Critical feminist narrative inquiry: advancing knowledge through double-hermeneutic narrative analysis.

Critical feminist narrative inquiry is informed by the theoretical triangulation of critical, feminist, and symbolic interactionist perspectives. We first locate this approach within narrative research and identify the epistemological underpinnings and assumptions supporting this innovative methodology. The analytic and interpretive objectives and processes involved to achieve a double-hermeneutic narrative analysis are detailed. We conclude by proposing that this novel approach is suitable to advance knowledge about the nature and context of individual experiences, to expose circumstances leading to social injustice and health inequities, and ultimately to contribute to improved health outcomes for traditionally silenced, marginalized, or vulnerable populations.

Two-eyed seeing: a framework for understanding indigenous and non-indigenous approaches to indigenous health research.

This article presents two-eyed seeing as a theoretical framework that embraces the contributions of both Indigenous and Western "ways of knowing" (world-views). It presents key characteristics and principles of these different perspectives and suggests ways in which they might be used together to answer our most pressing questions about the health of Indigenous people and communities. Presenting a critique of positivism, which has historically undermined and/or dismissed Indigenous ways of knowing as "unscientific," it discusses the origins of both Western and Indigenous approaches to understanding health; the importance of giving equal consideration to diverse Indigenous and non-Indigenous worldviews such that one worldview does not dominate or undermine the contributions of others; and how balanced consideration of contributions from diverse worldviews, embraced within a two-eyed seeing framework, can reshape the nature of the questions we ask in the realm of Indigenous health research.

Conceptual parameters of acculturation within the Asian and Pacific Islander American populations: applications for nursing practice and research.

TOPIC: Asian and Pacific Islander Americans (A&PIAs) are experiencing health inequities. For example, A&PIA is the only racial/ethnic group in America to experience cancer as their leading cause of death. Several studies within the A&PIA population have pointed to acculturation as a significant variable to explain their health and health-seeking behaviors. Acculturation is a key construct in understanding the health of the A&PIA population. OBJECTIVE: The purpose of this concept analysis is to provide a current conceptual understanding of the relationship between acculturation and health, especially within the A&PIA populations, which will serve as a pragmatic guideline for nursing practice and research. Understanding the contemporary issues surrounding the conceptual application of acculturation will aid in the development of appropriate programs to reduce health inequities. METHODS: Acculturation was explored using the Morse method of concept analysis. An iterative historical and contemporary literature review across the disciplines of anthropology, sociology, psychology, medicine, and nursing was completed. Analytical questions asked of the resultant data provided the theoretical definition, antecedents, key attributes, outcomes, and implications. RESULTS: The concept analysis resulted in a new theoretical definition that includes multidimensional concepts of acculturation. Dilemmas in the measurement of key attributes of acculturation include unidirectional and bidirectional analysis, psychometric issues, and the appropriateness of proxy measurements. Outcomes of acculturation on health can be positive or negative and depend on an individual's or group's ability to navigate freely with necessary supports. Results of the conceptual analysis resulted in recommendations for nursing practice and future acculturation research. CONCLUSION: While debate continues about the appropriate use and definition of acculturation, researchers agree that it is an important construct in understanding the health of migrating individuals and groups. Currently there is no testable framework that delineates the role of acculturation in health. Further research is indicated to clarify the relationship between acculturation and health.

Online communities of practice as a communication resource for community health nurses working with homeless persons.

AIMS: This study explored community health nurses' viewpoints about a Canadian online community of practice to support their practice with homeless or under-housed populations. BACKGROUND: Community health nurses who specifically work with homeless and marginally housed populations often report feelings of isolation and stress in managing complex problems in resource constraints. To strengthen intra-professional ties and enhance information access, an online community of practice was designed, implemented and evaluated by and for them. METHODS: Q-methodology was used. Sixty-six statements about the community of practice were collected from an online survey and focus groups, refined and reduced to 44 statements. In 2009, sixteen participants completed the Q-sort activity, rating each statement relative to the others. Scores for each participant were subjected to by-person factor analysis. RESULTS: Respondents fell into two groups -tacit knowledge warriors and tacit knowledge communicators. Warriors strongly believed that the community of practice could combat stigma associated with homelessness and promote awareness of homelessness issues, and valued its potential to validate and improve practice. Communicators would have used the community of practice more with increased discussion, facilitation and prompt responses. Generally, nurses viewed the community of practice as a place to share stories, validate practice and adapt best practices to their work context. CONCLUSIONS: Online communities of practice can be valuable to nurses in specialized fields with limited peer support and access to information resources. Tacit knowledge development is important to nurses working with homeless populations: this needs to be valued in conjunction with scientifically based knowledge.

Translation of health surveys using mixed methods.

PURPOSE: The purpose of this study was to determine the effectiveness of a process-based translation method for a health survey instrument, Searching for Hardships and Obstacles to Shots (SHOTS), using a community-based participatory approach with the Hmong community. DESIGN: The study was based on a cross-sectional survey to assess the reliability and validity of the SHOTS immunization survey, an instrument used in the Hmong community, who are refugees originally from Laos living in the United States. METHOD: Process-based universalistic health survey translation methods were used in a six-step procedure to translate the instrument. Mixed methods were used to analyze results, including cognitive interviewing, content validity indexing, Cronbach's α, t tests, and the Kolmogorov-Smirnov test. FINDINGS: Participants were able to accurately complete the SHOTS survey in either Hmong or English, depending on participant preference. CONCLUSIONS: Universalistic, process-based, mixed methods used to analyze language translation, in combination with the principles of community-based participatory research, provide effective methods to translate health surveys. Involvement of the community strengthens the quality of translation and improves reliability and validity of survey results. CLINICAL RELEVANCE: Healthcare providers require accurate and reliable information from evidence-based health surveys to plan for culturally responsive care. Cross-cultural research often relies on language translation. Translation of a health survey instrument may be improved with universalistic, process-based methodology.

Culturally sensitive community engaged research with African American young women: lessons learned.

The use of culturally sensitive research approaches is of paramount importance in conducting community-engaged research with African American communities. The purpose of this article is to describe the development and use of culturally and community sensitive research methods in a study to understand social messages about pregnancy and childbearing among low-income urban African American adolescent girls. Key elements of this community accepted focused ethnography study are described, including study design, recruitment, data collection, and analysis techniques.

Methodological challenges of researching in the care home sector.

Freda Mold, Julia Roberts, Joanne Fitzpatrick and Louise Barriball address the challenges encountered while undertaking a feasibility study to elicit the views of care home nurse managers on the needs of minority ethnic older residents. It includes advice for those who plan to conduct empirical work in this sector.

Q-methodology: an alternative approach to research in nurse education.

An understanding of student experiences and perspectives are central to the delivery of quality nurse education programmes; implicit with this is a need to understand the attributes and characteristics of such individuals, their subjectivity. Traditional such inquiry has taken the form of questionnaires or interviews and focus groups. Q-methodology is offered as an alternative approach which provides insight into, and a method for studying, individual subjectivity through the use of factor analysis. Within Q-methodology, individuals are asked to rank-order (Q-sort) statements, which are then intercorrelated and subjected to factor analysis. In this way groups of individuals holding similar expressed subjectivities are identified. The factors are interpreted to provide an understanding of underlying subjectivities. This paper explores the theoretical underpinnings of Q-methodology and its application as a research method in the field of nurse education, providing a brief illustration of its use in mental health nurse education.

Burnout and physical and mental health among Swedish healthcare workers.

AIM: This paper is a report of a study to investigate how burnout relates to self-reported physical and mental health, sleep disturbance, memory and lifestyle factors. BACKGROUND: Previous research on the possible relationship between lifestyle factors and burnout has yielded somewhat inconsistent results. Most of the previous research on possible health implications of burnout has focused on its negative impact on mental health. Exhaustion appears to be the most obvious manifestation of burnout, which also correlates positively with workload and with other stress-related outcomes. METHOD: A cross-sectional study was conducted, using questionnaires sent to all employees in a Swedish County Council (N = 6118) in 2002. The overall response rate was 65% (n = 3719). A linear discriminant analysis was used to look for different patterns of health indicators and lifestyle factors in four burnout groups (non-burnout, disengaged, exhausted and burnout). RESULTS: Self-reported depression, anxiety, sleep disturbance, memory impairment and neck- and back pain most clearly discriminated burnout and exhausted groups from disengaged and non-burnout groups. Self-reported physical exercise and alcohol consumption played a minor role in discriminating between burnout and non-burnout groups, while physical exercise discriminated the exhausted from the disengaged group. CONCLUSION: Employees with burnout had most symptoms, compared with those who experienced only exhaustion, disengagement from work or no burnout, and the result underlines the importance of actions taken to prevent and combat burnout.

Computer-assisted software transcription of qualitative interviews.

John Alcock and Ron Iphofen examine a method to assist with interview transcription using free, open source computer software and digital recordings, and consider some underlying practical, ethical and philosophical issues.

Measuring individualized nursing care: assessment of reliability and validity of three scales.

AIM: This paper is a report of a study to assess the reliability and convergent validity of three measures of nursing care individualization. BACKGROUND: Individualized care is a key element of nursing care quality, yet little is known about the extent to which it is implemented, its effects, and the factors that help or hinder nurses in giving individualized care. Therefore reliable and valid instruments are needed to measure individualized nursing care. METHOD: A cross-sectional correlational survey design was used. The purposive sample consisted of 861 patients from six hospitals in Finland (response rate 82%). Data were collected in 2004. The Individualized Care Scale was administered simultaneously with translated versions of the Schmidt's Perceptions of Nursing Care Survey and the Oncology Patients' Perceptions of the Quality of Nursing Care Scale. Internal consistency reliability and convergent validity were assessed for each scale. FINDINGS: Evidence for convergent validity was identified between the Individualized Care Scale (part A/B), the Individualization subscale (r = 0.64 with Part A, r = 0.66 with part B) and the Seeing the Individual Patient subscale (r = 0.68 with part A, r = 0.71 with part B). Cronbach alpha coefficient was 0.97 for the Individualized Care Scale, 0.82 for Seeing the Individual Patient and 0.87 for the Individualization subscale. CONCLUSION: Data provided preliminary evidence for the convergent validity of the individualized care scales, as well as acceptable internal consistency reliability for each scale. These scales represent useful measures for assessing patients' perceptions of the individualization of nursing care received.

Impact of nurse prescribing: a qualitative study.

AIM: This paper is a report of an investigation of the impact of prescribing on a group of recently qualified nurse prescribers in the United Kingdom. BACKGROUND: The creation of advanced nursing roles, and specific skills such as nurse prescribing, has resulted in nurses taking on roles that have traditionally been associated with doctors. The non-doctor prescribing initiative is continually developing and many nurses are now able to prescribe independently from almost the same range of medicines as doctors. Despite the advantages that appear to stem from nurses prescribing, some nurse researchers have been cautious about the impact that prescribing may have on the nursing profession. METHOD: Interviews were conducted during 2005 and 2006 with 45 nurse prescribers. All nurses had successfully qualified and registered as prescribers. Interviews were analysed thematically in line with the principles of grounded theory. FINDINGS: Prescribing allows nurses to overcome difficulties in the healthcare system that previously delayed patients' access to medicines. Prescribing is viewed as more than an 'add on' to current roles, it complements many aspects of nursing and integrates previously diffuse aspects of the nursing role. This enables nurses to adopt a more holistic approach to patient care and prescribing. Prescribing has the potential to increase job satisfaction and autonomous working, with the result that nurses are more likely to involve patients in decision-making about their care. CONCLUSIONS: Prescribing enhances nurses' knowledge about medication and increases their confidence to engage in prescribing decisions across the healthcare team. Nurse prescribing has the potential to improve service-user care, enhance collaboration and widen discussions about medicines. However, team members need to be prepared for the impact nurse prescribing could have on the dynamics of the multidisciplinary team. Preparatory information about nurse prescribing should be provided to all team members by trainee nurse prescribers. Information could include details about the proposed scope of future prescribing roles, allowing team members to consider how their roles could develop.

Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups.

AIMS: This integrated literature review seeks to identify the key considerations in conducting focus groups and discusses the specific considerations for focus group research with culturally and linguistically diverse groups. BACKGROUND: The focus group method is a technique of group interview that generates data through the opinions expressed by participants. Focus groups have become an increasingly popular method of data collection in health care research. Although focus groups have been used extensively with Western populations, they are a particularly useful tool for engaging culturally and linguistically diverse populations. The success of focus groups in this context is dependent upon the cultural competence of the research team and the research questions. METHODS: The electronic databases Medline, CINAHL, Embase, Psychlit and the Internet using the Google Scholar search engine were explored using the search terms 'focus group', 'cultural sensitivity', 'transcultural nursing', 'transcultural care', 'cultural diversity' and 'ethnic groups'. Hand searching of reference lists and relevant journals was also undertaken. English language articles were selected for the review if they discussed the following issues: (i) methodological implications of the focus group method; (ii) strengths and limitations of the focus group method; (iii) recommendations for researchers and (iv) use of the focus group in culturally and linguistically diverse groups. Conclusions were drawn from each of the articles and consensus regarding a summary of recommendations was derived from a minimum of two authors. RESULTS: Findings from this review revealed several key issues involving focus group implementation including recruitment, sample size, data collection, data analysis and use within multicultural populations. Strengths and limitations of the focus group method were also identified. CONCLUSIONS: Focus groups are a useful tool to expand existing knowledge about service provision and identify consumer needs that will assist in the development of future intervention programmes, particularly within multicultural populations. Careful planning related to methodological and pragmatic issues are critical in deriving effective data and protecting participants. RELEVANCE TO CLINICAL PRACTICE: Focus groups can facilitate increased understanding of perspectives of culturally and linguistically diverse groups and thereby shape clinical practice to better meet the needs of these groups.

Research-as-if-practice: a study of family nursing partnership with couples experiencing severe breathing difficulties.

Living with the symptoms of lung disease is challenging. The impact difficult breathing has on individuals and their families is frequently underestimated, with health care limited to managing physical manifestations of the origins of difficult breathing. This study describes a distinct approach to family nursing practice named partnership, which is based on a participatory worldview. Five couples in which the wife had severe breathing difficulties participated in the study. The research process is described as as-if-practice. The partnership process was illustrated in the theme "finding coherence in life with symptoms and treatment regimens." The outcome of the process was illustrated in the interrelated themes of "living life fully and taking things as they come" and "efficient use of health care." The study shows how the meaning that unfolded in the process reveals the insights of all participants into the families' health predicaments and what can be done with that insight.

The value of integrating interpretive research approaches in the exposition of health care context.

AIM: This paper discusses the use of a nested set of methodologies (dramaturgy, ethno-methodology and ethnography) to characterize and interpret the settings, practices and interactions inherent in the health care environment. The aim is to explain how a set of methodologies can help make sense of research data in the clinical setting. BACKGROUND: Despite the recognition of the importance of the context of care there has been limited debate about the use and value of research methods and methodologies and how they can be best applied to the health care context. DISCUSSION: Using dramaturgy the physical and social scene can clearly be established, to enable insight into 'how the scene is contrived'. The ethno-methodological approach assists in the examination of taken-for-granted assumptions inherent in the interactions between individuals in the 'scene', and the underlying 'shared' knowledge within interactions. 'Shared knowledge' identifies knowledge as a medium for communication. The use of ethnography ensures that social and cultural symbols, which are an integral component of how individuals collectively attribute meaning to places and events, become a significant part in the interpretation of interactions. CONCLUSION: The combination of these methods is advantageous in assisting qualitative researchers in the health care environment to 'make sense' of their complex field notes.

Job satisfaction in nursing: validation of a new instrument for the UK.

AIM: To develop a new, valid and reliable instrument that has been designed and evaluated to measure job satisfaction as perceived by nurses with specific aspects of contemporary nursing. BACKGROUND: Job satisfaction is a key concept within workforce research in nursing and is particularly important within the present climate in the UK due to findings linking satisfaction with both quality of care and retention of nurses. METHOD(S): Exploratory and confirmatory factor analyses were carried out on a large longitudinal dataset from a study of Adult-branch diploma-qualified nurses in England who completed the scale at three time-points after qualification. RESULTS: A six-factor solution was supported and replicated in a further sample of recently qualified graduate nurses. The instrument was also acceptably reliable. CONCLUSION: This new instrument is a concise, highly practical and flexible tool, which can be used in a range of health care settings and in different measurement contexts.

Enhancing the quality of hermeneutic research: decision trail.

BACKGROUND: Researchers have ethical and professional obligations to produce research of a high standard. The constituents of quality in research appear to differ between authors, leaving readers unsure about which pathway to follow. This can reflect inadequate consideration of the theoretical framework guiding the study. Many papers fail to consider the theoretical underpinnings of the methodology chosen and the link between these and the methods employed. These need to be accessible to readers in order to assess the trustworthiness of the research. AIM: This paper discusses the development of trustworthiness in hermeneutic phenomenological research. DISCUSSION: Referring to a study on lived experience of Chronic Fatigue Syndrome/myalgic encephalitis, I describe the decision trail and discuss the strengths and limitations of the choices made throughout the study. CONCLUSION: The methodology focused my approach more fully on the importance of recognizing the influences that I brought to the study and the impact of these in generating the data. It highlighted the fact that the process of setting out my horizon can never be complete, the importance of analysing the data at a macro and micro level, acknowledging the evolution of the data over time, and ensuring that analysis does not move beyond the data and out of the hermeneutic circle. In seeking to make the decision trail clear to others, researchers must distill the philosophical principles of the methodology and set these out in a way that is accessible and open to scrutiny.

A Q-methodological study on nursing students' attitudes toward nursing ethics.

PURPOSE: Professional nursing ethics is a living, dynamic set of standards for nurses'professional moral behavior. Furthermore, in daily clinical nursing training, nursing students are constantly confronted with decision-making that is moral in nature. The aim of this study was to identify the perceived ethical attitudes in the clinical training process of senior nursing students using Q-methodology to offer basic strategies for nursing ethics education and thereby improve patients'care. METHODS: Q-methodology provides a scientific method for identifying perception structures that exist within certain individuals or groups. Thirty-seven participants in a university rated 38 selected Q-statements on a scale of 1-9. The collected data were analyzed using pc-QUNAL software. RESULTS: Principal component analysis identified 3 types of ethical attitudes in nursing students in Korea. The categories were labeled Sacred-life, Science-realistic and Humane-life. Sacred-life individuals think that a life belongs to an absolute power (God), not a man, and a human life is a high and noble thing. Science-realistic individuals disagreed that allowing an induced abortion or embryo (human) duplication is unethical behavior that provokes a trend, which takes the value of a life lightly; most of them took a utilitarian position with respect to ethical decisions. Humane-life individuals exhibit a tendency toward human-centered thought with respect to ethical attitudes. CONCLUSION: This study will be of interest to educators of students of nursing and hospital nursing administrators. Also, the findings may provide the basis for the development of more appropriate strategies to improve nursing ethics education programs.

Development of cultural belief scales for mammography screening.

PURPOSE/OBJECTIVES: To develop instruments to measure culturally related variables that may influence mammography screening behaviors in African American women. DESIGN: Instrumentation methodology. SETTING: Community organizations and public housing in the Indianapolis, IN, area. SAMPLE: 111 African American women with a mean age of 60.2 years and 64 Caucasian women with a mean age of 60 years. METHODS: After item development, scales were administered. Data were analyzed by factor analysis, item analysis via internal consistency reliability using Cronbach's alpha, and independent t tests and logistic regression analysis to test theoretical relationships. MAIN RESEARCH VARIABLES: Personal space preferences, health temporal orientation, and perceived personal control. FINDINGS: Space items were factored into interpersonal and physical scales. Temporal orientation items were loaded on one factor, creating a one-dimensional scale. Control items were factored into internal and external control scales. Cronbach's alpha coefficients for the scales ranged from 0.76-0.88. Interpersonal space preference, health temporal orientation, and perceived internal control scales each were predictive of mammography screening adherence. CONCLUSIONS: The three tested scales were reliable and valid. Scales, on average, did not differ between African American and Caucasian populations. IMPLICATIONS FOR NURSING: These scales may be useful in future investigations aimed at increasing mammography screening in African American and Caucasian women.