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PubMed2002

Tauiwi general practitioners talk about Maori health: interpretative repertoires.

AIM: This paper reports findings from a qualitative research project investigating how Tauiwi general practitioners talk about Maori health. Tauiwi is a Maori term for non-Maori New Zealanders. METHODS: The transcripts of interviews with 25 general practitioners from urban Auckland on the topic of Maori health, were subjected to detailed discourse analysis. Through these readings, interpretative repertoires (patterns of language use on particular topics) that participants drew upon in their interviews, were described. RESULTS: We outline the main interpretative repertoires utilised by participants in their talk about Maori health. These include key explanatory forms relating to prevalence and causality of Maori health problems, and rationales for specialised practices when working with Maori. CONCLUSIONS: The repertoires, which are considered to be generalised discursive resources for the construction and elaboration of specific arguments, are oriented to constructions of Maori health that either blame Maori for their plight or justify existing service provision. As such, they are antithetical to arguments for changes to policy and practice that might bring about population-level health gains for Maori.

Attitude of Health Personnel↗
PubMed2001

Mothers' grief following the death of a child.

AIM OF THE STUDY: Research has shown that caring for a dying child is among the hardest and more demanding tasks in nursing, because the staff are forced to manage their heavy work with inadequate skills and experience. This article deals with the findings of a recent study, the purpose of which was to analyse the mother's grief and coping with grief following the death of a child under the age of 7 years. DESIGN: Data were collected from mothers using a survey (n=91) and an interview (n=50). As the topic was very sensitive ethically and emotionally, survey data were collected first and the mothers were asked to give their consent to taking part in an interview. The study employed both quantitative and qualitative methods. The data were analysed using statistical methods and content analysis. However, only the qualitative part of the study is presented in this article. FINDINGS: The findings show that nursing staff had skills to support grieving mothers, but that there were many feelings and experiences of grief that remained unidentified by staff. The staff's ability to meet the mothers' individual needs while the child was in hospital and after the child's death was inadequate. The information received from staff was perceived to be insufficient or offensive to mothers. CONCLUSIONS: The development of basic and further education and of various support measures would enable the staff to better cope with their work. Focusing on interactive skills and meeting the patient's individual needs using reflective practice would improve the quality of care. Communication and collaboration between different occupational groups should be promoted, because mothers were dissatisfied with dissemination of information, and ambiguous responsibilities between different occupational groups hampered the acquisition of information.

Adaptation, Psychological↗
PubMed2000

Interval estimation for Cohen's kappa as a measure of agreement.

Cohen's kappa statistic is a very well known measure of agreement between two raters with respect to a dichotomous outcome. Several expressions for its asymptotic variance have been derived and the normal approximation to its distribution has been used to construct confidence intervals. However, information on the accuracy of these normal-approximation confidence intervals is not comprehensive. Under the common correlation model for dichotomous data, we evaluate 95 per cent lower confidence bounds constructed using four asymptotic variance expressions. Exact computation, rather than simulation is employed. Specific conditions under which the use of asymptotic variance formulae is reasonable are determined.

Adult↗
PubMed1993

Can resident-centred inspection of nursing homes work with very sick residents?

This paper seeks to address the issue of whether a resident-centred inspection process can be effective in a nursing home environment dominated by residents who require high levels of care. Two fundamental criticisms of the current Australian monitoring process are its reliance on standards that are subjective resident-centred standards and its reliance on the views of residents concerning the quality of care provided in the home. These criticisms are becoming all the more important as survival rates for the aged increase and the average level of disability of nursing home residents continues to worsen. Our data suggest that the resident-centred process, despite some difficulties, is both reliable and practical, regardless of the care needs of residents in the home. Data collected from inspection teams show that inspectors use a variety of sources to validate information, with residents being one component. These sources vary little in importance between homes with different levels of care needs or behavioural problems. Perhaps of more importance is the finding that a home's overall performance across 31 resident-centred standards is not affected by either the home's average level of total care needs or the number of residents with severe behavioural problems. There are some significant effects (in both directions) of resident disability on compliance with particular standards. Most notable is the finding that the standard requiring appropriate use of restraint is less likely to be met when there are large numbers of residents with high levels of disability or behavioural problems.

Attitude of Health Personnel↗
PubMed1992

Shades of blue: the negotiation of limited codes by medical residents.

One of the most difficult decisions facing physicians in contemporary medical practice is whether to initiate or withhold cardiopulmonary resuscitation (CPR) for patients who are critically ill. Because of the problems surrounding these decisions, hospital guidelines have recently been developed for the appropriate use of do-not-resuscitate (DNR) orders. Despite the establishment of these guidelines, problems with the application of DNR orders remain. This study examines one strategy used by internal medicine resident physicians to cope with the problematic nature of decisions regarding resuscitation--the use of partial or slow resuscitation attempts, known as 'limited codes.' It analyzes how these code efforts play a role within the context of resident work by enabling residents to circumvent ethical and practical dilemmas created by the circumstances of their clinical practice.

Adaptation, Psychological↗
PubMed2001

Assessment of various topical oral formulations by bone marrow transplant recipients.

Topical approaches to management of oral mucositis have the advantages of high local concentration and limited or no systemic absorption, reducing the risk of systemic complications. The acceptability of topical therapies in cancer patients has not been evaluated. Thirty-eight transplant patients assessed the acceptability of three formulations (rinse, thin gel, thick gel) of a new compound developed to prevent oral mucositis. The rinse was selected as the most acceptable formulation. The thick gel received the lowest rating. Consistency was a major determinant of overall acceptability. A neutral taste was desirable for most participants. Room temperature of the formulation was rated as completely acceptable. Most participants would be willing to use the rinse or thin gel several times per day, to retain each dose in the oral cavity for up to 5 min, and to swallow it. The support of caregivers may be needed to achieve compliance with such regimens.

Administration, Oral↗
PubMed2002

Dying to know: qualitative research with terminally ill persons and their families.

This article illustrates the use of qualitative research methods in the field of thanatology. The authors--a former doctoral candidate and her dissertation chair--describe their ongoing naturalistic inquiry of terminally ill persons and their family members. By describing the reasoning and decision-making informing their study, the authors provide an instructive "how to" on the following topics: finding a research question and a method; assessing risks and benefits; sampling; gaining entry/access to research informants; participant observation; interviewing; analyzing data, and establishing "relational integrity." In a final section, the first author offers reflections on the personal challenges she faced while conducting her research.

Family↗
PubMedDate not supplied

Penny Feldman on home healthcare quality and research. Interview by Susan V. White.

Penny Hollander Feldman, PhD, is Vice President for Research and Evaluation at the Visiting Nurse Service of New York (VNSNY) and Director of the Center for Home Care Policy and Research. Prior to joining VNSNY, Dr. Feldman served on the faculties of the Kennedy School of Government and the Department of Health Policy and Management at the Harvard School of Public Health. At the Center for Home Care Policy and Research, she directs projects focused on improving the quality, outcomes, and cost-effectiveness of home-based care, supporting informed policymaking by long-term care decision makers, and helping communities promote the health, well-being and independence of people with chronic illness or disability. The translation and implementation of research in both service and policy settings has been an issue of ongoing focus for Dr. Feldman. She also served as a member of the Institute of Medicine Committee on Improving the Quality of Long-Term Care, which issued its report in 2001.

Aged↗
PubMed1992

Health care seeking behavior of the elderly: an empirical investigation.

The elderly population represents an increasingly large market for health care services and has typically been seen as a homogeneous market segment. This research indicates that the elderly market is in fact a very heterogeneous market which can be segmented by demographic and behavioral characteristics.

Aged↗
PubMedDate not supplied

[Facilities for the aged from an environment psychology viewpoint. An analysis of relationship between ratings of social climate and behavior of home residents].

We present a concept for the quantification of "social climate" in institutions for the aged. To receive such evaluations from the aged, according to our experience, it is necessary to apply special techniques of exploration to reduce response sets of defense and facade. Comparing different institutions and analysing the correlations with behavioral data we can demonstrate the usefulness of these environmental variables. Differential results point to the fact that some characteristics of the aged have to be considered to interpret these variable of "social climate".

Aged↗