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Biomedical subjects

P E Stevens

Publications and source records attributed to P E Stevens.

At least 19 recordsLinked to original sources
PubMed1997

Trauma of discovery: women's narratives of being informed they are HIV-infected.

The purposes of this research report are to describe women's subjective experiences of being informed of a positive HIV antibody test and, from their point of view, to explain the meaning and impact of discovering that one is HIV-infected. In this qualitative narrative study, a racially diverse, low-income sample of 38 HIV-infected women shared their stories of HIV discovery during in-depth interviews. Findings of a multi-staged narrative analysis suggest that, for women like those in this study, the discovery of HIV seropositivity is a traumatic event, carrying with it elements that are common to other types of trauma: perceived threat to one's life and perceived responsibility for the deaths of others. Overarching personal meanings, or metaphors, framed these women's experiences of the trauma of HIV discovery. HIV discovery was an epiphany for 10% of the sample, a confirmation for 37%, and a calamity for 53%. Among their calamitous reactions were shock, fear, anguish, and suicidality. The impact of learning that they were HIV-infected often took its toll in unrelenting misery, escalated drug use, transmission risks, and destabilization of relationships, income, and shelter. Extensive excerpts from participants' interviews illustrate analytic findings. Implications for counselling and follow-up at diagnosis and early in the course of HIV illness are elaborated.

Adult↗
PubMed1997

A descriptive study of the handwashing environment in a long-term care facility.

The authors present a clinical research project accomplished by a nurse during her first year of practice after graduating from a B.S.N. program. In her caregiving at a long-term care facility subacute unit, she was unable to do proper handwashing. The poorly placed pump-style paper towel dispensers were inadequate for the task. She knew that handwashing before and after resident contact is the single most effective infection control measure to prevent nosocomial infections. In consultation with her university professor, she designed and implemented a descriptive study of the facility's handwashing environment. She mapped and measured handwashing areas, explained constrictions the environment placed on handwashing technique, collected random cultures from the sinks and dispenser levers, and illustrated for administrative and auxiliary personnel the basic principles of microbiology. Implications for infection prevention and control in long-term care facilities are discussed in light of increased "high-end skilled nursing" being offered in subacute units.

Aged↗
PubMed1996

Mesalazine-associated interstitial nephritis.

BACKGROUND: When used for oral treatment of inflammatory bowel disease, Asacol (a coated form of mesalazine = 5-aminosalicylic acid) can cause interstitial nephritis. The spectrum of severity, frequency of occurrence and the best renal function test to detect this complication are not known. The value of immunosuppression in addition to drug withdrawal is similarly undetermined. METHODS: Four cases of interstitial nephritis which occurred in association with oral Asacol treatment are presented and a further 12 cases who received similar treatment are reviewed. Clinical trials published previously were scrutinized to assess the frequency of impaired renal function. RESULTS: The available evidence suggests that renal impairment of any severity may occur in up to 1 in 100 patients, but that clinically significant interstitial nephritis occurs in less than 1 in 500 patients. This is most reliably detected by an elevated serum creatinine concentration. If the diagnosis of nephrotoxicity is delayed until 18 months after commencement of medication, restoration of renal function, which is seen on withdrawal of medication alone up to 10 months, does not occur and there is no evidence to date to indicate that addition of immunosuppression confers any significant advantage at this later stage. CONCLUSIONS: It is suggested that serum creatinine concentration should be measured each month for the first 3 months of treatment, 3-monthly for the remainder of the first year and annually thereafter. The use of concurrent immunosuppressive therapy may necessitate extension to the period of intensive monitoring. Any elevation of serum creatinine which cannot be related to a relapse of inflammatory bowel disease should prompt immediate withdrawal of Asacol and related medications and substitution of alternative therapy. Neither the lack of urinary abnormalities on routine testing nor the absence of clinical or laboratory features of drug allergy can be relied upon to rule out interstitial nephritis during oral therapy with these drugs.

Administration, Oral↗
PubMed1996

An occupational transmission of HIV: collision of ethical worlds in nursing practice.

This article proposes a new theoretical frame for ethical practice in nursing by locating ethical questions within the worlds of everyday nursing experience. The authors advocate a process of ethical thought and action that is not so much a weighing of dichotomized alternatives as a continual journey in which nurses delve deeper into their examination of clinical contexts, structural contingencies, and the meanings of experience for themselves and their clients. This theoretical vision is illustrated with a case study about a nurse who was infected with HIV on the job. The purposes in presenting the case study are to give testament to this brave woman's story, illustrate the dynamics of a contextualized ethics, and challenge nurses to make changes in practice, policy, and structure to foster truly ethical work and relations with others.

Attitude of Health Personnel↗
PubMed1996

Focus groups: collecting aggregate-level data to understand community health phenomena.

Focus-group method is an apt strategy for studying community health phenomena at the aggregate level. Not only can its use facilitate the inclusion of segments of the population who have been underserved by previous research, but it can generate a depth of understanding about public health problems, community strengths, and potential interventions that have local meaning and utility. Advantages and potential uses of focus groups are explored, as well as purposes and processes of focus-group interviewing, strategies for analysis, methodological limitations, and implications for practice and policy. The author presents investigatory examples to illustrate how focus-group method expands on the possibilities of individual interviewing to explore community interpretations and understand the health needs and experiences of an aggregate.

Adult↗
PubMed1996

Struggles with symptoms: women's narratives of managing HIV illness.

The purpose of this research report is to derive a holistic view of the symptom experiences of women living with HIV/AIDS. A racially diverse sample of 38 HIV-infected women participated in in-depth narrative interviews describing their perceptions, evaluations, and responses related to HIV symptoms. Findings suggest a pattern to their struggles with symptoms: They experienced an accumulation of overwhelming symptoms, grew intensely fearful of these symptoms and what it meant to have HIV, and acted to protect themselves from allowing the HIV to "take hold". Many women perceived health care contact and cooperation with prescribed regimens as avenues for HIV to "take over" their lives, so they avoided these actions. Exemplar narratives illustrate analytic findings.

Adaptation, Psychological↗
PubMed1995

Doppler ultrasound in renal disease: not quite "the answer to a maiden's prayer".

Initial wild enthusiasm for the use of Doppler ultrasound in renal disease, particularly in renal transplants, led to claims that Doppler would enable diagnosis of various abnormalities without recourse to more invasive techniques. These claims have not been borne out by a more reasoned and scientific assessment of the role of Doppler ultrasound in the diagnosis of native and transplant kidney dysfunction. With the realization that changes in the Doppler findings merely reflect changes in renal blood flow induced by a variety of pathological processes has come a better understanding of how Doppler may be of benefit in the diagnosis and monitoring of these processes. The combination of duplex Doppler and color flow mapping with conventional B-mode ultrasound allows acquisition of both physiological and morphological information entirely non-invasively. Doppler ultrasound may not quite be "the answer to a maiden's prayer" in the evaluation of kidney disease but nevertheless represents a very useful tool in the nephrologist's investigative armamentarium, a tool which may be used repeatedly without detriment or risk to the patient.

Diagnosis, Differential↗
PubMed1994

Protective strategies of lesbian clients in health care environments.

In this triangulated, feminist narrative study, a multiethnic, socioeconomically diverse sample of 45 lesbians recounted their actions in health care in a total of 332 health care stories. Findings of a multistaged narrative analysis suggest that lesbians experience compounded vulnerability in health care environments. A repertoire of protective strategies intended to meet needs for safety characterized their actions in health care, including: rallying support, screening providers, seeking mirrors of one's experience, maintaining vigilance, controlling information, bringing a witness, challenging mistreatment, and escaping danger. Implications for theory and practice are drawn from these results.

Adaptation, Psychological↗
PubMed1994

HIV prevention education for lesbians and bisexual women: a cultural analysis of a community intervention.

AIDS is increasing almost four times as fast among women, yet lesbians and bisexual women are among the least studied, least understood and most elusive populations affected by the AIDS epidemic. This paper reports the results of community-level HIV prevention research designed: (a) to examine the knowledge, perceptions, social contingencies and political constraints affecting the HIV risk taking of lesbians and bisexual women; and (b) to offer them context specific HIV prevention education. The study was a peer educator-based intervention project situated in San Francisco's women's bars, dance clubs, and sex clubs to reach socially and sexually active lesbians and bisexual women in natural settings. Between June 1992 and May 1993, ethnographic interviews were conducted with 626 women attending the bars and clubs; group presentations at these locales reached 1,315 women. The structure of the intervention was effective in prompting interest in HIV prevention information and intent to change behavior. The resultant cultural analysis details risk behaviors lesbians and bisexual women participate in, myriad constraints they face in trying to enact safer behaviors, gaps in knowledge, difficulties comprehending the relevance of HIV prevention, and risk reduction strategies commonly employed.

Adult↗
PubMed1994

Marginalization: a guiding concept for valuing diversity in nursing knowledge development.

This article explicates marginalization as a guiding concept for the development of nursing knowledge that values diversity. The seven key properties of marginalization as it applies to the domain of nursing are (1) intermediacy, (2) differentiation, (3) power, (4) secrecy, (5) reflectiveness, (6) voice, and (7) liminality. Through examination of each of these properties, the relationship between marginalization and vulnerability is clarified, and by this means the relevance of marginalization for health is established. The implications for shaping future nursing research, theory, and practice related to the health of diverse populations are discussed.

Cultural Characteristics↗
PubMed1994

Scholarly caring in doctoral nursing education: promoting diversity and collaborative mentorship.

One of the most significant, yet not fully developed goals of doctoral education is the graduation of scholars who can make a major contribution to the discipline of nursing. There have been many discourses and debates about the essential criteria for quality in doctoral programs that create and promote scholarliness. Scholarliness in nursing includes critical thinking, a connection to practice, a commitment to the discipline's mission, substantive mastery areas, philosophical analyses, rigorous investigations, and a social awareness of the relationship between knowledge development and impact on society. Promoting scholarship necessitates the development of a culture of scholarly caring. Scholarly caring can be developed through promotion of diversity and through collaborative mentorship. Features of collaborative mentorship are negotiated relations, mutual interactions, facilitative strategies, and empowerment. To develop these properties of a scholarly doctoral program, attention must be paid to actions that compromise scholarly quality of programs such as the lack of resources and lowered expectations of students.

Cooperative Behavior↗
PubMed1994

Lesbians' health-related experiences of care and noncare.

In this feminist narrative study using in-depth interviews, focus groups, and a multistaged narrative analytic approach, a racially and economically diverse sample of 45 lesbians conveyed their health care experiences. Participants recounted a total of 332 health care interactions across a wide range of health care facilities, health care providers, and health conditions; 23% of these interactions they evaluated positively and 77%, negatively. In their stories, lesbians described the pivotal dimensions of face-to-face health care from their perspective as clients. Each of these interactional dimensions is defined by a fundamental experiential contrast gleaned from their descriptions of caring and noncaring clinical situations. They are as follows: existence: reflection versus facelessness; bodily integrity: intimate care versus intrusion; emotional integrity: sheltered versus shamed; worth: sustained versus abandoned; expression: voiced versus silenced; and power: solidarity versus dominance.

Adult↗
PubMed1993

Lesbians and HIV: clinical, research, and policy issues.

Sources of risk for HIV infection in members of the lesbian community are surveyed, together with factors that adversely affect access to appropriate health care by women in general and lesbians in particular. Issues of clinical practice, research, and public policy are examined with a view to promoting more effective prevention and treatment strategies.

Adult↗