Systematic review of the nature of nursing care described by using the Caring Behaviours Inventory.

AIM: To describe the nature of care received by patients measured through the Caring Behaviours Inventory. BACKGROUND: Professional nursing practice combines two dimensions of caring: instrumental care and expressive care. Instrumental care focuses on physical health needs, in terms of efficiency and employs interventions based on evidence. Expressive care is patient-centred and based on the interpersonal relationship. It requires caring attitudes that include respect, kindness, sensitivity and patience. The Caring Behaviours Inventory is a tool designed to assess the care expressed through the behaviours nurses perform, contextualised within the Jean Watson's Theory of Human Caring. METHODS: A systematic review following PRISMA recommendations. Scopus, PubMed and CINAHL databases were consulted using the keywords "Caring Behaviours Inventory" AND "Nursing". The Joanna Briggs Institute tool was used for the quality appraisal. A conceptual analysis and a thematic synthesis were performed for data extraction. RESULTS: 11 articles were selected. Three categories were identified: nature of caring, congruence between perceived care by patients and nurses, and factors associated with the expression of care. DISCUSSION: An emphasis on care of an instrumental nature was identified. The perception of patients differs from that of nurses, patients perceive a lower level of expressive caring than the one nurses believe to deliver. Caring behaviours are affected by the working environment, nurses' emotional intelligence and coping skills, and socio-demographic characteristics. CONCLUSION: This paper described the findings of previous research regarding the nature of care that is transmitted and received in clinical practice. Results highlight an emphasis on the instrumental aspect of the nursing care according to the patients' perception. RELEVANCE TO CLINICAL PRACTICE: Findings summarised in this review could contribute to a better understanding of the nursing care. Results reported in this paper could also help to improve the quality of care delivered by nurses as well as patient-centeredness.

Ethical considerations when conducting joint interviews with close relatives or family: an integrative review.

BACKGROUND: Researchers are obligated to do no harm to participants of research. Conflicts in relationships can cause negative well-being; therefore, insight is needed into the particular ethical considerations that arise when conducting joint interviews with close relatives or family members simultaneously in the healthcare setting. AIM: To collect and share knowledge related to ethical considerations conducting joint interviews. DESIGN AND METHODS: A literature review inspired by the integrative review method was performed. Data were retrieved through a structured search in PubMed, CINAHL and the Philosopher's Index and Academic Search Premier for articles published in English from 1980 to 2016 and included 18 articles, of a possible 2153. Article content was assessed line-by-line, and ethical considerations were extracted and organized in three subgroups regarding: Planning joint interviews; Conduction joint interviews and Reporting on joint interviews Findings: Participants should be offered the best terms for a constructive, on-going relationship after the joint interview has ended. This obligates the researcher to ensure a safe environment during the joint interview and create a delicate balance between the needs of the participants, using nonconfrontational techniques that foster equal and neutral but dedicated attention to all parties, before, during and after the joint interviews. CONCLUSION: Specific ethical considerations should be taken into account before, during and after joint interviewing. Further research is needed before a final conclusion can be drawn.

A methodological review of qualitative longitudinal research in nursing.

Qualitative longitudinal research (QLR) provides temporal understanding of the human response to health, illness, and the life course. However, little guidance is available for conducting QLR in the nursing literature. The purpose of this review is to describe the methodological status of QLR in nursing. With the assistance of a medical librarian, we conducted a thorough search circumscribed to qualitative, longitudinal nursing studies of patients' and care-givers' experiences published between 2006 and 2016. The methodological quality of the 74 reviewed studies varied tremendously; many reports lacked sufficient detail in reporting on sampling and attrition, retention strategies, and data collection and analysis, making it difficult for readers to evaluate the credibility and transferability of study findings. Based on the strengths and limitations of the studies reviewed and findings in the literature, we provide recommendations for enhancing the reporting of the research process as a supplement to the standards for qualitative research more broadly. These recommendations are offered in the spirit of encouraging dialogue among colleagues and assisting journal reviewers and editors in their evaluation of QLR.

Data analysis: comparison between the different methodological perspectives of the Grounded Theory. / Análise de dados: comparação entre as diferentes perspectivas metodológicas da Teoria Fundamentada nos Dados.

Grounded Theory (GT) has undergone many transformations since its proposition as a research method in the 1960s. As a result of these changes, three different GT approaches have been outlined: classic, straussian and constructivist ground theory, each with its peculiarities, but mainly concerning data analysis. Thus, this study aimed to describe and compare the data analysis process adopted by the different methodological perspectives of GT. The text is organized into two topics. Firstly, we present the common and differentiating characteristics of the three methodological perspectives of GT. In sequence, the data analysis system adopted in each of the GT methodological perspectives is described and exemplified, varying between two and three stages, and may or may not include the use of the paradigmatic model. Thus, this study provides support for understanding the different data analysis systems adopted in GT, which may contribute to the rigor and scientific quality of nursing research adopting this method.

Conflict between Family Caregivers and Staff in Nursing Homes: Feasibility of the Daily Diary Method.

OBJECTIVE: The purpose of this study was to investigate the daily diary method (DDM) for assessing family-staff conflicts in nursing homes, to provide descriptive information on conflict, and to examine the relationship between conflict and mood among family caregivers. METHODS: Participants were nine caregivers that experienced conflict with staff on an ongoing basis. They were contacted daily by telephone for 14 days and were asked (1) whether a conflict had occurred, (2) to describe the severity and type of conflict, and (3) to rate their positive and negative affect. RESULTS: Compliance was excellent with no attrition, and there were only 2 missing data points over 126 potential observations. Conflicts occurred on 22% of the days, were rated as moderately severe, and were related to poor resident care, lack of information, and staff attitudes. Participants reported significantly lower positive affect (p < .05) and higher negative affect (p < .001) on conflict versus no-conflict days. Exit interviews indicated positive attitudes towards the DDM. CONCLUSIONS: These results support the feasibility of the DDM for providing an in-depth understanding of family-staff conflict and its relationship to caregivers' mood. CLINICAL IMPLICATIONS: The DDM would ideally be used as an outcome measure in studies that assess interventions that target high-conflict family-staff relationships.

Sensitive Interviewing in Qualitative Research.

In this paper we focus on important considerations when planning and conducting qualitative interviews on sensitive topics. Drawing on experiences of conducting interviews with dementia caregivers, a framework of essential elements in qualitative interviewing was developed to emphasize study participants' needs while also providing guidance for researchers. Starting with a definition of sensitive research, the framework includes preparing for interviews, interacting with gatekeepers of vulnerable groups, planning for interview timing, and location, building relationships and conducting therapeutic interactions, protecting ethically vulnerable participants, and planning for disengagement. This framework has the potential to improve the effectiveness of sensitive interviewing with vulnerable groups. © 2016 Wiley Periodicals, Inc.

Maximizing Theoretical Contributions of Participant Observation While Managing Challenges.

Participant observation (PO) is an important method of data collection used in a variety of research methodologies. PO can inform theory development by providing understanding of participants' behaviors and the contexts that influence their behaviors. Because theory development is important in grounded theory studies, we emphasize theoretical contributions of PO while interrogating the challenges of using PO, in particular, attending to informed consent. We use the exemplar of a mid-range theory about nursing practice with hospitalized older adults to highlight contributions of PO to category development. While acknowledging theoretical contributions, we explore challenges entailed in observations where consenting participants interact with vulnerable patients and a changing cast of health care professionals in dynamic contexts. Reflexivity about interactions with vulnerable individuals, as well as other actions to avoid compromising voluntary consent, enhances contributions of PO.

Nursing researchers' modifications of Ricoeur's hermeneutic phenomenology.

Paul Ricoeur's hermeneutic phenomenology has proved to be very helpful in guiding nursing researchers' qualitative analysis of interview transcripts. Modifying Ricoeur's philosophy, a number of nursing researchers have developed their own interpretive methods and shared them, along with their experience, with research community. Major contributors who published papers directly presenting their modifications of Ricoeur's theory include Rene Geanellos (2000), Lena Wiklund, Lisbet Lindholm and Unni Å. Lindström (2002), Anders Lindseth and Astrid Norberg (2004) and Pia Sander Dreyer and Birthe D Pedersen (2009). The aim of this article was to delineate differences among these methods. Descriptive presentation of each method side by side makes clear the differences among them. In addition, Ricoeur's hermeneutic theory is portrayed and compared with the modifications. It is believed that differences that are found can stimulate further thoughts on how to apply Ricoeur's theory in qualitative research in nursing.

Toward interventions to address moral distress: navigating structure and agency.

BACKGROUND: The concept of moral distress has been the subject of nursing research for the past 30 years. Recently, there has been a call to move from developing an understanding of the concept to developing interventions to help ameliorate the experience. At the same time, the use of the term moral distress has been critiqued for a lack of clarity about the concepts that underpin the experience. DISCUSSION: Some researchers suggest that a closer examination of how socio-political structures influence healthcare delivery will move moral distress from being seen as located in the individual to an experience that is also located in broader healthcare structures. Informed by new thinking in relational ethics, we draw on research findings from neuroscience and attachment literature to examine the reciprocal relationship between structures and agents and frame the experience of moral distress. CONCLUSION: We posit moral distress as a form of relational trauma and subsequently point to the need to better understand how nurses as moral agents are influenced by-and influence-the complex socio-political structures they inhabit. In so doing, we identify this reciprocity as a framework for interventions.

Children's lived experiences of hematopoietic stem cell transplantation.

Although hematopoietic stem cell transplantation is a valuable treatment in many life-threatening pediatric disorders, a large number of children who receive hematopoietic stem cell transplantation are faced with a variety of physical and psychological problems throughout this process. In this study, we explored the lived experiences of these children during their treatment to provide a better understanding of their main concerns, emotions, and expectations. The participants were six children, aged between 6 and 17 years, who underwent hematopoietic stem cell transplantation. Data were collected through individual, in-depth, and semistructured interviews. Using interpretive phenomenological analysis, the findings revealed that the children experienced "transplantation rejoicing" in this "difficult passage", which was associated with "deepening of family ties". Awareness of these experiences, feelings, and concerns can help in the development of more professional interventions to provide children with holistic care during their hospitalization.

An introduction to the biographical narrative interpretive method.

AIM: To introduce the biographical narrative interpretive method (BNIM) to nurse researchers in search of a new methodology and method. BACKGROUND: Listening to and interpreting the narratives of patients is a core feature of nursing. Research methodologies and methods frequently do not fully take into account the historical, psycho-social and biographical dynamics of people's lives. DATA SOURCES: This paper draws from the experiences of both authors who have previously utilised the BNIM method, as well as sourcing relevant literature. REVIEW METHODS: This is a methodology paper that reviews the historical context of BNIM and provides an overview of its potential application for nursing research. Discussion The core assumptions and analytic strategy of BNIM focus on three inter-related facets: the person's whole life history or story (biography), how they tell it (narrative) and the social interpretation (interpretive). BNIM uses a unique interviewing technique to elicit an uninterrupted story from participants. The BNIM analytic tool is formulaic and uses nine stages to analyse individual cases. A tenth stage helps with analysis across cases. CONCLUSION: BNIM methodology and methods empower participants to articulate the vicissitudes of their life and experiences of illness while also providing the researcher with a framework for data analysis and interpretation to give meaning to individuals' life stories. IMPLICATIONS FOR RESEARCH/PRACTICE: The BNIM interview technique and analytic framework are useful tools to help with an in-depth qualitative exploration of life stories in context.

The roots and development of constructivist grounded theory.

AIM: To deconstruct how Charmaz's constructivist grounded theory (CGT) evolved from the original ideas of Glaser and Strauss, and to explore how CGT is similar to and different from the original grounded theory (GT). BACKGROUND: The origins of GT date to 1967 with Glaser and Strauss's study of the treatment of dying individuals, applying an inductive method allowing for the development of theory without the guidance of a preconceived theory. CGT moves away from the positivism of the Glaserian and Straussian GT schools, approaching GT through a constructivist lens that addresses how realities are made. DATA SOURCES: This article does not involve the collection and analysis of primary data; instead, academic literature written by leaders in the field of GT was reviewed to generate the ideas presented. REVIEW METHODS: Comprehensive literature review drawing on the 'integrative review' principles. DISCUSSION: When selecting a GT approach, the possibility of a congruence between the chosen methodology and the worldviews of the researcher's discipline and own outlook should be considered. CONCLUSION: The differences among the various schools of GT lie in their overarching goals and their perspectives of the nature of reality. IMPLICATIONS FOR RESEARCH/PRACTICE: Considering the alignment between the constructivist worldview and the field of nursing, CGT offers a valuable methodology for researchers in this area.

Challenges in combining different data sets during analysis when using grounded theory.

AIM: To describe the challenges in combining two data sets during grounded theory analysis. BACKGROUND: The use of grounded theory in nursing research is common. It is a suitable method for studying human action and interaction. It is recommended that many alternative sources of data are collected to create as rich a dataset as possible. DATA SOURCES: Data from interviews with people with diabetes (n=19) and their family members (n=19). REVIEW METHODS: Combining two data sets. DISCUSSION: When using grounded theory, there are numerous challenges in collecting and managing data, especially for the novice researcher. One challenge is to combine different data sets during the analysis. There are many methodological textbooks about grounded theory but there is little written in the literature about combining different data sets. CONCLUSION: Discussion is needed on the management of data and the challenges of grounded theory. IMPLICATIONS FOR RESEARCH/PRACTICE: This article provides a means for combining different data sets in the grounded theory analysis process.

Conducting qualitative research in the context of pre-existing peer and collegial relationships.

AIM: To highlight issues and challenges faced in recruitment and interviewing during a study that sought to explore the transition of nurses into academic life and the associated ethical implications. BACKGROUND: This paper explores the challenges faced in conducting research where the potential participants are peers and workplace colleagues. There are advantages when conducting research with those among whom a pre-existing relationship is shared. However, difficulties can also arise. REVIEW METHODS: A methodological review was undertaken. Key database searches included CINAHL, MEDLINE, PubMed, Scopus and Google Scholar using the keywords as search terms. Studies were included if they described in detail issues surrounding qualitative interviewing of peers and colleagues. DISCUSSION: Management of the issues involved is discussed, with emphasis on boundaries, trust and rapport, the use of self-disclosure and maintaining confidentiality. CONCLUSION: Research involving peers and colleagues has received relatively little consideration in the literature. There are difficulties associated with interviewing participants with whom the researcher has a pre-existing and ongoing relationship in the same organisation. To ensure ethical conduct, strategies can be used to mitigate negative situations such as issues surrounding dual roles, practising reflexivity, trust and rapport, self-disclosure and confidentiality. IMPLICATIONS FOR RESEARCH/PRACTICE: It is imperative that dual roles are declared and acknowledged. Researchers need to be mindful of the difficulties that may occur and prioritise participants' confidentiality and privacy.

Adapting qualitative research strategies to technology savvy adolescents.

AIM: To adapt research strategies involving adolescents in a grounded theory qualitative research study by conducting email rather than face-to-face interviews. BACKGROUND: Adolescent culture relies heavily on text-based communication and teens prefer interactions mediated through technology. Traditional qualitative research strategies need to be rethought when working with adolescents. Adapting interviewing strategies to electronic environments is timely and relevant for researching adolescents. DATA SOURCES: Twenty three adolescents (aged 16-21) were interviewed by email. A letter of invitation was distributed. Potential participants emailed the researcher to convey interest in participating. If the inclusion criteria were met, email interviews were initiated. Participants controlled the interviews through their rate of response to interview questions. REVIEW METHODS: A grounded theory methodology was employed. Initial contact with participants reiterated confidentiality and the ability to withdraw from the study at any time. Interviews began with the collection of demographic information and a broad opening based on a semi-structured interview guide. All data were permissible, including text, photos, music, videos or outside media, for example YouTube. The participant was allowed to give direction to the interview after initial questions were posed. Email interviews continued until saturation was reached in the data. DISCUSSION: Participants were enthusiastic about email interviewing. Attrition did not occur. Email interviewing gave participants more control over the research, decreased power differentials between the adolescent and researcher, allowed the study to be adapted to cultural, linguistic and developmental needs, and maintained confidentiality. CONCLUSION: As participants said that email communication was slow and they preferred instant messaging, replication in faster-paced media is recommended. Repetition in face-to-face settings is warranted to evaluate how technology may have influenced the findings. Implications for practice/research Adolescents' use of the internet and their preference for textbased communication makes a compelling support for modifying traditional face-to-face qualitative investigations to reflect these changing contextual conditions.

Engaging men with penile cancer in qualitative research: reflections from an interview-based study.

AIM: To explore the challenges of engaging men with penile cancer in qualitative interview research. BACKGROUND: Qualitative interviewing offers an ideal tool for exploring men's experiences of illness, complementing and providing context to gendered health inequalities identified in epidemiological research on men. But conducting interviews with men can be challenging and embarking on a qualitative interview study with males can feel like a daunting task, given the limited amount of practical, gender-sensitive guidance for researchers. Reflecting on a researcher's experience of conducting qualitative research on men with penile cancer, this paper explores the potential challenges of interviewing this group, but also documents how engagement and data collection were achieved. REVIEW METHODS: This is a reflective paper, informed by the experiences of a male researcher (KW) with no nurse training, who conducted 28 interviews with men who had been treated for penile cancer. The researcher's experiences are reported in chronological order, from the methodological challenges of recruitment to those of conducting the interview. IMPLICATIONS FOR PRACTICE/RESEARCH: The paper offers a resource for the novice researcher, highlighting some advantages and disadvantages of conducting qualitative interview research as a nurse researcher, as well as recommendations on how to overcome challenges. CONCLUSION: Engaging men with penile cancer in qualitative interview raises practical, methodological, ethical and emotional challenges for the researcher. However, when these challenges are met, men will talk about their health. Methodological procedures must enable an open and ongoing dialogue with clinical gatekeepers and potential participants to promote engagement. Support from colleagues is essential for any interviewer, no matter how experienced the researcher is.

Reflections on the added value of using mixed methods in the SCAPE study.

AIM: To reflect on the added value that a mixed method design gave in a large national evaluation study of specialist and advanced practice (SCAPE), and to propose a reporting guide that could help make explicit the added value of mixed methods in other studies. BACKGROUND: Recently, researchers have focused on how to carry out mixed methods research (MMR) rigorously. The value-added claims for MMR include the capacity to exploit the strengths and compensate for weakness inherent in single designs, generate comprehensive description of phenomena, produce more convincing results for funders or policy-makers and build methodological expertise. DATA SOURCES: Data illustrating value added claims were drawn from the SCAPE study. REVIEW METHODS: Studies about the purpose of mixed methods were identified from a search of literature. DISCUSSION: The authors explain why and how they undertook components of the study, and propose a guideline to facilitate such studies. CONCLUSION: If MMR is to become the third methodological paradigm, then articulation of what extra benefit MMR adds to a study is essential. The authors conclude that MMR has added value and found the guideline useful as a way of making value claims explicit. IMPLICATIONS FOR PRACTICE/RESEARCH: The clear articulation of the procedural aspects of mixed-methods research, and identification of a guideline to facilitate such research, will enable researchers to learn more effectively from each other.

Fact or fiction: exploring the use of real stories in place of vignettes in interviews with informal carers.

AIM: To consider the development and use of real stories rather than vignettes in interviews. BACKGROUND: Effective interprofessional working critically informed by the perspectives of informal carers was considered by the research team to be under-researched. It was proposed initially to use fictional vignettes as triggers in interviews with informal carers. It could be argued that the vignette does not represent the voice of the individual or may only represent a particular experience. Stories acknowledge a person's expertise in his or her experiences. A decision was made early in the design process to use real stories instead of vignettes. DATA SOURCES: A descriptive naturalistic design using a participatory approach. Two stories were developed by the researcher and two informal carers, and then used in interviews with other carers to explore their experiences and perceptions of interprofessional working. REVIEW METHODS: The paper provides a discussion of an alternative approach to data collection. DISCUSSION: The stories promoted a sense of support for the participants, which they gained from listening to and sharing stories of caring. This approach offered a different experience for the carers from the standard interview format. CONCLUSION: The paper describes the use of real stories in interviews, which is not a commonly reported method. Carers were involved in both the development and the use of the stories in the interviews. Those interviewed valued the credibility gained by using these real stories, as opposed to constructed vignettes. IMPLICATIONS FOR RESEARCH/PRACTICE: Using stories in this way contributes to methodological development, which allows perceptions and experiences to be captured.

Specific design features of an interpretative phenomenological analysis study.

AIM: Report of an innovative use of interpretative phenomenological analysis (IPA) to enable an in-depth study of the experiences of disengagement from mental health services of black men with diagnoses of severe and enduring mental illness. BACKGROUND: The aim of IPA is to explore the sense that participants make of their personal and social worlds, while recognising the contribution of the researcher in interpreting the participants' interpretations of their experiences. REVIEW METHODS: Seven black male research participants were recruited to the study. The components of the study that contribute to the body of literature on IPA research design include: an engagement stage in the research; a second clarifying interview; discussion of clarifying questions and emergent themes with two academic service-users; and a post-interview meeting to discuss the themes emerging from the research study. DISCUSSION: The paper focuses on the contribution of the four specific design features of the study and how these enabled the researcher to engage with a population that is often deemed 'hard to reach'. CONCLUSION: The four distinctive methodological developments in the study emphasise the flexibility of IPA. These innovations assisted the researcher in developing a broader double hermeneutic that enabled reporting of the experiences of disengagement from mental health services of black men with diagnoses of severe and enduring mental illness. IMPLICATIONS FOR RESEARCH/PRACTICE: The distinctive design of this study further emphasises the flexibility of IPA, while simultaneously showing fidelity to the core principles underlying the research methodology.

Breaking from binaries - using a sequential mixed methods design.

AIM: To outline the traditional worldviews of healthcare research and discuss the benefits and challenges of using mixed methods approaches in contributing to the development of nursing and midwifery knowledge. BACKGROUND: There has been much debate about the contribution of mixed methods research to nursing and midwifery knowledge in recent years. DATA SOURCES: A sequential exploratory design is used as an exemplar of a mixed methods approach. The study discussed used a combination of focus-group interviews and a quantitative instrument to obtain a fuller understanding of women's experiences of childbirth. REVIEW METHODS: In the mixed methods study example, qualitative data were analysed using thematic analysis and quantitative data using regression analysis. DISCUSSION: Polarised debates about the veracity, philosophical integrity and motivation for conducting mixed methods research have largely abated. A mixed methods approach can contribute to a deeper, more contextual understanding of a variety of subjects and experiences; as a result, it furthers knowledge that can be used in clinical practice. CONCLUSION: The purpose of the research study should be the main instigator when choosing from an array of mixed methods research designs. Mixed methods research offers a variety of models that can augment investigative capabilities and provide richer data than can a discrete method alone. IMPLICATIONS FOR PRACTICE/RESEARCH: This paper offers an example of an exploratory, sequential approach to investigating women's childbirth experiences. A clear framework for the conduct and integration of the different phases of the mixed methods research process is provided. This approach can be used by practitioners and policy makers to improve practice.