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Margarete Sandelowski

Publications and source records attributed to Margarete Sandelowski.

At least 19 recordsLinked to original sources

Comparability work and the management of difference in research synthesis studies.

The new imperative to be more methodologically inclusive has generated a burgeoning interest in synthesizing the findings of qualitative and quantitative studies, or mixed research synthesis. Yet, the very diversity seen to define the mixed research synthesis enterprise is also considered to defy it as it intensifies the problem of comparing the seemingly incomparable to enable the combination of the seemingly uncombinable. We propose here that the research synthesis enterprise, in general, and the mixed research synthesis enterprise, in particular, entail comparability work whereby reviewers impose similarity and difference on the studies to be reviewed. The very study diversity requiring management does not exist a priori but rather is itself an outcome of comparability work already done whereby judgments have been made about what constitutes methodological and topical diversity and uniformity. Conceiving the research synthesis process as defined by comparability work moves the backstage interpretive work of systematic review to center stage and, thereby, sets a new stage for addressing the methodological issues involved. These issues are explored by reference to the synthesis of empirical studies of antiretroviral adherence in HIV-positive women in the US.

Evidence-Based Medicine↗

Three months in the symptom life of a teenage girl undergoing treatment for cancer.

The purpose of this case study was to examine the daily symptom experience of a teenage girl, Abby, undergoing treatment for cancer. Quantitative and qualitative data collection and analysis techniques were used to ascertain patterns in daily experiences of pain, nausea, vomiting, retching, stress, sleep alterations, and anxiety. A time-series analysis focused on change and variability in patterns of symptom data. A key finding was that the predictability evident in Abby's symptom patterns were in direct contrast to her perception that there was no predictability or pattern to her symptoms. Her perceived lack of control over her symptoms generated worry, anxiety, and depression and led Abby to question whether she could continue with the treatment. Abby represented a case of "fighting the treatment," as opposed to "fighting the cancer," and it is the difference between these responses that may explain children's overall ability to tolerate intensive chemotherapy.

Adolescent↗

Research results have expiration dates: ensuring timely systematic reviews.

Time and timeliness are key issues in appraising and ensuring the clinical relevance of systematic reviews. Time considerations entering the systematic review process include the history of the clinical problem, disease, or treatment that is the target of the review, and the history of the research conducted to address it. These considerations guide: (i) formulation of the research problems and questions; (ii) setting of parameters for the search and retrieval of studies; (iii) determination of inclusion and exclusion criteria; (iv) appraisal of the clinical relevance of findings; (v) selection of the findings that will be synthesized; and (vi) interpretation of the results of that synthesis.

Humans↗

An evaluation of how well research reports facilitate the use of findings in practice.

PURPOSE: To analyze how research is reported in journal publications as a potential barrier to use of research findings in practice. DESIGN: Content analysis of 46 reports of diabetes self-management interventions published between 1993 and 2004. METHODS: Data were extracted from the publications using a coding scheme based on concepts from Rogers' theory of the diffusion of innovations. FINDINGS: Authors provided only some of the information potential users need to progress through Roger's stages of adopting an intervention and implementing it in practice. Authors provided only limited information on the target population; frequency, number, and duration of patient contacts; expertise and training required to deliver the intervention; intervention protocol; and the process of adapting and implementing interventions in practice settings. CONCLUSIONS: To close the gap between research and practice, authors should offer more information to help readers decide whether and how to adopt and implement interventions.

Diffusion of Innovation↗

From synthesis to script: transforming qualitative research findings for use in practice.

Although qualitative research synthesis has secured a place in the evidence-based practice movement, little effort has as yet been directed toward translating the results into material form for practice. The authors transformed a qualitative research synthesis of findings pertaining to stigma in HIV-positive women into a script and DVD. The process of transformation entailed bringing together the norms and imperatives of scientific research, clinical practice, and artistic presentation.

Adaptation, Psychological↗

Tenerlos en la Casa: the material world and craft of family caregiving for relatives with dementia.

The environment has been found to be critical to the well-being of patients with dementia. The purpose of this study was to describe strategies Colombian caregivers used in the home to manage the care of relatives with dementia. Grounded theory techniques were used. Interviews were conducted in Medellín, Colombia, with 18 primary caregivers and 2 health care professionals. Participant observations were conducted in caregivers' support groups and homes. Family caregivers rebuilt the environment as the disease progressed to accommodate caregiving and preserve family life. Caring for a relative with dementia is a craft that transforms the material world in which patient and caregiver live. The findings show the value of place-sensitive approaches to the study and practice of caregiving.

Adult↗

Types of social support in African Americans with cancer.

PURPOSE/OBJECTIVES: To determine the types of social support that African Americans use to cope with the experience of cancer. RESEARCH APPROACH: Qualitative study using a grounded theory approach. SETTING: Participants' homes in the southeastern United States. PARTICIPANTS: A purposeful sample of 13 African American men (aged 61-79 years) treated for prostate cancer and 15 African American women (aged 42-87 years) treated for breast cancer. Participants were selected according to key variables known to influence social support: age, gender, marital status, education, geographic region, and proximity to family. METHODOLOGIC APPROACH: Open-ended and semistructured interviews were conducted with each participant (N = 28). Participants were interviewed until informational redundancy was achieved. Constant comparison techniques were used to identify variations of social support within and across cases. MAIN RESEARCH VARIABLES: The experience of social support during diagnosis or treatment for cancer as well as post-treatment. FINDINGS: Participants used types of social support not currently emphasized in the literature. The emotional support of "presence" was reported most frequently. Instrumental support included not only current conceptualizations but also offers of prayers, assistance to continue religious practices, and assistance to maintain social roles. Informational support included what to expect and how to manage symptoms, interpret information, and validate information received. CONCLUSIONS: Findings suggest the need to reconceptualize social support for African Americans with cancer and to refine instruments to include these different manifestations of social support. IMPLICATIONS FOR NURSING: Researchers can use these findings in the design of culturally relevant questionnaires and interventions for this population. Clinicians can use knowledge of the types of social support valued among African American patients with cancer to develop more appropriate strategies to promote healthy outcomes for this population.

Adult↗

Stigma in HIV-positive women.

PURPOSE: To present a metasynthesis of qualitative findings on stigma in HIV-positive women. METHOD: Metasummary and metasynthesis techniques were used to integrate findings on stigma in 93 reports of qualitative studies conducted between 1991 and 2002 with a total of 1,780 women, mostly from minority groups. FINDINGS: Both perceived and enacted stigma were pervasive in the lives of HIV-positive women. HIV-related stigma was intensified in women because they were women. Stigma management largely involved efforts to control information in the service of preserving social relations and maintaining moral identity. DISCUSSION: This metasynthesis reprises and clarifies the connections between recurring themes in primary quantitative studies and metastudies of HIV-positive people and of stigmatizing diseases and conditions. This work also shows how affected people's location on key axes of difference can both facilitate and complicate efforts to manage stigma. CONCLUSIONS: HIV-positive women experience stigmatization in relationships with others. HIV-related stigma is as much a reflection of these others as it is central to the experience of HIV-positive people themselves. Even those not infected with HIV are still affected by it and are thus appropriate targets for interventions to reduce its negative effects.

Adaptation, Psychological↗

Using qualitative research.

A renewed urgency has emerged in the qualitative health research community concerning the utility of qualitative research. This urgency is the result of several converging trends in health care research, including the elevation of practical over basic knowledge, proliferation of qualitative health research studies, and the rise of evidence-based practice as a paradigm and methodology for health care. Diverse conceptualizations of use and users exist, and these have different implications for understanding, demonstrating, and enhancing the utility of qualitative research findings. Issues affecting the utilization of these findings include the varied ways in which they are conceived, presented, synthesized, signified, and translated, and the complex repertoire of skills required to activate the knowledge transformation cycle in qualitative health research fully.

Evidence-Based Medicine↗

Qualitative metasynthesis: reflections on methodological orientation and ideological agenda.

In an era of pressure toward evidence-based health care, we are witnessing a new enthusiasm for qualitative metasynthesis as an enterprise distinct from conventional literature reviews, secondary analyses, and the many other scholarly endeavors with which it is sometimes confused. This article represents the reflections of five scholars, each ofwhom has authored a distinct qualitative metasynthesis strategy. By providing the reader a glimpse into the tradition of their various qualitative metasynthesis projects, these authors offer a finely nuanced examination of the tensions between comparison and integration, deconstruction and synthesis, and reporting and integration within the metasynthesis endeavor. In so doing, they account for many of the current confusions about representation and generalization within the products of these inquiries. Through understanding the bases of their unique angles of vision, the reader is invited to engage in their commitment to scholarly integrity and intellectual credibility in this emerging methodological challenge.

Humans↗

Toward a metasynthesis of qualitative findings on motherhood in HIV-positive women.

A qualitative metasynthesis of qualitative findings ought to be more than a mere summary of those findings. Yet the processes by which the interpretive innovation expected of qualitative metasynthesis projects can be achieved remain opaque. Several analytic devices for the metasynthesis of findings were clarified in the course of an ongoing methodological project involving 45 reports of qualitative studies of HIV-positive women. These devices include the creation of a taxonomy of findings, the explicit use of sustained comparisons, the translation of in vivo concepts, and the use of imported concepts. Any qualitative metasynthesis of findings constitutes an interpretation at least three times removed from the lives represented in them. Clarifying the analytic devices used to create such metasyntheses is essential to demonstrating that despite being far away from participants' lives, these interpretations remain close to them.

Female↗

Motherhood in the context of maternal HIV infection.

Metasummary and metasynthesis techniques were used to integrate findings pertaining to motherhood in 56 reports of qualitative studies conducted with HIV-positive women. Motherhood in the context of maternal HIV infection entailed work directed toward the illness itself and the social consequences of having HIV infection in the service of two primary goals: the protection of children from HIV infection and HIV-related stigma and the preservation of a positive maternal identity. Motherhood both intensified and mitigated the negative physical and social effects of HIV infection. HIV-positive mothers engaged in a distinctive kind of maternal practice-virtual motherhood-to resist forces that disrupted their relationships with and ability to care for their children, as well as their identities as mothers.

Chronic Disease↗

The challenges of searching for and retrieving qualitative studies.

The authors' purpose in this article is to report the results of their search and retrieval efforts to date in an ongoing study to develop the procedural, analytic, and interpretive techniques to conduct qualitative meta-synthesis projects, using studies on women with HIV infection as the method case. For researchers conducting qualitative meta-synthesis projects, the ideal goal is to retrieve all of the relevant studies in a field--not simply a sample of them. Bates's model of berrypicking is used as the framework to describe the techniques used to conduct these searches. The authors discuss, in particular, the challenges of working with bibliographic databases, including choosing which databases to search, learning about the idiosyncrasies of working with each database, developing a list of search terms, and refining inclusion criteria regarding which studies to include in the meta-synthesis. Recommendations are given for searchers and writers of qualitative research.

Databases, Factual↗

Living the golden rule: reciprocal exchanges among African Americans with cancer.

Giving is receiving, and receiving is giving. This is the key finding from interviews conducted with 28 African American women and men with cancer who were active participants in dynamic relationships characterized by both giving and receiving. These participants engaged in reciprocal relationships varying in the number of persons involved, types of resources exchanged, and timing of exchange. Findings suggest the need to reconceptualize social support as caregiving and caregiving as social support. This study also points to the need to redesign intervention studies to be more inclusive of components that allow the elderly in illness-related situations to maintain their status as givers in their social networks.

Black or African American↗