Methodological considerations for grounded theory research in critical care settings.

BACKGROUND: The context of critical care and human phenomena involved in critical illness offer rich opportunity for nursing research. Naturalistic investigation with grounded theory methods can uncover previously unexamined elements and interactions in the critical care setting. This article presents methodological considerations for conducting grounded theory research in fast-paced physiologically and technologically complex critical care settings. APPROACH: Critique and recommendations are based in review and analysis of grounded theory research in adult critical care settings and on the literature describing grounded theory methods. The authors' experiences in medical and surgical intensive care units provide added practical context for this article. RESULTS: Barriers to achieving grounded theory in critical care settings, such as communication impairments, participant attrition, and observational difficulties, are explored. Methodological strategies and data sources particular to critical care settings are also discussed. Critical care settings offer a variety of data sources that should be rigorously pursued in grounded theory research. DISCUSSION: Given current trends in healthcare treatments and demographics, future research must examine physiological and technological data as integral components of basic social psychological or social structural processes in critical care interactions and should include technology as a component of nurse-patient interaction.

Backside first in head and neck surgery?: preventing pressure ulcers in extended length surgeries.

BACKGROUND: The operating room (OR) presents a high-risk environment for pressure injury. We designed a project to improve performance in the prevention of intraoperative pressure ulcers in extended length head and neck surgeries for malignancies (ELS) using a fluid mattress (RIK) intraoperatively. METHODS: A descriptive design was used to monitor performance improvement in this underrecognized aspect of patient care. A fluid, pressure-reducing OR mattress (RIK) was compared with the use of a standard foam OR mattress (Skytron). A convenience group of 36 consecutive patients, undergoing ELS, was included in the project. Patients were evaluated for presence or absence of a pressure ulcer immediately and 72 hours postoperatively. RESULTS: Patient groups were demographically and surgically comparable at a clinical level. Pressure ulcer incidence before intervention was 21% (4 of 19). This declined to 0% after intervention. CONCLUSIONS: Intraoperative pressure ulcers are a costly complication. Presence of a pressure ulcer extends time in the sick role and disrupts desired aesthetic outcomes. Use of a pressure-reducing device achieved the performance improvement objective. Implications for future research and current care are discussed.

Weighing behavior and symptom distress of clinic patients with CHF.

Congestive heart failure (CHF) is a prevalent disease that causes patients troubling symptoms, which can be difficult for clinicians to manage. A descriptive pilot study examining the weighing behaviors of patients with CHF and their symptom distress was conducted, and the findings have implications for future research and patient management.

Adolescents completing cancer therapy: meaning, perception, and coping.

PURPOSE/OBJECTIVES: To explore and describe adolescents' experiences and associated changes in coping strategies during the time period from three to six months before cancer therapy completion to six months after completion. DESIGN: Exploratory, descriptive, longitudinal, qualitative design using grounded theory techniques. SETTING: Pediatric oncology outpatient clinics in the San Francisco Bay area and British Columbia. SAMPLE: 13 adolescents undergoing cancer therapy. METHODS: Semistructured interview conducted at four points in time (three to six months prior to completion of chemotherapy, at time of completion, three months after completion, and six months after completion). Subjects' responses were tape-recorded, transcribed verbatim, and analyzed using constant comparative techniques. FINDINGS: Themes emerged from the data in three categories: meaning and perception of the experience of completing cancer therapy (task accomplishment, movement toward a normal life); coping strategies before completion of therapy (positive thinking, not thinking about treatments, "busy-ness," reinterpretation, and "philosophical stance"); and coping strategies after completion of therapy (negotiation, cognitive reliving, selective forgetting). CONCLUSIONS: Completion of cancer therapy is an event that is uniquely perceived by adolescents, and they employ different coping strategies before and after completion. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of adolescents' experiences of completing chemotherapy will assist nurses in offering support to the patient as well as to the parents who must support their child. Further longitudinal studies with larger samples are needed, as are studies comparing and contrasting the views of the adolescents and the parents.

The phenomenon of hand holding as a coping strategy in adolescents experiencing treatment-related pain.

The purpose of this study was to understand the phenomenon of hand holding as a coping strategy used by adolescents to deal with treatment-related pain. The convenience sample consisted of 20 adolescents whose ages were 11 to 19 years: 10 had cancer and 10 had renal disease (this served as the comparison group). Using a descriptive design, a semistructured interview was conducted with each adolescent. To supplement and support interview data, structured observations were conducted as adolescents underwent painful treatments (eg, blood draws, shunt placement, peripheral chemotherapy, lumbar punctures, and bone marrow aspirations). Data were analyzed using descriptive statistics and qualitative analytic techniques similar to those delineated by Strauss and Corbin. The results of this study indicated that subjects in both the cancer and the renal disease group perceived hand holding to be a very effective coping strategy in ameliorating treatment-related pain. Overwhelmingly the patients preferred to hold their mother's hand. When the mother was unavailable, they preferred to hold a specific nurse's hand. Hand holding functioned to reduce tension associated with impending treatments, as a source of distraction, and as a source of security. Accordingly, adolescents' subjective experience of treatment-related pain was reduced when they felt more secure, less tense, and were distracted.