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Biomedical subjects

S E Thorne

Publications and source records attributed to S E Thorne.

At least 19 recordsLinked to original sources
PubMed2001

Health care professional support for self-care management in chronic illness: insights from diabetes research.

While it has long been recognized that health care professionals play an important role in supporting self-care management in chronic illness, the nature of that support is not well understood. This paper represents an analysis of findings drawn from qualitative research into the development of self-care decision-making expertise in adults with longstanding Type I diabetes, specifically addressing ways in which health professionals' interactions support or fail to support such processes. These findings highlight issues associated with the disease trajectory, the assumptions about intended outcome, and the complex contexts in which individuals live with chronic disease, illustrating the manner in which varying kinds of support may be required at different points within the learning process. They further challenge notions of standardized communication and informational strategies, demonstrating the complexities inherent in the support needs of chronically ill persons as they change over time and context.

Adult↗
PubMed2000

Attitudes toward patient expertise in chronic illness.

Although it has become an accepted standard to acknowledge the patient as a full partner in health care decisions, replacing traditional authoritative relationships with those based on an emancipatory model, the experiences of persons living with chronic illness confirm that this paradigm shift is not yet apparent in many health care relationships. In this paper, the authors present a qualitative secondary analysis of combined data sets from their research into chronic illness experience with two quite different chronic diseases - Type I Diabetes (a socially legitimized chronic disease) and Environmental Sensitivities (a disease which is currently treated with considerable scepticism). Comparing the experiences of individuals with diseases that are quite differently socially constructed, it becomes possible to detect common underlying health professional values and attitudes that powerfully influence the experience of living with and negotiating health care for a chronic illness. In the discussion of findings from this study, the authors examine the implications of the spiral of behaviors that fuels mutual alienation in chronic illness care relationships if professionals are unable to value patient expertise.

Attitude of Health Personnel↗
PubMed2000

Two decades of insider research: what we know and don't know about chronic illness experience.

Chronic illness in a general sense and certain chronic diseases in particular have attracted considerable attention from qualitative researchers in nursing as well as in other health and social sciences. This review critically examines the body of available research about the experience of living with a chronic illness from an "insider" perspective. From this foundation the authors interpret the manner in which this large body of writing both contributes to and complicates our theoretical understanding of what it is like to live with a chronic disease. In so doing they illuminate themes within the knowledge that can be gleaned from qualitative inquiry into the chronic illness experience, as well as inherent limitations that must be taken into consideration when applying such knowledge to practice.

Adaptation, Psychological↗
PubMed1999

The science of meaning in chronic illness.

A generation of 'insider research' into the subjective experience of being ill and the social context in which illness experience is played out provides us with a developing theoretical knowledge of what has come to be understood as the 'meaning' of illness. In this paper, a critical analysis of the tradition of meaning research forms the basis for an interpretive synthesis of what we now know and where future research might most appropriately be directed. Problems arising from some of the traditional approaches to knowledge development are articulated and potential solutions arising from more recent methodological advances are proposed. The relevance of this analysis for nursing practice knowledge and for the strategies for nursing's scientific development are considered.

Chronic Disease↗
PubMed1999

Ideological implications of paradigm discourse.

Whilst the notions of paradigm and paradigm shift have become popularized in nursing's scholarly literature, there has been relatively little critical analysis of their impact upon theoretical understanding. In this paper, the authors attempt to deconstruct the ways in which paradigm discourse has been applied in nursing scholarship, looking beyond the claims that are made in the name of paradigm shifts to the apparent motivation underlying those claims. Comparing discourse associated with the paradigm shifts that have emerged in nursing education, research and practice theory, they reveal an inherently divisive purpose to which paradigm language is commonly used, and examine the implications of the discourse for nursing knowledge development. On the basis of this analysis, the authors urge a cautious approach to the extremes of paradigm claims, and argue for a more thoughtful and lively dialogue regarding the interests served by locating ideological positions within paradigm language.

Education, Nursing↗
PubMed1999

Communication in cancer care: what science can and cannot teach us.

Although research in the cancer communication field has produced a body of information applicable to clinical practice, there is little evidence that the new knowledge has led to any significant improvements in the health care communication experiences of patients and their families. In this article, an analysis of the existing research-based knowledge provides a basis for critical analysis of the gaps and limitations within it. Insights from the current literature are contrasted with interpretations deriving from consumer-perspective research by this author and others. The discontinuity between the problems consumers identify and the issues that attract research attention is examined in the context of the orientation to science that drives much of the research. The case is made for challenging traditional notions of what counts as evidence in developing education and practice standards for cancer care.

Attitude of Health Personnel↗
PubMed1999

Are egalitarian relationships a desirable ideal in nursing?

Recent discourse in nursing's various theoretical enterprises has been dominated by a passionate concern for the moral principle of equality. Although philosophical claims about equality shape current thinking in nursing education, research, and practice theory, this author contends that the dialogue has eclipsed an egalitarian view of justice and created the conditions under which only narrow, individualistic, and prima facie interpretations of equality can be sustained. Current interpretations of equality are linked to systematic patterns in theoretical reasoning and its application to various nursing contexts. Many nurse theorists have uncritically adopted equality as an incontestable and overarching truth, such that its limitations are overlooked and competing positions not afforded serious consideration; extreme and dichotomous positions proliferate within nursing scholarship. Deconstruction of the dominant discourse around equality raises questions about the way justice and truth are understood within nursing's theoretical, educational, and research scholarship.

Cultural Diversity↗
PubMed1998

A comparative longitudinal study of gastrostomy devices in children.

Long-term gastrostomy is a predictable intervention to ameliorate the effects of feeding and swallowing difficulties among children with severe spastic cerebral palsy. The evidence evaluating the efficacy and implications of the available gastrostomy devices in common use has focused primarily on the operative phase, ignoring the long-term effects that may be critical from a nurse's or family caregiver's point of view. In this study, the authors describe a sample of children with gastrostomy, comparing skin-level and tube devices on measures of nutritional outcome, complications, and caregiver satisfaction. In contrast to manufacturer's claims about the superiority of skin-level devices, the results presented here reveal few differences between the devices. The authors conclude, therefore, that device selection should be determined by individualized comprehensive assessment of the child and family circumstances.

Adolescent↗
PubMed1997

The multiple meanings of long-term gastrostomy in children with severe disability.

Although the physiological implications of long-term gastrostomy for children with severe disability are well documented in the nursing literature, little is known about the psychosocial effect of this technological intervention. This study documents and interprets the perspective of expert nurses and parents to reveal conflictual social processes associated with gastrostomy decision-making and the intense moral dilemma that these processes create. The findings suggest that gastrostomy denotes multiple meanings for parents and health care providers, and that an appreciation for these meanings can have a significant positive impact on nursing care for these children and their families.

Attitude of Health Personnel↗
PubMed1993

The experience of dyspnea in late-stage cancer. Patients' and nurses' perspectives.

We examined the phenomenon of dyspnea during the last weeks of life as it is experienced by patients with cancer and understood by the nurses providing their care. The literature on late-stage cancer suggests a discrepancy between the prevalence of this symptom and the degree to which it is considered clinically significant. Using a range of descriptive and interpretive approaches, we sought to interpret that discrepancy through an understanding of how patients and nurses interpret the nature and meaning of this serious and distressing symptom. Data sources included a pencil-and-paper survey of late-stage cancer patients, chart audit of a population of late-stage cancer patients in a metropolitan home-care hospice program, and intensive interviews with selected patients and nurses. The findings showed that although dyspnea seems to be a significant clinical problem for patients in late-stage cancer, and although effective intervention and management strategies are available, dyspnea often goes unreported by patients and unnoticed by healthcare professionals.

Activities of Daily Living↗
PubMed1990

Mothers with chronic illness: a predicament of social construction.

In the context of a larger qualitative study, a database including extensive interviews with a subset of sixteen chronically ill mothers was obtained. Secondary analysis revealed that the women's concerns about themselves and their children included issues of performance, availability, dependency, and socialization. Further, these women reported that the health care system seemed incapable of recognizing or accounting for the profound interrelationship between their mothering and their illness. Analysis of these findings in terms of the conflicting social obligations inherent in the roles of "mother" and of "chronically ill person" provides a means by which to understand the women's impressions that it was a contradiction in terms to be both an effective mother and a good patient.

Activities of Daily Living↗
PubMed1989

Guarded alliance: health care relationships in chronic illness.

A multiphase, qualitative study of ongoing health care relationships from the perspective of the chronically ill patient and family confirmed that such relationships evolve over time through three predictable stages: naïve trust, disenchantment and guarded alliance. In the final stage, four patterns of health care relationships were identified: hero worship, resignation, consumerism and team playing. The configuration of these relationships in guarded alliance is explained by dimensions of the core variable of reconstructed trust--patients' trust in a health care professional and their trust in their own competence.

Chronic Disease↗
PubMed1988

Health care relationships: the chronic illness perspective.

Most explanations of the relationships between health care providers and health care recipients reflect perspectives and belief systems peculiar to health care professionals. In contrast, this study combined data from two separate qualitative investigations to yield an analysis of these relationships from the perspective of family members involved with chronic illness. Relationships between health care providers and health care recipients are viewed as evolving over time through a process which has identifiable stages. The utility of such a process orientation for nurses and other health care professionals is the insight it provides into the possibilities for negotiating satisfying care.

Adult↗
PubMed1988

Reciprocal trust in health care relationships.

This paper examines the phenomenon of trust in health care relationships from a new perspective, that of the recipients of care for chronic illness. The authors argue that reciprocal trust is a necessary component of satisfying, effective health care relationships when the illness is of an ongoing nature. From the patient's perspective, reciprocal trust has a significant impact on the experience of being a receiver of health care and on the development of competency with illness management. Because of this, the authors claim that it is imperative for health care professionals to alter their traditional beliefs with regard to sick role and trust. With a new perspective, they may then develop the specific skills necessary to enact the caring aspect of the service they offer. The authors offer a number of suggestions for actualizing this reciprocal trust in clinical practice.

Attitude of Health Personnel↗