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PubMed2006

Why do parents take their children to homeopaths? -- an exploratory qualitative study.

BACKGROUND: There has been a threefold increase in the proportion of children among patients visiting homeopaths in Norway from 1985 to 1998. As no study has investigated the reasons for this increase, the aim of the present study was to explore why parents take their children to homeopaths. PARTICIPANTS AND METHODS: In this qualitative study, parents who had taken their child to a homeopath for the first time during the last 3 months were interviewed in depth using a semi-structured interview guide. The interviews were analysed using thematic analysis based on techniques from grounded theory. RESULTS: 9 parents were interviewed. Parents consulted a medical doctor to clarify how serious their child's health condition was, and sought treatment from a homeopath if the symptoms were not dangerous. Personal recommendations or personal experience of homeopathy were identified as being a main factor that triggered seeking treatment specifically from a homeopath. The reasons they sought an alternative, or rather complement, to conventional medical treatment were: they did not wish to give their child allopathic medication; they wanted to find an alternative treatment to their child's currently prescribed allopathic medication; they had ceased conventional medication due to its side effects; to obtain treatment whilst waiting for a problem to be assessed; or they were not offered any treatment by their medical doctor. CONCLUSION: Parents took their child to a homeopath due to experiences with the medical encounter or treatment and due to recommendations or own personal experience.

Adult↗
PubMed2002

Quality of life after postmastectomy breast reconstruction.

PURPOSE/OBJECTIVES: To explore women's expectations about postmastectomy reconstruction and factors affecting their quality of life after reconstruction. DESIGN: Qualitative focus group study. SETTING: Integrated healthcare system in a midwestern suburban community. SAMPLE: 17 women who had undergone mastectomies with immediate reconstruction between 1.4 and 5 years previously and had participated in a study of women newly diagnosed with breast cancer. METHODS: An experienced focus group moderator conducted two focus group sessions. Comments from the sessions were audiotaped and transcribed verbatim. The sessions involved semistructured, open-ended questions about perceptions of preparation, experience, and satisfaction regarding postmastectomy reconstruction. Thematic content analysis began with open coding at the level of individual comments and proceeded through two levels of higher-order categorization. FINDINGS: Although women felt well informed about breast surgery, they wished they had been more informed about some issues. Ratings of satisfaction generally were high despite some concerns about cosmetic outcome and persistent anxiety about recurrence. CONCLUSIONS: Reconstruction allows women to feel comfortable in clothing, but recovery can be difficult, and reconstruction does not neutralize the biggest emotional challenge of breast cancer: fear of recurrence. IMPLICATIONS FOR PRACTICE: Women appreciate thorough information to prepare them for reconstruction and recovery. For aspects of recovery in which substantial variation exists, the range of experiences should be provided.

Female↗
PubMedDate not supplied

[Comparative bibliometric study of the publications in Spanish and other European publications].

INTRODUCTION: Investigation in biomedicine carried out in Spain presently has a good level and has evolved positively in the last two decades. In order to know the research situation in psychiatry, the bibliometric study was used as a method of approach to the mentioned analysis. OBJECTIVES: To identify the Spanish scientific production in psychiatry during the last decade, its repercussion worldwide and to compare it to other countries of our surroundings. METHOD: Bibliographical revision of the psychiatric magazines with greater impact factor at present. Thematic magazines of psychiatry and other areas (child and adolescent psychiatry and the addictions) are reviewed. The articles of Spanish authors were analyzed and compared with other countries of the surroundings (Germany, France, Holland, Italy and Sweden). The data obtained are linked with the economic data of the countries in question, it being possible to obtain how much each one of the investigations in the diverse countries cost per citizen. RESULTS: Globally, the countries analyzed have increased their international scientific production and, specifically, Spain has doubled its scientific activity in psychiatry. CONCLUSIONS: Investigation in psychiatry in Spain is represented in publications of greater impact factor of the speciality and is comparable in volume to the other countries of our surroundings.

Bibliometrics↗
PubMed2006

Purposes and mechanisms of goal planning in rehabilitation: the need for a critical distinction.

PURPOSE: To determine a preliminary typology of purposes and mechanisms ascribed to goal planning in rehabilitation. To demonstrate the importance of making a critical distinction between these different purposes and mechanisms when reviewing or designing research on goal planning in rehabilitation. METHOD: A search of Medline, Embase, PsychINFO and CINAHL for articles on goal planning in rehabilitation. Articles were only included if they were about patient populations and made explicit statements regarding the function or purpose of goal planning in rehabilitation. Thematic analysis was used to qualitatively synthesise the purposes and mechanisms of goal planning described in the literature. RESULTS: Four major purposes for undertaking goal planning in rehabilitation are identified: (1) to improve patient outcomes (as determined by standardised outcome measures), (2) to enhance patient autonomy, (3) to evaluate outcomes, and (4) to respond to contractual, legislative or professional requirements. The first of these purposes is associated with four distinct mechanisms with the remaining three purposes appearing to relate to one underlying mechanism. CONCLUSIONS: This typology offers one approach for critically engaging with the wide-ranging issues in goal planning. Debate stemming from this work could facilitate systematic reviews of this area as well as guide research and application to practice.

Persons with Disabilities↗
PubMed2005

Juvenile drug use and delinquency: youths' accounts of their trajectories.

This study focuses mainly on youths' opinions about their delinquency and drug use trajectories. A qualitative approach was taken for this phenomenological research. The life account method was used to conduct a total of 62 interviews: 36 boys and 26 girls recruited in youth detention and addiction treatment centers, youth centers, high schools, and on the streets of three cities in Quebec between 1996 and 2002. Thematic analysis was used, and the deviant trajectories of the youths are broken down into five stages. Our study provides an incomplete view of these youths' more or less deviant trajectories. It would be interesting to do a follow-up study.

Adolescent↗
PubMed2006

Nursing diagnoses, interventions and outcomes - application and impact on nursing practice: systematic review.

AIM: This paper reports a systematic review on the outcomes of nursing diagnostics. Specifically, it examines effects on documentation of assessment quality; frequency, accuracy and completeness of nursing diagnoses; and on coherence between nursing diagnoses, interventions and outcomes. BACKGROUND: Escalating healthcare costs demand the measurement of nursing's contribution to care. Use of standardized terminologies facilitates this measurement. Although several studies have evaluated nursing diagnosis documentation and their relationship with interventions and outcomes, a systematic review has not been carried out. METHOD: A Medline, CINAHL, and Cochrane Database search (1982-2004) was conducted and enhanced by the addition of primary source and conference proceeding articles. Inclusion criteria were established and applied. Thirty-six articles were selected and subjected to thematic content analysis; each study was then assessed, and a level of evidence and grades of recommendations assigned. FINDINGS: Nursing diagnosis use improved the quality of documented patient assessments (n = 14 studies), identification of commonly occurring diagnoses within similar settings (n = 10), and coherence among nursing diagnoses, interventions, and outcomes (n = 8). Four studies employed a continuing education intervention and found statistically significant improvements in the documentation of diagnoses, interventions and outcomes. However, limitations in diagnostic accuracy, reporting of signs/symptoms, and aetiology were also reported (14 studies). One meta-analysis of eight trials including 1497 patients showed no evidence that standardized electronic documentation of nursing diagnosis and related interventions led to better nursing outcomes. CONCLUSION: Despite variable results, the trend indicated that nursing diagnostics improved assessment documentation, the quality of interventions reported, and outcomes attained. The study reveals deficits in reporting of signs/symptoms and aetiology. Consequently, staff educational measures to enhance diagnostic accuracy are recommended. The relationships among diagnoses, interventions and outcomes require further evaluation. Studies are needed to determine the relationship between the quality of documentation and practice.

Humans↗
PubMed2006

What do obstetricians think about media influences on their patients?

BACKGROUND: Patients are playing an increasingly active role in decision-making about their care and are becoming increasingly informed about their health. Traditionally, sources of information about pregnancy and birth were family and friends and, in more recent times, antenatal classes. Evidence suggests that the media, particularly the Internet, is an increasingly influential source of information about illness and health. AIMS: The aim of this study was to survey Australian Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) about their perceptions of sources of patient information about pregnancy and birth, particularly the media and the Internet. METHODS: A two-page survey with a reply paid envelope was sent to all Australian Fellows of RANZCOG. Most questions only allowed a selection of prespecified categorical options. Some questions allowed open-ended replies that were assessed using thematic analysis. RESULTS: RANZCOG fellows thought that family and friends were the most important source of information for patients about pregnancy and birth followed by formal antenatal education, although they ranked the influence of the Internet above that of free-to-air television. Responses suggested that women in both the public and the private sectors were accessing the Internet. CONCLUSIONS: Fellows felt that their patients are actively involved in decisions about their care during pregnancy and birth and that the media influences their knowledge and attitudes. The Internet appears to have an increasingly important role in providing women with information. Obstetricians need to be aware of what their patients are accessing on the Internet.

Attitude of Health Personnel↗
PubMed2000

[Medicine and literature--interpretation and discussion of literary texts in medical education].

BACKGROUND: In medical education, using literary texts as a starting point for discussion and reflection, is now quite common. Lectures and seminars in literature and medicine have been given at the University of Oslo since 1996. We describe our pedagogical approach as a "thematic interpretation and discussion of literary texts", theoretically grounded in reader-oriented criticism and problem-based learning (PBL). This article describes the kind of learning taking place during analysis and discussion of literary texts among medical students. MATERIAL AND METHODS: We evaluated a series of four elective seminars for first and second year students in the autumn 1998. We used qualitative approaches based on analysis of material from observations during seminars, reflections written by participants, and notes from a group interview at the end of the seminars. RESULTS: Analysis and discussion of literary texts may give medical students: A better understanding of communicative aspects in the doctor-patient-relationship. Experience with interpretation of narratives and insight into how differently we may interpret a story. Awareness of aspects and dilemmas related to being a doctor. Understanding of how people may experience illness and health. INTERPRETATION: Lectures and seminars on literary texts might be an important supplement to other practical or theoretical teaching for medical students.

Communication↗
PubMedDate not supplied

Care-giving and care-seeking behaviours of parents who take their children to an emergency department for non-urgent care.

OBJECTIVE: This study explored the care-giving and care-seeking behaviours of parents who took their children to the emergency department (ED) of a large urban hospital in Western Canada for non-urgent care. METHOD: Data were collected from a convenience sample of 114 parents during a two-week period in January 1992, using a self-administered 53-item questionnaire. The data were analyzed using nonparametric statistics (Chi-square) and thematic content analysis. RESULTS: Eighty-two percent of parents were unsure of or overestimated the seriousness of their child's illness or injury. Prior to attending the ED, 40% of parents administered comfort measures and 45% gave medications. Only 17% of parents used at-home reading materials, while 31% sought lay advice. Fifty-eight percent of parents did not try to contact their family physician or the ED by telephone before coming to the ED. Forty-eight percent of parents who phoned their family physician were unable to obtain advice, and those who did were almost always referred to the ED. Eighty-eight percent of those who phoned the ED were instructed to bring the child to the ED. INTERPRETATION: The results suggest the need for more acceptable, accessible community primary care services.

Adult↗
PubMed1994

Traditional medical records as a source of clinical data in the outpatient setting.

We conducted an observational study at a university hospital clinic to determine the success with which physicians find patient information using traditional hospital records as the source of data. We recorded 168 consecutive patient cases presented to attending physicians by internal medicine residents, and analyzed the transcripts to identify questions indicating that the physicians could not find patient information in the medical record. In 81 percent of the cases, physicians could not find all the patient information that they desired during a patient's visit. We performed thematic analysis to generate a set of 15 prototypical questions asked by physicians regarding patient information. The multiauthored medical record system we studied did not provide effective access to patient information for physicians making clinical decisions in an outpatient setting. Improved methods for addressing prototypical questions arising in routine practice are needed.

Decision Making↗
PubMed2006

"Smart boys" and "sweet girls"--sex education needs in Thai teenagers: a mixed-method study.

BACKGROUND: In Thailand, rapid increases in economic prosperity have been accompanied by erosion of traditional cultural and religious values and by negative effects on sexual health of young people. We investigated knowledge, attitudes, norms, and values of teenagers, parents, teachers, and policymakers in relation to sex and sex education in Chiang Mai, Thailand, with a view to informing sex education policy. METHODS: We selected six secondary schools for maximum variation in socioeconomic background, religious background, and location. Methods were: narrative interviews with key stakeholders, and analysis of key policy documents; questionnaire survey of 2301 teenagers; 20 focus groups of teenagers; questionnaire survey of 351 parents; and two focus groups of parents. Qualitative and quantitative data were assessed separately with thematic and statistical analysis, respectively, then combined. FINDINGS: We noted five important influences on Thai teenagers' sexual attitudes and behaviour: ambiguous social roles leading to confused identity; heightened sexual awareness and curiosity; key gaps in knowledge and life skills; limited parental input; and impulsivity and risk-taking. Male teenagers aspire to be "smart boys", whose status depends on stories of sexual performance and conquests. Female teenagers, traditionally constrained and protected as "sweet girls", are managing a new concept of dating without their parents' support, and with few life skills to enable them to manage their desires or negotiate in potentially coercive situations. School-based sex education is biologically focused and inconsistently delivered. INTERPRETATION: Results of this large exploratory study suggest five approaches that could be developed to improve sex education: targeted training and support for teachers; peer-led sex education by teenagers; story-based scenarios to promote applied learning; local development of educational materials; and use of trained sexual health professionals to address learning needs of pupils, teachers, and parents.

Adolescent↗
PubMed2002

Synergy towards health: a nursing intervention model for women living with fibromyalgia, and their spouses.

AIM: The purpose of this study was to develop a consensus-based nursing intervention model for women living with fibromyalgia, their spouses and nurses working in a community health centre in Québec, Canada. BACKGROUND: Fibromyalgia syndrome, a rheumatic disorder associated with severe chronic pain and fatigue, has a major impact on the lives of individuals and their family. To date, research results on effective interventions are somewhat limited and inconclusive. Few studies take into account the perspective of those who live with this health problem on a day-to-day basis. METHODS: Data were collected mainly in 1999, through in-depth interviews and through group meetings using a qualitative research design, along the lines of the constructivist paradigm. The analysis plan aims for movement between the global and the specific: synthesis and thematic analysis. Analysed data were submitted to all participants throughout the data-collection process, thus allowing for shared constructions. FINDINGS: Results present the general consensus stemming from shared construction in all three groups. The nature of the intervention involves two major elements, support and teaching along with the fundamental importance of believing in the person. The timing of the intervention and the health and social context in which the intervention occurs also emerge as integral parts of the model. Synergy towards health in fibromyalgia emerges as the constitutive pattern composed of the following three elements: personal growth, spousal and professional support. The discussion addresses the model's components and uses an ecological perspective, in order to consider all the contexts that greatly influence the intervention. Empowerment is embedded in this intervention model. CONCLUSIONS: This study shows that research based on partnership allows the integration of perspectives and skills of various actors so as to develop meaningful interventions for both those seeking care and health professionals.

Adaptation, Psychological↗
PubMedDate not supplied

The proving grounds: combat nursing in Vietnam.

PURPOSE: The profession of nursing has been greatly influenced by war, and the heroic nature of the work of nursing is often emphasized during war. The purpose of this research was to examine the stories of nurses' experiences during combat in Vietnam and identify themes that would corroborate, refute, or expand prior historical research. ORGANIZING CONSTRUCT AND METHODS: A content analysis to determine recurrent themes was performed on 18 oral histories of military nurses who served in Vietnam that were previously collected and published. Analysis of these collections of oral histories was conducted, and thick quotes contextualize and substantiate the thematic claims. FINDINGS AND CONCLUSIONS: This research confirms the analysis of prior historical research on nursing in Vietnam by finding similar experiences recorded in oral histories and further claims that an authentic professional identity is often forged during the hardships and heroic opportunities of war.

Adaptation, Psychological↗
PubMed2006

Perceptions of persons with multiple sclerosis on cognitive changes and their impact on daily life.

PURPOSE: Cognitive changes occur in over 50% of persons diagnosed with multiple sclerosis (MS). Although previous research has provided information of the nature and severity of cognitive changes among persons with MS, it has offered relatively limited insight on the impact of these changes on levels of functioning and disability. The purpose of this study was to explore the impact of cognitive changes on the lives of four individuals with MS with different life roles (worker, parent, retired older adult). METHOD: Qualitative methodologies were used in the study and included multiple open-ended interviews with the study participants and the completion of Cognitive Experience Forms in between interviews. In addition, the Perceived Deficits Questionnaire and a demographics form were administered. Thematic analysis was used to analyse the study data. RESULTS: Participants described the types of cognitive changes they are experiencing and how these changes affect their ability to participate and engage in desired activities and maintain their primary roles. Participants also talked about how cognitive changes affect their quality of life. CONCLUSIONS: This study points to the complexity of cognitive changes and highlight the importance of addressing these changes in rehabilitation.

Adolescent↗
PubMed2005

Advanced heart failure: impact on older patients and informal carers.

AIM: This paper reports a study exploring the impact of advanced heart failure on the lives of older patients and their informal carers. BACKGROUND: Prognosis is poor in heart failure, with more than a third of patients dying within 12 months of diagnosis, and end-of-life symptoms are distressing and poorly controlled. Although end-of-life care for people with heart failure has received increased attention in recent years, there are still few data on the impact of advanced heart failure on the lives of patients and their informal carers. METHODS: Focused interviews were conducted with 10 older people with advanced heart failure and their nominated informal carer identified from one district general hospital in the United Kingdom (UK). Joint interviews were conducted with patients and carers in their own home. Thematic analysis was used to identify themes and subthemes. FINDINGS: Heart failure affected all aspects of the lives of patients and carers and, in particular, curtailed everyday activities. Patients were very concerned about the 'burden' their illness placed on their carer, who in all cases was their partner, although carers did not conceptualize the situation in this way. The socially isolating influence of the condition on both patients and carers was compounded by lack of professional input, and confusion about diagnosis was evident. Concerns about the future were common and, although few participants reported having been explicitly told about their prognosis, many made realistic statements about their limited life expectancy. CONCLUSIONS: This older cohort of people suffering from heart failure appears to have needs not unlike those of patients with 'terminal diseases'. When people are diagnosed with more familiar terminal illnesses, in particular cancer, they are given ongoing explanations, reassurance and support. Similar professional input is needed for patients with advanced heart failure and their carers.

Aged↗
PubMed2004

How patients with diabetes who have foot and leg ulcers perceive the nursing care they receive.

OBJECTIVE: This Norwegian study set out to explore the nursing care experienced by patients with diabetes who have a foot and/or leg ulcer. METHOD: A qualitative method was used, with in-depth recorded interviews of patients living at home and receiving district nursing care. Seven patients were interviewed at home for 45 minutes to two hours. Interviews were transcribed and analysed using Kvale's thematic and meaning analysis. RESULTS: Several themes emerged, even though sample was not a homogeneous group: the expert patient (where patients acquired knowledge about their treatment and then passed this on to new and inexperienced nurses); fragmented nursing care (caused by lack of continuity in care); impersonal nursing care (where nurses did not view the patient as an individual, but focused solely on their wound); the ideal nurse (nursing attributes the patients valued most highly, such as engaging with them and attempting to understand their situation). CONCLUSION: Crucial to the successful treatment of patients with diabetes who have foot and/or leg ulcers is an understanding of their feelings about their ulcer and its impact on their quality of life. Further research in this area is recommended.

Adult↗
PubMed2004

Listening to the decision makers: sustainability of PBMA in Alberta.

BACKGROUND: Decision makers within the Calgary Health Region adopted and applied programme budgeting and marginal analysis (PBMA) for priority-setting activity across major service portfolios within the Region. METHODS: Seventeen in-depth qualitative interviews were conducted with senior managers and clinicians to gain a user perspective and identify specific areas for process refinement. Data were thematically coded and categorised into relevant themes. RESULTS: Key strengths included a culture shift in thinking about the need to reallocate resources within a fixed funding envelope, whereas a key challenge identified was in putting forth genuine disinvestment options. Areas suggested for improvement included evoking an incentive system for stakeholder engagement and having a mechanism for tracking the effect of resource reallocations. CONCLUSIONS: Both an evidence-based approach to priority setting, as well as a way of thinking around managing resource scarcity, can be integrated into organisational processes. Findings reported in this article will influence further application in Calgary and should provide insight for those attempting such activity elsewhere.

Administrative Personnel↗
PubMed2004

[Women caregivers' experiences in caring at home for a family member with dementia: a feminist approach].

PURPOSE: The purpose of this study was to explore women caregivers' lived experiences in caring at home for a family member with dementia and to identify conditions that oppress women in the context of family caregiving. METHOD: This study was conducted within the feminist perspectives using qualitative secondary data. Ten secondary data conveying self reflective contents were selected from the 25 original data obtained in 1999 to 2000. RESULT: Six themes that emerged from the qualitative thematic content analysis were; androcentric view of family caregiving, undervalued family caregiving by the family members, Self rationalization in the context of family caregiving, family-centric care mechanism, exemplary caring within the family context, and inter-familial relationships among women. CONCLUSION: The main focus of feminist research is to provide empowerment for the women research participants and to bring about social change of oppressive constraint through some actions. On the basis of the research findings, therefore, action strategies from feminist perspectives were suggested in some aspects of health care delivery sectors, nursing education and research sectors, and administrative sectors.

Adult↗