Ways of knowing on the Internet: A qualitative review of cancer websites from a critical nursing perspective.

People diagnosed with cancer typically want information from their doctor or nurse. However, many individuals now turn to the Internet to tackle unmet information needs and to complement healthcare professional information. The purpose of this study was to qualitatively explore the content of commonly searched cancer websites from a critical nursing perspective, as this information is accessible, and allows patients to address their information needs in ways that healthcare professionals cannot. This qualitative examination of websites is informed by Carper's fundamental patterns of knowing and complemented with the critical view to technology espoused by the philosophy of technology. We conducted a review of 20 websites using a two-step interpretive descriptive approach and thematic analysis. We identified the dominant discourse to be focused on empirical information on treatment, prognosis, and cure, and a paucity of sociopolitical, ethical, personal, and esthetic information. In place of holistic, nuanced, and accurate knowledge nurses may provide, patients find predominantly empirical and biomedical information online. Discussion explores and critiques online cancer content, gaps in information, and the importance of information diversity. Implications focus on needed discourse around pervasive technologies and the nursing role in assessing and directing patients to holistic information.

Developing and piloting an online graduate nursing course focused on experiential learning of qualitative research methods.

Despite the turmoil of a worldwide economic crisis, the health sector remains largely understaffed, and the nursing shortage represents a major issue that jeopardizes graduate nursing education. Access to education remains a challenge, particularly in rural and remote areas. This article reports the process of developing an asynchronous online qualitative research course. This online course was piloted among 16 interdisciplinary students. Participants agreed that experiential learning was useful to understand the intricacies of qualitative research. Within this constructivist approach, students were immersed in real-life experiences, which focused on the development of skills applicable to qualitative research. Based on the findings, we suggest that constructivism and the Four-Component Instructional Design (4C/ID) model (a four-part approach for fostering the development of complex skills) represent valuable ontological and pedagogical approaches that can be used in online courses. Triangulating these two approaches is also congruent with the student-centered philosophy that underpins nursing graduate programs.

The hope experience of older bereaved women who cared for a spouse with terminal cancer.

In this study we explore the experience and processes of hope of older women who were bereaved after caring for a spouse with terminal cancer, and we develop a tentative, emerging theory of their hope experience. We used constructivist grounded theory methods. We conducted 30 open-ended, in-depth, audiotaped interviews with 13 western Canadian women, aged 60 to 79 years, within the 1st year of bereavement, and collected 12 hope diaries. Data were analyzed using constant comparative analysis. Participants defined hope as a gradual process of regaining inner strength and building self-confidence to make sense of their completely changed situations. They were learning to stay positive and move ahead with their lives. The participants' main concern was losing hope, which they dealt with by searching for new hope through finding balance, new perspectives, and new meaning and purpose. The emerging theory is conceptualized as a spiral within the complex social context of bereavement after caregiving.

Caring for bereaved family caregivers: analyzing the context of care.

Deaths from cancer will continue to rise with an increasing and aging population. Family caregivers of patients with cancer will face loss, grief, and bereavement as a result. As mandated by cancer and palliative care clinical practice guidelines, support for family caregivers continues through the processes of grief and bereavement to facilitate a positive transition through loss. To provide evidence-based nursing with this population, an analysis of their context of care was undertaken. Key health policies, characteristics of the healthcare delivery system, and the results of research with bereaved palliative caregivers are described. A model of effectiveness, efficiency, and equity is used to examine the situation of bereaved caregivers and to suggest research questions to fill the gaps in what is known about their needs and experience. Bereaved caregivers are at high risk for many distressing symptoms, including depression and sleeplessness, related to a range of complex variables, such as age, gender, social support, resources, and their experiences during caregiving. Current systems of support have not been adequate to meet the needs of this population and very little is known about the caregivers' quality of life, well-being, and health outcomes or how best to provide compassionate and effective nursing care.

The experience of hope for informal caregivers of palliative patients.

This study explored the experience of hope for informal caregivers of palliative patients. Interviews were conducted with 10 caregivers living with and providing care to a palliative patient. The interview data were analyzed using grounded theory qualitative methods. "Eroding hope" was their main concern--a result of bad days, negative messages, and experiences with the health care system. The participants dealt with eroding hope by "hanging on to hope." Hanging on to hope had four subprocesses: a) doing what you have to do, b) living in the moment, c) staying positive, and d) writing your own story. The support of friends, family, and health care professionals, and spiritually connecting with something bigger and stronger were subprocesses. These findings have application for informal caregivers providing palliative care at home, as a basis for assessment and interventions. Health care professionals need to recognize and value the experience of hope for the informal caregivers of palliative patients.

Depressive symptoms, grief, and complicated grief among family caregivers of patients with advanced cancer three months into bereavement.

PURPOSE/OBJECTIVES: to describe depressive symptoms, grief, and complicated grief for bereaved family caregivers of patients who died from cancer-related causes and to explore relationships among these variables. DESIGN: a nonexperimental, secondary analysis of cross-sectional descriptive data from a longitudinal intervention study evaluating the effect of providing feedback from standardized assessment tools. SETTING: two large, private, not-for-profit hospices in Florida. SAMPLE: convenience sample of 280 family caregivers, bereaved three months. METHODS: secondary analysis of self-report, survey data three months following death. MAIN RESEARCH VARIABLES: depressive symptoms, grief, and complicated grief. FINDINGS: Three months after the loss of a loved one, 34% of the caregivers had clinically meaningful scores for depressive symptoms. A significant number of bereaved caregivers were experiencing grief and depression. CONCLUSIONS: bereaved caregivers were experiencing significant levels of depressive symptoms and complicated grief. Caregivers with higher levels of grief had more depressive symptoms. IMPLICATIONS FOR NURSING: tools are available to identify bereaved caregivers most in need of intervention.

Walking a fine line: an exploration of the experience of finding balance for older persons bereaved after caregiving for a spouse with advanced cancer.

PURPOSE OF THE RESEARCH: During the past decade, research regarding cancer patients has become more prevalent, however research regarding the needs of their family caregivers is limited. The purpose of this study was to explore the ways in which caregivers, who survive the loss of their spouse to cancer, find balance in their lives. METHODS AND SAMPLE: A constructivist grounded theory approach was undertaken which included the analysis of in depth interviews, journal entries and the researcher's field notes and memos. Interviews were conducted with 10 bereaved caregivers (7- females, 3-males) ranging in age from 66 to 83 years old. The data included 21 interviews and 8 journals. KEY RESULTS: For bereaved caregivers "walking a fine line" emerged as a major process, balancing between "deep grieving" and "moving forward" in order to successfully create a new life without their partner. The main concern of the participants was "losing control" of balance. The emergence of these processes reveals the importance of addressing the bereaved caregivers' need to find balance within their new lives. CONCLUSIONS: The findings of this study highlight the unique needs of bereaved caregivers who have lost a spouse to cancer, and provides a basis for ongoing research focused on assessment and intervention. Further research is needed to determine whether the process of finding balance is similar in other groups of caregivers who are bereaved.

Ways of knowing hope: Carper's fundamental patterns as a guide for hope research with bereaved palliative caregivers.

Carper's ways of knowing in nursing, empirics, esthetics, personal knowing, and ethics, provide a guide to holistic practice, education, and research. The origin and evolution of the ways of knowing are discussed and applied to current and proposed hope research with bereaved palliative caregivers, with the ultimate goal of promoting healthy, positive outcomes for this unique population. Bereaved palliative caregivers have unmet needs that may be addressed by research exploring hope during grief. For example, research from an empirical perspective identifies hope as a variable in grief resolution, esthetic knowing guides qualitative research on hope, personal knowing provides a constructivist philosophy to a qualitative inquiry, and ethical knowing includes the moral obligation for evaluation research. Unknowing and sociopolitical knowing offer a critical perspective as research is developed and applied, while considering complexity and social context. Nursing research from diverse epistemological perspectives will enhance the effectiveness and appropriateness of evidence-based practice.