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At least 451 records · Page 25Linked to original sources
PubMed2005

Managing urinary tract infections in nursing homes: a qualitative assessment.

OBJECTIVE: To elucidate the steps in the management of urinary tract infections (UTIs) in elderly nursing home residents, in order to derive data which would assist in an economic evaluation of such infections. METHOD: Maximum variation sampling was used to recruit General Practitioners (GPs) and nurses (who worked in nursing homes), into the study. Using semi-structured interviews, a topic guide was used to explore diagnosis, treatment and the role of GPs and nurses in the management of UTIs in nursing home residents. Thematic analysis was employed to identify the main themes. MAIN OUTCOME MEASURES: A comprehensive description of the management of UTIs in nursing home residents that will be used in a future economic evaluation of the costs of this prevalent infection in this setting. RESULTS: Ten GPs and nurses respectively took part in the interviews. Three overarching themes emerged from the interviews: information, processes and decision-making. Health care professionals described the key symptoms for diagnosis (information), testing procedures to confirm the presence of an infection (processes); many variations in management pathways were described. The nurse was central to decision-making in treatment i.e. prescribing of an antibiotic. Most GPs reported that they accepted the nursing staff's assessment of the resident and seldom visited a patient in a nursing home for a UTI. CONCLUSIONS: The management approach to UTIs varied greatly and was a more complex process than anticipated. Identification of the component steps will be used to perform an economic evaluation of UTIs in nursing homes.

Aged↗
PubMed2026

Uncertainty and information management for Lynch syndrome in a genomic screening cohort: Connections to clinical engagement.

OBJECTIVE: Lynch syndrome (LS) is a common hereditary cancer predisposition syndrome. This study explores how individuals learning about LS-related cancer risk through a population genomic screening program appraise, reappraise, and manage uncertainty and engage in medical management. METHODS: We recruited participants with an LS result from a population genomic screening study, purposively sampling based on the characteristics of sex, age, LS gene, and family history of cancer. Semi-structured interviews and chart reviews focused on participants' experiences of learning about the LS result and making management decisions. Thematic analysis and heatmapping were used to explore participant characteristics related to uncertainty management and clinical engagement. RESULTS: Seventeen participants completed interviews, describing uncertainty discrepancies or ambivalent appraisals. Most participants who appraised their LS risk as a threat had high clinical engagement. All participants who had lower clinical engagement received misinformation, had little support from clinicians, or had misunderstandings about LS. CONCLUSION: Accurate information from trusted sources is critical to support uncertainty management and subsequent engagement in clinical risk management choices. PRACTICE IMPLICATIONS: Ensuring primary care providers have the information and tools to provide patients with accurate information may support recommended clinical engagement, thereby improving health outcomes for this population.

Clinical Engagement↗
PubMed2006

[How do community-based mental health staff in Austria perceive their job? -- a qualitative study].

OBJECTIVE: The aim of this study was to explore, using a simple qualitative design, how community mental health staff in Austria perceive their job. METHOD: 195 community-based mental health professionals answered seven open questions on how they perceive their job. The main areas covered were the most important tasks of the job, skills necessary to perform these tasks, as well as positive and negative aspects of the job. Answers were subjected to thematic content analysis. RESULTS: For most professionals, contact with clients and team colleagues were the major rewards of the job. Aspects experienced as stressful were the clients' illness, role ambiguity, team conflicts and lack of time. Necessary skills many respondents did not feel competent in were specialised knowledge and psychosocial skills. CONCLUSIONS: It might be useful to revise existing forms of collaboration within multiprofessional teams. The responsibility for difficult patients may be shared by several members of the team, who should contribute their specific knowledge. Training should be tailored towards the needs of the different professional groups and focus on those skills that are required in community mental health care.

Attitude of Health Personnel↗
PubMedDate not supplied

International students of speech and language therapy in the UK: do we meet their needs?

BACKGROUND: Informal evidence suggests that many Speech and Language Therapy (SLT) students from outside of the UK and/or Republic of Ireland who come to the UK either do not return to their home country on qualification or do not practise as SLTs in the public sector. Many factors may contribute to this situation. Concern that it may result in part from a poor match between UK SLT education and the demands of the role in other countries led the Royal College of Speech and Language Therapists (RCSLT) to fund a study of international SLT students' experiences of UK qualifying courses. AIMS: To discover and describe the experiences, views and expectations of current and past international students studying SLT in the UK and past international students' experiences, views and expectations of practising as SLTS, both inside and outside the UK. To consider the implications of the findings for (1) international students planning to work as SLTs; (2) UK SLT students planning to practise outside the UK; and (3) all those involved in SLT education: educational institutions; supervising SLTs; RCSLT. METHODS & PROCEDURES: The study involved distributing 166 postal questionnaires (some directly to (ex)students and some to their Higher Education Institutes, or HEIs) and carrying out 23 interviews, with both current students and those qualifying since May 1994. Quantitative analysis was carried out using SPSS using descriptive statistics. Qualitative analysis used content and thematic analyses. OUTCOMES & RESULTS: Seventy-one questionnaires were received from current and past students, representing a minimum response rate of 43%. (It was not possible to verify exactly how many questionnaires were distributed by HEIs.) The results describe the diverse range of respondents' experiences of studying and working in the UK, their views of working in their home countries and the UK, and their suggestions about strategies that might be adopted to support them further. The results revealed that students come from a wide diversity of countries, with resulting differences in their experiences. However, there were some commonalities in the perceived advantages and disadvantages of working at home and in the UK. CONCLUSIONS: The suggestions for change included practical ideas for change both before and after qualification as an SLT. These included courses about the organization of health, education and social services in the UK, adaptations of course delivery and course work to include cross-cultural/linguistic work and 'home-based' projects. Implications of the findings and strategies for home as well as international SLT students are discussed.

Consumer Behavior↗
PubMed2004

Changing nurses' dis-empowering relationship patterns.

BACKGROUND: Nurses' inter- and intra-disciplinary relationships are frequently interpreted as oppressed group behaviours, contributing to their relatively dis-empowered status. In the context of restructuring in health care, this study examined the views of hospital staff nurses about their relationships with nursing colleagues and other health care professionals and their ideas for change. AIM: The aim of this paper is to report a study to add the views of staff nurses to the discourse on restructuring and to make visible the processes that contribute to their marginalization. DESIGN: The study was descriptive and exploratory. Staff nurses from various hospitals in a large Canadian city were selected by theoretical sampling. METHOD: Twenty volunteer staff nurses were interviewed between 1998 and 1999, using broad, open-ended questions and prompts to explore nurses' various relationships in the health care system. This approach allowed for multiple responses and expansions of ideas, without losing focus. The interviews were audio-taped and later transcribed. Thematic analysis was carried out. FINDINGS: Many participants were aware of inter-disciplinary hierarchies, particularly between nurses and physicians. Many also showed insights into their own intra-disciplinary hierarchies and mutual non-supportiveness. Both types of relationships were found to be inextricably linked, sustaining nurses' oppression through dis-empowering discourses. Nurses expressed many ideas about how to promote mutually supportive relationships. CONCLUSION: Change for the better needs to come from within the nursing profession. To develop effective strategies, bedside nurses have to be included in decision-making processes affecting them and their practice, about which they are the experts. Mutual respect, awareness-raising through education, development of caring nursing communities, mentorship and non-hierarchical leadership are key to stopping dis-empowering discourses and practices amongst nurses.

Attitude of Health Personnel↗
PubMed2005

Experiences of Australian parents caring for children with asthma: it gets easier.

OBJECTIVE: To describe the experiences of Australian parents caring for children with asthma. METHODS: A combination of random sampling, purposeful sampling and quota sampling was used to select care-givers from general practices in Melbourne's north and north-western suburbs. Data collection involved a single semi-structured in-depth interview with 21 parents caring for a child with asthma. Thematic analysis was aided by QSR NVivo. RESULTS: Children experienced predominantly mild-to-moderate, episodic asthma. Six themes emerged from the interviews: emotions and behaviours, coping strategies, disruption to activities, health and treatment beliefs, problems with asthma management, and relationships with doctors. Parents' experiences and health beliefs impacted on their management of asthma. These may act as barriers to optimal asthma care in some families. The overriding theme to emerge was 'it gets easier'. It got easier with time because the children could communicate more effectively, and were better able to take care of themselves, and their asthma became less severe or less of a problem. DISCUSSION: This research has highlighted the need for health professionals to emphasize the chronic nature of asthma, but negotiate strategies with care-givers to optimize the use of asthma medications, with consideration being given to care-givers' fears, frustrations and health beliefs.

Adaptation, Psychological↗
PubMedDate not supplied

Crafting the self: older persons' narratives of occupational identity.

OBJECTIVE: This study aimed to examine how engagement in creative occupations informed six older retired people's occupational identities. METHOD: Occupational narratives were gathered from in-depth interviews with 6 participants (75 years of age or older) who had extended experience of participation in creative occupations. A process of narrative-type inquiry produced summarized, chronological stories for each participant. Subsequently, a process of paradigmatic-type narrative analysis produced thematic categories related to how a sense of self is associated with creative occupational engagement in later life. RESULTS: Four themes derived from data analysis included the relevance of relational practices, changing self-awareness, enduring qualities, and reflective processes to the formation of a sense of self. CONCLUSION: This study adds to an understanding of how leisure occupations maintained across the life cycle contribute to building an occupational identity.

Aged↗
PubMed1996

'Doing clinical': the lived experience of nursing students.

This investigation looked at the phenomenon of 'doing clinical' from the nursing students' perspective. A qualitative descriptive research based on the phenomenological approach was chosen as the method to reveal the meaning of 'doing clinical', through the analysis of nursing students' descriptions of their everyday lived experience of undertaking the clinical program. Nine, second year Bachelor of nursing students with at least 13 weeks of clinical experience were interviewed. These intensive interviews were tape recorded and transcribed verbatim. A thematic analysis of significant statements of the text was conducted resulting in sixteen theme clusters deriving from specific themes. These sixteen themes clusters and specific themes fell into 6 categories and there were: being in a world of conflicting and confusing values, deciding whether nursing is for me, becoming a professional nurse, discovering what nursing is, being an active learner, and having mixed feelings and thoughts on entry to the clinical program. The essential structure of the meaning of 'doing clinical' from the students' perspective is described and implications for nursing education, practice and research is discussed.

Adaptation, Psychological↗
PubMed2003

Adolescent chronic illness: a qualitative study of psychosocial adjustment.

INTRODUCTION: The purpose of this study was to investigate the psychosocial issues facing young people living with a chronic medical condition. MATERIALS AND METHODS: Subjects were young people with a range of medical conditions who were on a waiting list to participate in the Chronic Illness Peer Support programme at the Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia. Young people agreed to in-depth interviews which were taped and transcribed. Thematic analysis was undertaken by two researchers working independently. RESULTS: Thirty-five young people were interviewed. Thematic analysis revealed five broad themes: control (in control, under control, out of control); emotional reactions (happiness, frustration, anger, sadness, anxiety); acceptance (of illness, of others, of self); coping strategies, and; a search for meaning. The importance of social connections was emphasised. While illustrating the difficulties of managing a chronic medical condition during adolescence, a generally positive message emerges about these young people. CONCLUSIONS: Many young people with chronic illness appear relatively resilient in the face of the adjustment challenges presented by their illness. Interventions that allow a young person to explore meaning, build self-esteem, and acceptance through positive social connections are likely to improve adjustment outcomes in this group.

Adaptation, Psychological↗
PubMed2001

Interaction relating to privacy, identity, autonomy and security. An observational study focusing on a woman with dementia and "behavioural disturbances", and on her care providers.

AIM: The study aims to illuminate how one woman with severe dementia and so-called behavioural disturbances acts in relation to her care providers and how the care providers act in relation to her. METHODS: Fourteen participant observations, including one woman with dementia and six care providers, were performed. A reflective dialogue focusing on the interaction between the woman and her care providers followed each observation. The tape-recorded observational notes and reflective dialogues were fixed as a text, which was subjected to a thematic content analysis. FINDINGS: The main findings are that the interaction between a woman with severe dementia and "behavioural disturbances" and her care providers relates to privacy, identity, autonomy and security. The phenomena are intertwined and also in conflict with each other. Interaction is a complex dialectic process in which those who are engaged meet problems that can be solved and are involved in dilemmas that cannot be solved, only related to.

Activities of Daily Living↗
PubMed2004

Communication with dying patients--perception of intensive care units nurses in Brazil.

AIMS AND OBJECTIVES: This study aimed to assess whether nurses working in intensive care units view the establishment of communication with patients beyond therapeutic possibilities as an effective palliative therapeutic resource, and which aspects of this communication they valued most. METHOD: Data were collected in November 2002, by semi-structured interviews with 10 nurses of both clinical and surgical intensive care unit at a school hospital in Sao Paulo city, Brazil. Interviews were recorded and transcribed to be further analysed according to the qualitative methodology of content analysis. RESULTS: Four categories of thematic order raised from the collected statements, which clarify (i) the value of communication with terminal patients; (ii) the obstacles found during this process; (iii) the need to identify the individual demands of each patient, (iv) be able to use communication as a tool in the palliative care of the dying patient. CONCLUSION: In conclusion, we found that the nurses working at the intensive care unit do consider communication with dying patients an effective therapeutic resource, in spite of their own difficulties in communicating with dying patients, viewing themselves as ill prepared to the task, and often, distancing themselves from the dying patients because of their inability to deal with their own feelings, which were brought forth by the confrontation with the imminence of death. RELEVANCE TO CLINICAL PRACTICE: Although the number of interviewed nurses in our study was small, the results corroborated the findings of other studies and revealed an educational aspect in nursing training that deserves serious consideration.

Adaptation, Psychological↗
PubMed1996

Functional disorganization of representations in schizophrenia.

The first part of this article describes a model of disorganization of representations in schizophrenia. We assume that subjects with schizophrenia have some interfering activity in memory. Such an interfering activity induces a functional decontextualization of information and the reciprocal is true. This model accounts for different classes of cognitive troubles that have been observed in schizophrenia. In the second part, we describe a text-comprehension experiment that studies two paradigmatic cases of episodic and semantic contextualization of information: the "compartmentalization" and the "thematization" of fictional narratives. Compartmentalization refers to the way in which representations of different narratives are separated in memory; thematization refers to the way in which representations of one narrative are structured in function of a theme. In our experiment, compartmentalization and thematization are assessed by a method of priming in word recognition. In agreement with our model, the results show that subjects with schizophrenia are impaired in compartmentalization and thematization when compared with anxious-depressed subjects.

Adult↗
PubMed2005

Nurse-led models of chemotherapy care: mixed economy or nurse-doctor substitution?

AIM: This paper reports a study exploring the perspectives of people affected by cancer (service users) and health care professionals' about current medical consultant-led services and the acceptability of a proposed nurse-led ambulatory chemotherapy service. BACKGROUND: A number of studies have evaluated a nurse-led model of cancer care delivery but little work has been undertaken in chemotherapy settings. Furthermore, many of these studies give little information on how the perspective of users was incorporated in the design and evaluation of these services. METHODS: Service users (n = 26) and health care professionals (n = 22) were recruited across the South East of England. A qualitative study was undertaken... Using a semi-structured interview schedule, participants were asked to give their perceptions of current chemotherapy services and the potential of a nurse-led service. A thematic analysis of data was undertaken. FINDINGS: This paper focuses on the theme of the current and future context of a chemotherapy service. Three sub-themes were identified: contextualizing roles, defining therapeutic outcomes, and demonstrating effectiveness. All interviewees saw this role as different but complementary to the role of medical staff. There were mixed opinions from service users and professionals on the acceptability of nurse-led chemotherapy provision. In defining potential outcomes of nurse-led care, service users described benefits in terms of service and economic outcomes. Professionals saw additional benefits in terms of patient-based outcomes. Professionals and service users expressed the need for appropriate education of nurses for this role and rigorous evaluation of any new service before widespread implementation. CONCLUSIONS: Understanding the perspective of users is imperative when re-designing cancer nursing services. Implementation of nurse-led models in chemotherapy services should be preceded by staff education and followed by systematic evaluation.

Adolescent↗
PubMed2006

Helping each other to learn--a process evaluation of peer assisted learning.

BACKGROUND: The benefits of Peer Assisted Learning (PAL) are well established with positive effects on examination scores, student satisfaction and personal and professional development reported. PAL is increasingly utilised as a resource within medical education where the restrictions on resources have forced teachers to look at creating new educational environments which can be delivered at a lower cost. This study sought to evaluate the processes at work as the emphasis of PAL research to date has largely been on the consideration of student outcomes. METHODS: Fifth-year medical undergraduates, who had completed their communication skills modular training and attended a preparatory workshop, facilitated a role-play session for their second-year colleagues within an Early Patient Contact programme. Semi-structured interviews and focus groups were used to collect data at different time points in order to establish the views of peer learners and tutors towards this new method of teaching. The data was analysed according to the principles framework analysis using N-vivo software. Themes were shared and debated with the multidisciplinary team of authors and a concordance of views on common themes was reached after discussion and debate. RESULTS: Analysis of the data resulted in the emergence of three thematic categories: Learning Environment, Educational Exchange and Communication and Modelling. The data demonstrated a concordance of the views between peer tutors and learners on barriers and levers of this approach as well as a heightened awareness of the learning environment and the educational exchange occurring therein. CONCLUSION: The data is significant as it not only demonstrates a high level of acceptability among tutors and learners for PAL but also indicates the reciprocity of educational exchange that appears to occur within the PAL setting. This study highlights some of the unique characteristics of PAL and we recommend the development of further qualitative studies around peer learners and tutors views of this process.

Adult↗
PubMed1997

Content analysis of coverage of alcohol control policy issues in black-oriented and mainstream newspapers in the U.S.

We conducted a content analysis of alcohol control policy issues in Black-oriented and mainstream newspapers in the United States from 1993 to 1995, using computerized content analysis methods. The specific purpose of our study was to compare differences in coverage of alcohol control policy issues in Black-oriented and mainstream newspapers. Fifteen Black-oriented and 12 mainstream newspapers were selected and analyzed. The number of policy paragraphs per year and the number of paragraphs in different policy thematic categories per year were examined. Regional differences in coverage of alcohol policy themes were examined for selected policies in mainstream newspapers. We found more similarities than differences in coverage of alcohol policy issues in Black-oriented and mainstream newspapers. Limiting the marketing/advertising and promotion of alcohol products was the most widely covered alcohol control policy issue over the three-year period in both Black-oriented media and mainstream newspapers. There were some important differences in coverage of alcohol policy issues. While economic alcohol policy issues were covered extensively in mainstream newspapers, these issues received far less attention in Black-oriented newspapers. Findings suggest that certain alcohol control policies may have less salience in African-American communities than in other communities.

Adult↗
PubMed2026

Implementing a novel digital health platform for self-management of postmenopausal osteoporosis: A qualitative study of user experiences, perspectives and implementation outcomes.

BACKGROUND: Osteoporosis self-management requires scalable support, and digital health platforms may meet this need. This study aimed to characterise the experiences and perspectives of postmenopausal women who participated in a 12-month randomised controlled trial (RCT) of a digital voice assistant (DVA) delivered osteoporosis self-management intervention, and to assess key implementation outcomes. METHODS: This was a qualitative analysis of interviews with postmenopausal women from the intervention arm (DVA group) of the RCT. The DVA program broadcast education videos, medication reminders, home-based exercise, nutrition advice and monthly quizzes through a DVA device. Semi-structured interviews were recorded, transcribed and managed in NVivo through reflexive thematic analysis, guided by the Practical Planning for Implementation and Scale-Up and Proctor's implementation outcome taxonomy frameworks. Evidence weighting summarised participant coverage and code density. RESULTS: Twenty-two of 25 (88%) DVA group participants completed semi-structured interviews. Thematic analysis identified seven themes mapped to Proctor's implementation outcomes. Evidence weighting indicated strong support for the intervention's appropriateness and acceptability, moderate support for its adoption, fidelity, feasibility and sustainability, and limited support for costs. Participants valued clear audiovisual guidance, conversation-based interactions with natural language, and flexible home-based access to self-management. CONCLUSION: Digital health platforms for osteoporosis self-management appear feasible, acceptable and sustainable among postmenopausal women. Findings indicate that these platforms are approaching readiness for evaluation in implementation-focused settings, contingent on streamlined content, reliable delivery modalities, accessible user support, clear privacy regulations and pragmatic pricing models.

Humans↗
PubMed2005

Exploring the social and cultural context of sexual health for young people in Mongolia: implications for health promotion.

Recent political, economic, and cultural changes in Mongolia make its large proportion of young people vulnerable to HIV infection. While there had been only two clinical cases of HIV in Mongolia by the year 2000, the incidence of sexually transmitted infections (STIs) is on the rise, especially among people aged 15-24. Little is known about the social and cultural context in which the sexual knowledge, attitudes, and behaviour of Mongolian young people are created and negotiated. This context must be better understood in order to promote safer sex practices. This study employed qualitative research methods to explore and describe the social and cultural context in which sexual behaviour is negotiated among secondary school students in Ulaanbaatar, Mongolia. Students and teachers from two schools in Ulaanbaatar and health professionals were selected by purposeful sampling to participate in six semi-structured focus group interviews in autumn 2000. Thematic content analysis was conducted on the focus group transcripts. Seven themes were extracted including embarrassment, lack of knowledge, concepts of sex, perceptions of condoms, gender roles, peer norms, and the influence of drinking on sexual activity. Results presented are the first description of the social and cultural context of sexual health and highlight the combined impact of these themes on safer sex practices in Mongolia. These findings are not generalizable, but their agreement with the Mongolian and the international literature indicates that they may be transferable. Implications for STI and HIV/AIDS prevention efforts and further research in Mongolia are discussed.

Adolescent↗
PubMed2006

"I really should've gone to the doctor": older adults and family caregivers describe their experiences with community-acquired pneumonia.

BACKGROUND: Responding to acute illness symptoms can often be challenging for older adults. The primary objective of this study was to describe how community-dwelling older adults and their family members responded to symptoms of community-acquired pneumonia (CAP). METHODS: A qualitative study that used face-to-face semi-structured interviews to collect data from a purposeful sample of seniors aged 60+ and their family members living in a mid-sized Canadian city. Data analysis began with descriptive and interpretive coding, then advanced as the research team repeatedly compared emerging thematic categories to the raw data. Searches for disconfirming evidence and member checking through focus groups provided additional data and helped ensure rigour. RESULTS: Community-acquired pneumonia symptoms varied greatly among older adults, making decisions to seek care difficult for them and their family members. Both groups took varying amounts of time as they attempted to sort out what was wrong and then determine how best to respond. Even after they concluded something was wrong, older adults with confirmed pneumonia continued to wait for days, to over a week, before seeking medical care. Participants provided diverse reasons for this delay, including fear, social obligations (work, family, leisure), and accessibility barriers (time, place, systemic). Several older adults and family members regretted their delays in seeking help. CONCLUSION: Treatment-seeking delay is a variable, multi-phased decision-making process that incorporates symptom assessment plus psychosocial and situational factors. Public health and health care professionals need to educate older adults about the potential causes and consequences of unnecessary waits. Such efforts may reduce the severity of community-acquired pneumonia upon presentation at clinics and hospitals, and that, in turn, could potentially improve health outcomes.

Aged↗