1,721,019 research outputs found
Medical hegemony in decision-making: a barrier to interdisciplinary working in intensive care?
No full textBackground: Health care policy in the United Kingdom identifies the need for health professionals to find new ways of working to deliver patient-focussed and economic care. Much debate has followed on the nature of working relationships within the health care team.Aim: This paper reports on an ethnographic study that examined the nursing role in clinical decision-making in intensive care units. This was chosen as a case for analysis due to the close doctor-nurse relationships that are essential in this acute and complex care setting.Methods: Data were collected during two-stages of fieldwork using participant observation, in-depth ethnographic interviews and documentation across three clinical sites.Findings: The findings revealed the different types of knowledge used for, divergence of roles involved in and degree of authority in clinical decision-making. Furthermore, conflict arose between doctors and nurses due to these differences and in particular because medicine dominated the decision-making process.Conclusions: The nursing role, whilst pivotal to implementing clinical decisions, remained unacknowledged and devalued. Medical hegemony continues to render nurses unable to influence substantially the decision-making process. This has fundamental ramifications for the quality of team decision-making and the effectiveness of new ways of inter-professional working in intensive care
How military nurses rationalize their postoperative pain assessment decisions
No full textAim. This paper is a report of a study to explore how military nurses rationalize their postoperative pain assessment decisions, particularly when these differ from patients’ pain self-reports.Background. Postoperative pain is a complex phenomenon influenced by many factors that make assessment difficult. Nurses are taught to believe what patients say about their pain. However, their attitudes to pain are influenced by their cultural background and they may disagree with patients’ self-reports. Military nurses belong to a military culture with different pain attitudes that may also influence their postoperative pain assessment.Method. An ethnomethodological ethnography study was carried out in 2003. A purposive sample of 29 British military surgical/orthopaedic Registered Nurses were interviewed to identify their taken-for-granted assumptions and commonsense cultural knowledge surrounding postoperative pain assessment. The data were analysed using a systematic process of inductive reasoning aided by Non-numerical, Unstructured Data for Indexing, Searching and Theorizing (qsr n6, nud*ist).Findings. Participants told two distinct stories in their postoperative pain narratives. The first, the cultural story, described how military nurses normally assess postoperative pain and revealed taken-for-granted assumptions surrounding this assessment. However, when military nurses believe that patients over- or under-report their pain, the cultural story was challenged through a collective story in which nurses used their commonsense knowledge to account for these differences.Conclusion. Postoperative pain assessment within a military culture is complex, but all nurses need to be aware that their socialization into different nursing cultures may influence their attitudes to postoperative pain assessment.<br/
Research activity and evidence-based practice within DNA: a survey
No full textIn this survey, research awareness and capacity within the Dermatology Nurses' Association (DNA) was investigated to inform the organization's development in both the use of research evidence to improve practice and the capacity to undertake research. The majority of respondents (almost 90%) indicated they were DNA members. Of the remaining respondents who did not answer this question, we could not be clear on their status and so decided not to separate member and non-member responses during analysi
Ethnomethodological ethnography and its application in nursing
No full textThis paper examines the use of a qualitative research methodology, ethnomethodological ethnography that has had little application within nursing, whether in the United Kingdom or elsewhere. This methodology is concerned with describing how members of a social group perceive, define and classify the ways that they perform their daily activities and what meanings they assign to these activities. Ethnomethodological ethnography analyses the everyday methods people use to construct and sustain the typical activities in their cultural world, that is, their ‘sense assembly equipment'. This enables them to act in ways that are congruent with their culturally learnt attitudes. Although this paper focuses on describing ethnomethodological ethnography, examples of its use in a study of nursing practice are provided from a doctoral study that explored the everyday methods military nurses used to rationalise their post-operative pain assessment decisions. From the experiences of this study, it is argued that ethnomethodological ethnography is a valuable methodology for investigating how nurses rationalise their decisions within nursing practice
Experiences of carers managing childhood eczema and their views on its treatment: a qualitative study
No full textBackground: Childhood eczema causes significant impact on quality of life for some families, yet non-concordance with treatment is common. Aim: To explore parents' and carers' views of childhood eczema and its treatment. Design and setting: Qualitative interview study in primary care in the south of England. Method: Carers of children aged ?5 years with a recorded diagnosis of eczema, who reported that eczema was still a problem, were invited to participate. Thirty-one parents were interviewed from 28 families. Results: Many parents expressed frustration with both medical care and prescribed treatments. They felt their child's suffering was not `taken seriously', and experienced messages about a `trial and error' prescribing approach and assurance that their child would `grow out of it' as a further `fobbing off', or dismissal. Many carers were ambivalent about eczema treatments, mainly topical corticosteroids but also emollients. Dietary exclusions as a potential cure were of interest to most families, although they perceived healthcare professionals as uninterested in this. Families varied in the extent to which they felt able to manage eczema and the length of time taken to gain control. In some instances, this was linked to not understanding advice or receiving conflicting advice from different healthcare providers. Conclusion: Poor concordance with treatments seems unsurprising in the presence of such dissonance between carers' and healthcare providers' agendas. Acknowledging the impact of the condition, greater attention to how key messages are delivered and addressing carers' treatment beliefs are likely to improve engagement with effective self-care
Managing childhood eczema: qualitative study exploring carers' experiences of barriers and facilitators to treatment adherence
No full textAIM: To explore parents and carers' experiences of barriers and facilitators to treatment adherence in childhood eczema BACKGROUND: Childhood eczema is common and causes significant impact on quality of life for children and their families, particularly due to sleep disturbance and itch. Non-adherence to application of topical treatments is the main cause of treatment failure.DESIGN: Qualitative interview study.METHODS: Qualitative interviews were carried out with 31 carers from 28 families of children with eczema. Participants were recruited through primary care and included if they had a child aged 5 or less with a diagnosis of eczema. Interviews were carried out between December 2010-May 2011. Data were analysed using a constant comparative approach.FINDINGS: Barriers to treatment adherence included carer beliefs around eczema treatment, the time consuming nature of applying topical treatments, and child resistance to treatment. Families employed a range of strategies in an attempt to work around children's resistance to treatment with varying success. Strategies included involving the child in treatment, distracting the child during treatment, or making a game of it, using rewards, applying treatment to a sleeping child or, in a few cases, physically restraining the child. Some carers reduced frequency of applications in an attempt to reduce child resistance.CONCLUSIONS: Regular application of topical treatments to children is an onerous task, particularly in families where child resistance develops. Early recognition and discussion of resistance and better awareness of the strategies to overcome this may help carers to respond positively and avoid establishing habitual confrontation
'You don't know which bits to believe': Qualitative study exploring carers' experiences of seeking information on the internet about childhood eczema
Get PDFObjective: We sought to explore parents and carers' experiences of searching for information about childhood eczema on the internet. Design: A qualitative interview study was carried out among carers of children aged 5 years or less with a recorded diagnosis of eczema. The main focus of the study was to explore carers' beliefs and understandings around eczema and its treatment. As part of this, we explored experiences of formal and informal information seeking about childhood eczema. Transcripts of interviews were analysed thematically. Setting: Participants were recruited from six general practices in South West England. Participants: Interviews were carried out with 31 parents from 28 families. Results: Experiences of searching for eczema information on the internet varied widely. A few interviewees were able to navigate through the internet and find the specific information they were looking for (for instance about treatments their child had been prescribed), but more found searching for eczema information online to be a bewildering experience. Some could find no information of relevance to them, whereas others found the volume of different information sources overwhelming. Some said that they were unsure how to evaluate online information or that they were wary of commercial interests behind some information sources. Interviewees said that they would welcome more signposting towards high quality information from their healthcare providers. Conclusions: We found very mixed experiences of seeking eczema information on the internet; but many participants in this study found this to be frustrating and confusing. Healthcare professionals and healthcare systems have a role to play in helping people with long-term health conditions and their carers find reliable online information to support them with self-care
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Support needs for diabetes self-management : exploring the views of Maltese individuals with type 2 diabetes using a grounded theory approach
Get PDFDiabetes is a long-term condition which causes significant public health concern in view of its increasing prevalence and associated morbidity. Notwithstanding this, effective management has been shown to prevent or delay the onset of diabetes complications, thereby improving prognosis. Diabetes has a high self-management demand. This involves behaviour modification together with psycho-social adjustments required to overcome challenges with integrating diabetes management in one’s life. Such challenges often originate from the socio-cultural context and it is recognised that support for diabetes self-management should target these challenges. The purpose of this study was therefore to explore how Maltese individuals with Type 2 diabetes believe they can be supported to manage their condition, as well as to examine whether, and if so how such views may be shaped by the Maltese socio-cultural environment.The study used a qualitative design guided by a Grounded Theory approach. Data were collected by in-depth focus group and one-to-one interviews, carried out amongst 52 adults with Type 2 diabetes recruited from an outpatient hospital clinic and community-based diabetes clinics in Malta. A total of six focus groups and twelve one-to-one interviews were conducted. Theoretical sampling was used and data analysis involved constant comparison of data, together with conceptualising and organising the data into categories. Generated categories were linked by exploring relationships between them, in the process of developing a substantive theory.The emergent theory describes how participants viewed diabetes self-management as involving the implementation of skills in thought and behavioural management. These skills were found to be key to coping and consisted of flexibility, proactive management, stress management and developing a positive mind-set towards diabetes. Furthermore, the theory outlines how aspects of Maltese culture, including those related to stigma, family, food and health services were seen to influence diabetes self-management directly, or through their impact on the development of such skills. A basic social process emerged representing individuals’ movement across the coping continuum, characterising transition to a higher/lower level of coping, during particular episodes in life. This process reinforced the identified relationship between the socio-cultural context and patient’s agency, demonstrating how such movement coincided with negative/positive experiences of socio-cultural influence.These findings have contributed new knowledge about the relationship between culture and diabetes-related coping. They suggest that patients may be supported in managing their diabetes by addressing cultural factors which influence the development of specific self-management skills. In Malta, this may involve new ways of delivering culturally sensitive care and education
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