자연주의적 탐구조사(Naturalistic Inquiry)

XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Aim. The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process.

Background.  Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated.

Discussion.  A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review.

Conclusion.  An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.

/pdf/the-integrative-review-updated-methodology-j4hzxjmz6b.pdf

The integrative review: updated methodology

Qualitative content analysis is commonly used for analyzing qualitative data. However, few articles have examined the trustworthiness of its use in nursing science studies. The trustworthiness of q...

https://journals.sagepub.com/doi/pdf/10.1177/2158244014522633

Qualitative Content Analysis: A Focus on Trustworthiness

The rejection of reliability and validity in qualitative inquiry in the 1980s has resulted in an interesting shift for "ensuring rigor" from the investigator’s actions during the course of the research, to the reader or consumer of qualitative inquiry. The emphasis on strategies that are implemented during the research process has been replaced by strategies for evaluating trustworthiness and utility that are implemented once a study is completed. In this article, we argue that reliability and validity remain appropriate concepts for attaining rigor in qualitative research. We argue that qualitative researchers should reclaim responsibility for reliability and validity by implementing verification strategies integral and self-correcting during the conduct of inquiry itself. This ensures the attainment of rigor using strategies inherent within each qualitative design, and moves the responsibility for incorporating and maintaining reliability and validity from external reviewers’ judgements to the investigators themselves. Finally, we make a plea for a return to terminology for ensuring rigor that is used by mainstream science.

/pdf/verification-strategies-for-establishing-reliability-and-2jxdw91v7c.pdf

Verification Strategies for Establishing Reliability and Validity in Qualitative Research

Much contemporary dialogue has centered on the difficulty of establishing validity criteria in qualitative research. Developing validity standards in qualitative research is challenging because of the necessity to incorporate rigor and subjectivity as well as creativity into the scientific process. This article explores the extant issues related to the science and art of qualitative research and proposes a synthesis of contemporary viewpoints. A distinction between primary and secondary validity criteria in qualitative research is made with credibility, authenticity, criticality, and integrity identified as primary validity criteria and explicitness, vividness, creativity, thoroughness, congruence, and sensitivity identified as secondary validity criteria.

/pdf/validity-in-qualitative-research-5gmqpr02r7.pdf

Validity in Qualitative Research

Chronic illnesses, such as cardiovascular disease, cancer, and diabetes, are among the most prevalent and costly of all global health problems (World Health Organization, 2011). They are the primary reason adults seek health care and are the leading cause of death and disability in the United States (U.S. Centers for Disease Control and Prevention, 2011). Chronic illnesses are long term, uncertain, and can be very intrusive to individuals' everyday lives (Larsen, 2009). Often, chronic illnesses have a course that varies over time specific to the etiology and physiology of the particular illness. However, there are common challenges across chronic illnesses, which include recognizing symptoms and taking appropriate actions, using medications effectively, managing complex regimens, developing strategies to deal with the psychological consequences of the illness, and interacting with the healthcare system over time (Wagner et al., 2001; U.K. Department of Health, 2003). Chronic illness management has been recognized as an important component of health care, and there is increasing awareness that similar strategies can be effective across different types of chronic illnesses (Dowrick, Dixon-Woods, Holman, & Weinman, 2005; Harvey et al., 2008; Swendeman, Ingram, Rotheram-Borus, 2009).

/pdf/processes-of-self-management-in-chronic-illness-2tapon5fus.pdf

Processes of Self-Management in Chronic Illness

Background The knowledge explosion in health care coupled with recent evidence-based practice initiatives has increased both the need for and the production of reviews of past research. The proliferation of such reviews has contributed to inconsistency in methods and terminology. Differing methods for integrative reviews, systematic reviews, meta-analyses, and qualitative reviews have been proposed, yet are not clearly differentiated in published reports. Although there are common features to these methods, each method has a distinct purpose, sampling frame, definition, and type of analysis. Approach The literature on research review methods was analyzed and synthesized. Specific attention was directed toward the issues specific to combining primary nursing research studies. Results The defining characteristics of different research review methods, the common stages of all research reviews, and criteria for evaluating quality are described. Discussion Greater clarity regarding research review methods has the potential to enhance methodological rigor and subsequently the applicability of findings of all review methods to practice and policy.

Combining evidence in nursing research: methods and implications.

In children with type 1 diabetes (T1DM), parents are ultimately responsible for daily management of T1DM, which has a significant impact on family life. Daily management of T1DM is time-consuming and requires a change to many well-established family routines. Although technological advances have greatly enhanced the ability of parents to monitor and manage T1DM in youth,1 the responsibility of T1DM management can contribute to parental stress, distress, and diminished quality of life. Understanding the experience of parenting a child with T1DM can provide insight into the challenges and needs of parents, thus informing the development of parental and/or family interventions. Considerable research has been undertaken to examine aspects of the parenting experience; however, there is a need to synthesize this literature to inform future research and clinical work.

Caring for a child with T1DM has been described as an overwhelming experience, requiring constant vigilance.2 Parents must come to terms with having a child with a life-threatening illness and carrying out a labor-intensive and complicated daily regimen.3 Parents live with constant worry about hypoglycemia or hyperglycemia, heightened feelings of responsibility for their child’s health, and the desire to promote optimal growth and development.4 At different developmental phases, new issues arise that require a complete reevaluation of previously established and effective management strategies.5 The ongoing stress and worry manifest in elevated rates of parents’ perception of stress and increased risk for depression and anxiety.

There is considerable research on the prevalence of parental psychological distress and the impact of such distress on child and family outcomes. Although the majority of parents of children with T1DM adjust well, approximately 20% to 30% of parents report clinically significant distress, which has been defined as stress (life stress or parenting stress) and symptoms of anxiety, depression, and/or posttraumatic stress.6–8 Parental psychological distress at the time of diagnosis has been found to predict later parental distress.9 In addition, parental psychological distress has health implications for the parent, the child with T1DM, and the overall functioning of the family.10 In parents of children with T1DM, psychological distress has been shown to affect family communication,11 increase family conflict,12 decrease the ability to parent effectively,13 negatively affect child psychological adjustment,9 and contribute to poor parental mental and physical health.14

Greater understanding of the relationship of parental psychological responses to having a child with T1DM is needed to guide clinical practice and future research. Thus, the purpose of this systematic mixed-studies review is to synthesize the research on the parental experience of having a child with T1DM, focusing on parental psychological adjustment. The aims are to describe the prevalence of psychological distress in parents of children with T1DM, the relationship between parental psychological distress and health outcomes, and the parental experience of having a child with T1DM. Clinical and research implications will also be presented.

/pdf/psychological-experience-of-parents-of-children-with-type-1-4vadbpo6uq.pdf

Robin Whittemore

Papers

The integrative review: updated methodology

Validity in Qualitative Research

Processes of Self-Management in Chronic Illness

Combining evidence in nursing research: methods and implications.

Psychological Experience of Parents of Children With Type 1 Diabetes A Systematic Mixed-Studies Review