to explore research staff perspectives about research governance. Survey data were analysed using Microsoft Excel, and a thematic analysis was used to elicit themes from the semi-structured interviews. The study lasted for 12 months and used a range of study sites, giving insight into potentially different experiences or approaches to implementing the research governance framework. FINDINGS: Questionnaire data revealed a good level of awareness about the Research Governance Framework. However, a range of concerns was also raised, such as the increased workload associated with the research governance application process and lack of transparency about the process. Five themes emerged from the focus groups: control, epistemology, organizational issues, impact on teaching and learning, and ambiguity in the definitions of research and audit. CONCLUSIONS: Recommendations emerging from the study include the promotion of transparent research governance guidelines for practitioners, and the need for staff education about governance processes and greater parity between organizations in research governance processes.

England↗
PubMed2006

The experience of fatigue for adults living with HIV.

AIMS: The aim of this study was to go beyond objective clinical assessment and explore the experience of fatigue and self-care strategies with adults who live with HIV. RATIONALE: This study responded to a perceived lack of available evidence to inform the practice of service providers about ways fatigue impacts on the lives of people with HIV. Prior understandings of fatigue are derived from survey or instrument-based tools or studies that do not consider the complexities of the personal experience that in-depth interviews can elicit. The focus remains generally on description, measurement or management from a biomedical perspective. METHODS: A qualitative study using participatory action research methods was conducted during 2003 with 15 adults diagnosed with HIV who perceived fatigue was a problem in their lives. Data were collected by individual interviews, researcher's notes and two participatory action research groups. RESULTS: Thematic analysis of data demonstrated that fatigue remains silent and invisible to participant's families, friends and employers. Fatigue experienced by people living with HIV generally also met with a lack of acknowledgement and understanding from health professionals. People developed self-care strategies over many years of trial and error. RELEVANCE TO CLINICAL PRACTICE: People living with a HIV seek to be acknowledged that fatigue is a legitimate concern, not only by health care professionals, but also people with whom they live. It is imperative that nurses who work with people living with HIV-related fatigue consider the wider social aspects of the person's life as well as physical symptoms. Most importantly, there then needs to be a process of engagement and active listening to the individual's account of their experience of fatigue. Advocating that fatigue is a legitimate complaint to the person living with HIV as well as the wider public and professional community is imperative.

Activities of Daily Living↗
PubMed2004

SARS and hospital priority setting: a qualitative case study and evaluation.

BACKGROUND: Priority setting is one of the most difficult issues facing hospitals because of funding restrictions and changing patient need. A deadly communicable disease outbreak, such as the Severe Acute Respiratory Syndrome (SARS) in Toronto in 2003, amplifies the difficulties of hospital priority setting. The purpose of this study is to describe and evaluate priority setting in a hospital in response to SARS using the ethical framework 'accountability for reasonableness'. METHODS: This study was conducted at a large tertiary hospital in Toronto, Canada. There were two data sources: 1) over 200 key documents (e.g. emails, bulletins), and 2) 35 interviews with key informants. Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation. RESULTS: Participants described the types of priority setting decisions, the decision making process and the reasoning used. Although the hospital leadership made an effort to meet the conditions of 'accountability for reasonableness', they acknowledged that the decision making was not ideal. We described good practices and opportunities for improvement. CONCLUSIONS: 'Accountability for reasonableness' is a framework that can be used to guide fair priority setting in health care organizations, such as hospitals. In the midst of a crisis such as SARS where guidance is incomplete, consequences uncertain, and information constantly changing, where hour-by-hour decisions involve life and death, fairness is more important rather than less.

Attitude of Health Personnel↗
PubMed2005

Implications of bride price on domestic violence and reproductive health in Wakiso District, Uganda.

OBJECTIVE: Bride price payment is a gender issue with implications on gender relations in different socio-cultural contexts. It also impacts Sexual and Reproductive Health and Rights. In a qualitative study on the perceptions of domestic violence in Wakiso district, payment of bride price emerged as one of the key factors associated with domestic violence. The study explored experiences, motivations, meanings, consequences and reproductive health implications of bride price payment in Wakiso district Uganda. METHODS: 10 single-sex focus group discussions and 14 in-depth interviews were conducted in Wakiso and Nangabo sub-counties, Wakiso district from July 2003 through March 2004. Data was analyzed by thematic content analysis, assisted by Easy Text software for data retrieval. FINDINGS: Participants perceived bride price as indicating that a woman was 'bought' into the man's household, which reduced her household decision-making roles. It limited women's independence and perpetuated unequal gender power relations, especially regarding health-seeking behaviour. CONCLUSION: Bride price payment is a contextual factor that the community in Wakiso District, Uganda, perceived as associated with domestic violence, with serious sexual and reproductive health implications.

Adolescent↗
PubMed2006

Student perspectives on pharmacy curriculum and instruction in Egyptian schools.

OBJECTIVES: To determine student attitudes and opinions towards pharmacy education in Egyptian universities to provide information for designing delivery of a revised pharmacy curriculum. METHODS: Students were recruited from the pharmacy faculties at a government-sponsored university and a privately funded university. Data were gathered using a structured questionnaire and statistically analyzed. Responses from open questions were subjected to thematic analysis. RESULTS: Students spent widely differing amounts of time on non-classroom study, little of which was self-directed. This was reflected in the low frequency of use of library facilities and the preference of students for passively acquired information. Themes that emerged on how students would improve the curriculum were to increase the use of computers and the Internet; make the course more relevant to pharmacy practice and/or clinical pharmacy; improve and expand the practical components of the course; increase their own involvement in learning; and increase their understanding of subjects as well as their knowledge. For many of the questions, there was a significant different between the responses of students at the 2 universities. CONCLUSIONS: Students relied on classroom teaching and devoted little time to self-directed study. However, students were aware of international developments in pharmacy education and practice and are receptive to change.

Attitude↗
PubMed2003

Children who suffer from headaches--a narrative of insecurity in school and family.

BACKGROUND: Headaches are common among schoolchildren, who seem to be afflicted increasingly. AIM: To analyse children's descriptions of their headaches and their thoughts about them, it being assumed that children have insight into the conditions that affect their health. DESIGN OF STUDY: Interview study. SETTING: Two state schools in the city of Malmö, Sweden. METHOD: Fourteen children aged between ten and 12 years, who had gone to the school nurse more than once during the previous two-month period complaining of a headache, took part in thematically structured interviews. Qualitative analysis was performed, aimed at identifying the basic themes involved. RESULTS: The children were found to consistently associate their headaches with conditions in school, specifically with more theoretically-oriented subjects (maths or Swedish), a noisy and disorderly school environment, and insecure relations with classmates. The second theme they took up was insecurity or conflict within the family. Reports of this constituted a major part of the children's accounts of their life situation, despite their failing to link such matters with their headaches. Many of the children considered their patterns of reacting, such as feeling unable to cope or becoming angry, as contributing to their getting headaches. CONCLUSIONS: The children related their headaches consistently to everyday situations and to their relations with others. This highlights the need for broadening the consultation in terms of including personal and contextual factors.

Adaptation, Psychological↗
PubMed2004

Falling in Parkinson's disease: the impact on informal caregivers.

PURPOSE: The aim of this study was to explore the views and experiences of the informal caregivers of repeat fallers with Parkinson's disease. METHOD: Individuals were invited to participate in this study if they were the informal caregiver of a person with Parkinson's disease (PD) who had experienced more than one fall in the previous 12 months. Participants were interviewed about their experience of managing falls using a semi-structured interview schedule. Interview data were transcribed and analysed using thematic analysis. RESULTS: Fourteen caregivers (11 female) participated in the study. All were marital partners of a repeat faller with Parkinson's disease. The average age of the participants was 69.9 years (44-79). Their partners had had PD for an average of 16.7 years. Six major themes emerged from the analysis of the interview data, four directly related to falls management (the falls; consequences of the falls for the person with PD; caregivers' experiences of falls; consequences of falls for the caregiver). The majority of caregivers were frightened about their spouse falling. They used a number of methods of getting their spouse up from the floor but often injured themselves as a consequence. Caregivers highlighted the high level of care they provided and the social and psychological impact of the condition on them. They received limited help in looking after their spouse and little information about falls or about the disease in general. CONCLUSION: Caregivers in this study felt unprepared for their role and expressed a need for more support and advice, especially about managing falls.

Accidental Falls↗
PubMed2025

Caregiver experiences after the death of a person with dementia with Lewy bodies: A mixed-methods analysis.

BackgroundDementia with Lewy bodies (DLB) is a common degenerative dementia, but no studies investigate bereaved caregiver experiences.ObjectiveTo investigate the experiences of caregivers three months after the death of persons with DLB using a mixed-methods approach.MethodsDyads of individuals with moderate-advanced DLB and their primary informal caregivers were followed prospectively every 6 months until the person with DLB died. Caregivers completed a study visit with questionnaires and a semi-structured interview ∼3 months later. Spearman correlation coefficients and Wilcoxon rank-sum tests evaluated the relationships of post-death measures with pre-death patient and caregiver variables. Thematic analysis was used to analyze the interviews.ResultsSeventy-three caregivers completed visits (mean 3.5 months post-death). Most of the caregivers were women (82.2%) and spouses (76.7%) or adult children (17.8%). Over 40% had scores indicating risk for clinical depression. Post-death caregiver experiences (depression, quality of life, grief, resilience) correlated with pre-death caregiver experiences. Post-death experiences did not associate with patient characteristics, disease-related symptoms, or healthcare services used in the last 6 months of life. Trajectories for caregiver measures from pre- to post-death visits varied widely. Interview themes included grief and sadness, anger, guilt and regret, relief, appreciation/gratitude, and adjusting to a new normal.ConclusionsThe finding that pre-death caregiving experiences have the strongest association with post-death experiences emphasizes the critical importance of accessible and evidence-based caregiver support before and after the death of a person with DLB. Research is needed to develop interventions for current and bereaved caregivers of individuals with DLB.Trial registration informationNCT04829656 (submitted 2021-03-22).

Caregivers↗
PubMed1999

Evaluating a clinical partnership model for undergraduate nursing students.

Since the transfer of nurse education to the tertiary sector in Australia there have been many challenges associated with the selection, administration and facilitation of clinical experiences for undergraduate nursing students. The School of Nursing at Australian Catholic University, McAuley Campus, planned and implemented a partnership model for clinical practice with the aim of improving current methods and overcoming some of the problems previously experienced. Evaluation of the model was conducted during the first year of implementation. An interpretive approach involving academic staff, clinical affiliates and students was used to evaluate the model. Thematic analysis of the data revealed three major themes of familiarity, acceptance and trust and supportive learning environments. It was found that students had been supported in their learning environment through the clinical affiliates commitment to teaching and learning, linkage of theory and practice and credibility as practising clinicians.

Attitude of Health Personnel↗
PubMed2006

A qualitative study exploring barriers to a model of shared care for pre-school children's oral health.

OBJECTIVE: To explore the oral health beliefs and practices of primary health care professionals which may act as barriers to the development of a model of shared care for the oral health of pre-school children. DESIGN: Qualitative focus group discussions and semi-structured interviews. SETTING: Four rural local government areas in Victoria, Australia, 2003. SUBJECTS AND METHODS SUBJECTS: maternal and child health nurses, general medical practitioners, dental professionals and paediatricians working in the four local government areas. DATA COLLECTION: discipline specific focus groups and semi-structured interviews. DATA ANALYSIS: transcription, coding, clustering and thematic analysis. RESULTS: Several strong themes emerged from the data. All participants agreed that dental caries is a significant health issue for young children and their families. Beliefs about the aetiology of dental caries and its prevention were variable and often simplistic focusing predominantly on diet. Dental professionals did not believe that they had a primary role in the oral health of pre-school aged children but that others particularly maternal and child health nurses did. However other health care professionals were not confident in assuming this role. CONCLUSIONS: This study has identified important barriers and possible strategies for the development of an integrated and shared approach to preventing dental caries in pre-school aged children. Clear and consistent oral health information and agreed roles and responsibilities need to be developed.

Attitude of Health Personnel↗
PubMed2001

Levels of compliance shown by hypertensive patients and their attitude toward their illness.

AIM: The aim of this paper is to describe hypertensive patients' compliance by finding out more specifically what compliance, intention, activity, responsibility and collaboration mean in the treatment of hypertensive patients. A further aim was to clarify their attitudes toward their illness. RATIONALE: This study is part of a project titled 'Patients' self-motivated control of hypertension. METHOD: The intervention consists of a multimedia computer program and effective lifestyle counselling. Nine male and 12 female patients from one municipality were included in an intervention programme. Data were collected through thematic interviews and analysed using content analysis. FINDINGS: Four levels of compliance were found: subconscious, cognitive, action and attitudinal level. Patients also had four different ways of feeling about hypertension and its treatment: some were careless, some were serious, some adjusted well and yet others felt frustrated. CONCLUSION: Health care professionals should recognize each patient's way of complying with his/her treatment and his/her attitude toward the illness. Different patients need different kinds of care and support. In addition health care professionals should also recognize their own attitudes toward hypertension and the patient's position in the health care system.

Adolescent↗