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

Doing qualitative research: a practical handbook, by David Silverman, Los Angeles, Sage, 2010, 456 pp., AU$65.00, ISBN 978-1-84860-033-1, ISBN 978-1-94960-034-8. Available in Australia and New Zeal...

Doing qualitative research: a practical handbook

Non-specific low back pain

Sufficient knowledge is available about the definition, details and differences of qualitative content and thematic analysis as two approaches of qualitative descriptive research. However, identifying the main features of theme as the data analysis product and the method of its development remain unclear. The purpose of this study was to describe the meaning of theme and offer a method on theme construction that can be used by qualitative content analysis and thematic analysis researchers in line with the underpinning specific approach to data analysis. This methodological paper comprises an analytical overview of qualitative descriptive research products and the meaning of theme. Also, our practical experiences of qualitative analysis supported by relevant published literature informed the generation of a stage like model of theme construction for qualitative content analysis and thematic analysis. This paper comprises: (i) analytical importance of theme, (ii) meaning of theme, (iii) meaning of category, (iv) theme and category in terms of level of content, and (v) theme development. This paper offers a conceptual clarification and a pragmatic step by step method of theme development that has the capacity of assisting nurse researchers understand how theme is developed. As nursing is a pragmatic discipline, nurse researchers have tried to develop practical findings and devise some way to “do something” with findings to enhance the action and impact of nursing. The application of a precise method of theme development for qualitative descriptive data analysis suggested in this paper helps yield meaningful, credible and practical results for nursing.

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Theme development in qualitative content analysis and thematic analysis

Objectives. People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring. Design. Feasibility “before-and-after” intervention study. Setting. Three care homes in Wales. Participants. Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine. Intervention. West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines. Outcome Measures. (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants’ records before and after introduction of the profile, and one month later. Results. Nurses recruited and retained 11 of 29 eligible service users. The profile took 20–25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation. Conclusions. Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.

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Medication Monitoring for People with Dementia in Care Homes: The Feasibility and Clinical Impact of Nurse-Led Monitoring

Qualitatives Design besteht aus verschiedenen Ansatzen zur Datenerhebung und -analyse, die insbesondere fur die Erstellung kultureller und kontextueller Beschreibungen und die Interpretation sozialer Phanomene anwendbar sind. Qualitative Inhaltsanalyse (QCA) und thematische Analyse (TA) stellen beides qualitative Ansatze dar, die ublicherweise von Forscher_innen aus unterschiedlichen Disziplinen gleichermasen eingesetzt werden. Allerdings besteht in der internationalen Literatur eine Leerstelle in Bezug auf den Begriff von "Thema" in beiden Ansatzen und des Prozesses der Entwicklung von Themen. Daher gehen wir in unserem Beitrag auf diese Leerstelle ein und stellen Unterschiede und Ahnlichkeiten zwischen beiden Methoden in Bezug auf das "Thema" als Endprodukt der Datenanalyse dar. Zur Unterstutzung unserer Sichtweisen und zur Erstellung international fundierter analytischer Begriffe von "Thema" greifen wir auf die aktuelle Literatur aus unterschiedlichen Disziplinen zuruck. Wir gehen davon aus, dass Forscher_innen von einem vertieften Verstandnis des Prozesses der Themenentwicklung in mehreren Hinsichten profitieren, namlich bei der Auswahl einer geeigneten Methode fur die Beantwortung ihrer Forschungsfrage, bei der Erzielung qualitativ hochwertiger und valider Ergebnisse sowie dabei, den analytischen Anforderungen an QCA und TA gerecht zu werden.

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Theme in Qualitative Content Analysis and Thematic Analysis

OBJECTIVES The purpose of this qualitative metasynthesis is to articulate the knowledge gained from a review of qualitative studies of patients' experiences of chronic low back pain. METHODS Meta-ethnographic methodology guided the review of 33 articles representing 28 studies published in English in peer-reviewed journals between 2000 and 2012. A systematic comparison of the main themes from each study was conducted and 'synthesised' to create superordinate themes. RESULTS Three overarching interrelated themes were identified: the impact of chronic low back pain on self; relationships with significant others that incorporated two streams - health professionals and the organisation of care and relationships with family and friends; coping with chronic low back pain. Coping strategies were predominantly physical therapies, medication and avoidance behaviours with very few successful strategies reported. Professional and family support, self-efficacy, motivation, work conditions and exercise opportunities influenced pain experiences. Review authors' recommendations included psychological therapies, education, the facilitation of self-management strategies and support groups. DISCUSSION The review substantiates chronic low back pain as complex, dynamic and multidimensional, underpinned by experiences of persistent distressing pain, loss, and lowered self-worth, stigma, depression, premature aging, fear of the future. Future research should address the paucity of longitudinal studies, loss and issues of ethnicity, gender, ageing.

Living with chronic low back pain: a metasynthesis of qualitative research

Interprofessional relations between doctors and nurses: perspectives from South Wales

This paper discusses findings from a study of interprofessional relationships between doctors and nurses in medical wards in three provincial general hospitals in south Wales. The aim of the research was to investigate the changing nature of doctor–nurse relations, and in particular, how far the notion of the doctor–nurse game, as developed by Leonard Stein ( Stein 1967, 1990), remains relevant to contemporary hospital work. The present paper concentrates on a subset of the findings concerned with doctors’ and nurses’ accounts of the hospital division of labour and the extent of any overlap in their work activities. Semi-structured interviews were conducted with 20 doctors and 39 nurses in their places of work over a period of 4 months. Inductive analysis of the data indicated that, whilst doctors and nurses perceived their roles in largely traditional terms, there was some recognition of blurring of occupational boundaries, especially when considering work pressures, working at night and differences in practice in more specialized clinical areas. Although nurses were generally reluctant to challenge doctors’ authority, some used the notion of patient ‘advocacy’ to frame and justify their questioning of particular decisions. Whilst doctors valued ‘experience’ in nurses and saw experienced nurses as the group who might most legitimately move into doctors’ territory, nurses valued formal education and saw advanced nursing qualifications as the route to role expansion.

Sherrill Snelgrove

Papers

Theme development in qualitative content analysis and thematic analysis

Medication Monitoring for People with Dementia in Care Homes: The Feasibility and Clinical Impact of Nurse-Led Monitoring

Theme in Qualitative Content Analysis and Thematic Analysis

Living with chronic low back pain: a metasynthesis of qualitative research

Interprofessional relations between doctors and nurses: perspectives from South Wales