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PubMed1995

[Vocational integration of physically handicapped persons--a regional study in the Regensburg district].

The present study had been aimed at tracing possible reasons for insufficient placement of people with physical disablement in the open labour market in the Regensburg region, at gaining insights on the prerequisites of and potential for improving vocational integration as well as at clarifying the relevance of alternative work and employment opportunities in terms of halfway and sheltered settings. Based on a structured questioning schedule, interviews were carried out with 10 experts, 32 physically disabled individuals and 30 employers concerning their placement notions and experience. Generally speaking, it was in particular found that insufficient placement cannot simply be attributed to economic trends; the groups interviewed, rather, differ in some of their underlying assumptions and expectations, a fact which impacts negatively on the integration process. Interaction of disabled and nondisabled persons hence requires greater attention. For the disabled, along with their educational-occupational qualifications, acquisition of communication and social skills is crucial in vocational integration, whereas the companies, in particular small and medium-sized ones, are in need of better information and counselling as well as appropriate supports to be provided by job or placement assistants when hiring physically disabled persons.

Adolescent↗

PubMedDate not supplied

Married couples' perspectives on prostate cancer diagnosis and treatment decision-making.

Prostate cancer is a disease of men. But for married men, it is commonly and quite reasonably expected that their wives will be significantly involved in dealing with the disease and its treatment. Yet, there are few data on how wives perceive the diagnosis and their role in responding to it. This study explores men's and their wives' perceptions of the prostate cancer diagnosis and their role in treatment decision-making. We conducted separate focus group interviews with seven married men with metastatic prostate cancer and their wives. The accounts of receiving the diagnosis and deciding on treatment that were told by the men differed in significant ways from the stories told in the wives' groups. We found that many men do not share their prostate-related health problems with their wives and some men choose their treatment without much spousal consideration. Our findings suggest that physicians may be in a position to influence how men and their wives interact in reaching a treatment decision.

Aged↗

PubMed2005

Experiences from the development of a comprehensive family support program for pediatric trauma and rehabilitation patients.

This report discusses the successes and problems associated with the development of a family support system designed to improve outcomes in a pediatric trauma population. Studies have demonstrated lowered health-related quality of life among injured children during rehabilitation, along with substantial parental stress. By developing comprehensive support services for families, we may decrease parental burden and improve parents ability to care for their children, thus improving health outcomes for them. Through analysis of data from a longitudinal study of injured children, focus group interviews with affected families, and consultation with a multidisciplinary team, interventions were developed. The resulting program consists of 3 main components: (1) efforts to increase coordination of discharge care, (2) establishment of educational protocols, and (3) implementation of support groups and a peer support program for families. Patient satisfaction and reported use of program materials is high; efforts to improve education, regarding transitions to school and other activities, are continuing. Early evaluation of the program suggests that it is effectively addressing family needs; evaluation of the programs long-term effect is ongoing. We are able to discuss successes and barriers to program implementation and make recommendations for others considering such an undertaking.

Brain Injuries↗

PubMed2002

A comparison of data obtained from service providers and service users to assess the quality of maternity care.

OBJECTIVE: to compare data obtained from two sources, service providers and service users, regarding the maternity services in Scotland. DESIGN: an audit of maternity services involving site visits, staff interviews and a cross-sectional survey of service users. PARTICIPANTS: lead professionals in every consultant-led maternity unit in Scotland and all 1639 women giving birth in Scotland during a ten-day period. DATA COLLECTION: structured group interviews with service providers and a questionnaire survey of recently delivered women. DATA ANALYSIS: professionals' and women's responses were cross-tabulated and differences in proportions were tested for statistical significance using the chi-square test. FINDINGS: a total of 1137 women completed the questionnaire (response rate 69%). Overall, there was good agreement between professionals' and women's perceptions of the aspects of care studied. However, there were disparities in some areas. For example, staff in eight units reported mechanisms to ensure early distribution of a free national pregnancy book; however, in six of these units less than 75% of women actually received this book prior to their first hospital visit. Eighteen units reported that they offer a postnatal 'reunion meeting'; in ten of these units, less than 50% of women were aware of the reunion meeting. Eighteen units reported a policy of each woman having a lead professional or care co-ordinator; in three of these units, less than 50% of women perceived that they had a care co-ordinator and for most women, the profession (midwife, general practitioner or obstetrician) of their perceived co-ordinator differed from that expected on the basis of staff reports. There was some evidence overall that unit policies had a direct influence on women's responses. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study demonstrates the importance of using a range of complementary methods of data collection and of ascertaining both service users' and providers' views when assessing the quality of care. Further research is required to explore differences in service provider's and women's perceptions and how this information can be used to improve the quality of maternity care. The finding that service provision may influence women's preferences has important implications for service planning, in particular the introduction of new models of care, and this needs further exploration.

Continuity of Patient Care↗

PubMed2003

Challenging heteronormativity in the consultation: a focus group study among general practitioners.

OBJECTIVE: To reflect on and further understand mechanisms of heteronormativity in the consultation, with special focus on the relative invisibility of lesbian women. DESIGN: Tape-recorded focus group interviews transcribed verbatim and analysed using qualitative methods. SETTING: General practitioners (GPs) from the city of Göteborg, Sweden, who had formerly answered a postal questionnaire about lesbian women in the consultation, were invited to take part in subsequent focus groups. SUBJECTS: Ten GPs from the questionnaire who accepted the invitation and volunteered to participate in focus groups. MAIN OUTCOME MEASURES: A discourse analytical approach using interaction regarding consensus and disagreement between informants in creating major and minor themes. RESULTS: Consultation skills were forwarded as a major tool in receiving optimal information from patients. However, traditional concepts of family and sexuality restricted information and hampered an accepting attitude. Bringing up issues of sexual identity/orientation was left to the lesbian patient and strongly related to her reason for attending. CONCLUSION: Consultation skills are a useful but not sufficient means of making lesbian women visible in the doctor-patient relationship. Doctors also need to transcend traditional concepts of family and sexuality and reflect on what is a relevant issue from the patient's perspective.

Adult↗

PubMedDate not supplied

When management works: an organizational culture that facilitates learning to self-manage type 2 diabetes.

This study describes women's perspectives of provider and setting factors that support their ability to be effective self-managers of type 2 diabetes. A qualitative approach with focus-group interviews and document review was used. The 17 women in this study had been nominated as exemplars in self-management by experts from a diabetes treatment and research center in the Midwest. Data generated from four structured focus group sessions, investigator fieldnotes, and clinic records of participants yielded the following themes: (1) turning points facilitated the management experience along with certain obstacles and barriers, (2) an organizational culture of caring facilitated learning self-management, (3) major shifts in provider-patient relationships accompanied a phasic process of learning management, and (4) a set of personal characteristics most likely influenced the learning process. The knowledge and skills obtained through diabetes education are essential for initiating the self-management process. However, becoming an effective self-manager requires an organizational culture that supports elements of a role reversal in which patients can be experts and providers can be mentors.

Aged↗

PubMed2004

To be a helpless helpoholic--GPs' experiences of women patients with non-specific muscular pain.

OBJECTIVES: To explore and describe what it means to be a GP meeting patients with non-specific symptoms. DESIGN: Focus group interviews analysed in a phenomenological approach. SETTING: GPs at two urban healthcare centres from a big city, a low socioeconomic area with mostly immigrants and a high socioeconomic area, and from a smaller town. SUBJECTS: 14 GPs in 3 focus groups. RESULTS: The essence of the study was the GPs' feeling of being a "helpless helpoholic". All GPs specified the patient with non-specific symptoms as a female patient with muscular pain. The key constituents were: inconsistent patient, insufficient tools, frustration, helplessness, and devotion to help. The tools were described as communication skills, biomedical education, and holistic perspective. Even if most informants were trained in communication skills, this did not help to avoid the feeling of helplessness. CONCLUSIONS: To be a "helpless helpoholic" may make the GPs less patient-centred and may create even more feelings of frustration and helplessness. This can be an important reason why consultations with female patients with non-specific muscular pain often fail.

Attitude of Health Personnel↗

PubMed2002

The hardest thing is the habit: a qualitative investigation of adolescent smokers' experience of nicotine dependence.

The aims were to explore adolescent smokers' understanding and their physiological and psychological experience of addiction to nicotine and to assess the content validity of the Hooked on Nicotine Checklist (HONC), a 10-item measure of nicotine dependence in youth. Six focus group interviews were conducted with male and female smokers recruited by school staff from among known smokers at one English and two French high schools in Montreal. Participants were 64 high-school students aged 14-17 years. Measurements were focus group discussion of smoking patterns and levels for self and others; feelings and sensations while smoking; physical and mental experiences of urges, feelings and sensations when smoking is prohibited; the physical, psychological, and social meanings of being hooked, dependent, or addicted; levels of dependence, desire to quit, and quit attempts. Participants readily identified nicotine dependence as relevant to their smoking experience. Dependence was described as the need to smoke, sometimes experienced as sensations of emptiness in the chest or blood and sometimes as a feeling in the mind. Smoking urges were often situationally determined and associated with hunger. With the exception of feeling sad, blue, or depressed on smoking withdrawal, participants endorsed almost all the symptoms in the HONC as relevant to their experience of dependence and identified several other symptoms as well. Adolescents are able to provide self-reports of symptoms of dependence that are consistent with a theoretically driven conceptualization of nicotine dependence. The HONC demonstrates content validity among adolescents but could be improved through removal of the item related to depression on withdrawal and possibly addition of items related to stress and appetite.

Adolescent↗

PubMed2006

Discursive patterns in multiprofessional healthcare teams.

AIM: The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions. BACKGROUND: Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self-presentations of a multiprofessional healthcare team. METHODS: A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south-east Sweden. The analysis focused on the participants' discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I. FINDINGS: The constructions of 'we' by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus. CONCLUSION: These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration.

Attitude of Health Personnel↗

PubMed2003

Preserving integrity: experiences of people with mental health problems living in their own home in a new neighbourhood.

For patients with mental health problems, de-institutionalization has meant a shift from institutional care to living in the community. However, several studies show that problems of stigmatization, loneliness and negative attitudes devalue the dignity and autonomy of these patients. The aim of this study was to gain a deeper understanding of how people with mental health problems experience living in an apartment of their own. The data collection method was focus group interviews. The constant comparative method revealed the main category 'preserving integrity'. The subcategories were: the need for control over information, similar relationships with both friends and neighbours (symmetrical contact), and 'My home is my castle'. Participants who lived in a group home had little or no contact with their neighbours. The participants experienced lack of acceptance and loss of autonomy when meeting people. Integrity was a necessary condition in order for them to become equal citizens, experience autonomy and dignity, and have the opportunity to develop social contacts.

Adaptation, Psychological↗

PubMed1999

The specialist breast care nurse: an evolving role.

The role of the specialist breast care nurse has not previously been described in the Australian context. A study was undertaken, utilising the Delphi technique and focus group interviews to determine the key elements of the role and to describe how these role elements are enacted by the nurses incumbent in these positions in six Australian states. Three rounds of questionnaires to 16 expert nurses established a consensus view as to the essential elements of the specialist breast care nurse's role. The 11 role elements that became significant during analysis of these data were: specialist nurse, supporter, educator, counsellor, adviser, team member, resource person, caregiver, public advocate, manager and researcher. Focus groups were held with nurses from each state and the findings allowed enhancement of the data from the questionnaires. Analysis of the interview data allowed a fuller description of how the nurses actualised their role. This data showed that the specialist breast care nurse co-ordinated the care of the woman and her family during the breast cancer journey. Integral to the role was the support for the woman and her family. It is concluded that in order to perform successfully in the role nurses require specialist education in supportive care, counselling, pathology and treatment of breast cancer, a broad knowledge of oncology nursing, management, research and teaching techniques.

Attitude of Health Personnel↗

PubMed2006

Change on the horizon: issues and concerns of neophyte advanced healthcare practitioners.

AIMS AND OBJECTIVES: The aim was to interview new entrants to a Master's level programme of educational preparation for advanced healthcare practice roles. The objectives were to gain an understanding of their issues and concerns as they looked ahead to their future development and to illuminate issues concerning their experiences as students and as employees. BACKGROUND: As advanced practice roles become more widespread in the United Kingdom and abroad, nurses and other healthcare professionals are becoming more involved in innovation and service development and experiencing greater autonomy in many areas, particularly in regard to clinical examination and diagnosis. DESIGN: A qualitative design was employed to illuminate issues and concerns of new students on a Master's degree programme of educational preparation for advanced healthcare practitioners. METHODS: Two focus group interviews were conducted in 2004. Sixteen students from two programme cohorts participated in the two groups. FINDINGS: Two main themes were outlined. These were: 'opportunities for development' and 'time pressures'. Subcategories within these two themes are also discussed. CONCLUSIONS: Students undertaking Master's level preparation for advanced healthcare practitioner roles perceive personal and professional benefits and opportunities to develop innovative services to improve patient care as accruing from the programme. These opportunities and benefits were related to the United Kingdom national health policy agenda. Some role difficulties were experienced. The additional burdens that the programme of study provided were an issue for some, but these were perceived as a temporary problem, worth undergoing for the likely long-term benefits. RELEVANCE TO CLINICAL PRACTICE: Students undertaking educational preparation for advanced practice roles see themselves as innovators, specifically aiming to develop and improve aspects of service provision. Education for advanced practice roles should not be undertaken lightly, but can equip students with various skills, particularly regarding clinical assessment, and these skills should underpin practitioners' autonomy.

Adaptation, Psychological↗

PubMed2001

Nurses' experiences of caring for culturally and linguistically diverse families when their child dies.

Nurses experience the care of a dying child and their family as a challenging but distressing event. In a paediatric intensive care unit (PICU), Melbourne, Australia, nurses expressed a concern that they may not be providing the most appropriate care when a cultural disparity exists between nurses and families experiencing the death of their child. A critically informed study was undertaken with six PICU nurses to explore their experiences of caring for a culturally and linguistically diverse family whose child had died. Three consecutive focus group interviews were conducted with the nurses to identify issues in this area of their nursing practice and to contemplate how their practice might be changed. The focus of this paper is on one particular finding of the study about the nurses' use of controlling practices to ensure families conformed to the established routines and values of the PICU staff.

Adult↗

PubMed2002

Clinical supervision using video-conferencing technology: a reflective account.

This paper discusses three nursing practitioners' experiences of clinical supervision using video-conferencing (VC) technology. The study, based on supportive action research, involved 40 practising community and hospital nurses from a variety of specialties and took place over an 18-month period. The research was collaborative, educational and applied and focused on the effects of remote clinical supervision on the development of professional practice. Data were obtained through pre- and post-study questionnaires, repertory grids, focus group interviews and written narratives. The three research participants found that clinical supervision, as a mediator of learning, was vital in enabling them to develop their reflective and problem-solving skills. Through critical conversations with either a supervisor or within peer group supervision, the participants increased both their confidence and self-awareness and gained more insight into the practices and needs of other practitioners. They also examined critically patient care issues resulting in attention to existing or the development of new care protocols. They did, however, experience some impediments to the process of clinical supervision, mainly lack of peer and management support and ongoing education. The participants had mixed perceptions with regards to using VC technology for clinical supervision. They experienced technical and accessibility problems and communication problems, suggesting the need for clear protocols for both technical support and applied training.

Clinical Nursing Research↗

PubMedDate not supplied

[Mental health of surgical patients: development of nursing activities through support groups].

The use of support groups as a resource for caring patients has been an usual modality of nursing assistance. This study aimed at using the support group for approaching the surgical in-patient in order to diminish present anxiety in these situations. The research has been developed at a surgical clinic at HCFM-UFG with 41 patients. The data collection has been done through individual interviews, groups emergent material and field diary. Generally speaking, we have observed that the patients show themselves actually involved with the work, demonstrating the group efficiency as a resource to deal with anxiety, fear and tension that are present during international process. We have pointed out the importance of the nurse to practice his/her role as a group co-ordinator, especially to deal with difficult handling situations. Meetings supervision as for their thematic constaint and performance are also indispensable.

Adaptation, Psychological↗

PubMed1999

Factors that influence job satisfaction of nurses in urban and rural community health centers in Cameroon: implications for policy.

There has been a growing recognition of work-related stress among nurses in Cameroon that has contributed to job dissatisfaction and high turnover. This study, which was conducted with 158 nurses in three major hospitals and three rural health centers in the Northwest Province of Cameroon, examined whether there were significant differences in job satisfaction between nurses in urban hospitals and rural community health settings in the six major components of the job: work, pay, promotions, supervision, co-worker relationships, and the job in general. A convenience sample of 158 staff nurses grouped into three categories (nurses' aides, registered nurses, and state registered nurses), volunteered to participate in this study. These nurses differ by level of educational preparation of 1, 2, and 3 years, respectively. The Job Descriptive Index questionnaires and the Job In General scales were used to measure job satisfaction. These data were analyzed with inferential statistics. Focus group interviews with 10 nurses were also done, and content analysis was used to analyze the data. The major findings indicated significant differences between job satisfaction and type of healthcare work setting, level of professional education, gender, years of service, and age group. These results are useful for nurse educators, administrators, and researchers in the formulation and implementation of effective health policies for nurses and health care organizations. This study also provided the groundwork for a future cross-cultural study of nurses in the United States and Cameroon.

Adult↗

PubMed2005

Participants' experiences of a support group intervention for family members during ongoing palliative home care.

The aim of this study was to describe family members' experiences of participation in a support group intervention during ongoing palliative home care. Four taped-recorded focus group interviews were conducted (in total, 13 persons) and a questionnaire was completed by 19 of 22 possible family members. The participants experienced increased perception of support and knowledge, and would recommend that a person in a similar situation join a support group. Categories that emerged in the qualitative content analysis concerned "reasons for support group participation", "group composition contributed to group cohesion", "experience and sensitivity of group leader was a catalyst", "meaningful dialogue helped to solve everyday problems", "sense of cohesion increased effectiveness of the group", and "group sessions and post-session reflection increased perception of inner strength". Support groups for family members seem to be a valuable contribution during ongoing palliative home care. The findings are discussed in relation to recruitment into and ending of support groups.

Adaptation, Psychological↗

PubMed2004

"New Choices" for women with addictions: perceptions of program participants.

BACKGROUND: Substance use in pregnancy is a major public health problem. It can have profound effects on pregnancy outcomes, and childhood health and development. Additionally, women who use substances have their own health-related issues. Although intervention is important, these women often have difficulty using traditional systems of care. The New Choices program is a centralized, multi-sector approach to service delivery that has attempted to overcome barriers to care by offering one-stop shopping in a supportive environment. As part of an evaluation of this program designed for women who are pregnant and/or parenting young children, interviews were conducted with participants to gain insight into their experiences in New Choices and perceptions of any changes attributed to program involvement. METHODS: A qualitative, exploratory design was used to guide data collection and analysis. Four women participated in a focus group interview and seven women agreed to individual interviews over the course of the program evaluation (N = 11). A semi-structured interview guide was used to explore women's experiences in New Choices and their perceptions of the program and its impact. The interview data were analyzed using NVivo software and an inductive approach to data analysis. RESULTS: The emergent themes captured women's motivations for attending New Choices, benefits of participation, and overall quality of the program. Children were the primary motivating factor for program enrollment. Perceived benefits included decreased substance use, improved maternal health, enhanced opportunity for employment, increased access to other resources, enhanced parenting skills, and improved child behaviour and development. Women highly valued the comprehensive and centralized approach to service delivery that provided a range of informal and formal supports. CONCLUSIONS: Interview findings endorse the appropriateness and potential efficacy of a collaborative, centralized approach to service provision for women with substance use issues. Although the findings provide insight into an alternative model of service delivery for women with addictions, future research is needed to evaluate the effectiveness of the intervention. Research also is needed to determine which program components or constellation of components contribute to desired outcomes, and to learn more about processes that underlie changes in behaviour.

Adult↗