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PubMed1997

The lifeworld of the chronic mentally ill: analysis of 40 written personal accounts.

In this study, chronicity in mental illness has been investigated as it is lived rather than how it might be conceptualized. Published first-hand accounts have provided the mechanism for direct access in coming to know the life of persons, their circumstances, and the meanings they associate with a life of persistent and enduring mental illness. These are unique and particular human experiences, and there are no empirical generalizations or law-like statements that can give such an understanding. Therefore the disclosure of meaning was sought through a hermeneutic-phenomenologic process. Four lifeworld existentials provide the framework for a combined description and interpretation of what it means to "live" chronic mental illness. The article concludes with a brief discussion of some implications for nursing practice, and commentary is made on the relevance of such insights to health care providers in both acute and community care settings.

Adult↗
PubMedDate not supplied

Bayesian learning for cardiac SPECT image interpretation.

In this paper, we describe a system for automating the diagnosis of myocardial perfusion from single-photon emission computerized tomography (SPECT) images of male and female hearts. Initially we had several thousand of SPECT images, other clinical data and physician-interpreter's descriptions of the images. The images were divided into segments based on the Yale system. Each segment was described by the physician as showing one of the following conditions: normal perfusion, reversible perfusion defect, partially reversible perfusion defect, fixed perfusion defect, defect showing reverse redistribution, equivocal defect or artifact. The physician's diagnosis of overall left ventricular (LV) perfusion, based on the above descriptions, categorizes a study as showing one or more of eight possible conditions: normal, ischemia, infarct and ischemia, infarct, reverse redistribution, equivocal, artifact or LV dysfunction. Because of the complexity of the task, we decided to use the knowledge discovery approach, consisting of these steps: problem understanding, data understanding, data preparation, data mining, evaluating the discovered knowledge and its implementation. After going through the data preparation step, in which we constructed normal gender-specific models of the LV and image registration, we ended up with 728 patients for whom we had both SPECT images and corresponding diagnoses. Another major contribution of the paper is the data mining step, in which we used several new Bayesian learning classification methods. The approach we have taken, namely the six-step knowledge discovery process has proven to be very successful in this complex data mining task and as such the process can be extended to other medical data mining projects.

Bayes Theorem↗
PubMed2004

Typical versus atypical unpacking and superadditive probability judgment.

Probability judgments for packed descriptions of events (e.g., the probability that a businessman does business with a European country) are compared with judgments for unpacked descriptions of the same events (e.g., the probability that a businessman does business with England, France, or some other European country). The prediction that unpacking can decrease probability judgments, derived from the hypothesis that category descriptions are interpreted narrowly in terms of typical instances, is contrasted to the prediction of support theory that unpacking will generally increase judged probabilities (A. Tversky & D. J. Koehler, 1994). The authors varied the typicality of unpacked instances and found no effect of unpacking with typical instances (additivity) and a negative effect with atypical instances (superadditivity). Support theory cannot account for these findings in its current formulation.

Humans↗
PubMed2006

Personal exposures and indoor, residential outdoor, and urban background levels of fine particle trace elements in the general population.

Personal exposures and indoor, residential outdoor, and urban background levels of PM(2.5) and PM(1) were measured simultaneously in Göteborg, Sweden. A total of 270 24 hour samples from 30 subjects were analyzed for elemental concentrations using X-ray fluorescence (XRF) spectroscopy. Personal exposures to PM(2.5) were significantly higher for Cl, Ca, Ti, and Fe compared with the other locations. For most elements, residential outdoor levels were significantly higher than urban background levels. Correlations between personal exposure and stationary measurements were moderate to high for Zn, Br, and Pb (r(s)= 0.47-0.81), while Ca and Cu showed low correlations. The penetration indoors from outdoors was 0.7, as calculated from S and Pb ratios. For the pairs of parallel PM(1) and PM(2.5) measurements, only Ca and Fe levels were significantly lower for PM(1) at all sites. Significant correlations were found between urban background mass concentrations and personal exposure levels for elements attributed to combustion processes (S, V, and Pb) and resuspended dust (Ti, Fe, and Zn), indicating that both sources could be relevant to health effects related to urban background mass. Air mass origin strongly affected the measured urban background concentrations of some elements (S, Cl, V, Ni, Br, and Pb). These findings were also seen for personal exposure (S, Cl, V, and Pb) and indoor levels (S, Cl, V, Ni, and Pb). No differences were seen for crustal elements. Air mass origin should be taken into account in the description and interpretation of time series studies of air pollution and health.

Air Movements↗
PubMed1980

Consonant similarity judgments by normal and hearing-impaired listeners.

This investigation attempted to identify listener strategies or perceptual modes that might be adopted by hearing-impaired listeners when making similarity judgments among pairs of speech sounds. Further, an attempt was made to describe the relationship between similarity judgments and auditory confusions for such listeners. Subjects provided similarity ratings and recognition responses to consonant pairs. The resulting similarity judgments were organized into a variety of similarity matrices and analyzed via multidimensional scaling and hierarchical clustering, as well as by traditional descriptive and interpretative statistics. The analyses of the similarity ratings between consonants showed that hearing-impaired listeners apply phonemic labels to the stimuli and base their ratings on these labels rather than on the unlabeled acoustic characteristics of the speech sounds. Analysis of the recognition data indicated that those consonants which are most confused are not necessarily the most conceptually similar to the listener.

Adult↗
PubMed1997

Using patients: exploring the ethical dimension of reflective practice in nurse education.

Within nurse education there is a growing interest in the use of reflective practice as a vehicle for professional development. Additionally, clinically reflective practice is seen as an ideal way of improving performance and patient care. In this paper it will be argued that whilst this development is potentially valuable to both professionals and clients, there are major ethical issues which need to be addressed. The "how to' literature appears to focus predominately on the practitioners subjective description and interpretation of events. It is usual for these events to include details of clients: but not usual for clients to be aware that information about them is being used in this way. Within a deontological ethical framework the use of people as means rather than ends is considered to be morally wrong. However, clients have probably always been used by professionals to some extent: Things such as case conferences and clinical trials are legitimated by the intention to improve training and practice, and are regulated by various professional codes and committees. It would appear, however, that reflective practice is quantitatively and qualitatively different from the above, and thus may cross a moral boundary. Reflective practice is not simply re-examining someone's case: it involves personal interpretation and judgement. The reflector may be recording incidents, verbally or in written form, which would not otherwise be recorded, and may be controversial. This raises questions about the nature and ownership of knowledge, and the responsibilities of people who have such knowledge. Systematic and continued reflection may be akin to action research and, as such, considerations of rigour, authenticity and informed consent need to be addressed. Thus whilst reflective practice may prove to be a good thing, it cannot be seen in isolation from wider ethical concerns.

Education, Nursing↗
PubMed2001

'Best research practice': in pursuit of methodological rigour.

RATIONALE: This paper is based on the rationale that misuse of methodological notions in research publications lays research studies open to criticism and dismissal. AIM: In search of 'best research practice', this paper aims to examine the different qualities of four major qualitative methodologies: ethnography, descriptive phenomenology, interpretative phenomenology/hermeneutics and critical social theory. DESIGN: The study presents a critical overview of methodological decision-making, illustrating the sorts of issues researchers must consider in order to justify to the readership and to themselves the employment of a particular methodology. This is presented alongside a general overview of qualitative research and a précis of each of the major qualitative methodologies. The paper describes the methodologies, salient features, and examines methodological similarities and differences. The paper concludes by examining the need for methodological rigour within the framework of the National Health Service (NHS) Executive's drive for evidence-based practice in health care. RECOMMENDATIONS: It is hoped that the paper will stimulate a deeper exploration of methodological rigour in future research publications.

Benchmarking↗
PubMed2004

Expert qualitative researchers and the use of audit trails.

BACKGROUND: Determining the credibility of qualitative research findings remains a contested area and leaves the way open for additional theoretical and methodological discussion. AIMS: In this paper we focus on audit trails and confirmability, within the context of 'expert' qualitative researchers. Having outlined the audit trail process, we develop existing arguments about the 'expert' qualitative researcher. We then juxtapose the two, highlighting a number of issues in an attempt to advance the debate. DISCUSSION: These issues discussed are: (1) The shifting sands of methodological orthodoxy - the historical context in which audit trails emerged. (2) The individual construction of logic. (3) 'Grounded in the data' or 'going beyond the words'- the key differences between descriptive and interpretive findings. (4) The singular relationship between qualitative researcher and their data. (5) The growing acknowledgement that method alone is insufficient. (6) The challenging example of visionaries. CONCLUSION: We argue that using audit trails as a means to achieve confirmability of qualitative research findings is an exaggeration of the case for method, and may do little to establish the credibility of the findings. We also introduce a preliminary case for testing the credibility of theory induced by expert qualitative researchers, in part by means of its usefulness; its 'fit and grab', rather than by the researcher's adherence to contemporary methodological orthodoxy. In other words, the absence of audit trails does not necessarily challenge the credibility of qualitative findings, particularly if an expert qualitative researcher produced the findings.

Data Collection↗
PubMed2001

Improving services for people with a psychotic disorder and problematic substance use: a multifaceted approach to project evaluation.

OBJECTIVE: The objective of this study was to conduct a multifaceted formative evaluation of the Central Sydney Area Health Service (CSAHS) Psychosis and Substance Use Project. METHOD: Four evaluative methods were used: (i) description and interpretation of the Project's documented processes and outcomes; (ii) a benchmark comparison of the Project processes and outcomes against three of the 11 National Standards for Mental Health Services; (iii) a survey of the Project's key stakeholders; and (iv) interviews with 12 purposefully sampled key informants. RESULTS: The Project achieved its aim to develop a strategy to improve services for people with comorbid psychosis and problematic substance use. Three of the five Project objectives were fully achieved: examination of current clinical services, development of a clinical services plan, and development of a staff education programme. The Project partially achieved two objectives: development of an information system, and a research agenda. The Project and CSAHS performed well when measured against three of the National Mental Health Standards. Project participants perceived the Project to have been successful and worth continuing, identified some shortcomings and made recommendations for the second phase. CONCLUSIONS: The participatory approach to the Project and the evaluation was successful. With some improvements the Project is worth continuing into a second phase. A multifaceted approach and qualitative research methods are useful for formative evaluation of health service programmes.

Australia↗
PubMed2003

The views of district nurses on their level of knowledge about the treatment of leg and foot ulcers.

OBJECTIVE: The aim was to survey the views of a sample of district nurses on their own level of knowledge about the treatment of leg and foot ulcers and what they considered to be the most important issues in wound treatment. DESIGN: A descriptive design was used. SETTING AND SUBJECTS: The subjects were all the nurses who treated leg and foot ulcers in the community health care service in Oslo, Norway, during autumn 1999. The subjects were selected after consultation with senior nurses. INSTRUMENTS: A structured questionnaire with blank spaces for in-depth comments was used. METHODS: The head of the nursing service in all 25 urban districts received a letter about the study with a questionnaire that they passed on to the nurses treating ulcers. Out of 173 eligible nurses, 102 (59%) filled in the questionnaires. Descriptive and interpretative analyses were then made. RESULTS: Most of the participating nurses (60%) believed that their knowledge of wound treatment was insufficient. A high degree of uncertainty related to wound treatment situations was also found. The uncertainty included wound treatment, wound assessment, wound healing products, and wound causes. The main sources of the nurses' knowledge were their own nursing practice and colleagues. Twenty different factors of importance in wound treatment were reported. The most frequently mentioned factors were: wound healing, continuity in the treatment process, alleviation of pain, hygiene, compression therapy, and diagnosis. The lowest scores were awarded to documentation and economic factors. CONCLUSIONS: The nurses perceived their knowledge of leg and foot ulcer treatment to be insufficient. Their own nursing practice and colleagues were their main sources of knowledge.

Adult↗
PubMed1996

Performance consistency in picture naming: a study of the rehabilitation effect on two aphasic patients.

We describe the effect of language rehabilitation on the naming deficits of 2 patients affected by longstanding amnestic aphasia. In particular, our aim was to study the evolution of the rate of inconsistent naming (i.e., performance with stimuli that were named sometimes correctly and sometimes incorrectly when the test was repeated at close intervals) by means of a stochastic model based on Markov chains (Faglioni & Botti, 1993). From a quantitative point of view, both patients showed a significant improvement that was still present several months after treatment. However, at baseline these patients showed different degrees of consistency which revealed a basic difference in the way their language functions. One case presented with low consistency, delayed responses, and self-corrections: A clear effect of rehabilitation was improvement in consistency and reduction of delays. In the other case, at baseline consistency was greater, but naming of pictures did not improve even after delay or self-correction; after rehabilitation more stimuli were named correctly, but only after delay and self-correction. The relevance of consistency and its relationship with delayed naming and self-corrections is discussed. It is suggested that consistency analysis based on stochastic models would make a useful contribution to the description and interpretation of naming deficits in aphasic patients.

Adult↗
PubMed2004

Internet use, social skills, and adjustment.

The present study investigated the extent to which inter-personal skills, personality, and emotional intelligence (EI) were related to the extent of usage of the Internet, as measured with the Internet Addiction Scale, on a sample of undergraduates. EI was assessed by performance measures derived from the identification and labeling of emotions as shown in pictures of facial expressions, and as interpreted from descriptions of social episodes. Use of the Internet was related to loneliness and adherence to idiosyncratic values (strong effects), and also to poorer balance between work and leisure and emotional intelligence (weaker effects). Big Five personality dimensions were also included in the study. No link was found between personality and usage of the Internet. Results suggest that frequent users tend to be lonely, to have deviant values, and to some extent to lack the emotional and social skills characteristic of high EI.

Adolescent↗
PubMed2003

Dissemination of heart health promotion in the Ontario Public Health System: 1989-1999.

This paper reports the results of an analysis of the dissemination of community-based heart health promotion strategies. The research draws on diffusion and socio-ecological theories to study the first 10 years of heart health promotion in the public health system in Ontario, Canada. Using case description and interpretive analysis, the study describes developments in five stages of dissemination, and examines the interplay of factors operating in the internal organizational setting and the external environment in order to explain these developments. Findings demonstrate that dissemination of health promotion is a long-term, iterative process involving multiple stages. Dissemination is influenced by a complex interplay of factors operating within the public health system (especially traditional public health practice and champions) and factors in the environment in which the public health system operates (especially research, practice information and health policies). Implications are that policy makers should take a long-term view of dissemination, identify intermediate and long-term goals consistent with dissemination stages, and capitalize on internal and external forces supporting dissemination goals. Similar case-study research in other public health systems and time periods, and in more advanced stages of dissemination, will add further insight into the dissemination process.

Health Promotion↗
PubMed2001

Mothers' strategies to meet their needs in the newborn intensive care nursery.

In this prospective, critical ethnographic study using a total of 448 hours of participant observations incorporating in-depth interviews, the author explored with 12 mothers of premature babies their descriptions and interpretations of their own needs in a tertiary-level newborn nursery (NICU) and their actions to address these needs. In the NICU the mothers demonstrated a repertoire of actions to vigilantly "watch over" their premature babies, which they extended to address their own needs as well. The mothers employed these actions in such a way as to minimize the potential for diverting resources from their babies and to minimize conflict with caregivers.

California↗
PubMed2005

The utility of MIB-1/Ki-67 immunostaining in the evaluation of central nervous system neoplasms.

The diagnosis and assignment of grade in neoplasms of the central nervous system (CNS), for the most part, are morphologically based and predicated on the interpretation of descriptions of what the phenotypic findings are for a particular tumor type. Not surprisingly, the application of various grading systems in CNS neoplasia has been limited somewhat by interobserver variability. Since assignment of grade and tumor type is the basis upon which therapeutic intervention is grounded, investigators have been searching for ancillary means by which morphologically based systems can be improved. Utilization of cell proliferation markers in the evaluation of tumors can be potentially useful in this endeavor. This review focuses on issues surrounding the utilization of MIB-1 or Ki-67 antibody in the evaluation of CNS neoplasms.

Antibodies, Antinuclear↗
PubMed2004

Nurse-patient communication: an exploration of patients' experiences.

BACKGROUND: Patient-centred communication is a basic component of nursing and facilitates the development of a positive nurse-patient relationship which, along with other organizational factors, results in the delivery of quality nursing care. Nurses are frequently described in the literature as poor communicators, however, very few studies have examined patients' experiences of how nurses communicate. AIMS AND OBJECTIVES: The aim of the study was to explore and produce statements relating to patients' experiences of how nurses communicate. DESIGN: A qualitative perspective using an hermeneutic phenomenological approach was considered to be the most appropriate methodology for this study. METHODS: Using purposeful sampling, eight patients in a general teaching hospital in the Republic of Ireland were interviewed. Data were collected using unstructured interviews. Data analysis was a reflective process and the findings were presented through the description and interpretation of themes and sub-themes. RESULTS: Following data analysis four themes emerged. These were, 'lack of communication', 'attending', empathy' and 'friendly nurses'. CONCLUSIONS: The findings of this study indicate that, in contrast to the literature that suggests that nurses are not good at communicating with patients, nurses can communicate well with patients when they use a patient-centred approach. However, health care organizations do not appear to value or recognize the importance of nurses using a patient-centred approach when communicating with patients to ensure the delivery of quality patient care. RELEVANCE TO CLINICAL PRACTICE: The implication of these findings for clinical practice is that the task-centred approach to patient care that is associated with nursing in the past, appears to be alive and well. If health care management want to ensure that patients receive quality nursing care, they will need to consider patient-centred communication to be essential to encourage and support nurses to communicate in this manner.

Adult↗
PubMed1995

Reshaping ethnography: contemporary postpositivist possibilities.

Following Leinginger's introduction of ethnography into the field of nursing research, numerous descriptive and interpretive studies of health care beliefs and practices have been conducted. The resultant data have been translated into recommendations relative to the areas of nursing education, administration and clinical practice in an effort to ensure that the identified cultural needs are recognized and met. In this paper the discourses that inform such work are explored. Its practices and emergent dilemmas are reassessed in the light of an emerging body of work that challenges its foundational assumptions. Linked under the umbrella of 'postpositivist ethnography', such work recognizes the research area as a social and political field of which the researcher is an integral part. Hence, as an informed subject, the researcher, like the informants, is seen to be implicated in the generation of data. She, or he, is not charged with occupying the opposing roles of objective researcher and subjective participant, nor with reporting 'the truth' as told by informants. This emergent tradition is not without its dilemmas and of particular concern is the issue of authority; that is, whose voice constructs the text? As nursing academics grapple with questions regarding the nature of the knowledge that informs their discipline, it is imperative that they critique potentially fruitful research practices before they appropriate them. Failure to do so may lead them to unwittingly generate knowledge that is inimical to their particular quest. The 'new ethnography' discussed in this paper, offers academics and others interested in the generation of knowledge, not only a methodology that invites the possibility of opening up previously hidden areas of practice, but one that actively involves the researcher in challenging her taken-for-granted assumptions.

Ethnology↗