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PubMed2006

Local anesthesia during transrectal ultrasonography-guided prostate biopsy: does it have any effect on sexual function?

INTRODUCTION: TRUS (Trans Rectal Ultra Sonographic)-guided biopsy of the prostate is the procedure of choice for prostate cancer diagnosis in urological clinical practice. TRUS-guided biopsies are associated with pain and anxiety and may interfere with sexual function and potency. The aim of this study was to evaluate whether local anesthesia during TRUS-guided prostate biopsies has any effect on the sexual behavior of patients and to compare the periprostatic infiltration with lidocaine to simple sonographic gel application in a randomized prospective trial. PATIENTS AND METHODS: A total of 62 consecutive patients were included in the study randomized in two groups; Group A (n = 30, control group) and Group B (n = 32, lidocaine infiltration group). Interviews regarding their sexual status were conducted at the time they were informed of the need for biopsy, at the time of biopsy and at two scheduled interviews following the biopsy. RESULTS: Similar results of sexual dysfunction were observed between the two groups. About 6% of patients experienced some degree of dysfunction in anticipation of biopsy (P > 0.02 between the two groups) that was resolved by the end of the follow-up period. In total, only one Group B patient continued to show sexual dysfunction at the time of the last interview compared to two patients in Group A. CONCLUSIONS: Local infiltration with lidocaine does not seem to play a role in sexual dysfunction following prostate biopsies. Psychological factors influence patients and the urologist should be ready to inform and reassure both the patient and his family.

Anesthetics, Local↗

PubMed2003

Courtesy stigma--a focus group study of relatives of schizophrenia patients.

BACKGROUND: Stigmatization of people with mental illness has been investigated in numerous studies. Little research, however, has been done to explore how relatives of people with schizophrenia perceive and experience stigmatization and how they can fight such stigmatization. METHOD: Aiming to explore stigma from the perspective of relatives of people with schizophrenia, focus group interviews were conducted with 122 members of advocacy groups from different parts of Germany. Focus group sessions were tape- and video-recorded and transcribed. Transcripts were coded using an inductive method, generating categories (domains) from the material. RESULTS: The analysis of focus group data shows that, contrary to previous research findings, discrimination and disadvantages encountered by relatives of schizophrenia patients reach far beyond the spheres of direct social interaction and access to social roles. Our study revealed two additional domains in which relatives encounter stigmatization: structural discrimination and public images of mental illness. Furthermore, psychiatry has been identified as one important source of stigma. Relatives also suggested numerous anti-stigma interventions. These can be grouped into five main categories: communication measures, support for the ill and their relatives, changes in mental health care, education and training, and control and supervision. DISCUSSION: Based on our findings,ways of how relatives of schizophrenia patients and mental health professionals can fight against stigma are discussed.

Adult↗

PubMed2005

Strategies to overcome obstacles in the facilitation of critical thinking in nursing education.

UNLABELLED: This paper seeks to describe strategies that can be used to overcome obstacles in the facilitation of critical thinking in nursing education. A qualitative, explorative, descriptive and contextual design was used to conduct the research in which fourth year basic comprehensive students and nurse educators volunteered to take part in the study by signing an informed consent. The participants were purposively selected. Focus group interviews were used to collect data from both groups. Tesch's descriptive method of open coding described in (Creswell, J. 1994. RESEARCH DESIGN: Qualitative and quantitative approach. Sage, London.) was used to analyse data. (Democratic Nursing Organisation of South Africa, 1998. Ethical standards for nurse researchers. Denosa, Pretoria) ethical standards for research were observed to maintain the standard and quality of the research. (Lincoln, Y.S., Guba, E.G. 1985. Naturalistic inquiry. Sage, London.) framework was used to ensure trustworthiness of the study. The following obstacles were identified and recontextualised within the existing literature to be able to describe the strategies to overcome the identified obstacles to the facilitation of critical thinking of students: the educators' lack of knowledge; use of teaching and assessment methods that do not facilitate critical thinking of learners; the negative attitudes of educators and their resistance to change; inappropriate selection process and poor educational background that did not facilitate critical thinking of students; inadequate socialisation, cultural and instructional language incompetence. Findings indicated that there is a need for nurse educators to model critical thinking in all aspects of nursing education. It is recommended that there be a whole paradigm shift in nursing education from the traditional teacher-centred methods to a more learner-centred approach that will facilitate critical thinking of student nurses.

Attitude of Health Personnel↗

PubMedDate not supplied

Extrapunitive and intropunitive anger of HIV caregivers: nursing implications.

The purpose of this qualitative study was to investigate the anger of individuals who have provided direct patient care to loved ones who are living with or who have died from AIDS. The sample consisted of eight individuals who are currently involved in an AIDS service organization in northeast Tennessee. Data were collected using semistructured taped interviews. At the beginning of the study, two group interviews were conducted. Subsequently, each of the participants was interviewed privately. Extrapunitive and intropunitive anger were predominant themes in each of the interviews. Participants also reported ways of coping with their anger. Nurses can suggest these strategies to other caregivers who are experiencing anger. Recommendations for additional nursing interventions are offered.

Adaptation, Psychological↗

PubMed2002

Vulnerability and security in seriously ill patients in intensive care.

The purpose of this research was to gain an understanding of the experience of being a seriously ill patient in an intensive care unit (ICU). Fourteen former patients, aged 17-71 years old, who had been in ICU 3-53 days, participated in focus group interviews 3-6 months after discharge. The focus groups met 3 times each for 1.5 hours, resulting in 13-14 hours of audiotaped discussions. The transcribed data were qualitatively analysed to identify themes representing participants' experiences. Vulnerability emerged as a central concept that captured the identified themes. The data reveal that patient vulnerability while in ICU was related to extreme physical and emotional dependency. Lack of information and depersonalizing care were associated with fear, anxiety and increased vulnerability. Lack of sleep and rest also contributed to patient fear and anxiety. Vulnerability decreased when patients were kept informed of what was occurring while in ICU, received care that was personalized to their individual needs, and when their families were present. The results of this study suggest that ICU patients' vulnerability may be decreased by the security that they experience when they are adequately informed about what is happening, and when nursing and medical care is personalized to their individual needs.

Adolescent↗

PubMed2001

From exercise and education to movement and interaction. Treatment groups in primary care for women with chronic muscular pain.

OBJECTIVE: To develop a group-based treatment programme in primary health care for women with chronic muscle pain, and adjust programme development according to experiences obtained by the participating women and health personnel. The aim of the programme was to help the women develop a tool for handling their chronic state of pain. The article describes and discusses experiences essential for elaboration of the treatment programme. DESIGN: Action research design. SETTING: Existing therapy groups in Stovner for women with chronic muscle pain. SUBJECTS: We arranged eight treatment groups, each lasting 12 weeks, and three groups lasting 10 months, with a total of 133 participants. MAIN OUTCOME MEASURES: Experiences were systematised by means of pragmatic analysis of qualitative data from field notes, tape recordings of focus group interviews, and video recordings of training and discussion groups. RESULTS: While initially the training programme aimed at increasing physical fitness and muscle strength, it gradually developed into activity based on movement with an emphasis on noticing and experiencing. The instruction programme initially aimed at providing information, and developed towards discussion groups with emphasis on mutual understanding and recognition. CONCLUSIONS: The training programme is now concentrated on a few, simple exercises and is characterised by awareness of the relationship between breathing and muscle tension. Groups were found to be the main pillar of the programme, characterised by security and a feeling of belonging with room for reflection and development.

Adult↗

PubMed2002

Empowerment as a dynamically developing concept for practice: lessons learned from organizational ethnography.

This article describes the process of developing an empowerment approach in a comprehensive child development program that defined its mission as empowerment of families living in poverty. This description is derived from a seven-year organizational ethnographic research project that included data from participant observation, agency documents, individual interviews of staff and family participants, and focus group interviews with staff. Findings concerning empowerment are presented in two areas: (1) resolution of contrasts and dichotomies related to the nature of services, understanding staff roles, and working with the federal government; and (2) lessons learned forprogram effectiveness. Implications for empowerment-oriented social work practice and policy are offered.

Child Development↗

PubMed1995

Communication in nursing: the theory-practice relationship.

The theory-practice relationship and the use of communication and interpersonal skills in nursing have been recurrently identified as issues causing concern. Four research questions form the basis of this small-scale exploratory study investigating the views of nurse teachers, mentors and students into the theory-practice relationship with regard to the communication and interpersonal skills theme of the Project 2000 common foundation programme (CFP) for British nursing students. Hierarchical focusing, involving individual interviews with teachers and mentors and small-group interviews with students, was undertaken. Volunteer sampling was used. Qualitative data analysis was undertaken using content analysis. Results are summarized with regard to each main research question. There was little consensus of opinion amongst participants, and the nature of the theory-practice relationship with regard to the communication and interpersonal skills theme for the CFP remains unclear. However, there was agreement that communication is fundamental to nursing and that the socialization process strongly influences the development of communication and interpersonal skills. There appears to be a reliance on mentors to assess student progress and determine whether they have knowledge underpinning practice. Classroom teaching was recognized as idealistic but the divisions in participants' opinions led to difficulty in determining whether a theory-practice gap actually exists. The main influences on the theory-practice relationship were the mentor's knowledge of the curriculum and mentoring system, the short amount of time spent in each placement and relationships between teachers, mentors and students. Recommendations include the need to ensure the reliability and validity of progressive assessment.

Clinical Competence↗

PubMed2005

The process of change: listening to transformation in meaning perspectives of adults in arthritis health education groups.

PURPOSE: This study explored client experiences in two different arthritis education groups to develop an understanding of meaningful group experiences in the process of change leading to desired health outcomes. METHOD: A qualitative framework with an inductive, descriptive, phenomenological method guided the study. Ten participants with rheumatoid or inflammatory arthritis were recruited. Individual and focus group interviews provided descriptions of experiences. RESULTS: Arthritis education group experiences led to improved client perceptions of ability to cope with chronic disease through a process of change in feelings, values and beliefs known as meaning perspectives. The change in meaning perspectives occurred through perceptions about disease, self and illness. PRACTICE IMPLICATIONS: This study provides important insights into the client's process of change in meaning perspectives that can lead to health behaviors and desired health outcomes. The study demonstrates the use of the group context as a tool to enable the process of change.

Adaptation, Psychological↗

PubMed2005

Determinants of health-service use by low-income people.

Poverty influences health status, life expectancy, health behaviours, and use of health services. This study examined factors influencing the use of health-related services by people living in poverty. In the first phase, 199 impoverished users of health-related services in 2 large Canadian cities were interviewed by their peers. In the second phase, group interviews with people living in poverty (n = 52) were conducted. Data were analyzed using thematic content analysis. Diverse health-related services were used to meet basic and health needs, to maintain human contact, and to cope with life's challenges. Use of services depended on proximity, affordability, convenience, information, and providers' attitudes and behaviours. Use was impeded by inequities based on income status. To promote the health of people living in poverty, nurses and other health professionals can enhance the accessibility and quality of services, improve their interactions with people living in poverty, provide information about available programs, offer coordinated community-based services, collaborate with other sectors, and advocate for more equitable services and policies.

Alberta↗

PubMed2006

Development of a complex intervention for secondary prevention of coronary heart disease in primary care using the UK Medical Research Council framework.

OBJECTIVE: To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials of complex interventions to a primary healthcare intervention to promote secondary prevention of coronary heart disease. STUDY DESIGN: Case report of intervention development. METHODS: First, literature relating to secondary prevention and lifestyle change was reviewed. Second, a preliminary intervention was modeled, based on literature findings and focus group interviews with patients (n = 23) and staff (n = 29) from 4 general practices. Participants' experiences of and attitudes toward key intervention components were explored. Third, the preliminary intervention was pilot-tested in 4 general practices. After delivery of the pilot intervention, practitioners evaluated the training sessions, and qualitative data relating to experiences of the intervention were collected using semistructured interviews with staff (n = 10) and patient focus groups (n = 17). RESULTS: Literature review identified 3 intervention components: a structured recall system, practitioner training, and patient information. Initial qualitative data identified variations in recall system design, training requirements (medication prescribing, facilitating behavior change), and information appropriate to the prospective study participants. Identifying detailed structures within intervention components clarified how the intervention could be tailored to individual practice, practitioner, and patient needs while preserving the theoretical functions of the components. Findings from the pilot phase informed further modeling of the intervention, reducing administrative time, increasing practical content of training, and omitting unhelpful patient information. CONCLUSION: Application of the MRC framework helped to determine the feasibility and development of a complex intervention for primary care research.

Clinical Trials as Topic↗

PubMedDate not supplied

Arab American adolescent perceptions and experiences with smoking.

The purpose of this pilot study was to gather information on Arab American adolescent tobacco use behavior. This information was used to modify the Project Toward No Tobacco Use cessation program so that it would reflect the cultural values of Arab American youths. Focus group interviews were conducted to collect qualitative data from 28 Arab American adolescents between the ages of 14 and 18 years. The number of participants in the focus groups ranged from three to eight; four sessions were conducted. A moderator, fluent in Arabic and English, facilitated the group's interactions. Each group addressed five interview questions. Discussions were audiotaped and transcribed with the expressed permission of study participants. Qualitative analysis consisted of careful reading of the transcripts and of the field notes for the purpose of identifying recurring themes around tobacco use. Those that emerged were Being Cool; Being able to "Nshar ma'a al shabab" (hang out with the guys); Present Orientation; Smoking feels good, tastes good, and keeps your mind off trouble; Availability and Accessibility of tobacco; and Barriers to Smoking Cessation Programs. The results of the focus group discussions provided valuable information about the tobacco use perceptions and behaviors of Arab American adolescents and the youths' need for a culturally relevant smoking cessation program.

Adolescent↗

PubMed2002

Asking for 'rules of thumb': a way to discover tacit knowledge in general practice.

BACKGROUND: Research in decision-making has identified heuristics (rules of thumb) as shortcuts to simplify search and choice. OBJECTIVE: To find out if GPs recognize the use of rules of thumb and if they could describe what they looked like. METHODS: An explorative and descriptive study was set up using focus group interviews. The interview guide contained the questions: Do you recognize the use of rules of thumb? Are you able to give some examples? What are the benefits and dangers in using rules of thumb? Where do they come from? The interviews were transcribed and analysed using the templates in the interview guide, and the examples of rules were classified by editing analysis. RESULTS: Four groups with 23 GPs were interviewed. GPs recognized using rules of thumb, producing examples covering different aspects of the consultation. The rules for somatic problems were formulated as axiomatic simplified medical knowledge and taken for granted, while rules for psychosocial problems were formulated as expressions of individual experience and were followed by an explanation. The rules seemed unaffected by the sparse objections given. A GP's clinical experience was judged a prerequisite for applying the rules. The origin of many rules was via word-of-mouth from a colleague. The GPs acknowledged the benefits of using the rules, thereby simplifying work. CONCLUSION: GPs recognize the use of rules of thumb as an immediate and semiconscious kind of knowledge that could be called tacit knowledge. Using rules of thumb might explain why practice remains unchanged although educational activities result in more elaborate knowledge.

Decision Making↗

PubMed2002

'I'm still waiting...': barriers to accessing cardiac rehabilitation services.

BACKGROUND: The United Kingdom (UK) National Service Framework for coronary heart disease challenges health services to address existing problems regarding the quality and content of cardiac rehabilitation services. Concern also exists regarding inequalities in access to services. The South Yorkshire Coalfields Health Action Zone (SYCHAZ) funded this study to harness the views and experiences of staff and patients regarding existing services. The intention is to use the information gained to develop acceptable and accessible services for the future. AIMS: To explore what barriers exist for patients in accessing cardiac rehabilitation services within the South Yorkshire Coalfield locality. ETHICAL ISSUES AND APPROVAL: Patients were identified and recruited with the assistance of staff responsible for their care. Informed consent was obtained prior to participation. Approval was obtained from the relevant Ethics Committees. METHODS: Qualitative methods were used, including semi-structured interviews and Framework Analysis techniques. Purposive sampling was used to select participants. INSTRUMENTS: Semi-structured individual interviews of 15 staff and 20 postmyocardial infarction patients. One group interview with seven health visitors and two with lay members of heart support groups. OUTCOMES: Barriers to accessing cardiac rehabilitation. RESULTS: This study revealed a limited service capacity. Big gaps exist between patches of service activity that most patients appear to slip through. Problems in accessing the service were categorized into five themes: absence, waiting, communication, understanding, and appropriateness. Some groups fared worse in terms of access to services, for example women, the elderly and those in traditional working class coalfields communities. Professional and more affluent participants appeared better able to negotiate their way around the system by seeking out advice or 'going private'. LIMITATIONS: The omission of medical staff and ethnic minority patients. CONCLUSIONS: Cardiac rehabilitation in the policy targets in UK will only be met with substantial investment to address the barriers identified here.

Aged↗

PubMed2001

Community well being and infectious diseases among Alaska Native communities in the Chugach Region.

OBJECTIVES: This study sought to examine how Native people of the Chugach Region of Alaska perceive their own communities' health and well being, particularly in regard to infectious diseases. STUDY DESIGN: Prospective focus group interview survey. METHODS: During September to December 1999, 12 focus groups were conducted in seven communities in the Chugach Region of Alaska with 97 participants. Using a set of eight questions, information gathered provided insights into the participants' health-related perceptions and provided previously nonexistent baseline data pertaining toTB and hepatitis. RESULTS: Participants showed a good working knowledge of common infectious diseases. There were misconceptions and a potential for increased knowledge in highly prevalent diseases, but more recently delineated infections in rural Alaska, e.g., respiratory syncvtial virus (RSV), Helicobacter pylori, and less prevalent diseases, e.g., Acquired Immunodeficiency Syndrome (AIDS). The participants expressed a desire for further infectious disease information and dialogue. CONCLUSIONS: This process can be used to develop a risk assessment tool for medical and clinical providers' use in an effort to increase testing for such infectious diseases as HIV, TB, Hepatitis C, and sexually transmitted diseases (STDs). In this case the authors also produced a STD prevention video for rural Alaska Natives, entitled, Summer Sun Winter Moon.

Adolescent↗

PubMed2002

Functional needs: agreement between perception of rural patients and health professionals in China.

This study aimed to investigate the common areas of functional needs of patients with different chronic diseases and to compare the level of agreement between patients and doctors, and patients and an occupational therapist, on perceived priority functional goals. A sample of 113 rural patients from Hebei Province attending outpatient neurology, orthopaedic and cancer clinics completed the COOP/WONCA Charts. These charts are a screening tool that assesses limitations in a set of functional domains. The 80 patients who indicated significant functional difficulty on the charts, 11 doctors and one occupational therapist then responded to questionnaires to elicit the perceived priority functional needs. Respondents remained blind to one another's responses. A consulting doctor and the occupational therapist saw each patient's COOP/WONCA Charts before interviewing the patient. Additional questionnaire items and a focus group interview provided data by professionals on health services thought to be beneficial to improve the function of clinic patients. The difference between the mean percentage of agreement on perceived functional difficulty in therapist/patient matches and doctor/patient matches was 18.5% (95% CI for the difference = 12.4% to 24.6%). The therapist on average agreed or matched with patients significantly more often than did doctors (p<0.0001). The discrepancy between the doctor's and patient's perception of priority functional goals was substantial, indicating a need for initiated effort to narrow this gap. The match rate of doctors with patients in choosing priority goals was significantly lower than for the therapist with patients in this study. Doctors expressed a desire for closer involvement in clinics by appropriate rehabilitation staff. This could expedite the process towards the starting level of a patient-centred approach to health care, within the natural context of teamwork, and with little disruption to clinic routines. Replication of this study using a control group would allow direct comparison of patient incidents when the charts are used and when they are not.

Adult↗

PubMed1998

Perceptions of clinical role modelling: an exploration of nursing students' experiential learning.

The purpose of this study was to reveal the essence of role modelling in relation to learning in the clinical field from the nursing student's perspective. Twenty-one final year nursing undergraduates voluntarily and purposefully participated as informants in the study. Each participated in a face-to-face interview with a nurse researcher. In addition, a focus group interview session was conducted with seven of the participating students. Using the phenomenological method, the essence of role modelling emerged as a core theme which was linked to the students' clinical learning experiences. Multi-dimensional elements of learning that were contingent upon role modelling were categorised into five major themes: Expectations of self and others; Situational conditional factors; Situational anxiety--reality of fear/nervousness; Application of theoretical knowledge to practice; and, Experiential knowledge--an active learning process. The students' experiences of how role modelling impacted on their learning has implications for nursing education. It is necessary to acknowledge the variety of health carers, and in particular, the clinical nurse educator, who have consequential influences on student learning in the clinical field.

Clinical Competence↗

PubMed1977

A study of pretherapy role induction as an influence process.

It is not clear whether the effectiveness of role induction procedures derives from the fact that they (a) provide clients with information about therapy; or (b) serve as a vehicle for influencing attitudes and beliefs about treatment. In this study 17 clients were assigned to one of two pretherapy interview conditions or to a control (no interview) group. In one condition, social influence aspects of the interview were maximized, while in the other they were minimized. Information given about therapy was the same in both circumstances. Results suggest that therapeutic gains were greatest for patients in the high influence condition. Implications are drawn for the conceptualization of role induction procedures.

Adaptation, Psychological↗