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PubMed2006

How are decisions to introduce new surgical technologies made? Advanced laparoscopic surgery at a Canadian community hospital: A qualitative case study and evaluation.

The introduction of many new surgical technologies is associated with increased costs and uncertainty regarding risks and benefits. Currently, little is known about how decisions are made regarding the adoption of surgical innovations. To study the decision-making process for adoption of advanced laparoscopic surgical procedures at a community hospital in Toronto, Canada, we used qualitative case study methods. Data were collected using semi-structured interviews with key informants. We performed a modified thematic analysis of the data, using the conceptual framework for priority setting known as accountability for reasonableness, which consists of 4 conditions: relevance, publicity, appeals, and enforcement. Several advanced laparoscopic surgical procedures were introduced at the hospital between 2000 and 2005. During that time, there was no structured, explicit process for making decisions about introducing new surgical technologies. Use of the new surgical technologies was relevant, as measured by the perception of patient benefit and alignment with the hospital's strategic priorities. There was no systematic structure in place to oversee publicity, appeals, or enforcement. The decision to adopt advanced laparoscopic surgery at a community hospital in Toronto, Canada, was made primarily on the basis of its relevance to patient care. The process for making decisions about the adoption of new surgical technologies can be improved.

Decision Making, Organizational↗
PubMed2005

[Research on contraception: opinion of researchers, subjects and advocates of women rights].

OBJECTIVE: To survey the opinion of researchers, women -- subjects of research-- and of advocates of women's rights about the meaning of "research" and "guinea pigs". METHODS: Researchers (11), women (18) and advocates (10) were interviewed. The study was qualitative and a thematic analysis was carried out. RESULTS: Participants experienced difficulty to explain what research meant and some were unable to do so. For the researchers and most of the women, subjects are not guinea pigs, because they have freedom of choice. Most of the advocates, however, said that subjects are guinea pigs, even when they consent to participate in a study. CONCLUSIONS: The difficulty experienced by researchers when explaining the meaning of research was surprising. The different opinions about "guinea pig" reflect the controversy about its meaning in research. Certainly the expression "guinea pig" does not apply to all studies however the different meanings identified should make researchers cautious about the ethical issues involved in their studies.

Brazil↗
PubMedDate not supplied

Oncology nurses' experiences with requests for assisted dying from terminally ill patients with cancer.

PURPOSE/OBJECTIVES: To explore oncology nurses' experiences with receiving requests for assisted dying from terminally ill patients with cancer. DESIGN: Descriptive, naturalistic. SETTING: RNs who identified themselves as direct care providers or clinical nurse specialist members of the Oncology Nursing Society. SAMPLE: 40 oncology nurses who responded to a randomized, sequential direct mailing submitted 48 stories for analysis. METHODS: Anonymously submitted written stories analyzed using Denzin's process of interpretive interactionism. MAIN RESEARCH VARIABLE: The experience of receiving a request for assisted dying. FINDINGS: Four main themes emerged from the thematic analysis: Control, Conflict, Covert Communication, and the Enduring Influence. Eleven subthemes included the Cry for Help, Hastening the Process, What if, Managing the Morphine, Countering With Palliative Care, Collision of Values, Sense of Distress, Dialogue Around the Request, Silent Knowing, the Unforgettable, and Reflections on Lessons Learned. CONCLUSIONS: Experiences included a mixture of direct-patient and family requests for pain relief, anticipatory fear of future pain, desire to end life before unacceptable deterioration, family requests to hasten the dying trajectory, and others. Stories reflected the larger societal struggle with desires to control life, health, and the dying process. IMPLICATIONS FOR NURSING PRACTICE: Nurses should be prepared to respond to such requests in a compassionate and helpful way that is respectful of both the patient's and the nurse's personal values. Diversity of individual values and priorities may trigger some patients to seek assistance in controlling the timing and circumstances of death. Thus, continued study of nurse, patient, and family member experiences with this ethical dilemma is warranted.

Adult↗
PubMed2002

Coping and self-help group membership in Parkinson's disease: an exploratory qualitative study.

The present small-scale, exploratory, qualitative study was conducted to investigate how Parkinson's disease, a chronic progressive illness, had affected the lives of eight participants. It also explored whether self-help group membership was related to coping methods (four of the participants were members of the Parkinson's Disease Society and four were not). Semi-structured interviews were conducted and thematic analysis was used to identify and group themes which emerged from the participants' discourse. It was found that all participants had experienced losses of physical and mental functioning and independence, self-identity and future, and were afraid of further losses. Although all participants used a range of coping methods, it was found that there were differences between members and non-members in the prominence of certain methods and overall coping style. For non-members, coping centred upon maintaining a normal life and denying the condition a central role, but for group members, the disease and its likely consequences were accepted and incorporated into everyday life. The discourse of non-members contained many references to a self-help group as a source of distress, while discourse of members identified it as a supportive resource. This exploratory study enhances our understanding of differences between people in their willingness to use a self-help group, and in turn, raises questions about the provision of psychological services in a chronic progressive illness.

Adaptation, Psychological↗
PubMed2004

Korean women's attitudes toward physical activity.

In this study attitudes toward physical activity of three groups of Korean women were explored using a feminist qualitative research design. Seventeen healthy Korean women, 11 Korean women at risk of muscular atrophy, and 16 Korean immigrant women were recruited using a purposive sampling method. In-depth interviews using an interview guide were audiotaped and transcribed. Data were analyzed using thematic analysis. The findings indicate that the women viewed physical activity holistically, that death was viewed as the opposite of physical activity, that exercise was differentiated from physical activity, that exercise was connected to health, and that the women rarely participated in exercise because of their busy lives. The findings confirm the importance of considering the psychosocial contexts of attitudes toward health behavior.

Adult↗
PubMed2005

Perspectives on Drug and Therapeutics Committee policy implementation.

BACKGROUND: Drug and therapeutics committees (DTCs) are expected to make difficult decisions that may have an impact on the clinical and economic outcomes of drug use. There have been few studies investigating the barriers to DTC policy implementation, and little is known about ways to improve the process. OBJECTIVES: The specific objectives of this qualitative study were to explore stakeholder opinions with respect to (1) the perceptions of barriers to Drug and Therapeutics Committee (DTC) policy implementation and (2) ways to improve DTC policy implementation. METHODS: Stakeholders of Australian DTCs participated in focus group discussions. Discussions were audiotaped and transcribed verbatim. Thematic content analysis was conducted. RESULTS: Six focus group discussions were conducted. A number of barriers were identified (lack of resources, lack of follow-up, lack of ownership, low DTC profile within the organization, and overreliance on pharmacy to implement policy). Participants were of the opinion that prioritizing decisions, optimizing pharmacy roles, provision of real-time information, and active procurement of organizational commitment were some of the ways to improve DTC policy implementation. CONCLUSIONS: Although this study was conducted in an Australian setting, the challenges facing DTCs in other countries are likely to be similar. Ownership, social influence, and resources are important issues in the implementation of policy/guidelines for many DTCs, both in Australia and internationally. It is expected that these issues will have an impact on policy implementation. Therefore, the findings of this study may be widely applicable. This work reinforced the notion that the significance of DTCs lies beyond decision making alone. The time and expertise invested in decision making could be undermined, if DTC policies are not effectively implemented.

Adult↗
PubMed2002

An evaluation of the role of the Clinical Placement Coordinator in student nurse support in the clinical area.

PURPOSE OF THE STUDY: The purpose of this study was to evaluate the role of the Clinical Placement Coordinator (CPC) and the continued development of the role in the context of the provision of student support in the clinical area. BACKGROUND: Following the introduction of the Registration/Diploma in Nursing Studies programme in the Republic of Ireland in 1994 the post of CPC was created to support student nurses in the clinical area. The CPC is an experienced nurse who provides dedicated support to student nurses in a variety of clinical settings however, unlike the role of mentor/preceptor they do not have a client/patient caseload. To date no major evaluation of the post has taken place. Therefore the Department of Health and Children commissioned a national evaluation of the post of which part of the findings are reported in this paper. METHODOLOGY: A two-stage study is described utilizing a mixed-methods approach. Data collection included individual and focus group interviews and questionnaires. Interviews were analysed using thematic content analysis and data collected from questionnaires were analysed utilizing descriptive and inferential statistics. FINDINGS: An analysis of the data identified the responsibilities and functions of CPC were multivariate, however, core elements of the role were evident. The core elements were identified as student support and practice development. The central and most frequent finding from the data collected was the individual support students received from CPCs throughout their clinical placement. CONCLUSION: The role of CPC was evaluated as a positive addition to the realm of student support and the clinical team. The positioning of the post in the clinical area also adds the dimension of a CPC being a link between student nurses and the various groups that provide student support, this is essential in light of the changing role of the nurse tutor following the full integration of preregistration nurse education into the third-level sector and the development of a formal preceptorship role for clinical nurses in the Republic of Ireland.

Attitude of Health Personnel↗
PubMed2006

Reframing birth: a consequence of cesarean section.

AIM: This paper is a report of a study to describe the childbirth expectations, influences and knowledge of a group of Western Australian women who experienced a cesarean section (CS) and would prefer a CS in a subsequent pregnancy. BACKGROUND: Evidence suggests that a previous CS is not an indication for an elective CS in a subsequent pregnancy, but western world data indicate high probability of repeat CS. METHODS: Community advertisements invited women who had experienced a CS to participate in a telephone interview. The thematic analysis presented in this paper is derived from data collected during 2003/2004 from 49 participants who had initially expected to birth vaginal but had a CS and who had planned a CS in a subsequent pregnancy or stated that they would choose this option in a future pregnancy. FINDINGS: Before the first CS most women expected and wanted to give birth normally. After having a CS, however, many reframed vaginal birth as uncertain, unsafe and unachievable. For this group of women, the medical discourse that promoted CS as the safest option was a major influence on their decisions. As a result, they reconstructed CS as an acceptable alternative that was safer for them and their babies, allowed them to be better prepared, and was convenient. CONCLUSION: In the present climate, enabling women to keep birth 'fear' in perspective may be an important strategy if we are to improve the uptake of vaginal birth after CS and the quality of care offered to women during the normal, but major, life event of childbirth.

Attitude of Health Personnel↗
PubMed2005

The stresses of volunteering in a hospice: a qualitative study.

OBJECTIVES: This study examined the stresses associated with hospice volunteering, ways of coping and perception of available support. METHODS: Two focus groups were conducted comprising 17 volunteers. The data obtained were transcribed and analysed using thematic analysis. RESULTS: Reported stressors included losing patients and dealing with disfigurement. However, informants generally reported the work as satisfying and generally stress-free. Coping strategies ranged from keeping a distance from clients, religious faith, to the realization that death was a merciful end and was not necessarily painful. Informants generally perceived support to be adequate. CONCLUSIONS: The implications of these findings for training volunteers are discussed, especially the need to educate volunteers about the symptoms and signs of cancer.

Adaptation, Psychological↗
PubMedDate not supplied

Learner concerns and teaching strategies for video-conferencing.

BACKGROUND: The purpose of this study was to understand the influences of interactive video-conferencing technology on learning experiences of RN students studying for baccalaureate degrees via interactive distance education. METHOD: Data collection in this phenomenological study used open-ended questionnaires, interviews, and focus groups. Preliminary thematic analysis of questionnaires shaped open-ended questions for interviews and focus groups with learners confirmed findings. RESULTS: Students identified themes of connecting with others, organization, negative influences, and personal factors as influential to their learning. They also identified useful teaching strategies to facilitate learning within this distance nursing education environment. CONCLUSION: University nursing programs using video-conferencing for distance education can foster learning by using teaching strategies that fit the technology, increase student interaction, and engage the students.

Attitude of Health Personnel↗
PubMed2005

Patients' perceptions of isotretinoin, depression and suicide--a qualitative study.

BACKGROUND: Isotretinoin is an effective acne medication. The evidence for it causing depression and suicide, although widely publicised, remains uncertain. METHODS: Twenty-six semi-structured interviews with patients with acne were coded and subjected to thematic analysis. RESULTS: Isotretinoin was perceived to be effective but dangerous. The most well known adverse effects were depression and suicide. DISCUSSION: The overemphasis of serious psychological adverse events in patients might discourage the use of isotretinoin by those who might benefit from it.

Abnormalities, Drug-Induced↗
PubMed1999

A qualitative analysis of parental decision making for childhood immunisation.

OBJECTIVE: Achieving high rates of childhood immunisation is an important public health aim. Currently, however, immunisation uptake in Australia is disappointing. This qualitative study investigated the factors that influence parental decision making for childhood immunisation, and whether parents' experiences were better conceptualised in terms of static subjective expected utility models or in terms of a more dynamic process. METHOD: Semi-structured in-depth interviews were conducted with 20 predominantly middle-class mothers--17 immunizers and three non-immunizers, in Melbourne, Victoria, in 1997. The data were then examined using thematic analysis. RESULTS: The results suggested that for these participants the decision regarding childhood immunization was better conceptualized as a dynamic process. The decision required initial consideration, implementation then maintenance. CONCLUSION: If a better understanding of immunization decision making is to be achieved, future studies must look beyond static frameworks. IMPLICATION: Clearer insight into the dynamic nature of immunization decision making should assist in the identification of more effective methods of promoting childhood immunization to groups at risk of non-compliance.

Adult↗
PubMed2003

Peer coaching as a technique to foster professional development in clinical ambulatory settings.

INTRODUCTION: Few studies have examined how peer coaching is an effective educational and development technique in contexts outside the classroom. This research focused on peer coaching as a platform to study the process of professional development for physicians. The purpose was to identify perceived benefits coaches received from a coaching encounter and how this relates to their own process of professional development. METHODS: Critical incident interviews with 13 physician coaches were conducted and tape recorded. Themes were identified using a thematic analysis technique. RESULTS: Themes emerged clustering around two distinct benefit orientations. Group 1, reflection and teaching coaches, tended to focus on others and discuss how positively they experienced the encounter. Group 2, personal learning and change coaches, expressed benefits along more personal lines. DISCUSSION: Peer coaching contributes to physicians' professional development by encouraging reflection time and learning. Peer coaching affords positive impact to those who coach in addition to those who receive the coaching. The two clusters of benefits support the performance, learning, and development theory in that there are multiple modes to describe adult growth and development. Programs of this type should be considered in medical faculty development activities associated with medical education.

Adult↗
PubMed2005

Processes of disengagement and engagement in assertive outreach patients: qualitative study.

BACKGROUND: Assertive outreach has been established to care for'difficult to engage' patients, yet little is known about how patients experience their disengagement with mainstream services and later engagement with outreach teams. AIMS: To explore the views of disengagement and engagement held by patients of assertive outreach teams. METHOD: In-depth interviews were conducted with 40 purposefully selected patients and analysed using components of both thematic analysis and grounded theory. RESULTS: Patients reported a desire to be independent, a poor therapeutic relationship and a loss of control due to medication effects as most important for disengagement. Time and commitment of staff, social support and engagement without a focus on medication, and a partnership model of the therapeutic relationship were most relevant for engagement. CONCLUSIONS: The findings underline the importance of a comprehensive care model, committed staff with sufficient time, and a focus on relationship issues in dealing with 'difficult to engage' patients.

Adult↗
PubMed2000

The effect on medical practice of disciplinary complaints: potentially negative for patient care.

AIM: To explore the personal and professional effect on general practitioners (GPs) of receiving a complaint against them to the (former) Medical Practitioners Disciplinary Committee, when the complaint did not proceed to a formal hearing. METHODS: Ten GPs were interviewed by telephone, following an enrollment procedure that protected identities from the interviewer. Qualitative (thematic) analysis of indepth interviews was used to categorise doctors' perceived effects of complaints on practice and to develop a theory on why such effects should occur. RESULTS: Receipt of a complaint had both short- and long-term effects on the doctor, and on their views of patients, society and the disciplinary process. There were immediate negative emotional responses that were sustained in the long-term in a way that adversely effected doctor-patient relationships beyond the relationship with the original complainant. Doctors reported short-term changes in their practice of medicine, with reduced ability to work confidently and decisively. Doctors also reported altered practice in the long-term in the direction of defensive medicine, by withdrawing from providing some services and avoiding perceived at-risk activities. CONCLUSION: The impact of a complaint on the self of the doctor suggests a shame response. There may be a need for the relevant professional college to establish a rapid response 'crash team' to minimize the negative personal and professional effects of a complaint, even when the complaint does not proceed to a formal hearing.

Attitude of Health Personnel↗
PubMed2003

Pathways to evidence-based reproductive healthcare in developing countries.

OBJECTIVE: Developing country clinicians are aware of the discourse of evidence-based medicine but heavily constrained in their ability to access and apply new knowledge. This study aimed to obtain primary descriptive data about access to and application of reproductive health-related medical knowledge in developing countries. DESIGN: Qualitative study using semi-structured interviews. SETTING: India and Yemen. SAMPLE: Forty-one doctors working in obstetrics, gynaecology, general practice and family planning services. METHODS: Interviews were tape recorded and transcribed verbatim. A theory-driven approach was conducted to carry out thematic analysis. MAIN OUTCOME MEASURES: Descriptions of experiences, attitudes and needs. RESULTS: Doctors felt the need to update their knowledge but this was not always achieved due to time and financial constraints. Alternative knowledge sources were described including the Internet, scientific meetings, medical family networks and speciality medical societies but access to these was limited by the expense of equipment, unfamiliarity with the technology and restricted advertisement of scientific meetings and conferences. Institutional hierarchy and conflict of generations were identified as barriers to change. Demoralisation was a common obstacle. On the positive side, involvement in medical education was a powerful driver for seeking new knowledge and applying research evidence to clinical practice. CONCLUSIONS: Priorities are to identify needs specific to different countries and medical settings in the developing world, access for all to full text journals and educational activities that fully engage practitioners in the early stages of their careers. Clinical teachers are the nodal group with the strongest incentive to obtain and use new knowledge.

Attitude of Health Personnel↗
PubMed1978

[Clinical psychopathological characteristics of acute atypical circular affective psychoses].

The clinical reality of acute atypical affective psychoses is recognized by almost all psychiatrists. A total of 229 cases of atypical circular psychosis have been studied. In many of these cases the "psychodynamic mobility" of the personality, i.e., the "fixed attitude" according to Usnadse, was studied in addition to a clinical analysis. The method used for this is described, and a number of criteria for evaluation are reported. Also, the thematic apperception test and Rorschach test as well as electroencephalographic examinations have been carried out on many of the patients included in this study. The results of clinical-psychopathological and experimental-psychological examinations enable better diagnoses of acute atypical affective psychoses to be established.

Diagnosis, Differential↗
PubMed2005

Pandora's electronic box: GPs reflect upon email communication with their patients.

BACKGROUND: Global access to information technology has increased dramatically in the past decade, with electronic health care changing medical practice. One example for general practitioners (GPs) is communication with patients via electronic mail (email). GPs face issues regarding e-communication with patients, including how and when it should it be used. OBJECTIVE: The study aims were to assess the extent that GPs communicate with patients by email and explore their attitudes to this mode of communication. METHODS: Design--telephone interview survey. Setting--primary care, largest urban and suburban area in New Zealand (NZ). Subjects--randomly selected GPs from the Auckland region. Main outcome measure--description of email use; analysis of issues by telephone survey. Data analysed using SPSS-12 and by thematic content analysis. RESULTS: At data saturation, 80 GPs had been interviewed. The majority (68%) had not used email with patients. Only 4% used it regularly. However, there was strong interest in this method. Perceived advantages were the ability to communicate at a distance and time convenient to both doctor and patient; communication where disability affected traditional methods; information-giving (for example, web links); passing on normal results. Identified problems involved inequity of access; linking of electronic data; security; unsuitability for some topics; medico-legal concerns; time; remuneration. CONCLUSION: Study sample closely mirrored current NZ GP population. Although few GPs emailed with patients, many might once barriers are addressed. GPs had a collective view of the appropriate boundaries for email communication, routine tasks and the transmission of information. GPs would encourage professional debate regarding guidelines for good practice, managing demand and remuneration.

Attitude of Health Personnel↗