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PubMed2004

Personal understandings of illness among people with type 2 diabetes.

BACKGROUND: Professionals and patients understand the experience of illness from different worlds. Professionals' explanatory models focus on aetiology, diagnosis, pathophysiology and treatment, while patients' explanatory models are more focused on consequences and influences on daily life. The differences between patients and professionals in their understanding often result in conflicting expectations about treatment, priorities and outcomes of care. AIM: The aim of this study was to describe personal understandings of illness among people with type 2 diabetes in Sweden. METHOD: A sample of 44 patients, 47-80 years, diagnosed with type 2 diabetes within the last 2 years, was recruited from four health care centres. Narrative thematic interviews were used covering the areas of developing, coping with and living with diabetes. Qualitative content analysis was performed. FINDINGS: The findings were formulated into six categories: image of the disease, meaning of the diagnosis, integration of the illness, space for the illness, responsibility for care and future prospects. CONCLUSIONS: The findings demonstrate that patients' personal understanding of illness is an important complement to the traditional professional view of diabetes. They could serve as a foundation for development of health history interviewing, as well as development of systems of documentation. Patients' personal understandings of diabetes in their daily lives are considered to be an important shared source of information for planning meaningful care.

Adaptation, Psychological↗
PubMed2004

Child protection and public health: nurses' responsibilities.

BACKGROUND: Health care workers have been recognized as having a key role in the protection and care of Scotland's children, particularly in respect of identification and detection of child abuse. Nurses, especially health visitors, are often the first professionals to suspect that child abuse has taken place. While previous research has found that health visitors have primarily perceived their role as that of providing support and advice to vulnerable families, there are pressures on them to fulfil a more narrow surveillance role. Concurrent with a lack of clarity about the role of health visitors in child protection, there has been increasing recognition that other nurses can also make an important contribution, including those who do not work directly with children. AIMS: The aim of the study was to explore nurses' understanding of their professional responsibilities in relation to child protection, and the potential for nurses to be involved in the protection of children from abuse. METHODS: A qualitative interview-based design was used, and 99 nurses working in an National Health Service trust in a Scottish city were interviewed, either individually or in groups, about their professional involvements in child protection issues. Interview data were subjected to thematic analysis. FINDINGS: There was lack of consensus among interviewees about the nursing remit in child protection issues, particularly with respect to the extent to which nurses should actively seek to detect cases of child abuse. An emphasis on identification and detection was not easily accepted by many nurses, and was perceived by some to be a change from their more traditional role of supporting families, as well as being potentially in conflict with some public health responsibilities. CONCLUSION: In spite of the perception of some nurses that there is a sharp divide between child protection work and public health interventions, many of the child protection roles identified by nurses, such as supporting families, parenting education and service development, are clearly within the ambit of contemporary notions of public health. Furthermore, it is clear that there is a role in child protection for a much wider group of nurses than health visitors.

Child↗
PubMed2005

Integration and individuality in healthy eating: meanings, values, and approaches of childless, dual earner couples.

INTRODUCTION AND OBJECTIVES: Although considered to be an important component of food choice, perceptions and practices regarding healthy eating vary between people and change over the life-course. The purpose of this paper is to examine integration and individuality in healthy eating meanings, values, and approaches of individuals in childless, dual earner couples. MATERIALS AND METHODS: Fourteen participants (from seven couples) were recruited using notices and snowball sampling. Food journals and individual interviews were used to explore the nature of and negotiations between partners' healthy eating values and approaches. Data were analysed through iterative procedures that included coding, thematic analysis and memo writing. RESULTS: Participants presented individual healthy eating values and approaches based on their own experiences with food over time. Cohabitation resulted in a continuum of healthy eating negotiation outcomes, including congruent values and approaches, congruent values but divergent approaches, and divergent values and approaches. In combination with other salient factors, cohabitation provides an opportunity for improving healthy eating approaches. DISCUSSION: Cohabitation has the potential to lead to positive changes in healthy eating approaches. Practitioners need to tailor messages for clients' specific needs and encourage change in the direction of the partner with the healthier eating approach.

Adult↗
PubMed2006

Community hospitals--the place of local service provision in a modernising NHS: an integrative thematic literature review.

BACKGROUND: Recent developments within the United Kingdom's (UK) health care system have re-awakened interest in community hospitals (CHs) and their role in the provision of health care. This integrative literature review sought to identify and assess the current evidence base for CHs. METHODS: A range of electronic reference databases were searched from January 1984 to either December 2004 or February 2005: Medline, Embase, Web of Knowledge, BNI, CINAHL, HMIC, ASSIA, PsychInfo, SIGLE, Dissertation Abstracts, Cochrane Library, Kings Fund website, using both keywords and text words. Thematic analysis identified recurrent themes across the literature; narrative analyses were written for each theme, identifying unifying concepts and discrepant issues. RESULTS: The search strategy identified over 16,000 international references. We included papers of any study design focussing on hospitals in which care was led principally by general practitioners or nurses. Papers from developing countries were excluded. A review of titles revealed 641 potentially relevant references; abstract appraisal identified 161 references for review. During data extraction, a further 48 papers were excluded, leaving 113 papers in the final review. The most common methodological approaches were cross-sectional/descriptive studies, commentaries and expert opinion. There were few experimental studies, systematic reviews, economic studies or studies that reported on longer-term outcomes. The key themes identified were origin and location of CHs; their place in the continuum of care; services provided; effectiveness, efficiency and equity of CHs; and views of patients and staff. In general, there was a lack of robust evidence for the role of CHs, which is partly due to the ad hoc nature of their development and lack of clear strategic vision for their future. Evidence for the effectiveness and efficiency of the services provided was limited. Most people admitted to CHs appeared to be older, suggesting that admittance to CHs was age-related rather than condition-related. CONCLUSION: Overall the literature surveyed was long on opinion and short of robust studies on CHs. While lack of evidence on CHs does not imply lack of effect, there is an urgent need to develop a research agenda that addresses the key issues of health care delivery in the CH setting.

Health Services Research↗
PubMed2002

Using local authority data for action on health inequalities: the Caerphilly Health and Social Needs Study.

BACKGROUND: Primary care organisations in the United Kingdom have been given new and challenging population health responsibilities to improve health and address health inequality in local communities through partnership working with local authorities. This requires robust health and social needs assessment data for effective local planning. AIM: To assess the use and value of local authority data shared through partnership working between Caerphilly Local Health Group and Caerphilly County Borough Council. DESIGN OF STUDY: Cross-sectional analysis of aggregate electoral division data. SETTING: Caephilly County Borough, south-east Wales. METHOD: Local authority datasets identified were categorised into one of six domains: income, unemployment, housing, health, education, and social services. Data were presented at electoral division level as rates in thematic maps and correlations between the variables within and between each domain were explored using Spearman's rank correlation coefficient, with particular focus on children in families. Local planning documents were scrutinised to ascertain the use and value of the data. RESULTS: A broad range of data described a comprehensive picture of health and social inequalities within the borough. Multiple deprivation tended to cluster in electoral divisions, particularly for data relating to children, painting an overwhelming picture of inequality in life chances. The data were used in a wide range of local partnership planning initiatives, including the Health Improvement Programme, Children's Services Plan, and a successful Healthy Living Centre bid. CONCLUSION: Local authority data can help primary care organisations in a population approach to needs assessment for use in local partnership planning targeted at reducing health inequalities.

Cross-Sectional Studies↗
PubMed2004

The views and experiences of severely mentally ill mothers--a qualitative study.

BACKGROUND: The majority of women with severe mental illness are mothers. Little is known about their experiences and the extent to which their needs are met. METHODS: Semi-structured interviews were carried out with 22 women with schizophrenia, bipolar affective disorder or severe depression with psychotic symptoms in Inner London. Participants' experiences, views about services and needs for support in parenting were discussed. Interviews were transcribed verbatim and qualitative thematic analysis carried out. RESULTS: Most participants who looked after their children described motherhood as rewarding and central to their lives. However, they described the demands associated with parenting and at the same time coping with severe mental illness as considerable, and some feared that their children would be adversely affected by their illnesses. Parenting responsibilities created practical impediments to engaging with mental health services. Fear of losing custody or access to children dominated interactions with mental health and social services, making most participants reluctant to disclose difficulties in parenting to professionals. A widespread assumption that mentally ill women are inherently poor parents, regardless of the facts of individual cases, was described, and stigma was seen as affecting children as well as mothers. Services were perceived as offering little continuing support in relation to parenting, intervening only in crises. CONCLUSION: Little attention has so far been paid in research and service development to the fact that the majority of mentally ill women are mothers. Strategies for assessing and meeting the resulting unmet needs should be developed and evaluated.

Adult↗
PubMed2000

Discharge from intensive care: a view from the ward.

Relocation stress is a common phenomenon in patients discharged from an intensive care unit (ICU) to a ward. A variety of nursing interventions, initiated by intensive care nurses, have been introduced following research in this area. Ward nurses are ideally situated to minimize stress in this patient population, yet their contribution has not been considered. The aim of this study was to identify the experience of the ward nursing staff when receiving a patient from the ICU. An exploratory pilot study was conducted over a 6-month period. The sample group comprised nursing staff in two wards, who regularly received ICU patients. Data collection methods were triangulated and involved the use of open-ended questionnaires and semi-structured interviews. Thirty-six questionnaires were sent, yielding a 36.1% (n = 13) response rate. Seven staff of various grades were interviewed. Data analysis was undertaken using Burnard's (1991) Thematic Content Analysis. Four major categories were identified in the analysis of the data. These were emotions; problems; communication; and interventions. However, the experience of ward staff receiving patients from intensive care differed according to grade.

Adaptation, Psychological↗
PubMed2006

Social and emotional impacts of farmwork injuries: an exploratory study.

CONTEXT: The physical hazards of farming have been extensively studied and reported upon. Far less studied are the social and emotional impacts of farmwork injuries and deaths. PURPOSE: To investigate and document broad but targeted issues regarding the impact on individuals, families, and communities of farmwork injuries and fatalities of farmer leaders. METHODS: Ten incidents of farmwork injuries with disabilities or fatalities in Pennsylvania were used for a collective case study. Data were collected through a total of 47 interview sessions with 66 individuals including next of kin, other family members, injured persons, and community members. Thematic analysis was used to identify themes and issues in this descriptive study. FINDINGS: Community members missed the rich, broad, and comprehensive skills, abilities, and perspectives that farmers brought to community service. Participants expressed that the community assistance and support provided to injured persons and families benefited not only the injured persons and their families and farms but also the community members. Participants reported emotional anguish and loss as well as positive transformations and consequences. As expressed by participants, God and religion play an important role in their beliefs regarding the occurrence and outcome of farmwork injury incidents. CONCLUSIONS: Social and emotional impacts on individuals, families, and communities are varied and multileveled. The role that religion and storytelling play in the process of dealing with serious injury incidents raises questions regarding agricultural injury prevention.

Accidents, Occupational↗
PubMed2005

Avoidance as a strategy of (not) coping: qualitative interviews with carers of Huntington's Disease patients.

BACKGROUND: Since Huntington's Disease (HD) is a familial disease with an average onset in the mid-thirties, one might expect that spousal carers are concerned with providing care for off-spring who may turn out to be affected. METHODS: This study involved ten face-to-face interviews with carers of spouses affected by HD in Northeast Scotland. Carers were recruited through two channels: a genetic clinic and the Scottish Huntington's Association (SHA). Interviews were conducted in carers' own homes. A thematic analysis of the transcripts was conducted. RESULTS: Although carers did worry about their children, they did not envisage being involved in their care. Many avoided talking about the disease, both within and outwith their family; this may have greatly reduced the level of support provided by family members. Conversely, avoidance was often accompanied by symptom-spotting. For example, several people had given up driving, before they were incapable of doing so. The explanation appears to be that they avoided getting into situations in which HD may express itself. Support meetings seem to be valued amongst patients with other serious diseases and their carers, however, although all participants had had contact with the SHA, only one regularly attended meetings. It was felt that seeing others with HD provided a constant reminder of the possible effect of HD on the wider family, which seemed to outweigh the benefit of attending. Overall, the analysis highlighted 'avoidance' as a key theme. CONCLUSION: Many denied symptoms of HD in their spouses, pre-diagnosis. All had pretended at some point that it was not happening, through ignoring early signs and 'obvious' symptoms. Some partners had refused to go to the doctor until it was no longer possible to deny symptoms. Formal health and social care seemed to play a very small role compared to informal care arrangements.

Adaptation, Psychological↗
PubMed2006

Implementing chlamydia screening: what do women think? A systematic review of the literature.

BACKGROUND: Chlamydia trachomatis is a common sexually transmitted infection that can have serious consequences. It is universally agreed that screening for chlamydia infection should be offered to sexually active young women. We undertook a literature review to document the views, attitudes and opinions of women about being screened, tested and diagnosed with Chlamydia trachomatis. METHODS: Online databases (MEDLINE, Meditext, PsycINFO, Web of Science) and reference lists searched up to August 2005. Search terms: chlamydia, attitude, attitude to health, interview, qualitative, women. ELIGIBILITY CRITERIA: about chlamydia, included women, involved interviews/surveys/focus groups, looked at women's views/opinions/attitudes, published in English. Thematic analysis identified the main and recurrent themes emerging from the literature. We compared our thematic analysis with the Theory of Planned Behaviour to provide a model that could assist in planning chlamydia screening programs. RESULTS: From 561 identified articles, 25 fulfilled inclusion criteria and were reviewed. 22: USA, UK; 3: Holland, Sweden, Australia. Major themes identified: need for knowledge and information, choice and support; concerns about confidentiality, cost, fear, anxiety and stigma. Women are more likely to find chlamydia screening/testing acceptable if they think chlamydia is a serious, common condition which can cause infertility and if they understand that chlamydia infection can be asymptomatic. Women want a range of options for chlamydia testing including urine tests, self-administered swabs, pelvic exams and clinician-collected swabs, home-testing and community-based testing. Tests should be free, easy and quick. Women want support for dealing with the implications of a chlamydia diagnosis, they feel chlamydia diagnoses need to be normalised and destigmatised and they want assistance with partner notification. Women need to know that their confidentiality will be maintained. CONCLUSION: Our review found that women from various countries and ethnic backgrounds share similar views regarding chlamydia screening, testing and diagnosis. The acknowledged importance of women's views in planning an effective chlamydia screening program is expanded in this review which details the nature and complexity of such views and considers their likely impact.

Attitude to Health↗
PubMed2001

Women's work and symptoms during midlife: Korean immigrant women.

PURPOSE: To describe how Korean immigrant women tend to describe their work experiences within their daily lives and how they relate their work to the symptoms experienced during midlife. DESIGN: Cross-sectional study using methodological triangulation. Using a convenience sampling method, 119 Korean immigrant women were recruited for the quantitative phase, and 21 among the 119 women were recruited for the qualitative phase. Data were collected using both questionnaires and in-depth interviews. The data were analyzed using descriptive and inferential statistics and thematic analysis. FINDINGS AND DISCUSSIONS: The symptoms that the women experienced during midlife were influenced by their work experience, which was complicated by their cultural heritage, gender issues embedded in their daily lives, and immigration transition. IMPLICATIONS: Complexities and diversities in women's work need to be incorporated in menopausal studies.

Cross-Sectional Studies↗
PubMed2004

Lived experience of critically ill patients' family members during cardiopulmonary resuscitation.

BACKGROUND: During resuscitative efforts, patients' family members are often barred from the patients' rooms and may never have the opportunity to see their loved ones alive again. Recently, the need to ask family members to leave the room is being questioned. Little is known about families' perceptions of cardiopulmonary resuscitation. OBJECTIVE: To describe the experiences, thoughts, and perceptions of family members of critically ill patients during cardiopulmonary resuscitation in the intensive care unit. METHOD: Six family members whose loved ones underwent cardiopulmonary resuscitation and survived consented to an audiotaped interview. During the interview, family members were asked to describe their experiences during the resuscitation. Interviews were transcribed and were analyzed for relevant themes by using Van Manen thematic analysis. RESULTS: One major theme emerged. Should we go or should we stay? Additionally, 2 subthemes emerged: What is going on? and You do your job. A model, the family's experience with cardiopulmonary resuscitation, was developed to reflect the research findings. CONCLUSIONS: During the period of resuscitation, healthcare professionals neglect to recognize that patients' family members are experiencing crisis along with the patients and that coping mechanisms are impaired. Moreover, the family members' informational and proximity needs are often ignored during this time of crisis. Addressing these needs through appropriate nursing interventions will become increasingly important as patients' family members begin to remain with their loved ones during cardiopulmonary resuscitation.

Cardiopulmonary Resuscitation↗
PubMed2004

An insight into Australian nurses' experience of withdrawal/withholding of treatment in the ICU.

BACKGROUND: The success of biotechnology has created moral and ethical dilemmas concerning end-of-life care in the Intensive Care Unit (ICU). Whilst the competent individual has the right to refuse or embrace treatment, ICU patients are rarely able to exercise this right. Thus, decision-making is left to medical professionals and family/significant others. AIM: This study aimed to explore the lived experience of ICU nurses caring for clients having treatment withdrawn or withheld, and increase awareness and understanding of this experience amongst other health professionals. METHODS: Van Manens' (1990) phenomenological framework formed the basis of this study as it provided an in-depth insight into the human experience. A convenience sample of ten ICU Nurses participated in the study. Conversations were transcribed verbatim and analysed using a process of thematic analysis. RESULTS: Five major themes emerged during the analysis. These were: (1) comfort and care, (2) tension and conflict, (3) do no harm, (4) nurse-family relationships and (5) invisibility of grief and suffering. CONCLUSION: The experience of providing care for the adult having treatment withdrawn or withheld in the ICU represents a significant personal and professional struggle. Improvements in communication between health professionals, debriefing and education about the process of withdrawing or withholding treatment would be beneficial to both staff and families and has the potential to improve patient care and reduce burden on nurses.

Australia↗
PubMed2005

What is important to measure in the last months and weeks of life?: A modified nominal group study.

BACKGROUND: Identifying the most important issues for palliative care patients and their families, and assessing whether services address these appropriately is important. Little is known about the views of United Kingdom service users and whether, and in what ways, they differ from those in the published literature from other countries, or from health professionals. AIMS: To investigate what is important to measure at the end of life from the perspectives of United Kingdom patients, bereaved relatives and health care professionals. METHODS: Ten focus groups, using a modified nominal group technique, with a total of 75 participants (10 patients, 35 professionals and 30 bereaved relatives) enabled issues participants thought important to measure at the end of life to be identified and prioritised using ratings and rankings. Thematic analysis of the data was conducted to enable cross-group comparison. FINDINGS: Seven themes were identified as most important to participants: symptom management; choice and control; dignity; quality of life; preparation; relationships; and co-ordination and continuity. Bereaved relatives and professionals emphasised symptom management, relationships and quality of life, whilst patients prioritised issues around preparation. CONCLUSIONS: The study was successful in identifying aspects of end of life care that are important to patients, families and health professionals in the United Kingdom. Although participants were not representative of the wider population in the United Kingdom, the degree of concordance with published studies from outside the United Kingdom increases the credibility of the findings. Quality assurance initiatives need to ensure that they act on information such as this on users' priorities. Further research is needed to test out the findings in other settings in the United Kingdom, to build on the findings about different participants' views and to identify similarities and variations between countries.

Activities of Daily Living↗
PubMed1996

Almost 'like family': emergency nurses and 'frequent flyers'.

OBJECTIVE: Heavy users (HUs) of emergency services ("repeaters" or "frequent flyers") are often regarded by emergency nurses as "problem patients." Yet, these patients also solicit deeper clinician involvement because of their familiarity and their often intractable medical and social problems. The primary objective of this study was to contribute to improved understanding of the phenomenon of heavy ED use by describing the context within which such use occurs and its meanings to patients and to clinicians. METHODS: Observational and narrative data were collected during ethnographic fieldwork in two inner-city trauma center emergency departments. Data were interpreted using interpretive phenomenological strategies. FINDINGS: Relationships between ED clinicians and HU patients in the study hospitals were characterized by complexity and ambivalence, but thematic analysis of interviews revealed commonalities. Recognition practices, discussed in this article, were central to both centers. DISCUSSION: Frustration with a system that focuses on control but often leaves ED clinicians feeling like failures as they try to pick up the pieces for failing or absent families, communities, and social programs can contribute to stigmatization of HU patients, missed clinical diagnoses, and reduced nurse morale. Acknowledging the reasonable limits of control, and engaging in simple recognition and inclusion practices, may be more meaningful in furthering changes in HU patients behavior than biomedically oriented interventions.

Adult↗
PubMed2006

Family members' perceptions of augmentative and alternative communication device use.

PURPOSE: Although advancements in technology have expanded the use of augmentative and alternative communication (AAC) devices for children with disabilities, the use of AAC devices in school and home settings is often inconsistent. The purpose of this study was to examine family members' perceptions regarding the use of AAC devices. Factors that were perceived to affect student's use of AAC devices, family expectations, and benefits of AAC device use were explored. METHOD: Semistructured interviews were conducted with 6 family members (primary caregivers) of 7 youth who primarily use AAC devices to communicate in the school environment. The interviews were analyzed using cross-case analysis. RESULTS: A variety of common perspectives emerged from the data, including four thematic categories: expectations, facilitators, barriers, and benefits of AAC device use. IMPLICATIONS: Information gained in this investigation may be used to improve professional-family and teaming relationships and serve to benefit AAC users in school and home settings.

Adolescent↗
PubMed2006

Multidisciplinary perceptions of the role of nurses and healthcare assistants in rehabilitation of older adults in acute health care.

AIM: This paper describes the perceptions of nurses, healthcare assistants, doctors and therapists of rehabilitation and the role of nurses and healthcare assistants on an acute older adults ward in a London teaching hospital. BACKGROUND: The role perception, education and training and attitudes towards the older adults have been identified as barriers that have an impact upon the nurses' role within rehabilitation. However, little is known about the role of nurses and healthcare assistants in rehabilitation of older adults in acute health care. DESIGN: Action research study. METHOD: Twenty-four semi-structured interviews were conducted and audio recorded about healthcare professionals' understanding of rehabilitation, the type of skills needed and their perceptions of the role of nurses and healthcare assistants in rehabilitation. The interview transcripts were analysed using the thematic content analysis. RESULTS: The findings suggest that the therapists relied on nurses and healthcare assistants for therapy carry-over. Healthcare assistants were perceived as the professional group who could deliver therapy carry-over. There was an evidence of role hierarchy as healthcare assistants perceived that they were not actively involved in decision-making or discharge planning. CONCLUSION: This paper suggests that healthcare assistants and nurses are viewed as the professional group best placed to deliver therapy carry-over. However, whilst there is an acknowledgement of their role, there remains a reluctance to acknowledge healthcare assistants as a professional group and to involve them within decision-making and discharge planning. RELEVANCE TO CLINICAL PRACTICE: Employers must be seen to advocate, support and implement education and training programs for healthcare assistants. However, whilst nurses and healthcare assistants have an integral role in rehabilitation, there needs to be more research into the how they are supported by therapy professionals.

Aged↗