To assess the effectiveness of multidimensional rehabilitation programs in terms of maintaining or improving the physical and psychosocial well-being of adult cancer survivors. The review will evaluate the extent to which: • Professionally led multidimensional rehabilitation programs achieve better outcomes than standard services for patients with cancer and their caregivers • Rehabilitation programmes exert a different impact on different domains (e.g. psychological health, physical functioning) • Different modes of delivery and different settings influence outcomes • There is relationship between the number, duration and intensity of rehabilitation sessions and degree of change in measured outcomes.
Title. Validity, trustworthiness and rigour: reasserting realism in qualitative research Aim. This paper challenges recent sceptical approaches to the possibility of validating qualitative research and underlines the benefits of adopting a realist approach to validity. Background. In recent discussion about the methodological bases for qualitative research it has been argued that, because different methodologies take different approaches to validity, attempts to develop a common set of validation criteria are futile. On the basis of this sceptical view, a number of strategies for judging qualitative research have been proposed. These include suggestions that: it should be judged according to aesthetic or rhetorical criteria, rather than epistemological validity; responsibility for appraisal should move from researchers to readers; each methodology should be assessed individually according to its own merits. Discussion. None of these suggestions provide a viable alternative to validity, defined as the extent to which research reflects accurately that to which it refers. Because the form of research does not determine its content, replacement of epistemology by aesthetics is unsustainable. Because research reports mediate between writer and reader, a one-sided approach to this relationship constitutes a false dichotomy. If we accept the criterion of practitioner confidence as a means of judging methodological approaches, this involves rejection of judgement according to a methodology's own merits. Conclusion. If qualitative research is actually about something, and if it is required to provide beneficial information, then a realist approach to validity holds out greatest promise.
AimTo determine the Rapid Response System programme theory and investigate how the mechanisms of implementation and the characteristics of context combine to enable or constrain the implementation of Rapid Response Systems and the achievement of desired outcomes.
The problem addressed in this paper is how nurse-doctor power relations are manifested in a hospital setting. A review of the literature identified four major ideal types of interaction between nurses and doctors in decision-making processes. These were unproblematic subordination, informal covert decision making, informal overt decision making and formal overt decision making on the part of nurses. Each of these types was tested against empirical data gained from participant observation of interactions between the nurses and doctors working in an intensive care unit and a general medical ward. It was concluded that while both the unproblematic subordination and the informal covert decision-making types of interaction appeared superficially to be used frequently, closer examination revealed that, with the exception of nurse-consultant interactions, nurses were less dependent on these subordinate modes of interaction than much of the literature suggested. Formal overt decision making, despite official encouragement, was also infrequently utilized. However, it was noticed that senior nurses especially used informal overt strategies to involve themselves in decision-making sequences. Use of such strategies had the effect of reducing though not eliminating the power differential between doctors and nurses.
This volume launches an exciting new series which explores the relationship between sociological principles and nursing practice. It introduces the nurse to social theory, and examines its importance in the development of nursing's own theoretical base. The relevance of theory to what is essentially a practical discipline is amply demonstrated. This book and its followers will be essential reading for students at both pre-registration and post-registration levels. Many practitioners will also find much to stimulate them.
The purpose of this paper is to identify a philosophy for ethnography which could overcome some of the epistemological criticisms to which it has recently been subjected, notably by Martin Hammersley (1990, 1992). It is argued that Roy Bhaskar's (1989a) theory of critical realism is capable of solving many of the problems raised in relation to representational claims, theoretical focus and explanatory status. A substantive example of how critical realist ethnography can be used is given in a participant observation study of how racism affects occupational relationships between nurses and doctors, and how its effects are mediated by professional ideology. It is argued that the universalist-achievement ethos of professionalism tends to counter the ascriptive nature of racism. Thus, as long as a functional-specific pretext is unavailable, the effects of structural racism will remain latent in social situations where professionalism has a powerful influence.
In the perceived hierarchy of research designs, the results from randomised controlled trials are considered to provide the highest level of evidence. Indeed, these trials have been upheld as the gold standard in research. The benefits and limitations of the randomised controlled trial as a method of evaluating the effectiveness of healthcare interventions are presented. The paper then examines the different levels of complexity within healthcare interventions and the problems this poses in determining effectiveness. In an effort to provide a solution to this problem, the Medical Research Council produced a framework to assist investigators to develop and evaluate complex healthcare interventions. The framework is described with reference to an example of implementing and evaluating protocols for weaning patients in the intensive care unit. The framework is critiqued on the basis that it involves an ambiguous or contradictory ontology, which fails to articulate the relationship between the positivism of randomised controlled trials with the relativism of qualitative approaches. It is concluded that the use of realist strategies in combination with randomised controlled trials provides the most coherent solution to this quandary.
The aim of this paper is to examine how the structural influence of gender affects nurses in their working lives. Gender segregation exists both within and between the occupations of medicine and nursing. It is largely founded on the social construction of a skills/caring dichotomy. An analysis of how the gender of nurses and doctors affects their interactions with co-workers reveals that the increasing proportion of female doctors has attenuated power differences between the two occupations. Examination of nurses' attitudes to gender demonstrates that they are very aware of the problem, despite a tendency to accept credentialist justifications of inequality. As a result of this they are becoming more assertive. The issue of sexual stereotyping is addressed and it is noted that popular mythology about sexual relations between doctor and nurses is highly misleading. Privatised aspirations are having a decreasing influence over nurses' working lives. In conclusion, while gender inequality is losing some of its power in nurse-doctor relationships, it is becoming an increasingly significant factor in the relationship between male nurse managers and female workers.
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