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PubMed2001

[Knowledge of flap complications in finger pulp surgery and patient education--ethical implications].

INTRODUCTION: The two highest French courts have recently decided that not to fully inform a patient constitutes negligence, and that doctors should be able to prove that the information has been given. The medical community is now debating as to how to protect physicians without harming the doctor-patient relationship. Following this study we put forward the hypothesis that although information might not be available to surgeons nevertheless this should not prevent them taking the ethical steps necessary to redress the situation. METHODS: We conducted a telephone interview to discover what surgeons knew about the complications of finger flaps used for the reconstruction of pulp defects. Four flaps were studied: the VY flap described by Atasoy, the island finger flap known as Ventataswami's, the reverse island flap and the thenar flap. Surgeons were asked to give the percentage of necrosis, infection, sensory disturbances, digital stiffness and exclusion, as well as the time off work, the time of healing and the sensory discrimination of the flap. The results obtained were compared to those obtained by a literature review. RESULTS: Twenty one qualified hand surgeons answered the questionnaire. Many answers were absent or only fragmentary when sought in the literature. Where complication rates were available, there was a huge variation among series. A large variety of answers was also found in our study. The direct island flap was the best known flap. Complications of the reverse island flap and the thenar flap were overestimated in the group interviewed. DISCUSSION: There is no true answer, either in the literature or from the study group. There is a gulf between the jurists' demand and the possibilities of knowledge by surgeons. We are still waiting for clinical studies that will answer the questions asked by patients regarding the complications of surgery. However, even if absolute knowledge is not available, it is the ethical duty of surgeons to give the patient information that is as close as possible as the "truth", and that will be helpful to them.

Adult↗

PubMed2004

Dimensions of quality of life for Chinese adults with spinal cord injury: a qualitative study.

PURPOSE: The purpose of this study was to explore meaning and components of quality of life (QOL) perceived by Chinese adults with a spinal cord injury (SCI) and to examine the frame of reference that this population used to assess quality of their life. METHOD: A qualitative research approach was used. Six focus group interviews were conducted with 40 adults with SCI from a northeastern city in China. A content analysis was conducted on interview data to determine meaning and components of QOL perceived by the participants. RESULTS: Participants defined QOL as satisfaction with one's life, which might vary from person to person and change when the circumstance changed. They identified 18 QOL components that could be grouped into five domains: physical, psychological, economic, social well-being, and a least restrictive environment. When assessing quality of their life, participants used both internal (comparing with oneself) and external (comparing with others) comparisons. CONCLUSIONS: The results of this study contribute to the understanding of dimensions of QOL for people with SCI in China. Although several domains of QOL identified in the present study were similar to those found in previous studies conducted elsewhere, several unique components of QOL, such as relationship with extended family and neighbours, government support, peace in the world and the nation, were identified by the participants. These components appeared to be related to the Chinese culture and socioeconomic system. Specific QOL measurements that address these unique components are needed when assessing QOL of this population.

Activities of Daily Living↗

PubMed2004

Public perceptions and risk communications for botulism.

Formative research findings from 10 focus group interviews on botulism are described. Data were collected from a diverse sample of people throughout the United States in 2003, as part of a collaborative multisite initiative sponsored by the Centers for Disease Control and Prevention to improve communications materials on bioterrorism agents. Focus group guides included questions on knowledge, action, emotions, and information seeking in response to a series of scenarios on a hypothetical terrorist attack using botulinum toxin. Data were collected, transcribed, coded, and analyzed using content domains based on risk and health communications theories. Initial participant responses to scenarios were emotional, changing into immediate health and survival concerns conceptualized as information specific to the agent and event. Knowledge about botulism was low, and participants wanted clear, concise, and actionable messages. Broadcast media, the internet, and community-based sources were cited as sources of information. Findings have implications for botulism preparedness messages and for general public risk communications.

Attitude to Health↗

PubMed2005

"I know what love means." Gender-based violence in the lives of urban adolescents.

OBJECTIVES: In focus groups designed to probe violence and fighting, urban youth emphasized the impact of gender-based violence in their lives. We used this opportunity to qualitatively explore how gender-based violence affects the lives of urban adolescents. METHODS: Thirteen structured focus group interviews were held with youth from three high-violence settings: a large, urban high school, a training center for disadvantaged youth, and a school for adjudicated youth. Participants were 120 urban, predominant African American youth and young adults ages 14-22. Seven focus groups were conducted with females and six with males. RESULTS: Participants did not talk about violence without discussing the gender-based violence they experienced in a number of social roles: as witnesses to family violence, as victims of intimate partner and dating violence, or as peer observers of harassing and violent behavior. Male participants felt that other males used violence as a way of maintaining a sense of power over their partners. Participants of both genders struggled to identify the boundaries between playing, harassment, and abuse. Female participants suggested that females sometimes wanted males to hit them, interpreting this violence as a sign of commitment. Similarly, females struggled to determine if gender-based violence could be a reflection of love. CONCLUSIONS: Gender-based violence is a significant issue in the lives of urban adolescents. Youth experienced gender-based violence in a number of contexts and roles, and many had concluded that such violence was sometimes acceptable. Prevention strategies should start early and address the spectrum of youths' experiences.

Adolescent↗

PubMedDate not supplied

The impact of a nurse externship program on the transition process from graduate to registered nurse: Part II. Qualitative findings.

This article reports the qualitative findings from a focus group interview conducted with six currently registered nurses who participated in a summer nurse externship program. It is Part II of a three-part study that examined the influence of nurse externship programs on the transition process from graduate to professional nurse. The focus group explored the perceptions of former nurses about the impact of the externship program on their transition into the professional nurse role. In the role of nurse externs, individuals were able to view, experience, and, consequently, come to understand the culture of nursing in an acute healthcare system without being full-fledged members of it. Three themes induced from the analysis of the findings were as follows: (1) being a part of the real scene; (2) figuring out the environment; and (3) gaining awareness and becoming frightened.

Attitude of Health Personnel↗

PubMed2005

Volunteer youth sport coaches' perspectives of coaching education/certification and parental codes of conduct.

The vast majority of youth sport programs in the United States relies primarily on parent volunteers to serve as coaches. Unfortunately, most of these volunteer coaches have not received formal training to prepare them adequately for the role of youth sport coach. To exacerbate the issue, according to the popular media, parents and other adults can commit belligerent and even violent acts around, and often resulting from, poorly managed youth sport events. Although some efforts have been made to standardize curricula, provide training for coaches, and contain or prevent inappropriate parent behaviors, few efforts have been directed at investigating the self-described needs and concerns of the coaches from their perspectives. The purpose of the current study was to investigate the concerns and issues of youth sport coaches related to coaching and parental education. Five focus group interviews with 25 volunteer youth sport coaches were conducted to investigate these issues. Results were organized around four higher order themes that emerged from inductive content analyses: (a) coaching education content areas of need, (b) barriers and problems of offering coaching education, (c) coaching education format recommendations, and (d) efficacy of parental codes of conduct. Results were discussed in terms of the potential impact administrators, coaches, and parents could have in implementing formal coaching education programs and developing their coaching education practices.

Adult↗

PubMed1999

Discharging older people from hospital to care homes: implications for nursing.

This paper summarizes a research study which explored the experiences of older people being discharged from hospital to nursing and residential homes in the North East of England. While there has been considerable research which has looked at the discharge of patients from hospital to their own homes, little literature could be found which addressed discharge to care homes. While this may reflect an assumption that this form of discharge is less problematic, it is arguable that this is only the case for staff - there is a body of literature on re-location which suggests that the move to a care home is a major life event for older people. Taking a qualitative approach, this study interviewed 20 older people and 17 of their family members after discharge from hospital to a care home. We found that few people had been offered opportunities to discuss their move with nurses, and that older people tended to adopt a stoical attitude. In focus groups, interviews and written responses from 23 members of staff in the hospital and in care homes, we found that there was a lack of clarity over whose role it was to initiate such discussions. The paper concludes with some discussion of the implications for nursing practice of changing care interfaces.

Aged↗

PubMed2006

Nurses' experiences of caring for South Asian minority ethnic patients in a general hospital in England.

Healthcare provision for minority ethnic groups in the UK has generally revealed inequalities in access and differential service provision. British healthcare policy has started to address such issues. However, very few studies have specifically examined the experiences of nurses caring for minority ethnic patients. This paper focuses on the focus group interviews of a broader ethnographic study, aimed at describing nurses' experiences of caring for South Asian minority ethnic patients, in a general hospital in the south of England. A sample of 43 nurses of all grades from six medical wards took part in the focus groups: three ward sisters, 22 staff nurses and 18 care assistants; 40 participants were white, one was African-Caribbean and two were South Asian. Data analysis revealed eight themes: changes in service provision; false consciousness of equity; limited cultural knowledge; victim blaming; valuing of the relatives; denial of racism; ethnocentrism, and self-disclosure. The study revealed a good local service response to government policies in addressing inequality. However, there was a tendency to treat all minority ethnic patients the same, with evidence of ethnocentric practices, victim-blaming approaches and poor cultural competence in nursing staff, which raise questions about the quality of service provision. The study indicates that ongoing training and development in the area of cultural competence is necessary.

Anthropology, Cultural↗

PubMed2000

Assessing the educational needs and concerns of nursing home staff regarding end-of-life care.

The purpose of this study was to explore and describe the educational needs and concerns of licensed nursing staff and certified nursing assistants (CNAs) regarding end-of-life (EOL) care. Focus group interviews were conducted at two nursing homes in the Pacific Northwest. Separate interviews were conducted for licensed staff (RNs and LPN/LVNs) and CNAs. A total of 15 licensed staff and 39 CNAs participated in the study. Interviews were transcribed and themes were extracted through consensus reached by three investigators. The major concerns of these nursing home staff focused on symptom management, communication and interactions, goals of care, role delineation, time constraints, self-care needs, and emotional attachment to residents. Although both groups described similar themes, specific issues within each topic often were different for licensed staff and CNAs. These findings can be used to guide the design of educational programs aimed at assisting nursing home staff in providing high level end-of-life care.

Aged↗

PubMed1999

Research methodology issues related to interviewing the mechanically ventilated patient.

Difficulties conducting research in vulnerable or frail patient populations limit the data-based information on which to base practice in these populations. Although there are many challenges in this type of research, they are not insurmountable, and, in an effort to encourage others interested in studying vulnerable patient populations, we discuss the methodological process used to prospectively study one vulnerable group. Interviews about perceptions of weaning, fatigue, mood, and sleep/rest states were conducted with 20 patients who were chronically critically ill and required long-term mechanical ventilation. Illness severity and communication difficulties were primary considerations in the design, development, and implementation of the study. Ethical considerations, informed consent, sample representation, and data collection issues are discussed.

Adult↗

PubMed2002

A comparative evaluation of the perceptions of health of elders of different multicultural backgrounds.

The purpose of this study was to discover the perceptions of health and the health maintenance practices of 4 different cultural and ethnic groups. Interviews were conducted at senior citizen centers in and around a large metropolitan center in Texas. Five Native Americans, 44 African Americans, 32 Latinos, and 13 Vietnamese were questioned about their views on being healthy. Huff and Kline's Cultural Assessment Framework was used to analyze the responses. Functionality and independence were dominant themes noted in the responses of all participants from all 4 cultural groups.

Black or African American↗

PubMed2002

Development of questionnaires to measure physical activity cognitions among Taiwanese adolescents.

BACKGROUND: Although a number of studies have investigated perceived self-efficacy, perceived benefits, and perceived barriers and their relationship to adolescents' participation in physical activity, the validity and reliability of the instruments used have not been consistently examined. The purpose of the present study was to develop culturally sensitive, reliable, and valid instruments to measure physical activity cognitions among Taiwanese adolescents. METHODS: The items generated for the instruments were drawn from a comprehensive literature review and a focus group interview. The instruments were translated using the back-translation technique and evaluated by a panel of experts. Psychometric testing was performed and confirmed with convenience samples of 110 and 969 Taiwanese adolescents. RESULTS: Psychometric testing demonstrated satisfactory internal consistency and validity of the instrument for this group of Taiwanese adolescents. Cronbach's alpha's ranged from 0.79 to 0.90. Construct validity was supported by exploring the factor structure of the instrument using confirmatory factor analysis and correlation with the outcome variable of physical activity. CONCLUSIONS: The study identified culturally sensitive items to measure physical activity cognitions in urban Taiwanese students in their early adolescence. Clinicians or practitioners can use the instruments developed and tested in this study for clinical assessment to identify risk factors for inactivity as well as for further research in similar populations.

Adolescent↗

PubMedDate not supplied

Critical care nurses--perceptions of 12-h shifts.

BACKGROUND: Twelve-hour shifts have been illustrated in the literature as being a highly contentious shift pattern. However, it has also been highlighted that there is a distinct paucity of literature solely related to such a shift pattern in critical care areas, where there is high activity and a requirement for multiple and highly significant decision-making situations. It was therefore identified that such an area deserved further exploration. AIM: This study aimed to elicit critical care nurses' perceptions of working 12-h shifts. METHODS: Fifty-four nurses from three critical care areas within a large local NHS teaching hospital currently working 12-h shifts completed a self-administered questionnaire on their perceptions of 12-h shifts. Following on, a focus group interview was conducted to complement this questionnaire in an attempt to further explore these perceptions. RESULTS: From the results of the questionnaire, patient care, job satisfaction, off duty and family life achieved the most positive responses, whereas communication, fatigue and education achieved the most negative. The focus group explored these issues with added comments on work-shy staff, suggestions on shift patterns, breaks and staffing levels. CONCLUSIONS: Twelve-hour shifts in critical care areas are suitable shift patterns for nurses, patients and management, provided that they are fundamentally well-managed.

Absenteeism↗

PubMed2004

Urban youths' perspectives on violence and the necessity of fighting.

OBJECTIVES: To assess youth perceptions of the causes and consequences of violence generally, the causes and consequences of fighting specifically, and to determine how best to approach fighting in the context of violence prevention activities. METHODS: Thirteen structured focus group interviews with youths from three high violence urban settings: a large, urban high school, a training center for disadvantaged youths, and a school for adjudicated youths. Participants were 120 urban, predominately African-American youths and young adults ages 14-22 years (mean: 17.2 years). Seven focus groups were conducted with females, and six with males. RESULTS: Adolescents identified the causes of violence on multiple levels including: individual, family, interpersonal, and community level factors. Most youths (89%) had been in a physical fight. Participants felt that fighting was not "right", but identified situations in which it was necessary. Specifically, fighting was used as a problem solving tool, and could prevent escalation of violence. Youths felt that the adults in their lives, including physicians, were generally ill equipped to give advice about violence, as adults' experiences were so removed from their own. Participants looked to experienced role models to offer problem solving and harm reduction strategies. Youths were open to receiving anticipatory guidance about violence and fighting from primary care physicians they felt comfortable with, and who showed respect for their experiences. CONCLUSIONS: Interventions that include blanket admonitions against fighting should be reassessed in light of youth perceptions that fighting plays a complex role in both inciting and preventing more serious violence.

Adolescent↗

PubMed2000

Pupils' causal attributions for difficult classroom behaviour.

BACKGROUND: Studies of causal attributions within educational contexts have tended to concentrate on academic performance. There have been a smaller number of investigations of teachers' attributions for pupils' behaviour in school. AIMS: The present study examines the causal attribution made by pupils for difficult behaviour in classrooms. It reveals the structure of these attributions and serves as a comparison with the teacher studies. SAMPLE: The participants were 105 pupils (52 males and 53 females) in the first year of secondary schooling, all drawn from the same inner city school. METHOD: Four initial small group interviews were used to identify a wide range of factors that pupils viewed as being causes of difficult classroom behaviour in the 18 primary schools they had previously attended. A questionnaire was then constructed incorporating items from these discussions and administered to the whole of the year group of pupils, but omitting the participants in the initial group discussions. RESULTS: The results of a factor analysis indicated that pupils' attributions for misbehaviour at school were best represented by four factors: (1) 'fairness of teacher's actions', (2) 'pupil vulnerability', (3) 'adverse family circumstances' and (4) 'strictness of classroom regime'. While there were no gender differences, pupils saw the 'fairness of teacher's actions' and 'pupil vulnerability' as more significant contributors to pupil misbehaviour than either 'adverse family circumstances' or 'strictness of classroom regime'. CONCLUSION: The attributions by pupils for difficult classroom behaviour differ markedly from those obtained in studies of teachers. Policy and practice initiatives which do not attend to conflicting attributional styles are unlikely to succeed in improving levels of pupil behaviour in schools.

Child↗

PubMedDate not supplied

Consensus about the marital relationship during transition to parenthood.

This research was designed to identify anticipated and actual postpartum concerns about the marriage relationship during the period of transition to parenthood. It also investigated: (1) the accuracy of prediction of postpartum concerns by the prenatal group; (2) states of consensus within the marital dyad regarding the importance of postpartum concerns; and (3) the relationship between communication about the concerns and the relative importance of concerns. Twenty-two couples expecting their first child were randomly assigned to either the prenatal or postpartum interview groups. Husbands and wives individually rank-ordered 35 postpartum concerns from Most Important to Least Important and estimated how their spouses would rank the concerns. Husbands and wives also indicated the three concerns they discussed the most and the three they discussed the least. Couples tended to discuss most often those concerns they ranked most important. However, there were only moderate levels of agreement on the importance of concerns, discrepancies between perceived agreement and actual agreement, and low to moderate levels of accuracy in estimating the importance of concerns for spouses.

Adolescent↗

PubMed2005

Teaching and learning in dental student clinical practice.

Clinical learning in restorative dentistry is principally centred around the provision of patient care, yet we know very little about the learning processes occurring within the clinical environment. A study of undergraduate dental student clinical practice used a combination of group interview and questionnaire techniques to explore some of the characteristics of student/teacher interaction that students finds significant, and which they consider to affect their learning of clinical skills. Study data, when analysed, revealed three major categories of teacher or student behaviour which appear to be of importance to students. This paper focuses on one of these, describing a number of behaviours, grouped together under the category of 'teaching/learning behaviours'. The aim of the paper is to report these results and to discuss their application to clinical teaching of restorative dentistry.

Education, Dental↗

PubMed2001

Sources of uncertainty and coping strategies used by family members of individuals living with end stage renal disease.

This article presents an analysis of the experience of family members of individuals with chronic renal disease undergoing dialysis therapy. Themes are derived from interviewing family members regarding the sources of uncertainty experienced and the types of coping strategies used to manage the stress related to uncertainty. The sample consisted of 41 family members including spouses, adult children, siblings, a niece, and a daughter-in-law from Eastern Canada. Data were collected from focus group interviews and thematic analysis was used to derive the themes. Emerging themes of uncertainty arose from many sources including: the patient's health, dialysis treatment, potential loss of the patient, and/or the availability of a kidney transplantation. The family members coped with the stress generated by the uncertainty by living each day as it comes, finding positive meaning, hoping for a transplant, and/or drawing on God's strength. Findings from this study provide direction for renal health care professionals to assist family members to prepare for, to understand, and to adapt to constant sources of uncertainty in their lives.

Activities of Daily Living↗