Showing papers in "Journal of Advanced Nursing in 1997"

Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries?

Abstract: Sampling is a very complex issue in qualitative research as there are many variations of qualitative sampling described in the literature and much confusion and overlapping of types of sampling, particularly in the case of purposeful and theoretical sampling. The terms purposeful and theoretical are viewed synonomously and used interchangeably in the literature. Many of the most frequent misinterpretations relate to the disparate meanings and usage of the terminology. It is important that the terminology is examined so that underlying assumptions be made more explicit. Lack of shared meanings and terminology in the nursing discourse creates confusion for the neophyte researcher and increases the production of studies with weak methodologies. This paper analyses critically purposeful and theoretical sampling and offers clarification on the use of theoretical sampling for nursing research. The aim is not to make prescriptive statements on sampling; rather, to enhance understanding of the differences between purposeful and theoretical sampling for nursing research.

Sampling hard to reach populations.

Abstract: Studies on 'hidden populations', such as homeless people, prostitutes and drug addicts, raise a number of specific methodological questions usually absent from research involving known populations and less sensitive subjects. This paper examines the advantages and limitations of nonrandom methods of data collection such as snowball sampling. It reviews the currently available literature on sampling hard to reach populations and highlights the dearth of material currently available on this subject. The paper also assesses the potential for using these methods in nursing research. The sampling methodology used by Faugier (1996) in her study of prostitutes, HIV and drugs is used as a current example within this context.

Social support: a conceptual analysis

Abstract: Using the methodology of Walker and Avant, the purpose of this paper was to identify the most frequently used theoretical and operational definitions of social support. A positive relationship between social support and health is generally accepted in the literature. However, the set of dimensions used to define social support is inconsistent. In addition, few measurement tools have established reliability and validity. Findings from this conceptual analysis suggested four of the most frequently used defining attributes of social support: emotional, instrumental, informational, and appraisal. Social network, social embeddedness, and social climate were identified as antecedents of social support. Social support consequences were subsumed under the general rubric of positive health states. Examples were personal competence, health maintenance behaviours, effective coping behaviours, perceived control, sense of stability, recognition of self-worth, positive affect, psychological well-being, and decreased anxiety and depression. Recommendations for future research were made.

The meaning of spirituality: a literature review

Abstract: This paper presents a literature review in relation to the meaning of spirituality. It is proposed that meeting the spiritual needs of patients is a fundamental part of providing holistic nursing care, but that the assessment and meeting of those needs is impeded by inadequate definitions and conceptual frameworks. It should not be assumed that spirituality is either synonymous, or coterminous, with religion, and it is suggested that to adopt this restrictive view is unhelpful in the provision of individualized care. Reflection on the literature reveals that the self, others and 'God' provide the key elements within a definition of spirituality, and that other emerging themes namely meaning, hope, relatedness/connectedness, beliefs/belief systems and expressions of spirituality, can be articulated in the context of those three key elements. In particular, it is proposed that the nature of 'God' may take many forms and, essentially, is whatever an individual takes to be of highest value in his/her life. It is suggested that the themes emerging from the literature can be utilized as a framework to give practitioners and researchers a direction for future exploration of the concept of spirituality.

An exploratory study examining the influence of translation on the validity and reliability of qualitative data in nursing research

Abstract: Although the complexity of undertaking qualitative research with non-English speaking informants has become increasingly recognized, few empirical studies exist which explore the influence of translation on the findings of the study. The aim of this exploratory study was therefore to examine the influence of translation on the reliability and validity of the findings of a qualitative research study. In-depth interviews were undertaken in Cantonese with a convenience sample of six women to explore their perceptions of factors influencing their uptake of Pap smears. Data analysis involved three stages. The first stage involved the translation and transcription of all the interviews into English independently by two translators as well as transcription into Chinese by a third researcher. The second stage involved content analysis of the three data sets to develop categories and themes and the third stage involved a comparison of the categories and themes generated from the Chinese and English data sets. Despite no significant differences in the major categories generated from the Chinese and English data, some minor differences were identified in the themes generated from the data. More significantly the results of the study demonstrated some important issues to consider when using translation in qualitative research, in particular the complexity of managing data when no equivalent word exists in the target language and the influence of the grammatical style on the analysis. In addition the findings raise questions about the significance of the conceptual framework of the research design and sampling to the validity of the study. The importance of using only one translator to maximize the reliability of the study was also demonstrated. In addition the author suggests the findings demonstrate particular problems in using translation in phenomenological research designs.

Professional identity: values embedded in meaningful nursing practice

Abstract: The main research question addressed in this two-phase descriptive study was 'What are the values underlying nurses' professional identity as expressed through what is meaningful in nurses' work? The first phase was a survey of 767 randomly selected nurses with one, five, and 10 years of experience in nursing, and in the second phase data on work-meaning were obtained from a convenience sample of six nurses by in-depth interviews eliciting nurses' stories about providing care to patients. Content analysis of survey-data revealed that the nurses held both other-oriented and self-oriented values, i.e. moral and work values. Human dignity and altruism were the most prominent moral values, whereas the most significant work-values were intellectual and personal stimulation. The interview-data, analysed by means of hermeneutic and narrative analysis, revealed a greater diversity in value-expressions compared to the survey-data. Altruism, the moral orientation of care, was the overall philosophy, and human dignity appeared as a core value. The nine additional values appeared to be linked to human dignity either by arising from it and/or being aimed at preserving this basic value.

Undergraduate nursing students' perceptions of their clinical learning environment

Abstract: The clinical learning environment (CLE) is an interactive network of forces influencing student learning outcomes in the clinical setting. This study used mixed methods to identify factors characterizing students' perceptions of the CLE. The sample consisted of 229 undergraduate students in the second or third year of their biophysical nursing strand. The five subscales of the Clinical Learning Environment Scale, ‘Staff-student relationships’, ‘nurse manager commitment’, ‘patient relationships’, ‘student satisfaction’ and ‘hierarchy and ritual’, were supported by qualitative data obtained from student interviews. Interpersonal relationships between the participants in the CLE were crucial to the development of a positive learning environment. Student satisfaction with the CLE was both a result of, and influential in creation, a positive learning environment. Nurse educators, clinical venues, and all others participating in the undergraduate nursing students' clinical education, must colloborate in order to crate a CLE which promotes the development of well-educated registered nurses capable of providing safe, cost-effective patient care.

Becoming a mother — an analysis of women's experience of early motherhood

Abstract: This paper presents the results of a qualitative study conducted by midwife researchers into women's experience of new motherhood. Data were collected using focus groups involving 55 first-time mothers and analysed using grounded theory method. The analysis produced six categories: 'realizing', 'unready', 'drained', 'aloneness', 'loss' and 'working it out'. The core category, 'becoming a mother', integrates all other categories and encapsulates the process of change experienced by women. Also explained are factors mediating the often distressing experience of becoming a mother. The analysis provides a conceptualization of early motherhood enabling the development of strategies for midwives, nurses and other helping women negotiate this challenge.

The trait and process of resilience

Abstract: Resilience is the ability of people to 'spring back' in the face of adversity. It is an important concept for nurses as we endeavour to assist individuals to meet the challenges of living with illness and ageing. Researchers from many disciplines in both the social and health sciences have investigated resilience of individuals throughout the life cycle in a variety of situations related to health as well as other life events. Some researchers have investigated resilience as a trait of individuals while other view resilience as a process. This article reviews the current literature on resilience from many disciplines and discusses implications for nursing practice and research.

Focus groups: issues of analysis and interpretation.

Abstract: Focus groups have become a popular method in nursing research. Their history can be traced back to marketing research methods, but they have also been used in qualitative, ethnographic research. Our study, which used this approach as part of data collection, raised many issues of analysis and interpretation: in particular, the importance of paying attention to the sequence of focus group discussions, the individuals involved, and the social context of the focus group. We conclude that focus groups are not a 'quick and easy' method of collecting data, and that issues of validity and the relationship between focus group data and other data require careful consideration.

Husserl, phenomenology and nursing

Abstract: Discussions of phenomenological research in nursing consistently appeal to either Husserl or Heidegger in justifying the technical and conceptual resources they deploy. This paper focuses on Husserl, and examines the relationship between his phenomenology and the accounts of it that are to be found in the nursing literature. Three central ideas are given particular attention: the phenomenological reduction, phenomena, and essence. It is argued that nurse researchers largely misunderstand these concepts and that, as a result, their version of Husserl's philosophy bears little resemblance to the original. A further consequence is that the project of identifying the 'essential structure' of a phenomenon, typically adopted by the nurse researchers who cite Husserl as an authority, comes close to being unintelligible. It is suggested that, while the methods used in 'phenomenological' nursing research may still have some legitimacy, they cannot achieve what they are alleged to achieve, and they should be detached from the framework of Husserlian ideas and terminology which is supposed to justify them.

Men in nursing: issues of gender segregation and hidden advantage

Abstract: The small but growing number of men in the nursing profession does not herald a progressive integration of masculine and feminine sex roles. The evidence presented in this paper suggests that even in female-dominated occupations such as nursing, patriarchal gender relations which reflect a high valuation of all that is male and masculine, play a significant role in situating a disproportionate number of men in administrative and elite specialty positions. At the heart of this gender dynamic is the need to separate the masculine from the lesser valued feminine. Male nurses do this by employing strategies that allow them to distance themselves from female colleagues and the quintessential feminine image of nursing itself, as a prerequisite to elevating their own prestige and power. They are aided in this task by patriarchal cultural institutions that create and perpetuate male advantage, as well as by women nurses themselves who, consciously or unconsciously, nurture the careers of men colleagues.

Integrative nursing research--an important strategy to further the development of nursing science and nursing practice.

Abstract: In this paper it is argued that integrative nursing research has a great potential for clarifying the theoretical perspective and substance of the nursing discipline as well as making research-based knowledge more accessible to clinical nurses. Two general kinds of integrative research are introduced and illustration provided of how these have been practiced within nursing. Significant strengths and weaknesses in current practice is highlighted. It is argued that nursing should pay more attention to this kind of research, specifically in terms of developing sound methodological approaches and overcoming the traditional schism between empirical and theoretical research. Sound integrative nursing research promises to improve the development of nursing science as well as making the products of nursing research more easily available for clinical nurses.

Distress, stress and coping in first-year student nurses.

Abstract: Levels of affective distress, sources of stress and coping strategies reported by first-year student nurses in Tayside, Scotland, were measured using the General Health Questionnaire (30-item version), the Beck & Srivastava Stress Inventory (BSSI) and a modified 'Ways of Coping Questionnaire'. Screening showed that, around the time of an initial series of hospital placements, 50.5% of students in cohort 1 (n = 109, week 40) and 67.9% of students in cohort 2 (n = 111, week 24) suffered significant affective distress. This exceeds levels reported in published studies of degree nursing students, fourth-year medical students, and the general female population. Distressed students reported the same sources of stress as the non-distressed students, but suffered them more intensely. Many BSSI items were seen as common sources of stress; however, the frequency with which an item was reported to be stressful was not related to whether scores on that item predicted overall distress. In both cohorts, the use of direct coping was associated with lower levels of distress, and with lower total stress scores on the BSSI. The use of fantasy and hostility was associated with high levels of distress and stress, in both groups. This screens of 220 first-year student nurses suggests that there is a problem with student distress around an initial series of general/surgical and psycho-social ward placements. The possible determinants of this distress and complex, and it is unlikely that presenting information alone will be sufficient to reduce this distress.

Vulnerability, health and health care

Abstract: The concept of vulnerability is an important one for nurses because of its implications for health. The experience of vulnerability creates stress and anxiety which affects physiological, psychological and social functioning. Although everyone is vulnerable at different times in his or her life, some individuals are more likely to develop health problems than others. Vulnerability is affected by personal factors as well as factors within the environment. Trends in society indicate that increasing numbers of vulnerable people will create additional demands on an already over-burdened health care system. Vulnerability is an area that requires much further research and application.

Informational needs of women with a recent diagnosis of breast cancer: development and initial testing of a tool.

Abstract: This study developed and tested the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ-BC), a questionnaire designed to identify the information which women with a recent diagnosis of breast cancer need to deal with their illness. The 73-item questionnaire had content validity based on findings in the literature and opinions of expert oncology nurses. It was administered to 114 women with a recent diagnosis of breast cancer during chemotherapy (n = 39), radiation therapy (n = 40) or surgery (n = 35). Item analysis determined that 51 items in five subscales should be retained in the questionnaire. The subscales, labelled Disease, Investigative Tests, Treatments, Physical, and Psychosocial had good internal consistency reliabilities with Cronbach's alphas of 0.81 to 0.93. Informational needs of women were high with mean scores over 200 in a possible range of 51-255. Informational needs were greatest in either the Disease or Treatments subscales. Marital status, level of education, and level of income were not related to level of informational need. Younger women had a greater need for information than older women (r = -0.35, P = 0.003). The results suggest that information is important to help women with breast cancer manage their illness. Nurses should give women an opportunity to ask questions and be prepared to give accurate information.

Aggression in clinical settings: nurses' views.

Abstract: Although much has been written about 'aggression' from a variety of viewpoints, little systematic information has been gathered about what nurses see as 'aggression'. Also, it is not clear from previous reports just how important horizontal violence is for nurses compared with the other "aggressions' encountered at work. A qualitative approach was adopted as this was an initial exploratory study to describe nurses' views regarding the nature and extent of aggression in the clinical setting. A total of 29 nurses were interviewed. Findings indicate that nurses are most concerned about their colleagues' aggression towards them. Colleague abuse ranged from non-verbal innuendo to physical assault. Nurse managers were criticized for failing to implement supportive structures when aggression did arise (from colleagues or others) or to take appropriate action to prevent its recurrence. On a practical level much of the aggression reported can be seen as a breakdown in 'relationship rules', i.e. staff failed to respect each other's privacy, were unwilling to help out, keep confidences and so on.

Information needs of women during early treatment for breast cancer.

Abstract: This study assessed the information needs of 70 women with breast cancer being treated by surgery, chemotherapy or radiation therapy. Information needs were measured by the breast cancer version of the Toronto Informational Needs Questionnaire (TINQ-BC). All women had high information needs, irrespective of type of treatment received. They mainly wanted information about their disease, treatments and investigative tests. An examination of individual items on the TINQ-BC revealed that all women wanted information about recurrence, specifically they wanted to know if the cancer would come back and how to tell if it had recurred. The results provide nurses with some direction as to what information to give women receiving early treatment for breast cancer.

Caring for a demented elderly person--burden and burnout among caregiving relatives.

Abstract: Fifty-two family caregivers for demented elderly people were investigated for burden and burnout experiences. A structured burden questionnaire and the Burnout Measure were used. Burnout is described in relation to the caregiver's gender, age, family relationship and the demented person's living place. Older wives and daughters-in-law also risked developing burnout. Regression analysis showed that limitation in social life, poor health and a lack of positive outlook on caring were the most important independent variables explaining variance in burnout among caregivers having their demented elderly person living at home and those having them in an institution.

Advocacy in nursing--a review of the literature

Abstract: Patient/client advocacy has been claimed as a new role for the professional nurse. This paper presents a critical review of the literature on advocacy in nursing. After briefly outlining the conditions which may have instigated the need for patient advocacy, meanings and models of advocacy are discussed. It is argued that although there are many examples of the advocacy role in health care, models proposed for the nurse as advocate are indeterminate which leads to multiple interpretations and lack of clarity in operationalizing advocacy. Much of the literature focuses on justification arguments for claiming the advocacy role. Key themes are outlined and include: patient advocacy as a traditional role, nurses are in the best position in the health care team, nurses have the knowledge to advocate and finally nurses and patients can be partners in advocacy. However, critical examination reveals many counter-arguments to the above claims and finally concludes that advocacy is a potentially risky role to adopt. It is argued that support systems are inadequate except in low-risk situations and ultimately acts of advocacy remain a moral choice for the individual nurse. Finally the need to conduct research into the interpretation of the patient advocate role by nurses in the United Kingdom is highlighted.

Being a stroke patient: a review of the literature.

Abstract: The purpose of this paper is to review the research literature on the patient's experience of stroke. Four qualitative studies on how patients experience stroke were identified. The findings of these studies show that the stroke patient often has clear goals for himself in relation to functional abilities, against which he measures all success and forward progress in his rehabilitation. Even though the stroke patient accepts a lower level of functional ability, he is not willing to accept the rehabilitation professionals' prediction of his ultimate functional level if it is lower than his own goal. Furthermore, stroke patients see recovery as a return to the existence they had lived before the stroke, which is different from the health care providers' view. To the health care provider, recovery is measured in terms of isolated and discrete return of movement, whereas in the eyes of the patients, recovery is a return to previously valued activities. Further, studies on psychosocial function after stroke were reviewed. Recent studies show that the psychological impact of the stroke experience is immense and that stroke patients experience stress on a variety of levels. Also, depression exists in a large portion of the stroke population. The impact of stroke also influences the patient's social existence, as studies have shown that stroke patients do manifest diminished social function. However, the reviewed studies are not without limitations. Further studies, with a qualitative design, are needed to throw light on the patient's experience of being ill with stroke, and the process of his recovery.

"Becoming a mother'--developing a new theory of early motherhood.

Abstract: This paper explains the methods used in a grounded theory analysis of the experience of 55 first-time mothers in Australia, presented in the first of this series of two papers. The categories identified in the research are realising, readiness, drained, aloneness, loss and working it out, encompassed in the core category becoming a mother. Specifically, this paper extends the analysis and explains the application of a 'paradigm model' and the identification of a Basic Social Process (BSP). The paper links the analysis to the literature on early motherhood from nursing, midwifery, feminist, and sociological research. A substantive theory is proposed to explain women's experience in becoming mothers that demonstrates how, when responsive to the needs of those researched, a grounded theory analysis can provide a framework for nursing and midwifery care.

Heuristics, servants to intuition, in clinical decision‐making

Abstract: This paper explores intuitive judgements of nurses in clinical decision-making situations. The qualities of intuition are presented from both theoretical and practical perspectives and attitudes towards intuition from both nurses themselves and other health professionals are identified. An heuristic framework from cognitive psychology is applied to intuitive aspects of the clinical judgements that nurses have made. This interpretation is proposed as a partial explanation of intuition, and its use in advancing the understanding of intuition is recommended.

Using research for practice: a UK experience of the BARRIERS Scale

Abstract: It is generally recognized that the majority of health care has been largely based upon opinion rather than research evidence of clinical effectiveness. Attempts to rectify this have been initiated by increasing emphasis on the dissemination of findings. For example, in the UK this had been supported via the Cochran Collaboration and the Centre for Dissemination and Reviews. Dissemination does not, however, guarantee implementation. The complex nature of research utilization has been studied and obstacles identified that can influence the uptake of research by practising nurses. Sandra Funk and colleagues developed the BARRIERS Scale using this research and literature on research utilization. The scale may be helpful for identifying and measuring the barriers to research utilization perceived by nurses working within the UK and has formed the basis of the present study. A convenience sample of 316 comprising a broad spectrum of nurses working in the UK provided the data. Comparison is made with North American nurses from the studies used in the scale's development. The results suggest there are items which are consistently perceived as either strong or negligible barriers by both groups of nurses. Differences, however, did emerge between nurses from the UK and North America on several items. These included the confindence in evaluating research and the perception of the nurse's authority to change patient procedures. Psychometric evaluation was also done. These findings are presented and discussed.

Developing the reflective teacher

Abstract: The conceptual issues and research findings surrounding the meaning and use of reflection are examined in this paper and serve as a foundation for discussing significant assumptions and beliefs regarding the use of reflection in nursing education. The strengths and limitations of reflection are discussed. The paper links current knowledge about reflection to the development of reflective thinking and its use by nurse educators and suggests strategies to enhance this development.

A conceptual foundation for human suffering in nursing care and research.

Abstract: Suffering is a significant, yet elusive, phenomenon in nursing and health care. Despite the importance and prevalence of suffering, there is only a small body of substantive literature on this topic. Some of the difficulty in expanding this knowledge base undoubtedly is related to the lack of a solid conceptual foundation for exploration of this phenomenon. Although there have been attempts to provide needed conceptual clarity, these efforts typically have not been based on systematic inquiry. In this study, the method of concept analysis was used to inductively generate a definition of the concept of suffering and to clarify various contextual aspects of the concept. Suffering is defined as an individualized, subjective, and complex experience that involves the assignment of an intensely negative meaning to an event or a perceived threat. Implications of these findings and additional contextual aspects of the concept for nursing practice and inquiry are presented. These results help to provide the conceptual foundation needed to enhance recognition and understanding of the human experience of suffering.

Promoting autonomy and independence for older people within nursing practice: a literature review

Abstract: The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.

Learning from errors in nursing practice

Abstract: Little attention is paid to the issue of errors in nursing practice. Staff are reluctant to discuss or publicize them. However, as clinical audit and quality management become more important and established in the health service, there is now a greater need to investigate and monitor the incidence of errors. The purpose of this study was to examine the causes and consequences of errors as well as the potential for errors to initiate changes in practice. One hundred and twenty-nine nurses answered a 22-item questionnaire relating to an error they had made. Nurses reported that the most common causes of errors were lack of knowledge or information, work overload, stressful atmosphere and lack of support from senior staff. Nurses were found to have recourse to a number of coping strategies in the aftermath of the error. Accepting responsibility and planful problem-solving were found to lead to positive changes in practice, whereas distancing and self-controlling strategies were associated with defensive changes, particularly with a tendency not to divulge the error. The findings also showed that errors had the potential to effect learning. The study suggests the need for staff to be encouraged to accept responsibility for their error within the framework of support. Strategies should be developed so that errors can be managed in a more constructive manner.

The transition to nursing home life: a comparison of planned and unplanned admissions

Abstract: The percentage of elderly people in nursing homes increases with age from 7% for adults aged 75-84 years to 20% for those over 85 years old. Limited research has been done with elderly people whose admission to a nursing home was planned or unplanned. This study addressed: what are the initial experiences of elderly people in making the transition to nursing home life when the admission was planned or unplanned? A grounded theory approach using constant comparative methods was used to discover the process and patterns of transition to nursing home life. Data were collected 24 hours after admission and every other day for 2 weeks, and 1 month post-admission using in-depth semistructured interviews and field notes. Data analysis demonstrated that the transition to nursing home life occurred in three phases: overwhelmed, adjustment and initial acceptance phase. The phases of adjustment are discussed along with interventions to assist older adults in making this transition.

Nurses' views on empowerment: a critical social theory perspective

Abstract: This is the first study which describes British nurses' views on the concept of empowerment. Despite the frequent call for nurses to empower patients there was no evidence in the literature about British nurses' views. The study was carried out prior to a course exploring empowerment for practice. Focus groups were used to gather the data. Critical social theory and the work of Paulo Freire (1972) and Jurgen Habermas (1971, 1979) was used as a theoretical framework to underpin the enquiry. Taped interview transcripts were analysed thematically. Four categories emerged from the data to provide the framework for the themes: 'empowerment', 'having personal power', 'relationships within the multidisciplinary team', and 'feeling right about oneself'. It is suggested that the nurses in this study manifested signs of being oppressed and striving for liberation. The limitations of the study are identified, but the overall conclusion is that the teaching of critical social theories as an empowerment paradigm is relevant in nurse education today.