In the UK, researchers' access to study populations and control over selection of participants is becoming increasingly constrained by data protection and research governance legislation. Intervening stages placed between researchers and the population they wish to study can have serious effects on recruitment and ultimately on the validity of studies. In this paper we describe our experiences of gaining access to patients for a study of palliative care in primary care. Despite considerable time and resources dedicated to recruitment, a smaller than anticipated study sample was achieved. We found that gatekeeping by ethics committees and practitioner control over sample selection were significant hurdles in accessing patients for the study. Gatekeeping responsibilities represent considerable challenges for researchers seeking to obtain a representative study sample, not just in palliative care, but for research in general in health care.
Title. Reflexivity, critical qualitative research and emancipation: a Foucauldian perspective. Aim. In this paper, we consider reflexivity, not only as a concept of qualitative validity, but also as a tool used during the research process to achieve the goals of emancipation that are intrinsic to qualitative research conducted within a critical paradigm. Background. Research conducted from a critical perspective poses two challenges to researchers: validity of the research must be ensured and the emancipatory aims of the research need to be realized and communicated. The traditional view of reflexivity as a means of ensuring validity in qualitative research limits its potential to inform the research process. Data sources. The Medline and CINAHL data bases were searched (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008) inclusive) using keywords such as reflexivity, validity, subjectivity, bias, emancipation, empowerment and disability. In addition, the work of Michel Foucault was examined. Discussion. Using the work of the late French philosopher Michel Foucault, we explore how Foucault's 'technologies of the self' can be employed during critical qualitative research to achieve emancipatory changes. Using research conducted with marginalized populations as an example (specifically, individuals with disabilities), we demonstrate the potential for using reflexivity, in a Foucauldian sense, during the research process. Conclusion. Shifting the traditional view of reflexivity allows researchers to focus on the subtle changes that comprise emancipation (in a Foucauldian sense). As a result, researchers are better able to see, understand and analyse this process in both the participants and themselves.
Despite the remarkable institutional promotion of 'ready-made' and 'ready-to-use' guidelines, we demonstrate how the RNAO deploys BPGs as part of an ideological agenda that is scientifically, socially, politically and ethically unsound. Implications for nursing management Collaborations between health care organizations and professional organizations can become problematic when the latter dictate nursing conduct in such a way that critical thinking is impeded. We believe that nurse managers need to understand that the evidence-based movement is the target of well-deserved critiques. These critiques should also be considered before implementing so-called 'Nursing Best Practice Guidelines' in health care milieux.
Interview location has been widely overlooked in the nursing literature. This paper presents a discussion of interview location in the context of nursing research with particular emphasis on the concepts of space and place. It draws on six research projects that were conducted between 2008 and 2013 in Canada, and is informed by key texts on the concepts of space and place. We argue that thinking about space and place in the context of interviewing is one way to engage in reflexivity. The reflexive accounts featured in this paper support the need for nursing researchers to engage in explicit analysis of their own interview locations and to discuss the significance of space and place in their own work. These accounts suggest that location is a fundamental aspect of the interview process.
The aim of this study was to examine UK district nurses' perceptions of their role in supporting palliative care cancer patients. Patients with cancer are living longer with the disease. District nurses are the largest UK workforce caring for people with cancer at home, the preferred place of care. Meeting patients' supportive and palliative care needs is complex. Little is known about district nurses' supportive role in the early phase of palliative care. Semistructured interviews were conducted with 34 district nurses. Data were analyzed thematically, with assistance from Atlas/ti. A dominant theme emerging from the interviews was ambiguity in the district nurses' supportive role in early palliative care. District nurses discussed the importance of making contact early on to support cancer patients and their families but had difficulty articulating this "support." Ambiguity, lack of confidence, and perceived skill deficits presented district nurses with dilemmas that were difficult to resolve. District nurses have great potential for meeting cancer patients' supportive and palliative care needs, a potential not currently realized. Education alone is unlikely to improve practice without an understanding of the tensions faced by district nurses in their work. Recognizing and addressing dilemmas in the everyday work of district nurses is central to moving practice forward.
Nurses occupy and strive to maintain, the role of a caring agent. However, aspects of the clinical, institutional and broader social environments may undermine their ability to promote sexual health. In nurses' efforts to maintain therapeutic relationships with clients, sexual health is often medicalised to legitimize it as an appropriate topic of discussion with patients and families. Facilities serving youth with disabilities should take steps to address barriers to the delivery of sexual health promotion and several solutions are proposed.
The purpose of the study was to investigate psychometric properties of CAMPAS-R, an instrument for prospectively monitoring patients' symptoms and needs during palliative care at home. CAMPAS-R was piloted for face and content validity and then administered alongside criterion measures to a home care sample. Cronbach's alpha was used to test internal consistency and criterion-related validity was tested by non-parametric correlation with Brief Pain Inventory (BPI), Hospital Anxiety and Depression Scale (HADS) and EORTC QLQ-C30. Predictive validity was assessed by relating CAMPAS-R scores to survival. One hundred and nine patients were recruited to the study. Good reliability and high correlations between CAMPAS-R and criterion measures were found. Predictive validity was demonstrated by significant differences in symptom scores between groups differing in length of survival. CAMPAS-R is acceptable to patients, families and primary care professionals and is a valid, reliable instrument, which has the benefit of being easy to score.
Background Human milk expression, primarily by pump, is practiced by the majority of breastfeeding mothers in affluent countries. Existing literature is focused on determining prevalence and duration rates and the factors behind this trend. There is less research exploring mothers’ perspectives and experiences related to expression. Research aim To gather the experiential wisdom of mothers with a focus on their information needs and sources related to human milk expression. Methods Audiotaped interviews were conducted with 35 mothers of infants, aged birth to 24 months, who had expressed milk at least once in western Canada. This study was guided by interpretive description, an applied qualitative research approach. Results Registered nurses and international board-certified lactation consultants were the most common sources of information, with Internet, friends/family, and other mothers also important. Inconsistent expression advice was confusing for participants, and many reported health care providers did not address all their expression learning needs. Desired topic areas included practical advice on how to express, determining expression frequency/timing/duration, milk storage guidelines, the influence of expression on milk supply, product information, and general support/encouragement. Conclusions Assessment of expression learning needs should be part of routine lactation support at each encounter. Nonjudgmental, factual guidance will assist mothers in making evidence-informed decisions related to expression practices that are consistent with their unique breastfeeding goals. This should be supplemented by reputable online resources that provide timely and accurate information as well as efforts to connect mothers with peer support groups.
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