Qualitative analysis of a nurse's responses to stroke caregivers on a web-based supportive intervention.

BACKGROUND: Approximately 800 000 people experience a stroke every year; most are cared for by unpaid family members in home settings. Web-based interventions provide 24/7 access to education/support services and have been explored in the literature with family caregivers dealing with chronic conditions. Current research into nurses' web-based interactions with caregivers in these interventions is lacking. OBJECTIVE: The aim of this qualitative secondary data analysis was to examine a nurse specialist's responses and advice that she gave in a web-based supportive intervention for stroke family caregivers used in a randomized controlled trial for 1 year. METHODS: Using a qualitative research design, caregivers were recruited from rehabilitation facilities in Ohio and Michigan (n = 36). They accessed the intervention's email forum and discussion group facilitated by the nurse. These email message data were examined using rigorous content analysis. RESULTS: The caregivers were primarily white women caring for a spouse, with an average age of 54 years. From the 2148 email messages between the nurse and caregivers, five themes emerged and were drawn to Friedemann's Framework. These themes included: getting to know the situation (Friedemann's coherence and individuation), validating emotions (individuation), promoting self-care (individuation), assisting in role adaptation (system maintenance and individuation), and providing healthcare information (system maintenance and individuation). CONCLUSIONS: These caregivers of stroke survivors were asking for advice, seeking support, and looking for information from an advanced practice nurse. Nurses, and others, in supportive roles can use these findings to promote informed care and directed interventions for caregivers dealing with stroke and its outcomes.

Linking theory with qualitative research through study of stroke caregiving families.

PURPOSE: This theoretical article outlines the deliberate process of applying a qualitative data analysis method rooted in Friedemann's Framework of Systemic Organization through the study of a web-based education and support intervention for stroke caregiving families. METHODS: Directed by Friedemann's framework, the analytic method involved developing, refining, and using a coding rubric to explore interactive patterns between caregivers and care recipients from this 3-month feasibility study using this education and support intervention. Specifically, data were gathered from the intervention's web-based discussion component between caregivers and the nurse specialist, as well as from telephone caregiver interviews. FINDINGS AND CONCLUSIONS: A theoretical framework guided the process of developing and refining this coding rubric for the purpose of organizing data; but, more importantly, guided the investigators' thought processes, allowing them to extract rich information from the data set, as well as synthesize this information to generate a broad understanding of the caring situation.

Implementation of Agile in healthcare: methodology for a multisite home hospital accelerator.

BACKGROUND: The diffusion of innovation in healthcare is sluggish. Evidence-based care models and interventions take years to reach patients. We believe the healthcare community could deliver innovation to the bedside faster if it followed other sectors by employing an organisational framework for efficiently accomplishing work. Home hospital is an example of sluggish diffusion. This model provides hospital-level care in a patient's home instead of in a traditional hospital with equal or better outcomes. Home hospital uptake has steadily grown during the COVID-19 pandemic, yet barriers to launch remain for healthcare organisations, including access to expertise and implementation tools. The Home Hospital Early Adopters Accelerator was created to bring together a network of healthcare organisations to develop tools necessary for programme implementation. METHODS: The accelerator used the Agile framework known as Scrum to rapidly coordinate work across many different specialised skill sets and blend individuals who had no experience with one another into efficient teams. Its goal was to take 40 weeks to develop 20 'knowledge products',or tools critical to the development of a home hospital programme such as workflows, inclusion criteria and protocols. We conducted a mixed-methods evaluation of the accelerator's implementation, measuring teams' productivity and experience. RESULTS: 18 healthcare organisations participated in the accelerator to produce the expected 20 knowledge products in only 32 working weeks, a 20% reduction in time. Nearly all (97.4%) participants agreed or strongly agreed the Scrum teams worked well together, and 96.8% felt the teams produced a high-quality product. Participants consistently remarked that the Scrum team developed products much faster than their respective organisational teams. The accelerator was not a panacea: it was challenging for some participants to become familiar with the Scrum framework and some participants struggled with balancing participation in the Accelerator with their job duties. CONCLUSIONS: Implementation of an Agile-based accelerator that joined disparate healthcare organisations into teams equipped to create knowledge products for home hospitals proved both efficient and effective. We demonstrate that implementing an organisational framework to accomplish work is a valuable approach that may be transformative for the sector.

Reduction of post-surgical pericardial adhesions using a pig model.

BACKGROUND: Post-surgical pericardial adhesions pose an increased risk of complications during redo sternotomies. Adhesive tissue formation is a normal response to tissue injury and involves complex patho-physiological processes including the actions of prostaglandins to cause plasma leakage and fibrin formation. The purpose of this study was to assess the ability of two non-steroidal anti-inflammatory agents (Indomethacin and Rofecoxib) and a barrier (Coseal, a polyethylene glycol) to limit adhesion formation following cardiac surgery in a pig model. METHODS: Forty-four piglets were allocated equally to four treatment groups: Group 1: Control, Group 2: intramuscular Indomethacin, Group 3: oral Rofecoxib and Group 4: Coseal sprayed on the heart. A full median sternotomy was performed on each animal and the heart exposed. Adhesions were induced by rubbing tissues with gauze, applying sutures and leaving blood in the pericardial sac before chest closure. Plasma inflammatory markers including prostaglandin E(2) and thromboxane B(2) were measured preoperatively and on Days 2, 5 and 10 after surgery. Eight animals from each group were slaughtered after 12 weeks and 3 after 25 weeks. Adhesions were assessed macroscopically and microscopically. RESULTS: Compared to the Control group, the extent of adhesions was significantly less in all other groups whilst adhesion density was least in the Indomethacin and Coseal groups. Indomethacin and less so Rofecoxib, inhibited the synthesis of prostaglandin E(2) and thromboxane B(2) but there were no significant changes in other inflammatory markers. CONCLUSIONS: We conclude that systemic Indomethacin, and locally applied Coseal are suitable methods to markedly reduce pericardial and retrosternal adhesions.

Caregivers' incongruence: emotional strain in caring for persons with stroke.

PURPOSE: Guided by Friedemann's framework, the purpose of this study was to examine the dimensions of new family caregivers' emotional strain in caring for persons with stroke. METHOD: Seventy-three caregivers who were new to that role participated in an interview every 2 weeks for a year as part of a NIH project. Of these caregivers, 36 participants were randomly assigned and had access to a Web-based intervention and its e-mail discussion. In this secondary data analysis, 2,148 e-mail discussion messages plus 2,455 narrative interview entries were used to examine dimensions of caregivers' emotional strain. Rigorous content analysis was applied to these data. RESULTS: The majority of these caregivers were white women with an average of 55 years who cared for spouses. Three themes emerged from these data: (1) being worried, (2) running on empty, and (3) losing self. DISCUSSION: Caregivers worried about themselves and their care recipient, sharing feelings of being just "plain tired." The caregivers felt that their lives were lost to giving care. They described in detail the emotional strain that they felt, as they took on new roles in caring for the person with stroke. CONCLUSION: This study informs nurses about new family caregivers' emotional strain, or incongruence in Friedemann's terms, from their viewpoint and provides direction for supportive education interactions.

Two sides to the caregiving story.

PURPOSE: This descriptive study examined problems and successes that a sample of 73 adult caregivers new to the role expressed in the first year of caring for stroke survivors. Data were collected from May 2002 to December 2005. METHOD: Bimonthly, trained telephone interviewers asked the participants open-ended questions to elicit their experience in caregiving. Guided by Friedemann's framework of systemic organization, we analyzed the data using Colaizzi's method of content analysis. RESULTS: There were 2,455 problems and 2,687 successes reported. Three themes emerged from the problems: being frustrated in day-to-day situations (system maintenance in Friedemann's terms), feeling inadequate and turning to others for help (coherence), and struggling and looking for "normal" in caring (system maintenance vs. change). Three themes were attributed to the successes: making it through and striving for independence (system maintenance), doing things together and seeing accomplishments in the other (coherence), and reaching a new sense of normal and finding balance in life (individuation and system maintenance). CONCLUSION: These findings provided an in-depth, theorybased description of the experience of being a new caregiver and can help explain how caring can be a difficult yet rewarding experience. Knowledge of the changes over time allows health care professionals to tailor their interventions, understanding, and support.

Battered pets and domestic violence: animal abuse reported by women experiencing intimate violence and by nonabused women.

Women residing at domestic violence shelters (S group) were nearly 11 times more likely to report that their partner had hurt or killed pets than a comparison group of women who said they had not experienced intimate violence (NS group). Reports of threatened harm to pets were more than 4 times higher for the S group. Using the Conflict Tactics Scale, the authors demonstrated that severe physical violence was a significant predictor of pet abuse. The vast majority of shelter women described being emotionally close to their pets and distraught by the abuse family pets experienced. Children were often exposed to pet abuse, and most reported being distressed by these experiences. A substantial minority of S-group women reported that their concern for their pets' welfare prevented them from seeking shelter sooner. This seemed truer for women without children, who may have had stronger pet attachments. This obstacle to seeking safety should be addressed by domestic violence agencies.

Communicative competence in the delivery of bad news.

Grounded in the Cegala and Waldron (Communication Studies 43 (1992) 105) model of communicative competence, the present study applied the McNeilis (Health Communication 13 (2001) 5) provider-patient coding scheme to video tapes of 3rd year medical students delivering bad news to a standardized patient. The goal of the study was to understand the specific communicative moves that are associated with perceptions of competence during bad news delivery. The coding scheme assesses Content, Acknowledgment Tokens, Interruptions, Alignment, and Function of the message. Naïve observers also evaluated the tapes on several items, assessing empathy and communicative effectiveness. Nonmedical talk was the most common type of content, followed by discussion of the current health problem. Neither acknowledgment tokens nor interruptions were frequent. The most common function of a message was a closed question, followed by explanations, assertions, and open questions. Summing across the functions indicated that information giving was the nost common behavior. The perceivers' data showed fairly neutral assessments of the medical students--they were generally not evaluated very positively, although they were not disliked. Regression analyses indicated numerous specific communicative behaviors that were associated with judgments of competence. Statements falling into the Nonspecific Content category were associated with more positive perceptions, while relational statements, moderately closed questions, solicited answers, expansions, restatements, assertions, explanations, open questions, bracketing, and small talk as well as information verifying, seeking, and giving (summed functions) led to more negative perceptions. The results indicate that the delivery of bad news requires communicative moves that differ from other kinds of medical communication. Depending on the results of future analyses of this topic health are providers may be well advised to focus little of their communication information seeking, giving, or verifying during the initial lab news delivery consultation, but rather to save most communication information for a follow-up scheduled shortly afterwards.

Family conversations about organ donation.

OBJECTIVE: To describe family conversations about organ donation and to examine interrelationships among the content and outcomes of these conversations, and attitudes toward organ donation. DESIGN: Closed and open-ended survey questions. PARTICIPANTS: 353 men and 488 women. MAIN OUTCOME MEASURES: Content analysis of reports of conversations and of reactions of family members to the conversations, as well as closed items assessing both those issues and attitudes toward donation. RESULTS: Most respondents who were willing to donate their organs had not talked with their families about their donation wishes. Conversations that did occur were typically about the patient's donation wishes and moral and altruistic reasons for donation, or included a story about donation. These approaches, as well as talking about the reasons for wishing to donate, were associated with positive responses from family members, whereas discussing fears about being declared dead prematurely or about the medical establishment were associated with negative responses.

Caregivers dealing with stroke pull together and feel connected.

Changes that can accompany stroke may create considerable stress for individuals caring for the affected person. This study explored the coping process for nine rural-dwelling caregivers of persons with stroke and the responses of these caregivers to a Web-based support program. The qualitative data management program QSR N 5 was used to analyze quotes from telephone interviews and computer entries. Stories of how caregivers came together and supported one another emerged from the data collected as part of a larger study that examined the experience of caring. Friedemann's framework of systemic organization guided data analysis and interpretation. Actions demonstrated by the caregivers illustrated the process of crisis resolution through family togetherness in which nurses were included. The findings of this study aided in understanding this process and gave direction for nurses working with such clients.

RehabNurse-L: an analysis of the rehabilitation nursing LISTSERV experience.

Computer-mediated discussion is a form of communication via the Internet through groups known as listservs, chatrooms, bulletin boards, newsgroups, or discussion forums. An increasing number of professionals are using these forums to ask and answer common concerns about their practices. Deeper meaning lies within messages that is broader than just an individual posting or a simple communication thread. The messages can have far-reaching effects. Our purpose in this qualitative research was to understand why RehabNurse-L LISTSERV (RehabNurse) participants use the listserv, describe their RehabNurse experiences, how they used information from postings, and their perception of the value of using RehabNurse for their practice. The Rehabilitation Nursing Foundation funded this study. Nurses identified the RehabNurse as a means of "keeping up," sharing, learning, problem solving, and support within their practice. They appraised the information posted on RehabNurse in search of credible entries as well as experiences similar to their own. Nurse respondents described their RehabNurse involvement in terms of community and connectedness, identifying roles familiar to the participants. Rehab-Nurse postings not only were shared within the discussion group, but also extended to their work environment--team members, peers, administrators, patients, and families.

You've got mail: rehabilitation nurses on the RehabNurse-L LISTSERV.

Rehabilitation nursing is a specialty with its own values, beliefs, practice, and language. Nurses are socialized to a specialty through their work interactions, professional readings, and professional affiliations. In this new millennium, nurses can communicate beyond their immediate environment with peers around the world through e-mail discussion groups (e.g., LISTSERV). The Association of Rehabilitation Nurses (ARN) created the RehabNurse-L LISTSERV in May 1999 to provide a vehicle for nurses to network with colleagues worldwide. In this study, we reviewed the communications posted on that LISTSERV in an 18-month period to identify the discussion topics and the demographics of the 475 people who became members of the LISTSERV simply by logging onto the site. Of that number, 318 posted some type of communication--whether it be a comment or a question or a response to a previously-asked question. Members were from Australia, Canada, Finland, Ireland, Portugal, Slovenia, the United Kingdom, and the United States. Topics discussed included professional and clinical issues, disability and impairment, administration and regulation, cultural and international issues, and LISTSERV housekeeping issues. LISTSERV provides quick access to peers, an avenue for information sharing, and a unique support system--all of which offer many potential benefits to professional nurses in their daily practice.

The effect of curriculum on the attitudes of nursing students toward disability.

Societal attitudes toward people with differing abilities are often based on a lack of understanding, fear of the unkNown, and stereotypes learned from others. Nursing students enter their educational programs with similar attitudes and experiences. Attitudes of nurses are key to how they respond toward individuals with disabilities and chronic illnesses. The nurses' attitudes affect the individual client's understanding of the disability and his or her self-concept as he or she adjusts to major life changes. The purpose of this descriptive study was to identify whether a change in curriculum and experience had an effect on nursing student attitudes. Using the Attitudes Toward Disabled Persons (ATDP) Scale, a pre-post study of 42 nursing students' attitudes toward individuals with disabilities was conducted. Tests were administered as the students entered their senior year and took the chronic illness course, and again at the completion of the senior year. The students' attitudes were significantly more positive at the completion of their senior year. The findings suggest that education about, and experience with, individuals with disabilities positively affect the attitudes of nursing students toward individuals with disabilities.