Lived experience of the intensive care unit for patients who experienced delirium.

BACKGROUND: Delirium is a common occurrence for patients in the intensive care unit and can have a profound and lasting impact on them. Few studies describe the experience of intensive care patients who have had delirium. OBJECTIVE: To understand the lived experience of intensive care for critically ill patients who experienced delirium. METHODS: The study participants consisted of 7 men and 3 women, 46 to 70 years old, who had delirium according to the Confusion Assessment Method for the Intensive Care Unit. The van Manen method of hermeneutic phenomenology was used, and data collection entailed audio recorded semistructured interviews. RESULTS: Four themes were detected: "I can't remember," "Wanting to make a connection," "Trying to get it straight," and "Fear and safety concerns." CONCLUSION: Nurses working in intensive care units need to assess patients for delirium, assess the mental status of patients who have delirium, and help patients and patients' families learn about and deal with the psychological effects of the intensive care unit experience.

"It is my destiny as a woman": on becoming a new mother in Indonesia.

PURPOSE: The purpose of the study was to provide a greater understanding of the experience of the new Indonesian mother. DESIGN: This study was a hermeneutic phenomenological study. Data were obtained from 13 first time Indonesian mothers through semi-structured interviews. FINDINGS: Two main themes were identified: "trying to be a good mother " and "confirming my destiny as a woman." A number of subthemes were identified to understand of how women in rural West Java perceived the meaning of being a new mother. These themes and subthemes described the woman's responsibilities as a new mother and some of the challenges that she accepted as a part of her destiny. CONCLUSION: This study provides nurses and others with insights into the experiences of Indonesian women with early motherhood, their feelings about taking on the mothering role, and some of their needs during this period.

Constant negotiating: managing work-related musculoskeletal disorders while remaining at the workplace.

We used grounded theory to explore processes and strategies used by workers affected by work-related musculoskeletal disorders (WMSDs) while they remained in the workplace, and we developed a theory to describe the overall process. Participants included 25 workers affected by WMSDs who were currently employed in various workplaces in Newfoundland and Labrador, Canada. The theoretical model has five main phases: (a) becoming concerned, (b) getting medical help, (c) dealing with the workplace, (d) making adjustments to lifestyle, and (e) taking charge, each with separate subphases. Constant negotiating was the core variable that explained the overall process, with workers engaged in negotiations with others in occupational, health, and social contexts. Using a two-dimensional figure, we illustrate the negotiation strategies workers used. We discuss implications for health care, workplaces, education, and research for creating a culture of understanding and respect for injured workers who wish to remain working after developing WMSDs.

Understanding the role of communities of practice in evidence-informed decision making in public health.

In this article we report on qualitative findings that describe public health practitioners' practice-based definitions of evidence-informed decision making (EIDM) and communities of practice (CoP), and how CoP could be a mechanism to enhance their capacity to practice EIDM. Our findings emerged from a qualitative descriptive analysis of group discussions and participant concept maps from two consensus-building workshops that were conducted with public health practitioners (N = 90) in two provinces in eastern Canada. Participants recognized the importance of EIDM and the significance of integrating explicit and tacit evidence in the EIDM process, which was enhanced by CoP. Tacit knowledge, particularly from peers and personal experience, was the preferred source of knowledge, with informal peer interactions being the favored form of CoP to support EIDM. CoP helped practitioners build relationships and community capacity, share and create knowledge, and build professional confidence and critical inquiry. Participants described individual and organizational attributes that were needed to enable CoP and EIDM.

Organ donation experiences of family members.

The objective of this qualitative research study was to describe and interpret what life is like for individuals who have consented to donate the organs of a deceased relative for transplantation. This study captures the meaning of this phenomenon in a way to help nurses develop new insights into the lives of these individuals, enable them to implement strategies to better assist and support the family, and perhaps decrease barriers to organ donation. Thematic analysis of the participants' narrative descriptions identified five essential themes: the struggle to acknowledge the death, the need for a positive outcome of the death, creating a living memory, buying time, and the significance of support networks in the organ donation decision. The integration of these themes revealed the essence of the experience as creating of a sense of peace. These five themes and the essence of the experience are discussed in relation to the literature, followed by recommendations for future nursing practice, education, and research.

The lived experience of fathers who have children with asthma: a phenomenological study.

Asthma is a common chronic illness of childhood and a major cause of school absenteeism and hospitalization. When a child is diagnosed with asthma, parents become responsible for the long-term management of a chronic condition that is characterized by unpredictable and irregular episodes. Much of the research concerning parenting children who have asthma had focused on mothers. Paternal experiences in caring for a child with asthma have received little attention. In this phenomenological study, van Manen's (Researching Lived Experience: Human Science for an Action Sensitive Pedagogy. The Althouse Press: London, ON) method of inquiry was used to explore the lived experience of fathers who have children with asthma. Eight fathers with children aged between 7 and 11 years who had been diagnosed with asthma were interviewed. Five themes were identified: feeling relief in knowing the diagnosis, learning the ropes, being vigilant, living with concern, and being comfortable with asthma management. Understanding the experience of fathers who have children with asthma and gaining insight into their needs and concerns are essential first steps to providing supportive nursing care.

Losing one's memory in early Alzheimer's disease.

A Heideggerian hermeneutical phenomenological research method was used to investigate the experience of memory loss in twelve individuals with early Alzheimer's disease or mild cognitive impairment. Data analysis proceeded as described by Diekelmann, Allen, and Tanner (1989), and incorporated the methods of Benner (1994), Thomas and Pollio (2002), and van Manen (1990). Three constitutive patterns with relational themes were identified. The first pattern, experiencing breakdown, consisted of two themes: awakening to breakdown and living with forgetting. The second pattern, temporality, consisted of three themes: being in the nothing, forgetting the past, and looking ahead. The third pattern, managing forgetting, consisted of the themes: remembering with cues, writing things down, recognizing what made remembering better or worse, and using laughter. The finding show that early Alzheimer's disease is more than an illness of cognitive losses and that forgetting is significant in light of the meaning that it has within everyday life.

A responsive evaluation of an Aboriginal nursing education access program.

Nursing education access programs have been introduced in a number of countries to address the shortage of healthcare providers of Aboriginal descent. An evaluation study of a nursing education access program in Labrador, Canada, was undertaken using a Responsive Evaluation approach. Interviews and focus groups with program stakeholders were conducted. Program effectiveness was influenced by culturally relevant curriculum, experiential and authentic learning opportunities, academic and social support, and the need for partnership building between stakeholders. The authors report key findings resulting from the Responsive Evaluation.

Prostate cancer screening attitudes and continuing education needs of primary care physicians.

BACKGROUND: In May 2003, a survey questionnaire was distributed to all licensed primary care physicians in Newfoundland and Labrador. The objective was to examine the attitudes, self-reported practices, and continuing medical education (CME) preferences of primary care physicians as they pertain to prostate cancer screening. METHODS: Data was obtained from 485 primary care physicians using self-reports of prostate cancer screening practices, attitudes towards prostate cancer screening, and CME preferences. Respondents' characteristics were also collected (eg, gender, years of experience). RESULTS: A majority of respondents screen asymptomatic male patients for prostate cancer. Screening behaviour was related to high volume practice settings, fee-for-service and increased with patient age. Most common reasons for screening were family history, age of patient, and patient request. Majority of physicians agreed that prostate screening should be routinely performed on all men beginning at age 50, however half of physicians believe there is lack of evidence to support digital rectal examination (DRE) and one-third of physicians do not believe the prostate-specific antigen (PSA) nor DRE are accurate screening tests. Areas of greatest interest for CME included topics related to prostate cancer screening effectiveness, strategies for prevention, sexual dysfunction, available treatments and their side effects, and management options. CONCLUSION: Physicians are supportive of the value of screening, however the reliability of and evidence to support DRE and PSA as prostate cancer screening tests are in question. CME which addresses issues surrounding prostate screening and areas related to patient education and counselling are of greatest need.

Experiences of rural women with breast cancer receiving social support via audioconferencing.

We examined the process of social support for breast cancer survivors in rural Newfoundland and Labrador. The subjects were 11 participants in a social support programme that made use of audioconferencing. The core social psychological process by which women received social support consisted of four distinct but overlapping stages: getting connected to the network; finding a voice; connecting with others; and becoming empowered. The findings suggested that support groups facilitated via audioconferencing can transcend geographical distance and permit women living in rural areas to share experiences with each other and to learn from and teach each other. The use of telephone and audioconferencing technologies should be encouraged for the provision of information and support to people in rural settings, where such services may be especially beneficial.

A comparison of the mental health of employed and unemployed women in the context of a massive layoff.

The purpose of this study was to assess the impact of unemployment on the mental health of women in the context of massive unemployment. Comparisons were made between the level of mental distress experienced by unemployed and employed women, in two areas of Newfoundland, Canada that were affected by the northern cod moratorium. In addition, the relationships between women's mental distress and a number of variables were explored. Questionnaires were administered to 112 unemployed and 112 employed women three years after the moratorium began. The unemployed women reported significantly poorer mental well-being in the year prior to data collection. At the time of the study, however, both groups of women were experiencing high levels of distress. The moratorium, financial problems, and feelings of uncertainty were identified as key stressors for all the women, but especially for those without work. Among the working women, past experience with unemployment and level of education had significant correlations with their mental well-being.

Struggling to understand: the experience of nonsmoking parents with adolescents who smoke.

Smoking among adolescents is a major public health concern. Most parents would not want their children engaged in this risk-taking behavior. Although a majority of parents of smokers are themselves smokers, many are nonsmokers. The purpose of this grounded theory study was to understand what nonsmoking parents experience due to their adolescent children 's smoking behavior. The purposive sample consisted of 25 parents. The interview data generated the theory that nonsmoking parents struggle to understand their adolescents' smoking. They experienced four stages: discovering the smoking, facing the problem, reflecting, and waiting it out. Their experience can be examined from a stress paradigm. Programs are needed that provide parents with the knowledge and skills required for effective prevention and intervention strategies.