자연주의적 탐구조사(Naturalistic Inquiry)

http://www.bwgriffin.com/gsu/courses/edur7130/content/Qualitative_content_analysis_Graneheim_Lundman_2003.pdf

Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness

The job demands-resources (JD-R) model proposes that working conditions can be categorized into 2 broad categories, job demands and job resources. that are differentially related to specific outcomes. A series of LISREL analyses using self-reports as well as observer ratings of the working conditions provided strong evidence for the JD-R model: Job demands are primarily related to the exhaustion component of burnout, whereas (lack of) job resources are primarily related to disengagement. Highly similar patterns were observed in each of 3 occupational groups: human services, industry, and transport (total N = 374). In addition, results confirmed the 2-factor structure (exhaustion and disengagement) of a new burnout instrument--the Oldenburg Burnout Inventory--and suggested that this structure is essentially invariant across occupational groups.

The job demands-resources model of burnout

Objective To develop and validate a new standardized confusion assessment method (CAM) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk settings. Design Prospective validation study. Setting Conducted in general medicine wards and in an outpatient geriatric assessment center at Yale University (site 1) and in general medicine wards at the University of Chicago (site 2). Patients The study included 56 subjects, ranging in age from 65 to 98 years. At site 1, 10 patients with and 20 without delirium participated; at site 2, 16 patients with and 10 without delirium participated. Measurements and main results An expert panel developed the CAM through a consensus building process. The CAM instrument, which can be completed in less than 5 minutes, consists of nine operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). An a priori hypothesis was established for the diagnostic value of four criteria: acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness. The CAM algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion. At both sites, the diagnoses made by the CAM were concurrently validated against the diagnoses made by psychiatrists. At sites 1 and 2 values for sensitivity were 100% and 94%, respectively; values for specificity were 95% and 90%; values for positive predictive accuracy were 91% and 94%; and values for negative predictive accuracy were 100% and 90%. The CAM algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium. The CAM was shown to have convergent agreement with four other mental status tests, including the Mini-Mental State Examination. The interobserver reliability of the CAM was high (kappa = 0.81 - 1.0). Conclusions The CAM is sensitive, specific, reliable, and easy to use for identification of delirium.

Clarifying Confusion: The Confusion Assessment Method: A New Method for Detection of Delirium

OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

This study describes a phenomenological hermeneutical method for interpreting interview texts inspired by the theory of interpretation presented by Paul Ricoeur. Narrative interviews are transcribed. A naive understanding of the text is formulated from an initial reading. The text is then divided into meaning units that are condensed and abstracted to form sub-themes, themes and possibly main themes, which are compared with the naive understanding for validation. Lastly the text is again read as a whole, the naive understanding and the themes are reflected on in relation to the literature about the meaning of lived experience and a comprehensive understanding is formulated. The comprehensive understanding discloses new possibilities for being in the world. This world can be described as the prefigured life world of the interviewees as configured in the interview and refigured first in the researcher's interpretation and second in the interpretation of the readers of the research report. This may help the readers refigure their own life.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1471-6712.2004.00258.x

A phenomenological hermeneutical method for researching lived experience

Different concepts have been presented which denote driving forces and strengths that contribute to a person's ability to meet and handle adversities, and keep or regain health. The aim of this study, which is a part of The Umea 85+ study, was to describe resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health in a sample of the oldest old. The study sample consisted of 125 participants 85 years of age or older, who ranked themselves on the Resilience Scale, Sense of Coherence Scale, Purpose in Life Scale and Self-Transcendence Scale and answered the SF-36 Health Survey questionnaire. The findings showed significant correlations between scores on the Resilience Scale, the Sense of Coherence Scale, the Purpose in Life Test, and the Self-Transcendence Scale. Significant correlations were also found between these scales and the SF-36 Mental Health Summary among women but not among men. There was no significant correlation between perceived physical and mental health. The mean values of the different scales showed that the oldest old have the same or higher scores than younger age groups. Regression analyses also revealed sex differences regarding mental health. The conclusions are that, the correlation between scores on the different scales suggests that the scales measure some dimension of inner strength and that the oldest old have this strength at least in the same extent as younger adults. Another conclusion is that the dimensions that constitute mental health differ between women and men.

Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old

The aims of this study were to estimate the incidence of acute confusional state (ACS), its predisposing factors and consequences in 111 consecutive patients operated for fractured neck of the femur. The incidence of ACS was 61 percent and the predicting factors were old age and dementia. Drugs with anticholinergic effect, depression, and previous stroke were factors that seemed to be associated with the development of ACS. Ninety-two percent of the patients who had severe perioperative blood pressure drops developed ACS. The consequences of ACS were prolonged ward-stay at the orthopedic department, a greater need for long-term care after discharge, and poor walking ability at discharge and six months after surgery. The confused patients also had more complications, such as urinary problems, feeding problems and decubital ulcers, as compared with the nonconfused patients.

Acute confusional states in elderly patients treated for femoral neck fracture.

The meaning of the lived experience of hope in patients with cancer in palliative home care

AIM: This paper reports a study examining factors that may contribute to burnout among healthcare personnel. BACKGROUND: The impact on burnout of factors such as workload and interpersonal conflict ...

Astrid Norberg

Papers

A phenomenological hermeneutical method for researching lived experience

Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old

Acute confusional states in elderly patients treated for femoral neck fracture.

The meaning of the lived experience of hope in patients with cancer in palliative home care

Burnout and 'stress of conscience' among healthcare personnel.