Biomedical subjects
R Whittemore
Publications and source records attributed to R Whittemore.
Validity in qualitative research.
Much contemporary dialogue has centered on the difficulty of establishing validity criteria in qualitative research. Developing validity standards in qualitative research is challenging because of the necessity to incorporate rigor and subjectivity as well as creativity into the scientific process. This article explores the extant issues related to the science and art of qualitative research and proposes a synthesis of contemporary viewpoints. A distinction between primary and secondary validity criteria in qualitative research is made with credibility, authenticity, criticality, and integrity identified as primary validity criteria and explicitness, vividness, creativity, thoroughness, congruence, and sensitivity identified as secondary validity criteria.
Consequences of not "knowing the patient".
"Knowing the patient" is an emerging concept in nursing that appears to be a central aspect of practice. "Knowing the patient" encompasses the complex process whereby the nurse acquires understanding of a specific patient as a unique individual, which subsequently enhances clinical decision-making, selection of optimal nursing interventions, and patient outcomes. Despite these heralded benefits, "knowing the patient" is severely undervalued in contemporary health care. Organizational arrangements, economic restraints, and efficiency of healthcare systems currently are of top priority. The potential effect on nursing practice is disconcerting; the effect on the discipline and the patient potentially devastating. This article explores the specific bureaucratic obstacles that impinge on "knowing the patient" within the context of nursing practice. It is hoped that illumination of the issues will beget viable alternative solutions, facilitating the transformation of awareness into action.
Strategies to facilitate lifestyle change associated with diabetes mellitus.
PURPOSE: To critically examine the literature about strategies and factors that influence lifestyle change in people with diabetes mellitus. METHOD: This integrative literature review included an extensive search of published literature about strategies to facilitate lifestyle change related to diabetes mellitus. Articles reviewed were empirical studies focused on lifestyle change and were published between 1985 and 1999. Meta-analyses and relevant reviews of the literature were also included. Over 90 article were initially identified, 72 met the specified criteria and could be categorized according to a theoretical framework or a broad topic area. FINDINGS: Studies were clustered into the categories of educational, behavioral, cultural, and health beliefs that influence or are barriers to lifestyle change. Studies indicate that positive outcomes are associated with diabetes education programs that focus on self-management, emphasize behavioral strategies, and provide culturally relevant information. CONCLUSIONS: Theoretically grounded research in diabetes care is imperative for the future. Expansion of research methods, continued methodological rigor of studies, and instrument development would contribute to knowledge development in diabetes care. Research priorities are proposed.
The peer advisor experience providing social support.
Research shows a link between increased social support and decreased complications after myocardial infarction (MI). In a current randomized controlled trial (RCT), a social support intervention administered by nurse and peer advisors is being examined to determine its influence on the health outcomes of unpartnered, post-MI elders. This qualitative study (as part of the larger RCT) sought a better understanding regarding the experience of the peer advisor. Data sources included peer advisor logs, a focus group, and telephone interviews with peer advisors. Findings revealed that helping, mutual sharing, committing, and benefiting are characteristics of peer experiences. Primarily because of their personal experience of recovery from MI, peer advisors had a remarkable ability to relate to assigned post-MI elders, offering a unique form of social support complementary to current health practices.
Living with chronic venous leg ulcers: a descriptive study of knowledge and functional health status.
A descriptive design was used to identify the functional health status and knowledge level of individuals living at home with chronic venous leg ulcers (N = 21). Limitations in physical function and vitality were moderate to severe, impacting on study participants' productive activities and activities of daily living. Severe to moderate pain was experienced by 19% of the participants. In addition, knowledge deficits were apparent regarding the cause and treatment of leg ulcers. Findings of this study suggest the importance of assessing these factors in addition to the wound when caring for individuals in the community with chronic venous leg ulcers.
Natural science and nursing science: where do the horizons fuse?
The natural sciences have an influential effect on society, contemporary world-views, and other scientific disciplines. A brief history of the major advances in the natural sciences and the associated philosophies provides a platform for scholarly discourse regarding the subsequent influence on nursing epistemology. The concepts of knowledge and understanding are differentiated and a cautionary word is expressed not to cast aside the natural sciences and their corollary philosophies as nursing embarks upon its epistemological journey into the 21st century. Aesthetics is presented as a possible fusion of horizons of nursing and natural science.
To know is to act knowledge (Analects 2,17).
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Pressure-reduction support surfaces: a review of the literature.
This review of the literature summarizes research completed during the past 10 years with regard to pressure-reduction support surfaces. Data are summarized within Tables, focusing on each type of support surface (foam overlays, air overlays, and replacement mattresses) with the corresponding tissue interface pressure research and clinical trials. The review is intended to provide an evidence-based platform for selecting a support surface in clinical practice.
A second-generation study of 427 probands with congenital heart defects and their 837 children.
OBJECTIVES: This study attempted to answer the question, Do mothers with congenital cardiovascular defects have more affected children than fathers with cardiac anomalies? BACKGROUND: In the 1950s to 1960s, concern was expressed about the safety of pregnancy in women with cardiac anomalies and the possibility of inheritance. METHODS: In a prospective study over 25 years, 236 women with cardiac defects were followed through pregnancy, and their 418 offspring were examined during their 1st 3 years. A high incidence of congenital cardiac malformations was noted. Then, a retrospective study of 191 men from the same clinic group and their total family (419 children) was performed to compare the incidence of affected children between the maternal study and this subsequent paternal study. RESULTS: Of 837 live children of these 427 probands, 14.1% (118) had a congenital heart defect (13.4% in the maternal study, 14.8% in the paternal study). There was no correlation with the surgical status of the proband. Concordance was somewhat greater among the children of affected mothers compared with those of affected fathers. Included in these studies were 31 high risk probands, 10 with genetic syndromes and 21 who had an affected sibling. Respectively, 53% and 41% of their children had cardiac anomalies, with a concordance > 50%; three fourths of these children had moderate to severe anomalies. CONCLUSIONS: The incidence of congenital heart defects in the children was not statistically different between the maternal and paternal studies. With removal of the high risk probands from the total study group, the risk of one affected parent having a child with a cardiac anomaly was 10.7%. Of the entire 837 children, only 7.5% had moderate or severe defects.
Maternal transmission of congenital heart disease.
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Catecholamine-metabolizing enzyme activity in the nigrostriatal system.
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Helen Brooke Taussig: 1898 to 1986.
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A 40-year prospective of pediatric cardiology: from Powers to Pearson.
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Genetic counseling for young adults who have a congenital heart defect.
Early individual guidance is needed for all adolescents and young adults with congenital heart defects. This should include not only a personal interest in the individual but also an attempt to identify concerns about sex education, smoking, drugs and the risks of pregnancy and possible inheritance. In a prospective study of 252 women with various cardiac malformations, the incidence of congenital heart defects in their progeny was 15.7% (13% exclusive of genetic syndromes and those with a positive family history). In those with a positive family history or a genetic syndrome the incidence was 56% in the offspring. Genetic syndromes with cardiac components are increasingly apparent. The role of teratogens such as medications, illicit drugs, and environmental exposure play a not yet clearly defined role. Careful discussion with potential parents, giving facts but with a positive approach, is an obligation of every physician.
Intrathecal morphine analgesia for vaginal delivery in a woman with a single ventricle. A case report.
In a pregnant woman with a single cardiac ventricle, the coexisting cardiac anomalies provided a means of compensation. For vaginal delivery, intrathecal morphine was used for analgesia.
Sulfate conjugation of dopamine in rat brain: regional distribution of activity and evidence for neuronal localization.
Brain tissue contains at least two forms of phenolsulfotransferase that are involved in the sulfate conjugation of biogenic amines and their metabolites. Two apparent Km values were obtained for p-nitrophenol at pH 7.4 (0.6 microM and 0.3 mM) but only one enzyme had the capacity to conjugate dopamine (Km = 130 microM). Dopamine sulfotransferase activity was found to vary 17-fold in different brain regions, with the highest levels in diencephalon, hippocampus, and striatum. To determine the cellular localization of the enzymes, phenolsulfotransferase activity was measured in striatum following selective destruction of striatal neurons by stereotaxic injection of 2 micrograms kainic acid. Fourteen days after injection the catecholamine sulfotransferase activity in the lesioned striatum was reduced to approximately 40-50% of that in the control contralateral striatum. There was a statistically significant correlation between the ratio of lesioned to control activity for the sulfotransferase and the neuronal marker enzymes glutamate decarboxylase and neuron-specific enolase. p-Nitrophenol sulfotransferase activity was also decreased in the lesioned striatum. These results suggest that PST activity is present within the kainic acid-sensitive neurons of the striatum. The regional variation in activity, together with the results of the kainic acid studies, suggest that sulfate conjugation of biogenic amines and their metabolites in brain may take place within specific types of neurons.