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Verbatim
Kinds of Verbatim Terms modified by Verbatim Selected AbstractsVerbatim and gist recall of sentences by dyslexic and non-dyslexic adultsDYSLEXIA, Issue 3 2006T. R. Miles Abstract Forty-eight college students, 24 of them dyslexic, were presented with four sentences of increasing complexity. Participants were asked to repeat each sentence and a record was kept of the number of repetitions required before 100% correct accuracy was achieved. None of the 24 control participants required a total of more than eight repetitions over the four sentences, whereas among the dyslexics the total number of repetitions needed ranged from one to 25. Dyslexic participants were unpredictable in their performance from one level of difficulty to the next and inter-individual variability was far greater in the dyslexic group than in the control group. Overall, despite their relatively poor performance in achieving verbatim accuracy relative to non-dyslexic participants, dyslexic individuals regularly managed to preserve the gist of the sentences. Some theoretical issues arising from these results are discussed. Copyright © 2006 John Wiley & Sons, Ltd. [source] Student use of computer-assisted learning (CAL) and effects on learning outcomesBIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION, Issue 2 2003Craig Zimitat Abstract This article reports on a qualitative evaluation of student use of a computer-assisted learning (CAL) program and associated learning outcomes. Learning outcomes were classified by analysis of examination scripts using the Structure of Observed Learning Outcomes (SOLO) taxonomy, and individuals were interviewed to uncover aspects of their learning processes while using the CAL program. All students were aware of the "design for learning" features of the CAL program, although not all students were able to take advantage of these because of their own note-taking practices. Verbatim or excessive note-taking was associated with surface learning outcomes, while summarizing or personal note-taking and engagement with the program was associated with deep learning outcomes. Other factors affecting learning outcomes included students' perceptions of the role of the program, social elements of the learning environment, and a lack of distinction between major and minor issues in the content. [source] Living with a child with a severe orofacial handicap: experiences from the perspectives of parentsEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 1 2003Ulrika Trulsson Orofacial functions include competences/abilities such as eating, breathing, speech/language, mimicry, as well as oral health, and disturbances are common in children with rare disorders. To describe parental experiences of orofacial function and needs in children with rare disorders, in-depth interviews focusing on orofacial function were carried out with 14 parents. Interviews were transcribed verbatim and analysed in open, axial (theoretical) and selective coding processes according to Grounded Theory. Two core categories emerged from data in the analysis: ,the vulnerable family' and ,support perceived from others'. The data indicated the importance of a balance between these two core categories: the strain caused by living in a family with a child with a severe disability/handicap, and the availability of perceived support from caregivers and significant others. This balance was necessary for the parents in developing self-reliance and in reconciling themselves to their life situations. Parents described orofacial dysfunction in terms of feeding and communication problems, needs for orthodontic treatment to reduce risk of trauma or improve chewing, and drooling. Oral health issues such as dental caries and gingivitis were not mentioned. Five aspects of good professional attitude were recognized: respect, involvement, continuity, knowledge, and availability. [source] Non-supportive interactions in the experience of women family caregiversHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2007Anne Neufeld RN PhD Abstract The purpose of this ethnographic study was to identify and describe types of non-supportive interactions perceived by 59 women family caregivers in four diverse situations. Participants included 15 mothers of infants born prematurely, 14 mothers of a child with a chronic disease (asthma or diabetes), and women caring for an adult family member with either cancer (15) or dementia (15). Data collection methods included an initial in-depth interview with all women, followed by a second interview with a smaller group of caregivers including a card sort exercise that was based on thematic content analysis of the first interview data. A typology of non-supportive interactions was developed from analysis of the first two interviews and confirmed in a final interview with a subset of study participants. Interviews were audio-taped and transcribed verbatim. Women in all caregiving situations described experience with three types of non-supportive interactions. These interactions were negative, ineffective, or lacking expected support. The women's appraisal of interactions as supportive or non-supportive was rooted in their personal expectations and the context of their situation. Information about types of non-supportive interactions can sensitise professionals, family and friends to mismatches between their assistance and caregivers' requirements, potentially avoiding negative consequences. [source] Dental hygienists' views on communicative factors and interpersonal processes in prevention and treatment of periodontal diseaseINTERNATIONAL JOURNAL OF DENTAL HYGIENE, Issue 3 2010J Stenman To cite this article: Int J Dent Hygiene,8, 2010; 213,218 DOI: 10.1111/j.1601-5037.2010.00459.x Stenman J, Wennström JL, Abrahamsson KH. Dental hygienists' views on communicative factors and interpersonal processes in prevention and treatment of periodontal disease. Abstract:, Objective:, The aim of this study was to explore views of DHs on communicative issues and interpersonal processes of importance in the prevention and treatment of periodontal disease. Method:, The qualitative method of Grounded Theory (GT) was chosen for data sampling and analysis. Audio-taped and open-ended interviews were conducted with 17 dental hygienists. The interviews were transcribed verbatim and analysed in a hierarchical coding process, according to the principles of GT. Result:, In the analysis a core category was identified as ,to be successful in information and oral health education and managing desirable behavioural changes'. The core concept was related to four additional categories and dimensions; (i) ,to establish a trustful relationship with the patient', (ii) ,to present information about the oral health status and to give oral hygiene instructions', (iii) ,to be professional in the role as a dental hygienist' and (iv) ,to have a supportive working environment in order to feel satisfaction with the work and to reach desirable treatment results'. Conclusion:, The results describe a psychosocial process that elucidates the importance of building a trustful relationship with the patient, feeling secure in one's professional role as a DH and last but not least, the importance of having support from colleagues and the clinical manager to be successful in the prevention and treatment of periodontal diseases. [source] An exploration of work-related stress in Northern Ireland community pharmacy: a qualitative studyINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 5 2009Laura McCann Abstract Objectives The aim of this study was, through qualitative methodology, to explore the factors which contribute to job-related stress in community pharmacy in Northern Ireland. Methods All community pharmacists in Northern Ireland were invited to participate in one-to-one semi-structured interviews. Interview schedules explored pharmacists' attitudes to job-related stress and the situations that may contribute to stress. All interviews took place at participants' work sites between December 2007 and April 2008, were audio-taped, transcribed verbatim, read independently by the authors and analysed using thematic analysis. Key findings Seventeen pharmacists participated in the interviews. The main themes that emerged in relation to job-related stress were workplace issues, issues regarding professional expansion, recognition and responsibility, and a demanding public. Although there was general support for development in community pharmacy, this was tempered by concerns as to how expectations would be met and how all services would be delivered. Conclusions The themes that emerged from this work reflect what was reported from a survey conducted in 2007 and reinforce the tension between developments in practice and the ability to deliver. Developments in professional practice can be positive; however, commissioners and policy-makers need to consider whether community pharmacists have the infrastructure in terms of environment, personnel and multi-professional support to deliver what is required of them. [source] Orthopaedic patients' experience of motor vehicle accident in SingaporeINTERNATIONAL NURSING REVIEW, Issue 1 2008K.L. Tan mn (ortho nrsg) Aim:, The purpose of this paper is to present a study that explored the experiences of orthopaedic patients injured in motor vehicle accidents (MVAs), from the time of the accident until 6 months after being discharged from hospital. Background:, Trauma injuries from MVAs are increasing, with the number of deaths from such injuries continuing to rise. Victims often sustain open fractures to more than one part of their body and need rehabilitation and support to adjust to long-term chronic or permanent disability. In the last decade, research pertaining to trauma nursing has concentrated on neurologically injured patients. Although there is a paucity of research on the nursing perspective of psychological care for non-neurologically injured patients, the majority of studies located were mainly quantitative in nature and did not analyse the personal experiences of orthopaedic patients. Method:, A qualitative naturalistic inquiry approach was used, which provided a first-hand account of the traumatic MVA event experienced by six orthopaedic participants in Singapore. Data were collected from face-to-face in-depth interviews. Participants were voluntarily recruited through purposeful sampling and ,snowballing'. Interviews were audiotaped and transcribed verbatim in preparation for analysis. Findings:, The analysis of information explicated four main themes: the experience of the event, the effect of hospitalization, surviving the event and self-transformation. Conclusion:, The study provided an understanding of orthopaedic patients' experience of MVA in Singapore. The findings of the study have the potential to contribute to the limited qualitative research available concerning victims' experiences of MVAs and nurses caring for MVA victims. [source] Professional competence: factors described by nurses as influencing their developmentINTERNATIONAL NURSING REVIEW, Issue 1 2006R. Tabari Khomeiran bs mscn phd Aim:, To discuss the results of a study that explored factors that may influence competence development. Background:, Competence, a controversial issue in health care settings, affects many aspects of the nursing profession, including education, practice and management. Although a number of research and discussion papers have explored the issue, in particular the meaning and assessment of nursing competence, to date little research has explored factors identified by nurses themselves as influencing their development of professional competence. Methods:, A purposive sample of 27 registered nurses was recruited from two university-affiliated hospitals. Data collection was by tape-recorded semi-structured interviews. Interviews were transcribed verbatim and analysed according to the qualitative methodology of content analysis. Findings:, Six descriptive categories were identified from the data: experience, opportunities, environment, personal characteristics, motivation and theoretical knowledge. Conclusions:, The findings suggest that the factors influencing the process of developing professional competence in nursing extend across personal and extra-personal domains. An understanding of these factors may enhance the ability of nursing managers and educators to enable student and qualified nurses to pursue effective competency development pathways to prepare them to provide a high standard of care. These findings, which may have important implications for nursing practice, management and education, are being further tested in a larger study. [source] Patients' experiences of hip fractureJOURNAL OF ADVANCED NURSING, Issue 4 2003Graeme Archibald BA MSc RN Background., Hip fracture is a major cause of mortality and morbidity, particularly among older people, but there is little information on how individuals experience this. Aims., This study was conducted to explore the experiences of individuals who had suffered a hip fracture. The aim was not to produce generalizable findings but, rather, to generate a rich description of the experience of incurring and recovering from a hip fracture, to inform nursing practice. Method., Phenomenological methodology was used. A purposeful sample of five older patients was interviewed, following a stay in a community hospital for rehabilitation after surgical repair of a hip fracture. The unstructured interviews were tape-recorded, transcribed verbatim and analysed for significant statements and meanings. Findings., Four major themes emerged: the injury experience, the pain experience, the recovery experience and the disability experience. The injury experience consisted of storytelling, recalling the experience of the injury itself. The pain experience consisted of coping with the pain. The recovery experience involved the operation, beginning the struggle of recovery, and regaining independence. The disability experience consisted of the disability itself, depending on others, and being housebound. Conclusions., Pain management, meeting psychological and physical needs for nursing care, planning for discharge, and ensuring a reasonable quality of life are areas for nursing care development. Consideration of appropriate settings for rehabilitation is needed and there should be further investigation into improving quality of life after discharge. [source] Videotaped recording as a method of participant observation in psychiatric nursing researchJOURNAL OF ADVANCED NURSING, Issue 5 2000Eila Latvala RN PhD Videotaped recording as a method of participant observation in psychiatric nursing research This paper describes videotaped recording as a data collection method when conducting participant observation in a psychiatric nursing study. The videotaped episodes were part of the daily life of psychiatric nursing in a hospital environment. The advantages and limitations of using videotaped recording in nursing research will be discussed. This paper is based on two studies. The data consisted of 21 videotaped episodes of nursing report sessions or interdisciplinary team meetings in the psychiatric clinic of a university hospital. The participants consisted of patients, their significant others, nurses, doctors, social workers and physiotherapists. All videotaped material was transcribed verbatim. An essential advantage of videotaping is that most potentially useful interaction and behaviour can be captured. The advantage in terms of the credibility of videotaping was that the investigator was able to review the same videotaped situations again and again. Videotaped material is rich and provides several possibilities for analysing the data. In these studies data and source triangulation enabled the researchers to reduce personal influence on the results. The investigator must also be aware of the limitations concerning this method. The most essential limitations are mechanical problems and the influence of videotaping on behaviour. Careful ethical considerations are important concerning personal privacy, informed consent and respect for the self-determination of psychiatric patients. [source] Women's perceptions of chemotherapy-induced cognitive side affects on work ability: a focus group studyJOURNAL OF CLINICAL NURSING, Issue 9-10 2010Fehmidah Munir Aims and objectives., To investigate women's awareness of chemotherapy-induced cognitive changes, their perception of cognitive limitations in carrying out daily tasks and subsequent return to work decisions and perceptions of work ability. Background., Evidence suggests that women diagnosed with breast cancer experience cognitive changes as a consequence of chemotherapy treatment. Although these changes tend to be subtle deficits in memory, concentration and the ability to organise information, there has been no published research identifying how they can impact patient's ability to work and subsequent employment decisions. Design., This was a qualitative study. Method., Data were collected from breast cancer survivors using semi-structured interviews with two focus groups (n = 6, n = 7). Interviews were transcribed verbatim and analysed using template analysis. Results., Data were categorised into four main themes: (1) awareness of cognitive changes during and following chemotherapy, (2) cognitive ability and confidence in return to work, (3) impact of cognitive changes on work ability and (4) information on the cognitive side effects of chemotherapy. Conclusions., The views and experiences of breast cancer survivors towards returning to work and subsequent work ability were affected by chemotherapy-induced cognitive impairment. More specifically the appraisal of returning to work and ability to manage work were influenced by three interrelated factors: (1) actual cognitive ability following chemotherapy, (2) awareness of cognitive failures by the women and their families and (3) the subsequent impact on their confidence in carrying out daily tasks including work tasks. Relevance to clinical practice., More information and support is needed to help patients with cancer to manage chemotherapy-induced cognitive impairments in home and workplace. Nurses are increasingly asked about the impact of cancer and its treatment on work and are therefore well positioned to offer this advice. Subsequently, nurses require additional knowledge and guidance to provide this information and support. [source] Promoting the health of people with chronic obstructive pulmonary disease: patients' and carers' viewsJOURNAL OF CLINICAL NURSING, Issue 3-4 2010Ann Caress Aims and objectives., The aim of this study was to generate in-depth insights into patients' and family members' understanding of the causation, progression and prevention of chronic obstructive pulmonary disease and the role of health promotion with this population. In particular, we were interested in identifying the ways patients and family members considered that they could maximise their (patients') health, in the presence of this disease. Background., Chronic obstructive pulmonary disease is highly prevalent and a significant cause of morbidity and mortality, impacting on quality of life and healthcare expenditure. Health promotion is, therefore, an important consideration. There are few examples in the literature of health promotion programmes for this population, including those directed at smoking cessation, which also focus on the family or significant others. Design., An exploratory, descriptive design was employed. Method., Semi-structured, audio-recorded interviews were conducted with 14 patients and 12 family caregivers. Interviews were transcribed verbatim and thematically analysed using content analysis procedures which captured the meaning of the data. Results., The three main themes were ,health promotion: what's that?', ,community resources for health promotion' and ,it wasn't just the smoking'. Many participants seemed unaware that their health might benefit from a healthier life style and provided little spontaneous information on any activities they carried out to maintain or improve their health. Conclusions., This study highlighted a dearth of health promoting activity amongst people affected by chronic obstructive pulmonary disease. The reality for most patients was to manage the day-to-day demands that the symptoms of the disease imposed on them. Our data suggest that a more wide-ranging approach, encompassing aspects of health promotion, might be welcomed by many patients and their family carers. Relevance to clinical practice., The findings from this study highlight gaps in patients' and carers' understanding of the potential role of health promotion in chronic obstructive pulmonary disease and areas for intervention by health professionals. With the increase in smoking rates of women and predicted future increases in chronic obstructive pulmonary disease, it is imperative that health professionals find effective ways to provide support and health promotive care for patients and families. [source] Opioid-taking tasks and behaviours in Taiwanese outpatients with cancerJOURNAL OF CLINICAL NURSING, Issue 15 2008Shu-Yuan Liang PhD Candidate Aim., The aim of this study was to describe those tasks and behaviours that contribute to self-efficacy in the context of opioid-taking in Taiwanese outpatients with cancer and to explore those factors that influence a patient's self-efficacy with engaging in these behaviours. Background., Self-management with prescribed opioid regimen has become a necessary component of the cancer pain experience at home. Tailoring prescribed regimens is a complex and continuing effort for cancer pain control. Few studies, however, have explored the specific skills and behaviours required by patients to manage their opioid analgesics effectively. Design., A qualitative approach was used to explore those behaviours that contribute to patients' ability to self-manage medication for their cancer pain. Method., Ten Taiwanese cancer patients aged between 41,75 years attending two oncology outpatient departments, who were prescribed opioid analgesics, were interviewed. All interviews were tape-recorded and were transcribed verbatim. Qualitative content analysis was undertaken to identify categories. Results., Five main categories of behaviours were identified, which reflected patient's perceptions of the actions required for effective opioid-taking. These behavioural domains included communicating about pain and analgesic-taking, taking analgesics according to schedule, obtaining help, tailoring medication regimens and managing treatment-related concerns. In addition, patients described various situations in which performance of these behaviours was more or less difficult. Conclusions., Our results suggest that self-efficacy with opioid-taking includes not only beliefs about the ability to communicate, but also the ability to fulfil more complex tailoring of medication regimens and management of treatment-related concerns. Relevance to clinical practice., Health professionals need to incorporate strategies to assist cancer patients' ability to engage in these behaviours and to manage situational impediments that may influence this ability. More importantly, clinicians need to assist patients to enhance their beliefs in their ability in overcoming various situation impediments for opioid-taking. [source] A study of a training scheme for Macmillan nurses in Northern IrelandJOURNAL OF CLINICAL NURSING, Issue 2 2008BSocSc, Cert Ed., DipDN, Johnston Gail PhD Aim., To evaluate a one year training scheme for Macmillan Nurses. Background., The role of the clinical nurse specialist has evolved and expanded greatly over the past few years so that it now encompasses components far beyond the traditional nursing remit of direct clinical practice. While several studies have looked at the barriers and facilitators to this process for clinical nurse specialists in particular, none has looked at the benefits of a structured training scheme which involves both a theoretical and clinical component. Methods., Tape recorded, semi-structured interviews were undertaken with a purposive sample of trainees who undertook the scheme, their practice-based facilitators and another person(s) involved in the trainee's support Analysis., Tapes were transcribed verbatim and each transcript anonymized to prevent identification of participants. Data were analysed thematically using the main headings of expectations, experience and impact and the structured prompts from the aide-memoir within these headings. Results., Results showed that the majority of respondents felt the scheme had been successful with one of the main achievements being that trainees were perceived to be adequately prepared to take on the role of a CNS on completion of the scheme. While the Role Development Programme was thought to provide a good academic structure for the scheme some participants thought that more theory on symptom control and communication skills and a placement in a specialist palliative care centre should also be included. Conclusion., The Macmillan Trainee Scheme has succeeded in its objectives to facilitate the transition from generalist to specialist nursing. It should be extended to include an induction and consolidation period and more theoretical input on communication skills and symptom control. Relevance to clinical practice., With these improvements, the scheme could be used as a standard model for training specialist practitioners and a means to address the current issues of workforce planning. [source] Lucidity in a woman with severe dementia related to conversation.JOURNAL OF CLINICAL NURSING, Issue 7 2005A case study Aims and objectives., The aim of this study was to explore the presence of lucidity in a woman with severe dementia during conversations and whether it occurred when conversational partners or the woman with severe dementia initiated the conversation topics about the present, past or future time and whether she was presented with support or demands during the conversation. Background., Communication problems as well as episodes of lucidity in people with dementia are reported in the literature. Design., A researcher held 20 hours of conversation with a woman with severe dementia. A daughter participated for about three and a half hours. The conversation was tape-recorded and transcribed verbatim. Methods., The text was divided into units of analysis. Each unit of analysis was then assessed separately and discussed among the authors. Chi-square tests and logistic regression analysis were performed. An ethics committee approved the study. Results., The woman as initiator of the conversation topic and support to the women during conversation from the conversation partner were found to be the most significant factors explaining lucidity, while conversation about the present or past time showed no connection with lucidity. Very few topics (n = 7) concerned future time and they were not used in the statistical analysis. The researcher initiated 41%, the woman 43% and the daughter 16% of the topics. Support was registered in 49%, demands in 15% and both support and demands in 16% of the units of analysis. There were 58% topics about present and 40% about the past time. Conclusions., The presented study is a case study and the results cannot be generalized. For the woman with severe dementia, lucidity was promoted by the conversational parties carefully focusing on conversation topics initiated by the woman while supporting her during conversation. Relevance to clinical practice., To share the same perception of reality, focusing on the topics initiated by the patient with severe dementia and a supporting attitude to what the patient tells, will hopefully give more episodes of lucidity in the patient. This approach in caring for patients with severe dementia might give more meaning and well-being to the conversational partners in daily care. [source] Information needs of women with non-invasive breast cancerJOURNAL OF CLINICAL NURSING, Issue 5 2000Marina Brown BN ,,The purpose of this inquiry was to gain a better understanding of the experience of women who have had surgery for non-invasive breast cancer. In particular, issues surrounding information were explored. ,,Six women who had undergone surgery for a non-invasive breast cancer (ductal carcinoma in situ or DCIS) participated in the research and an interpretive approach was used to guide the research process. ,,In-depth interviews took place in the women's homes and the interviews were transcribed verbatim. ,,Through a process of familiarization with the tapes and transcripts, clusters of significant statements were assembled into individual stories of each woman's experience. ,,The findings highlight the individual nature of the experience of information, with the women wanting information that is tailored to their personal needs. ,,Nurses can provide care that is more responsive to the information needs of each woman by being aware of the diverse ways in which women experience information. ,,This small study contributes to the limited understanding of the experience of having surgery for ductal carcinoma in situ and the information needs of these women. [source] Experiences of diagnosis and treatment among people with multiple sclerosisJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2008Rhiannon G. Edwards MSc Abstract Rationale, aims and objectives, The aim of this qualitative study was to examine patients' experiences of being diagnosed with multiple sclerosis (MS), the information that they were given at this time, subsequent treatment and its impact on their lives. Method, Data were collected through semi-structured interviews with 24 people with MS. The use of interviews allowed participants' experiences to be explored in depth. Participants were recruited by the MS Society through membership details and through a press release in a local newspaper. Telephone interviews lasted between 30 and 60 minutes, were tape-recorded and transcribed verbatim. Data were analysed using thematic content analysis. Results, The majority of participants were female (n = 17), with ages ranging from 35 to 72 years. Disease duration ranged from 1 to 37 years. Many participants' diagnosed before and after 2000 had experienced long delays in diagnosis. At the point of diagnosis, participants had to make sense of and understand their diagnosis often with insufficient support. Some participants expressed anger about the way they had been given their diagnosis. Many felt they had not received sufficient information about their illness at this time and had responded by conducting their own searches for information to satisfy this need. Conclusion, Improving the way in which doctors communicate with patients experiencing diagnostic delay and at the point of diagnosis deserves further study, in order to avoid later adjustment problems. [source] Thromboprophylaxis for hospitalized medical patients: A Multicenter Qualitative study,,JOURNAL OF HOSPITAL MEDICINE, Issue 5 2009Deborah Cook MD Abstract BACKGROUND: Observational studies have documented that medical patients infrequently receive venous thromboembolism (VTE) prevention. OBJECTIVE: To understand the barriers to, and facilitators of, optimal thromboprophylaxis. PATIENTS: Hospitalized medical patients. DESIGN: We conducted in-depth interviews with 15 nurses, 6 pharmacists, 12 physicians with both clinical and managerial experience, and 3 hospital administrators. SETTING: One university-affiliated and 2 community hospitals. INTERVENTION: Interviews were audiotaped and transcribed verbatim. Transcripts were reviewed and interpreted independently in duplicate. MEASUREMENT: Analysis was conducted using grounded theory. RESULTS: Physicians and pharmacists affirmed that evidence supporting heparin is strong and understood. Clinicians, particularly nurses, reported that mobilization was important, but were uncertain about how much mobilization was enough. Participants believed that depending on individual physicians for VTE prevention is insufficient. The central finding was that multidisciplinary care was also perceived as a barrier to effective VTE prevention because it can lead to unclear accountability by role confusion. Participants believed that a comprehensive, systems approach was necessary. Suggestions included screening and risk-stratifying all patients, preprinted orders at hospital admission that are regularly reevaluated, and audit and feedback programs. Patient or family-mediated reminders, and administrative interventions, such as hiring more physiotherapists and profiling thromboprophylaxis in hospital accreditation, were also endorsed. CONCLUSIONS: Universal consideration of thromboprophylaxis finds common ground in multidisciplinary care. However, results of this qualitative study challenge the conviction that either individual physician efforts or multidisciplinary care are sufficient for optimal prevention. To ensure exemplary medical thromboprophylaxis, clinicians regarded coordinated, systemwide processes, aimed at patients, providers, and administrators as essential. Journal of Hospital Medicine 2009;4:269,275. © 2009 Society of Hospital Medicine. [source] Identifying facilitators and barriers to physical activity for adults with Down syndromeJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 9 2010J. Mahy Abstract Background Adults with Down syndrome are typically sedentary, and many do not participate in the recommended levels of physical activity per week. The aim of this study was to identify the facilitators and barriers to physical activity for this group. Method Semi-structured interviews were conducted to elicit the views of adults with Down syndrome and their support people about what factors facilitate physical activity and what factors are barriers to activity. A sample of 18 participants (3 men, 15 women) was recruited through two agencies providing services for adults with disabilities; six participants were adults with Down syndrome and 12 participants were support people (four were parents of adults with Down syndrome and eight participants were employed by day programmes attended by the adults with Down syndrome). The interviews were recorded, transcribed verbatim and independently coded by two researchers. Results Three themes around facilitators to physical activity were identified: (1) support from others; (2) that the physical activity was fun or had an interesting purpose; and (3) routine and familiarity. Three themes around barriers were also identified: (1) lack of support; (2) not wanting to engage in physical activity; and (3) medical and physiological factors. Conclusions The results suggest that support people play a key role, both as facilitators and barriers, in the participation by adults with Down syndrome in physical activity. Many of the barriers and facilitators of activity for adults with Down syndrome indentified are similar to those reported for adults without impairment. Our findings are also consistent with established theories in the field of health behaviour change. [source] Beneath the Surface: A Story of Leadership, Recruitment, and the Hidden Dimensions of Strategic Workplace DesignJOURNAL OF INTERIOR DESIGN, Issue 1 2000Sheila Danko M.I.D. ABSTRACT The purpose of this article is to explore issues related to workplace design and corporate leadership in the 21st century, specifically the strategic leadership initiatives needed to recruit, retain, and motivate talented employees. The research design uses a qualitative research method called narrative or life stories in combination with a traditional case study approach. Cases selected had to be strategic, inspiring/aspiring, authentic, and multivocal. Both design process and design product were examined as well as the impact of design on the individual and the organization. Interview data were collected on site, audio taped, and transcribed verbatim to ensure accuracy. Focused narratives were then generated from the case study interview data. The transcripts were reviewed to identify major issues, recurring themes, and categories of analysis. The raw interview data were then sifted through Labov's six-part framework for organizing and interpreting narratives. The process of evolving the raw interview transcripts into a meaningful story followed Lieblich, Tuval-Mashiach, and Zilber's (1998) holistic-content approach. A story entitled "Beneath the Surface" forms the basis of the results and discussion section, and presents a true account of how workplace design impacted the interview process through the eyes of a young executive recruit. The story revealed that the design of space factored heavily into the new recruit's decision-making process and ultimate acceptance of the position, and that the impacts of the workplace design extended beyond the initial recruitment to have longer-term implications for corporate competitiveness. The narrative also revealed that the chief administrative officer (CAO) and new director of organizational development viewed design as a strategic tool, and that the managing partner used design elements strategically to communicate her divisions' values and social mission. The story reveals strategic implications of both design process and product for six strategic leadership initiatives thought to impact overall quality of work life, and to enhance recruitment and retention: differentiating quality of life as a competitive edge, aligning individual values with corporate values, building a sense of community, nurturing professional growth and knowledge transfer, communicating social mission, and leaving a legacy of social change. Design was shown to play a supportive role for each of the above leadership initiatives. [source] Locally targeted initiatives to recruit and retain nurses in EnglandJOURNAL OF NURSING MANAGEMENT, Issue 4 2006DINAH GOULD BSc MPhil PhD RGN RNT Aim, The aim of this study is to provide a detailed account of the locally targeted strategies to improve staffing levels by senior nurses responsible for recruitment and retention in acute trusts in the National Health Service in England. Background, There is a shortfall in nursing numbers throughout England. Some trusts have employed senior nurses with a specific remit to improve recruitment and retention, but little has been published about their work or its success. Methods, Data were collected by telephone using semi-structured interviews with standard probes. The tape-recorded interview data were transcribed verbatim and analysed by content. Results, Of the 156 acute trusts in England, 36 employed a senior nurse to deal with recruitment and retention. Twenty-nine were interviewed. All were using a range of locally targeted initiatives to attract and retain health-care assistants, newly qualified and more experienced practitioners. They also worked closely with university staff to attract and retain student nurses who would later seek employment locally. Different approaches were used to secure the services of different types of staff. Conclusion, This exploratory study has revealed a wealth of valuable data concerning locally targeted recruitment and retention strategies. Further research is needed to examine the effectiveness and cost-effectiveness of the initiatives described. [source] Sexual Protective Strategies of Late Adolescent Females: More Than Just CondomsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 4 2001M. Katherine Hutchinson RN Objective: To identify the sexual protective strategies of late adolescent heterosexual women. Design: Open-ended questioning regarding sexual protective strategies was included in a larger cross-sectional survey on sexual risk. Participants' responses were recorded verbatim and analyzed using content analysis. Participants: 234 African American, Hispanic/Latina, and non-Hispanic white 19- to 21-year-old females were recruited from the driver's license records of a mid-Atlantic state. Main Outcome Measures: Participants re-1 to the on-ended question, "How or what do you do to reduce your risk for sexually transmitted diseases and HIV?" Results: Seven primary sexual protective strategies were identified from participants' responses: using condoms, abstaining or postponing sexual intercourse, getting tested for human immunodeficiency virus (HIV) and sexually transmitted diseases (SIDs), selecting safe partners, negotiating condom use, talking about sexual risk histories, and limiting the number of sexual partners. Conclusions: Some of the sexual protective strategies identified by study participants were less than effective and left young women vulnerable to infection with HIV and STDs. In addition, the use of these alternative strategies may leave young women feeling less at risk and thus less likely to use other more effective strategies such as condoms. The implications for nursing practice and the assessment of the sexual protective strategies of young heterosexual women are discussed. [source] Facing inadequacy and being good enough: psychiatric care providers' narratives about experiencing and coping with troubled conscienceJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2009V. DAHLQVIST rnt phd The aim of this study is to illuminate the meaning of encounters with a troubled conscience among psychiatric therapists. Psychiatric care involves ethical dilemmas which may affect conscience. Conscience relates to keeping or losing a sense of personal integrity when making judgments about one's actions. Ten psychiatric therapists were interviewed in June 2006. The interviews were tape-recorded, transcribed verbatim and interpreted using a phenomenological-hermeneutic method. Two themes Facing inadequacy and Struggling to view oneself as being ,good enough' are presented. In the therapists interviewed, awareness of their use of power, a sense of powerlessness and a sense of blame gave rise to feelings of betrayals and shameful inadequacy. By sharing their inadequacy with co-workers, they managed to endure the sense of their inadequacy which otherwise would have threatened to paralyse them. Finding consolation in sharing wearing feelings, becoming realistic and attesting their worthiness, they reached reconciliation and found confirmation of being good enough. The findings are interpreted in light of Lögstrup's ethics of trust, according to which conscience alerts us to silent but radical ethical demand and the risk of self-deception. [source] Qualitative assessment of patient experiences following sacrectomy,JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2010K.M. Davidge MD Abstract Background and Objectives The primary objective was to investigate patient experiences following sacral resection as a component of curative surgery for advanced rectal cancers, soft tissue and bone sarcomas. Methods Qualitative methods were used to examine the experiences, decision-making, quality of life, and supportive care needs of patients undergoing sacrectomy. Patients were identified from two prospective databases between 1999 and 2007. A semi-structured interview guide was generated and piloted. Patient interviews were transcribed verbatim and analyzed using standard qualitative research methodology. Grounded theory guided the generation of the interview guide and analysis. Results Twelve patients were interviewed (6 female, 32,82 years of age). The mean interview time was 34,min. Five themes were identified, including: (1) the life-changing impact of surgery on both patients' and their family's lives, (2) patient satisfaction with immediate care in hospital, (3) significant chronic pain related to sacrectomy, (4) patients' need for additional information regarding long-term recovery, and (5) patients' gratitude to be alive. Conclusions Sacrectomy is a life-changing event for patients and their families. Patients undergoing sacrectomy need further information regarding the long-term consequences of this procedure. This need should be addressed in both preoperative multi-disciplinary consultations and at follow-up visits. J. Surg. Oncol. 2010; 101:447,450. © 2010 Wiley-Liss, Inc. [source] Living with chronic illness: A phenomenological study of the health effects of the patient,provider relationshipJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 3 2008Associate Professor of Nursing), CNS (Psychiatric, Mental Health Clinical Specialist, Sylvia Fox PhD Abstract Purpose: To understand the patient,healthcare provider (HCP) relationship from the lived experience of women with chronic disease and determine how this relationship affects women's health. Data sources: Narrative accounts of 25 women's relationships with HCPs in repeated group and individual interviews were audio-taped and transcribed verbatim. Interpretive phenomenology was used to explore the data using three interconnected modes of paradigm cases, exemplars, and themes. Conclusions: Women with chronic disease believed their health was significantly affected by their relationships with HCPs. They experienced a greater sense of well-being and security in connected relationships and had more confidence and motivation to manage their illness. Implications for practice: This research suggests that for women with chronic disease, relationships with HCPs that are connected, and characterized by partnership, and personableness result in the women feeling better in many dimensions. The context of today's healthcare system often pushes the nurse practitioner (NP) to provide care more attuned to medical issues, leaving little time for the development of connected relationships. In spite of this pressure, NPs need to strive to develop relationships with patients that are intersubjective/connected. [source] ,You're judged all the time!' Students' views on professionalism: a multicentre studyMEDICAL EDUCATION, Issue 8 2010Gabrielle Finn Medical Education 2010: 44: 814,825 Objectives, This study describes how medical students perceive professionalism and the context in which it is relevant to them. An understanding of how Phase 1 students perceive professionalism will help us to teach this subject more effectively. Phase 1 medical students are those in the first 2 years of a 5-year medical degree. Methods, Seventy-two undergraduate students from two UK medical schools participated in 13 semi-structured focus groups. Focus groups, carried out until thematic saturation occurred, were recorded and transcribed verbatim. Data were analysed and coded using NVivo 8, using a grounded theory approach with constant comparison. Results, From the analysis, seven themes regarding professionalism emerged: the context of professionalism; role-modelling; scrutiny of behaviour; professional identity; ,switching on' professionalism; leniency (for students with regard to professional standards), and sacrifice (of freedom as an individual). Students regarded professionalism as being relevant in three contexts: the clinical, the university and the virtual. Students called for leniency during their undergraduate course, opposing the guidance from Good Medical Practice. Unique findings were the impact of clothing and the online social networking site Facebook on professional behaviour and identity. Changing clothing was described as a mechanism by which students ,switch on' their professional identity. Students perceived society to be struggling with the distinction between doctors as individuals and professionals. This extended to the students' online identities on Facebook. Institutions' expectations of high standards of professionalism were associated with a feeling of sacrifice by students caused by the perception of constantly ,being watched'; this perception was coupled with resentment of this intrusion. Students described the significant impact that role-modelling had on their professional attitudes. Conclusions, This research offers valuable insight into how Phase 1 medical students construct their personal and professional identities in both the offline and online environments. Acknowledging these learning mechanisms will enhance the development of a genuinely student-focused professionalism curriculum. [source] Identifying challenges for academic leadership in medical universities in IranMEDICAL EDUCATION, Issue 5 2010Ali Bikmoradi Medical Education 2010: 44: 459,467 Context, The crucial role of academic leadership in the success of higher education institutions is well documented. Medical education in Iran has been integrated into the health care system through a complex organisational change. This has called into question the current academic leadership, making Iranian medical universities and schools a good case for exploring the challenges of academic leadership. Objectives, This study explores the leadership challenges perceived by academic managers in medical schools and universities in Iran. Methods, A qualitative study using 18 face-to-face, in-depth interviews with academic managers in medical universities and at the Ministry of Health and Medical Education in Iran was performed. All interviews were recorded digitally, transcribed verbatim and analysed by qualitative content analysis. Results, The main challenges to academic leadership could be categorised under three themes, each of which included three sub-themes: organisational issues (inefficacy of academic governance; an overly extensive set of missions and responsibilities; concerns about the selection of managers); managerial issues (management styles; mismatch between authority and responsibilities; leadership capabilities), and organisational culture (tendency towards governmental management; a boss-centred culture; low motivation). Conclusions, This study emphasises the need for academic leadership development in Iranian medical schools and universities. The ability of Iranian universities to grow and thrive will depend ultimately upon the application of leadership skills. Thus, it is necessary to better designate authorities, roles of academic staff and leaders at governance. [source] Medical students' first clinical experiences of deathMEDICAL EDUCATION, Issue 4 2010Emily Kelly Medical Education 2010: 44: 421,428 Objectives, Many medical students feel inadequately prepared to address end-of-life issues, including patient death. This study aimed to examine medical students' first experiences of the deaths of patients in their care. Methods, Final-year medical students at the Schulich School of Medicine & Dentistry, University of Western Ontario were invited to share their first experience of the death of a patient in their care. The students could choose to participate through telephone interviews, focus groups or e-mail. All responses were audiotaped, transcribed verbatim and analysed using a grounded theory approach. Results, Twenty-nine students reported experiencing the death of a patient in their care. Of these, 20 chose to participate in an interview, five in a focus group and four through e-mail. The issues that emerged were organised under the overlying themes of ,young', ,old' or ,unexpected' deaths and covered seven major themes: (i) preparation; (ii) the death event; (iii) feelings; (iv) the role of the clinical clerk; (v) differential factors between deaths; (vi) closure, and (vii) relationships. These themes generated a five-stage cyclical model of students' experiences of death, consisting of: (i) preparation; (ii) the event itself; (iii) the crisis; (iv) the resolution, and (v) the lessons learned. ,Preparation' touches on personal experience and pre-clinical instruction. ,The event itself' could be categorised as referring to a ,young' patient, an ,old' patient or a patient in whom death was ,unexpected'. In the ,resolution' phase, coping mechanisms included rationalisation, contemplation and learning. The ,lessons learned' shape medical students' experiences of future patient deaths and their professional identity. Conclusions, A tension between emotional concern and professional detachment was pervasive among medical students undergoing their first experience of the death of a patient in their care. How this tension was negotiated depended on the patient's clinical circumstances, supervisor role-modelling and, most importantly, the support of supervisors and peers, including debriefing opportunities. Faculty members and residents should be made aware of the complexities of a medical student's first experience of patient death and be educated regarding sympathetic debriefing. [source] How should trainees be taught to open a clinical interview?MEDICAL EDUCATION, Issue 5 2005Alex Walter Aim, To characterise the opening of secondary care consultations. Method, We audio-taped 17 first consultations in medical clinics, transcribed them verbatim, and analysed verbal interactions from when the doctor called the patient into the consulting room to when she or he asked clarifying questions. Results, The interviews did not open with the sequence, reported by previous researchers, of ,doctor's soliciting question, patient's opening statement, interruption by the doctor'. Doctors (1) called the patient to the consultation; (2) greeted them; (3) introduced themselves; (4) made a transition to clinical talk; and (5) framed the consultation. They used a referral letter, the case notes, computer records and their prior knowledge of the patient to help frame the consultation, and did so informally and with humour. Conclusion, These 5 steps could help trainees create a context for active listening that is less prone to interruption. [source] The acceptability of 360-degree judgements as a method of assessing undergraduate medical students' personal and professional behavioursMEDICAL EDUCATION, Issue 1 2005Charlotte Rees Introduction, Medical students' personal and professional behaviours have been assessed poorly in medical schools. No research exists exploring the acceptability of 360-degree judgements as a method of assessing such behaviours. This study aims to explore students' and assessors' views and experiences of 360-degree judgements. Methods, Eighteen students and 12 assessors participated in 4 focus group discussions in spring 2003. Discussions were audio-taped and transcribed verbatim and the transcripts were theme analysed independently by 2 analysts. Results, Although 360-degree judgements were felt to drive students' behaviour positively, they were also thought to influence learning and behaviour adversely. Various factors were thought to influence assessors' abilities to make good quality judgements, such as situational factors like the length of time spent with students, characteristics relating to the assessment criteria and characteristics of the assessor, such as apathy. Discussion, Additional research using qualitative and quantitative methods is needed to explore these issues further. 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