Creating theory: Encouragement for using creativity and deduction in qualitative nursing research.

Texts about theory in nursing often refer to theory construction by using inductive methods in a rigid way. In this paper, it is instead argued that theories are created, which is in line with most philosophers of science. Theory creation is regarded as a creative process that does not follow a specific method or logic. As in any creative endeavour, the inspiration for theory creation can come from many sources, including previous research and existing theory. The main idea put forward is that deductive qualitative research approaches should play a key role in theory creation. Furthermore, there is a need to differentiate between theory creation and theory justification. A model that emphasizes the creative aspects of theory creation and theory justification using qualitative approaches is presented. The model suggests that knowledge development is a deductive trial-and-error process where theory creation is followed by testing. Scientific theory creation and justification are presented as an iterative process that is deductive in that a testable hypothesis is derived from the theory. If the hypothesis is falsified, then the theory needs modification or might be altogether wrong. Several factors can block the creative process, both in theory development and in finding ways to test a theory in the justification phase. Some of these blockers are the idea of 'building blocks' and the inductive view of science often brought forward in nursing. Other blockers include striving for consensus and adherence to existing nursing philosophies and existing theories. Research and knowledge development are creative processes, and following predefined methods is not enough to ensure scientific rigour in qualitative nursing research.

Concept analysis and the building blocks of theory: misconceptions regarding theory development.

AIM: The purpose of this article is to discuss the attempts to justify concepts analysis as a way to construct theory - a notion often advocated in nursing. BACKGROUND: The notion that concepts are the building blocks or threads from which theory is constructed is often repeated. It can be found in many articles and well-known textbooks. However, this notion is seldom explained or defended. The notion of concepts as building blocks has also been questioned by several authors. However, most of these authors seem to agree to some degree that concepts are essential components from which theory is built. DESIGN: Discussion paper. DATA SOURCES: Literature was reviewed to synthesize and debate current knowledge. IMPLICATIONS FOR NURSING: Our point is that theory is not built by concepts analysis or clarification and we will show that this notion has its basis in some serious misunderstandings. We argue that concept analysis is not a part of sound scientific method and should be abandoned. CONCLUSION: The current methods of concept analysis in nursing have no foundation in philosophy of science or in language philosophy. The type of concept analysis performed in nursing is not a way to 'construct' theory. Rather, theories are formed by creative endeavour to propose a solution to a scientific and/or practical problem. The bottom line is that the current style and form of concept analysis in nursing should be abandoned in favour of methods in line with modern theory of science.

The myth of induction in qualitative nursing research.

In nursing today, it remains unclear what constitutes a good foundation for qualitative scientific inquiry. There is a tendency to define qualitative research as a form of inductive inquiry; deductive practice is seldom discussed, and when it is, this usually occurs in the context of data analysis. We will look at how the terms 'induction' and 'deduction' are used in qualitative nursing science and by qualitative research theorists, and relate these uses to the traditional definitions of these terms by Popper and other philosophers of science. We will also question the assertion that qualitative research is or should be inductive. The position we defend here is that qualitative research should use deductive methods. We also see a need to understand the difference between the creative process needed to create theory and the justification of a theory. Our position is that misunderstandings regarding the philosophy of science and the role of inductive and deductive logic and science are still harming the development of nursing theory and science. The purpose of this article is to discuss and reflect upon inductive and deductive views of science as well as inductive and deductive analyses in qualitative research. We start by describing inductive and deductive methods and logic from a philosophy of science perspective, and we examine how the concepts of induction and deduction are often described and used in qualitative methods and nursing research. Finally, we attempt to provide a theoretical perspective that reconciles the misunderstandings regarding induction and deduction. Our conclusion is that openness towards deductive thinking and testing hypotheses is needed in qualitative nursing research. We must also realize that strict induction will not create theory; to generate theory, a creative leap is needed.

The importance of preoperative information for patient participation in colorectal surgery care.

AIMS AND OBJECTIVES: To identify and describe patients' experiences of a preoperative information session with a nurse, as part of the enhanced recovery after surgery (ERAS) concept, and its impact on patient participation in their own care. BACKGROUND: Enhanced recovery after surgery is a standardised, multimodal treatment programme for elective colorectal surgery, leading to faster recovery and shorter hospital stays via interprofessional collaboration. The ERAS concept is initiated for patients a week before surgery when the patient receives detailed information about the care process during a meeting with a nurse. DESIGN: The study is a qualitative interpretive study based on interviews. METHODS: Twelve patients, nine men and three women, were interviewed. The interviews were transcribed verbatim and analysed using interpretive phenomenological analysis (IPA). RESULTS: The analysis identified and formulated five themes: being seen, security, trust, responsibility and participation. All themes are closely related and illustrate positive and negative sides of the patient's experience. They hang together and form a complete set of experiences: ERAS conversation and its impact on patients' participation. CONCLUSIONS: The results show that patients feel confirmed in the ERAS conversation. Healthcare professionals need to be bonding more information call during hospitalisation. It is important to confirm the patient in order for them to participate and take responsibility. Reliance on caregivers is important for patients to feel safe and to participate in their own care. This study shows that the ERAS conversation was experienced as being structured and individually tailored, but the information must apply to the patients throughout the period of care. RELEVANCE TO CLINICAL PRACTICE: Some shortcomings have been revealed, which should enable improvement in the care of patients. Healthcare professionals need to raise awareness of patients' responsibilities for participation in their own recovery and care. Healthcare professionals and patients need to be aware of each other's responsibilities.

Women's lived experiences of sex hormones and life-related to bariatric surgery: an interpretative qualitative study.

OBJECTIVES: The study aimed to explore the lived experiences of women with severe obesity before and after undergoing bariatric surgery with a special focus on possible effects of changed sex hormone levels. DESIGN: A qualitative interview study with transcribed text analysis based on Gadamer's hermeneutics. SETTING: Regional hospital and outpatient bariatric clinic in central Sweden. PARTICIPANTS: Ten women (age 23-38 years) having undergone Roux-en-Y gastric bypass surgery between 2016 and 2019 were interviewed. RESULTS: The transcribed interviews were analysed according to Gadamer's hermeneutics. Text horizons, interpreter horizons and fact horizons were derived and formed the fusions 'Recognition of unhealthy body weight', 'Dealing with other people's opinions and society's norms', 'Life has changed in a positive way' and 'Accepting inner self and bodily changes'. CONCLUSION: Women highlighted weight and body size in their responses. The study provided a deeper understanding of the situation of women living with obesity and pros and cons of having undergone bariatric surgery. Experiences of changes in sex hormones and fertility were discussed but not central to the informants. Participants emphasised the need to be prepared and properly supported in dealing with changes in life after bariatric surgery and subsequent weight loss.

Sexuality in the context of prostate cancer narratives.

In this study we explored how men diagnosed with prostate cancer experienced their sexuality from a lifeworld perspective. One essential meaning was identified: "having the elixir of life stolen." This essential meaning had four constituents: "something that no longer exists," "the threat to manhood," "intimacy," and "staged manhood." The lifeworld for these men comprised the dynamic interaction between being deprived of their "life's elixir" and their ability to have and experience intimacy. The men were preoccupied with embodied experiences unfamiliar to them. They mourned the loss of sexuality in connection with their new life situation that threatened their identity. Their female partner was a great support, and with her the man could picture himself and at best renegotiate his sexuality. In the future, cancer care should be organized so as to enable all aspects of sexuality to be acknowledged and discussed.

Caring with difficulty: Brazilian nurses' experiences of gynaecological surgery care.

This study was made by a qualitative approach based on symbolic interactionism and grounded theory. The subject was defined as what mutilation means for nurses who take care of women submitted to gynaecological surgery. The aim was to identify the interaction relationship of nurses as female with the phenomenon of mutilation in gynaecological surgeries and how it affects their relationship with female patients in this situation. Data were obtained by interviews with 16 nurses who work in gynaecology units. The findings present two core categories: speaking as a professional and speaking as female. When they spoke as professional nurses they defined mutilation technically. As females they verbalized their conflict and difficulty in working with mutilation and redefined it as being the loss of something very important for themselves. We conclude that female nurses when confronting female surgery distances themselves behind the professional nurse and performs nursing care as a daily routine. It means that these nurses live a personal conflict that influences directly on how they supply care. They care for, but do not care about; the ethos of biomedicine leads carers on to a technical path from which it is difficult to get off.

How Women with Endometriosis Experience Health Care Encounters.

Objective: The aim of this meta-synthesis was to synthesize and interpret the available qualitative studies to increase our understanding and extend knowledge about how women with endometriosis experience health care encounters. Methods: The literature review was carried out using CINAHL, Psychinfo, Academic Search Premier, PubMed, and Scopus, from 2000 to 2018, and was limited to articles in English. Articles were only included if they reported original relevant research on endometriosis and women experiences. Results: The meta-synthesis was based on 14 relevant studies. They included 370 women with diagnosed endometriosis, 16-78 years of age. Three fusions were identified and interpreted in this meta-synthesis. The first was: Insufficiency knowledge, where the physicians could judge the symptoms to be normal menstruation without examining whether there were other underlying causes. The second fusion was Trivializing-just a women's issue, where the physicians thought that the symptoms were part of being a woman, and women's' discomfort was trivialized or completely disregarded. The third fusion was Competency promotes health, where the insufficiency of knowledge became a minor concern if women had a supportive relationship with their physician and the physician showed interest in their problems. Conclusions: Women with endometriosis experience that they are treated with ignorance regarding endometriosis in nonspecialized care. They experience delays in both their diagnosis and treatment and feel that health care professionals do not take their problems seriously. In addition, it appears that increased expertise and improved attitudes among health care professionals could improve the life situation of women with endometriosis.

Observations of health-care professionals sharing and contributing responsibility in paediatric caring situations.

This study aimed to identify, describe and generate concepts regarding health care professionals' information exchanges with minors and/or their parents/guardians in paediatric caring situations. The study took place at three paediatric outpatient units at a university hospital and there were 15 health care professionals involved. Using the grounded theory and the constant comparative analysis methods, the data collection and analysis was undertaken simultaneously, using participant observation, review of medical records and follow-up interviews. The main concern of the health care professionals that emerged as the core category was: sharing and contributing responsibility, interrelated with the six categories; interchanging of knowledge, relationship-creating chat, calculated confirming, encouraging, dichotomous talking and of situation related effects. This research has explored the elements of information exchange in caring situations and highlighted the interaction between the involved persons. These findings could be valuable to health care professionals in order to develop and improve their caring skills.

The ethical demand in nursing: a scandinavian perspective.

In this column the authors discuss the ethics of information exchange in nursing practice with children. Five concepts identified in three Swedish grounded theory studies and a content analysis that used the theoretical framework of ethical demand were analyzed. A simultaneous concept analysis found five related concepts: being interconnected, acting according to accepted procedure, completeness, interdependence, and social intercourse. These concepts are synthesized in the concept of intergrade, which emphasizes the value of maintaining the integrity of all involved in information exchange.

Living as an oldest old in Rio de Janeiro: the lived experience told.

This phenomenological-hermeneutic study was an inquiry into the lived experience of 16 very old persons who were living in their own homes. The nursing perspective was Gadow's existential advocacy for nursing practice. The study findings led to the essence of the phenomenon: pragmatic transition to old age, within a restricted future. Heideggerian concepts were applied and the findings were discussed in relation to the guiding theoretical perspective and related literature. Understanding the meaning of being a very old person is fundamental to developing nursing interventions to help people remain independent, with a sense of self-determination, for as long as possible.

Talking about sexuality: desire, virility, and intimacy in the context of prostate cancer associations.

Prostate cancer and its outcomes are a real threat for health and well-being for men living in the Western world. The number of men with a diagnosis of prostate cancer, before the age of 65 years, has increased in recent decades. The aim of this study was to explore how some of these Swedish men experienced and talked about their sexuality. Four focus group discussions were performed in the context of associations for prostate cancer. Using qualitative content analysis, it was identified how the diagnosis was a threat to their male identity; the men's vulnerability as a group in society was made explicit. Their sexuality was diminished by their illness experiences. These experiences were difficult to share and talk about with others and therefore connected with silence and sorrow. As a result of this, the informants often played a passive role when or if they discussed issues related to sexuality with someone in the health care organizations. The possibility of voluntarily joining a cancer association was probably highly beneficial for these men. During the sessions, several men expressed the opinion that "it is always great to talk."

Routine ultrasound examination during pregnancy: a world of possibilities.

OBJECTIVE: to identify and describe the meaning of the routine ultrasound scan to pregnant women. DESIGN: a qualitative descriptive study using a grounded theory approach, with individual interviews to collect data. SETTING: three antenatal clinics in a Swedish county of approximately 400,000 inhabitants. PARTICIPANTS: voluntary samples of 10 pregnant Swedish women, 26-38 years of age, were interviewed prior to their first routine ultrasound. FINDINGS: 'making it possible' was the core category that explained and illustrated the meaning of the scan. The core category showed that the women considered the examination to be filled with possibilities to reach different goals during pregnancy. It also explained the categories: ultrasound as an event; ultrasound as a situation; ultrasound as a test; and the effects of ultrasound; as well as how they related to each other. The findings are considered the beginning of a theory concerning the meaning of the first ultrasound to pregnant women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: pregnant women can see their first ultrasound as a tool that enables them to reach different goals during their pregnancy. Many of the goals concern meeting and connecting with the baby, suggesting that pregnant women consider the examination an important step towards parenthood. An ultrasound examination offered for medical reasons, which has other meanings than the intended for pregnant women, is important knowledge. It can be useful when giving information about the scan, addressing the woman during the examination, and for understanding and handling possible reactions.

Living with breast cancer: its effect on the life situation and the close relationship of women in Brazil.

The diagnosis and treatment of breast cancer induces adverse effects. In this interpretive phenomenological study, 11 Brazilian women diagnosed and treated for breast cancer were interviewed. Data included audiotaped interviews where the women's lived experiences were articulated. Data were interpreted through Heidegger's existential phenomenology. Themes that were found were interrelated and presented the essential structure of the essence the women were living-living side by side with the phantom of death. The 4 themes that were interpreted and identified were as follows: gaining a positive attitude for life, wanting to be recognized as a woman with certain needs, considering body image/self-image, and making efforts to hide. The findings of the study point out the importance of the fact that illness elicits more than fitting the body into traditional community expectations or surrendering the body to professional medicine. Even with all the deep changes in their lives and changed life priorities, the women want to carry on and live the best life they could. To put this idea in the front line makes the difference for the transition of these women.

Advoy.com™ ajuda a melhorar a qualidade de vida dos pacientes portadores de transtornos de imunodeficiência primária? / Does Advoy.com™ help patients with primary immunodeficiency diseases; experience that their life situation has improved?

A terapia vitalícia com imunoglobulina para pacientes portadores de transtorno de imunodeficiência primária é, freqüentemente, realizada em casa. Investigamos o impacto de viver com uma doença crônica, as condições vida e também a utilização de Advoy, um diário do paciente com base na rede mundial de computadores, com funções de envio de mensagem. Doze suecos adultos escreveram, cada um, um ensaio sobre sua doença e sobre como se sentiam sendo usuários de Advoy. O texto foi examinado utilizando análise de conteúdo qualitativa direcionada. Os entrevistados declararam que estavam vivendo no limite; portanto, suas vidas melhoraram muito depois que iniciaram a terapia domiciliar. O uso de Advoy proporcionou-lhes muito mais confiança, pois a visão geral e o histórico de seus tratamentos forneceram informação e entendimento sobre seus problemas. Foi difícil navegar no site de Advoy, o que frustrou alguns dos entrevistados; eles o utilizaram, então, para simplesmente documentar o tratamento. Advoy precisa sofrer alterações para melhorar as atividades com os cuidados pessoais.

Affected self-respect and self-value: the impact of breast cancer treatment on self-esteem and QoL.

There is a need to understand and explain the impact of breast cancer on women's self-esteem and quality of life. The purpose of the present study was to identify and describe, from the perspective of the women's lived experiences, the impact of breast cancer on women's self-esteem and elucidate its impact on their quality of life. Thirteen women diagnosed as having breast cancer were interviewed about these phenomena. The narrated interviews, tape-recorded and transcribed verbatim were analysed and interpreted using a qualitative text analysis, based on the following question: What sense of satisfaction and importance is there with respect to the women's value and preferences? The findings were interpreted as affected self-respect and self-value, which were found to be important aspects affecting the quality of life of these women, within this lies the satisfaction of desire, to be respected and loved as the women they are. Concerns related to their quality of life seemed to be heightened when treatment has been completed, i.e. when the psychological effects of the treatment experience become a reality. Health professional need to be aware of how to recognise these women, in order to provide them with support to maintain a positive self-esteem to enhance quality of life as a caring outcome.

Estudo de métodos mistos de diagnóstico de câncer de pulmão que afetam a qualidade de vida / A mixed methods study of lung cancer diagnosis affecting quality of life

Os objetivos deste estudo eram avaliar a qualidade de vida (QV) em pacientes com um câncer de pulmão inoperável recentemente diagnosticado e comparar os números da QV com os resultados de um estudo de entrevista qualitativa. Foi usado um projeto de triangulação simultânea descritiva dos métodos mistos para alcançar objetivos específicos. Vinte e três pacientes participaram do projeto. A QV foi avaliada através de dois questionários; Organização Européia para Pesquisa e Tratamento de Câncer, EORTC-C30, e o módulo complementar específico para câncer de pulmão, o QOL-LC-13. Os dados foram analisados de acordo com os procedimentos recomendados pela EORTC. Estes resultados foram comparados com os resultados de um estudo de entrevista qualitativa. Todos os questionários EORTC-QLQC30 + LC-13 foram preenchidos, já que havia apenas 23 entrevistados, e foram calculados os valores médios ao nível individual. A QV foi classificada pelo paciente com uma pontuação média de 4.5. Nas entrevistas de QV esta foi expressa como vida normal. Parece, com relação à medição de escalas funcionais e QV global, que existem resultados semelhantes usando um questionário ou uma entrevista qualitativa. Conseqüentemente, a entrevista qualitativa proporcionou maior multiplicidade e conhecimento mais profundo sobre os diversos domínios. Os resultados desta comparação enfatizam a importância de se identificar a QV a partir das perspectivas destes pacientes.