Research ethics in accessing hospital staff and securing informed consent.

Qualitative researchers cannot rely on research ethics to be a static practice. In this article we discuss how observation of guidelines for inquiry and international agreements on the dignity of health care research are not sufficient on their own to ensure that the challenges inherent in the everyday management of a project are regulated. We focus in particular on ethics in accessing participants and the construction of informed consent. During our study, important contrasts emerged between the ideal presented for the standard ethics review process and practical ethics. As a result, we focused on building open communication with the participants through rigorous project management. We analyzed the data and wrote this article collaboratively to represent the empirical reality of a team of researchers aiming to take ethical challenges seriously while collecting data in three National Health Service Trusts in the United Kingdom.

Accounting for the hero: a critical psycho-discursive approach to children's experience of domestic violence and the construction of masculinities.

This article employs a critical psycho-discursive approach to social identity processes and subjectivity in an important and under-researched area; the psychological impact of domestic violence on children. We use a case study of interview interaction with two teenage brothers talking about their father's past violent behaviour to show that a highly idealised, dominant form of hegemonic masculinity--'heroic protection discourse' (HPD)--was a major organising principle framing both brothers' understandings of events. However, significant differences occurred in how each boy identified and made sense of self and others within this discourse. We discuss our findings in terms of (1) the destructive power of HPD to position sons as responsible for a father's violent behaviour and (2) the utility of our approach for developing a better understanding of when, if or why psychological and behavioural problems associated with domestic violence are likely to develop in a particular child. In so doing, we hope to contribute to theoretical debates in social psychology on identity and subjectivity by showing how it is possible to make sense of the 'collision' between structure and agency through the study of social interaction.

It's just the worry about not being able to control it! A qualitative study of living with overactive bladder.

OBJECTIVES: This study reports the perceptions of patients with a diagnosis of OAB and people with undiagnosed OAB symptoms about their health-related quality of life (HRQL) and psychological consequences. DESIGN: A qualitative study which employed a series of in-depth, semi-structured individual and group interviews using thematic and interpretive techniques of data analysis. METHODS: A mixture of previously diagnosed patients and people bothered by OAB symptoms were recruited from three British cities. The interviews explored issues around HRQL. Data were transcribed verbatim and analysed thematically to draw out the context in which people experience OAB. The study design was reviewed by a Multi-Centre Research Ethics Committee and subjected to local research governance. RESULTS: OAB has devastating consequences for sufferers of both sexes which impact upon their HRQL, self-esteem and relationships. OAB without incontinence causes anxiety, fear of incontinence, a sense of depression and hopelessness all of which are worse for those with incontinence. Many sufferers feel too embarrassed to seek medical care. CONCLUSIONS: The psychological and HRQL consequences for OAB sufferers overlap with trajectories associated with chronic illness. However, because many sufferers avoid admitting to the condition and/or seeking treatment the psychological costs to them are even greater than with a diagnosed illness because the disruption remains unacknowledged and therefore unresolved.

What is 'normal' about women's (hetero)sexual desire and orgasm?: a report of an in-depth interview study.

This paper challenges the rapidly re-emerging medicalised model of women's sexual problems, or female sexual dysfunction, particularly those concerned with problems of orgasm. It reports a qualitative in-depth interview study of 33 women between the ages of 19 and 60 years (mean age 28.6 years) where the data analysis particularly focused upon their subjective perceptions of what constituted 'normal' sexual satisfaction for themselves and other women. The data comprised taped interviews which were fully transcribed and analysed using an interpretive framework based on both symbolic interactionist and psychodynamic concepts. The results indicated that these women's desires and expectations differed appreciably from those reported in the typical clinical and sexological literature. Women interviewed here seemed less concerned with achieving orgasm through heterosexual intercourse for themselves than the literature suggested they might be. There was however, evidence of a strong desire to experience orgasm in this way for the sake of their male partners. Thus, it is suggested that there is probably a closer relationship between popular beliefs about what is 'normal' based upon the medical model with women placing themselves in a dysfunctional category, than there is between the everyday enjoyment of sex and women identifying themselves as being sexually healthy.

Quality of life, distress and self-esteem: a focus group study of people with chronic bronchitis.

Chronic bronchitis (a form of chronic obstructive pulmonary disease or COPD) is a common cause of morbidity and mortality resulting in around 5% of deaths in the UK. Over recent years, there has been an increased emphasis on patient-based evaluation of health and social care, which has led to a rapid growth in quality of life measures and an increase in measuring quality of life for COPD patients. However, less attention has been paid to patients' perceptions and experiences of everyday life, specifically their active engagement in the psychological, emotional and social aspects of adjustment and adaptation to living with chronic bronchitis. This study employs a series of four focus groups (N = 20) to identify key experiences of living with chronic bronchitis. The results, obtained through using both thematic and conceptual qualitative analysis, within a broadly symbolic interactionist framework, describe the subjective and sometimes contradictory ways in which the disease leads to psychological distress, dependency on medication, and disruption to social and family relationships, and has a negative impact on self-esteem. The study further argues for greater awareness of qualitative approaches to the broad view of quality of life as complementary to quality of life assessments.

The meaning of 'satisfaction' for people with dermatological problems: reassessing approaches to qualitative health psychology research.

A qualitative study was undertaken to explore descriptions of satisfaction with health care, with 30 dermatology patients. The relevance and usefulness of the approach chosen to analyse the data-interpretative phenomenological analysis (IPA) was also retrospectively evaluated. The findings suggest that 'satisfaction' is a complex and fluid construct, which is defined, redefined and re-evaluated by participants throughout the interview process. IPA was useful in guiding the analysis. However, in order to build upon this approach, it is suggested that more attention be paid to the sequential nature of an individual account/interview, which might lead to a more informed understanding of the meaning of patient satisfaction.

Constructions of pregnant and postnatal embodiment across three generations: mothers', daughters' and others' experiences of the transition to motherhood.

The academic study of the 'body' has come to occupy the foreground over the past two decades and the differential influences of physical and social worlds particularly upon body management practices have become fundamental to the 21st-century 'project' of the body. In this article we explore three generations of women's accounts of living in/with a pregnant and postnatal body which is now both visible and 'public' as women 'leave' the home for work. However this now takes place in the context of public surveillance (and self-surveillance) particularly about food/eating, 'health' and 'beauty'.

Becoming an advanced practitioner in neonatal nursing: a psycho-social study of the relationship between educational preparation and role development.

AIMS AND OBJECTIVES: The aims of this research were to identify (a) the educational and working experiences and (b) subsequent training needs of graduates of one ANNP course in the UK. The objectives were (a) to assess the medium to long-term impact of the training programme on the professional development of the respondents; (b) identify potential areas of excellence and (c) areas for improvement in this and other training programmes for ANNPs. BACKGROUND: Neonatal intensive care continues to be a rapidly changing area of work. Nurses and doctors in neonatal intensive care units (NICUs) have to be skilled equally in interpersonal communications and technical expertise. The Advanced Neonatal Nurse Practitioner (ANNP) training programme was introduced in 1992 in the UK in the broader political context of extending nursing roles in a range of specialties. The role of the neonatal intensive care nurse had expanded elsewhere previously, particularly in North America as a response to medical staffing crises where the practice and the training/education programmes were expanded during the 1970s/1980s and continued to evolve to encompass an advanced role for the neonatal nurse practitioner. DESIGN: This was a study of five cohorts of graduates from one university course training programme for advanced neonatal practitioners (ANNPs) to explore their experiences of their role as ANNPs in the context of changes and developments in the British National Health Service and their own personal and professional development. METHODS: This study employs mixed methods (interviews, focus groups and a survey) and forms of data analysis (qualitative and quantitative) to explore the experiences of the transition to becoming an advanced practitioner. Data were collected from a sample of five cohorts; members of the current course team and the nursing and medical staff at one NICU which employs many of these graduates. RESULTS: Most graduates value their course experience and the ANNP role and the findings suggest that confidence about practice develops naturally with postcourse experience. However, the more experienced and confident ANNPs frequently reported increased inter-professional role confusion/conflict with junior doctors, and some consultants particularly where there are only one or two ANNPs overall in the team. CONCLUSIONS: There are personal and professional benefits to individual nurses who have had this training. However more attention needs to be paid to ongoing professional development particularly the management of professional role relationships among all nurses and between nurses and doctors. RELEVANCE TO CLINICAL PRACTICE: A focus on professional role relationships and more effective communication in the clinical setting would be of benefit to all members of multi-disciplinary teams. A greater level of day-to-day support is required for ANNPs, other neonatal nurses and junior doctors if this is to be achieved, especially in clinical settings where there are few ANNPs or the addition of these clinical specialists is relatively new.

Effectiveness of appropriately trained nurses in preoperative assessment: randomised controlled equivalence/non-inferiority trial.

OBJECTIVE: To determine whether preoperative assessments carried out by appropriately trained nurses are inferior in quality to those carried out by preregistration house officers. DESIGN: Randomised controlled equivalence/non-inferiority trial. SETTING: Four NHS hospitals in three trusts. Three of the four were teaching hospitals. PARTICIPANTS: All patients attending for assessment before general anaesthesia for general, vascular, urological, or breast surgery between April 1998 and March 1999. INTERVENTION: Assessment by one of three appropriately trained nurses or by one of several preregistration house officers. MAIN OUTCOME MEASURES: History taken, physical examination, and investigations ordered. Measures evaluated by a specialist registrar in anaesthetics and placed in four categories: correct, overassessment, underassessment not affecting management, and underassessment possibly affecting management (primary outcome). RESULTS: 1907 patients were randomised, and 1874 completed the study; 926 were assessed by house officers and 948 by nurses. Overall 121/948 (13%) assessments carried out by nurses were judged to have possibly affected management compared with 138/926 (15%) of those performed by house officers. Nurses were judged to be non-inferior to house officers in assessment, although there was variation among them in terms of the quality of history taking. The house officers ordered considerably more unnecessary tests than the nurses (218/926 (24%) v 129/948 (14%). CONCLUSIONS: There is no reason to inhibit the development of nurse led preoperative assessment provided that the nurses involved receive adequate training. However, house officers will continue to require experience in preoperative assessment.