'Because it's the wife who has to look after the man': A descriptive qualitative study of older women and the intersection of gender and the provision of family caregiving at the end of life.

BACKGROUND: Research indicates that women are the primary family caregivers for others at life's end and, because of ageing populations, will keep fulfilling this role as they age. Yet, little is known about how the gendered nature of caregiving contributes to older women's understandings of providing care. AIM: To explore how gender norms constructed older women's views about the appropriate roles of women and men in providing palliative and end-of-life care for family members. DESIGN: Six focus groups were conducted with 39 community dwelling older adults (36 women and 3 men) using two vignettes to prompt discussion about experience of end of life caring and attitudes towards Advance Care Planning. This article reports on data gathered from female participants' reactions to Vignette 1 which prompted significant discussion regarding the intersection of gender and older women's caregiving experience. SETTING/PARTICIPANTS: A total of 36 women in the age ranges of '50-59 years' through to '90-99 years' from New Zealand. RESULTS: Three themes regarding gender and caregiving were identified: the expectation women will care, women's duty to care and women's construction of men in relation to caregiving and illness. The women adhered to stereotypical gender norms that regard women as primary caregivers. There was little connection between the burden they associated with caregiving and this gender construction. CONCLUSION: The expectation that older women will provide end-of-life care even when experiencing considerable burden is an unacknowledged outcome of gender norms that construct women as caregivers.

The experiences of women (65-74 years) living with a long-term condition in the shadow of ageing.

AIMS: This paper reports on a study that explored experiences of women (65-74 years) as they grow older while living with a long-term condition. The phenomenon of focus was 'ageing with a long-term condition', rather than the experience of developing a long-term condition after reaching older adulthood. BACKGROUND: People with long-term conditions are living into older age. There is limited literature on the nexus of ageing with a long-term condition. It is known that ageing shapes and is shaped by women's experiences of living with a long-term condition. METHODS: In this interpretive descriptive study, nine women participated in a series of three focus groups held in 2007 and 2008. Transcripts were analysed thematically and participants given the opportunity to respond to the analysis. FINDINGS: 'In the shadow of ageing' was the overarching theme. The women reported that although their long-term condition remained the referent point in their daily lives, for others including health professionals, the focus was on their appearance and the effects of older age. To overcome the back-grounding of their long-term condition, the women used 'strategies already-in-place'; it became 'just another thing to deal with'. Ageing, however, remained 'a privilege'. CONCLUSION: If health professionals focus on age and its concomitant effects, rather than a woman's long-term condition, they are at risk of delivering inappropriate care. They need to be prepared to advocate for the special needs of older women who live with a long-term condition and remain cognizant of the women's resourcefulness and expertise developed over time.

Perceived unmet needs for health care among Parkinson's Society of New Zealand members with Parkinson's disease.

UNLABELLED: We surveyed nationwide health needs for Parkinson's disease (PD) among New Zealand Parkinson's Society members with PD. BACKGROUND: Little literature assesses how people with PD perceive their health needs for this medical condition. METHOD: Cross-sectional survey of health needs through personal, structured telephone interviews with a random sample of 500 Parkinson's Society members with PD. RESULTS: Many participants wanted improved access to specialist care but their reported attendance rates suggest provider adherence to guideline recommendations. More general practitioners (GPs) than specialists were said to offer less information than wanted. Getting enough information in usual care was the best predictor (odds ratio 3.44, 95% CI: 1.93-6.13, p=0.000) of seeing a specialist for PD as often as wanted. CONCLUSIONS: People with PD have an important perspective in assessments of their health needs. GPs require training support in providing patient information about PD. Our study results may apply to Parkinson's Society members in similar health systems.

From experience to definition: addressing the question 'what is qualitative research?'.

Most health professionals today have heard of 'qualitative research' but many remain confused as to what it is and how to go about doing it. In this paper, two experienced qualitative researchers become engaged in conversation exploring the question 'what is qualitative research?' Lynne Giddings and Liz Smythe are Associate Professors in the Faculty of Health & Environmental Sciences at the Auckland University of Technology. They engage a reader in exploring issues such as: What might draw you to qualitative research? How does qualitative research make a difference to practice? How can reading a qualitative research article inform practice? From a qualitative perspective, what is 'truth'? How many participants? What happens to the data? What about the bias of the researcher? Can qualitative findings be trusted? Stories and exemplars are used to highlight the processes and issues involved in undertaking a qualitative research study.

Mixed methods research for the novice researcher.

Mixed methods research is becoming increasingly popular in the health and social science disciplines. The aim of this article is to give an overview of the varieties of mixed methods designs. We begin by situating mixed methods research in the context of a paradigmatic framework which assists a researcher in making decisions concerning the design of their study. Although the most commonly used mixed methods designs are underpinned by positivist/postpositivist assumptions, the combination of qualitative and quantitative methods can be used within any research paradigm.

How to survive (and enjoy) doing a thesis: the experiences of a methodological working group.

'Doing a thesis', whether for Masters or PhD, can be a lonely and tortuous journey. This article offers a complementary process to the traditional apprenticeship supervision model. It describes the experiences of students who during their thesis research met monthly in a grounded theory working group. They reflected on their experiences during a focus group interview. After describing the background to how the group started in 1999 and exploring some of the ideas in the literature concerning the thesis experience, the article presents the interview. To focus the presentation, specific questions are used as category headings. Overall, the participants found attending the group was a "life-line" that gave them "hope" and was complementary to the supervision process. Through the support of peers, guidance from those ahead in the process, and consultancy with teachers and visiting methodological scholars, these students not only successfully completed their theses, but reported that they had some enjoyment along the way. This is the fifteenth in a series of articles which have been based on interviews with nursing and midwifery researchers, and were primarily designed to offer the beginning researcher a first-hand account of the experience of using particular methodologies.

A theoretical model of social consciousness.

The article presents a theoretical model of social consciousness developed from nurses' life histories. A 3-position dialectical framework--acquired, awakened, and expanded social consciousness--makes visible the way people respond to social injustice in their lives and in the lives of others. The positions coexist, are not hierarchical, and are contextually situated. A person's location influences her or his availability for social action. Nurses who could most contribute to challenging social injustices that underpin health disparities are relegated to the margins of mainstream nursing by internal processes of discrimination. More inclusive definitions of "a nurse" would open up possibilities for social change.

Vulnerable bodies: competing discourses of intimate bodily care.

Nursing practices are subject to intersecting and competing discourses, which give them different, sometimes contradictory, meanings. In this article, using a case of intimate bodily care, we explore the workings of these discourses in a nursing student's account of her first experience of bathing an elderly woman. In particular we were interested in how different meanings of nursing "care" figure into the student's story. Through our analysis, we realized that a range of contradictions and tensions structured the student's experience. These contradictions were primarily produced by a collision between two discourses: the student's commonsense way of understanding the intimacy of such an act (liberal humanist discourse) and the impersonal approach characteristic of institutionalized care (scientific medical discourse). This collision caused distress and confusion, such that the student became almost as vulnerable as her patient. We argue that this type of detailed analysis of a nursing student's experience may increase our understanding of the discursive struggles that occur for students during their shifting between classrooms and clinical sites, between theory and practice, in the process of becoming professionals. Understanding these struggles and the relationships of power that produce both nursing student and patient as "vulnerable bodies" is important for nurse educators because they offer opportunities for intervention in the shaping of nursing professionals.

A longitudinal survey of nurses' self-reported performance during an entry to practice programme.

Performance expectations are a critical issue in the transition from student to practising nurse for both nurses and their employers. We conducted a study to compare self-reported changes in both frequency and quality of performance of nursing behaviours in a cohort of Aotearoa/New Zealand recently graduated nurses undertaking a one year entry to practice programme. Thirty-three nurses were surveyed, seven weeks after beginning the programme and again seven months later, using a modified version of Schwirian's (1978) Six-Dimension Scale of Nursing Performance (6-DSNP). Over the study period participants reported significant increases in frequency of performance for the domains of leadership, critical care, teaching/collaboration, and planning/evaluation. Significant increases in the quality of nurse behaviours in the domains of critical care, planning/evaluation and interpersonal relations/communication were also reported. The modified Schwirian 6-DSNP was found to be a useful instrument for measuring nurses' self reporting of performance during periods of transition.

Making sense of methodologies: a paradigm framework for the novice researcher.

Methodologies abound in the field of health and social science research, making a confusing terrain for new researchers. In this article, we offer order out of confusion. Drawing on our work as postgraduate teachers, we outline a paradigm framework which proposes that methodologies are similar or different because of their underlying assumptions and values. We identify four major paradigms, explain the distinctive assumptions which underpin them, and show how each figures the researcher and the researcher-researched relationship. Along the way, we place a variety of methodologies into their paradigm of origin and offer some illustrative examples of health research.

A Trojan horse for positivism?: a critique of mixed methods research.

Mixed methods research is captured by a pragmatically inflected form of postpositivism. Although it passes for an alternative methodological movement that purports to breach the divide between qualitative and quantitative research, most mixed methods studies favor the forms of analysis and truth finding associated with positivism. We anticipate a move away from exploring more philosophical questions or undertaking modes of enquiry that challenge the status quo. At the same time, we recognize that mixed methods research offers particular strengths and that, although it serves as a Trojan Horse for positivism, it may productively carry other paradigmatic passengers.

Women's experience of ageing with a chronic condition.

AIM: This paper is a report of a study to explore the experiences of 'almost old' women as they grow older while living with a chronic condition. BACKGROUND: Little is known about the contextual effects of ageing and how it shapes and is shaped by a woman's chronic illness experience. Nurses' understanding of this phenomenon can have positive effects on how their client accesses and responds to healthcare. METHOD: Seven women aged between 50 and 58 years participated in this interpretive descriptive study that explored the issues of ageing with a chronic condition. Three focus groups were held between March 2003 and March 2004. Transcriptions were analyzed after each focus group. Participants were given the opportunity to respond to the findings as the analysis progressed. FINDINGS: The experience of living with a chronic illness foreshadowed what was to come with ageing and embodied the ageing process: it was just part of their lives. Alongside this, the women now felt less out of place. Their peers were catching up and beginning to experience aspects of participants' everyday reality. The women, however, experienced double jeopardy because ageing amplified the ongoing vulnerabilities of living with a chronic condition. CONCLUSION: Nurses who recognize the resourcefulness and expertise of women who live with a chronic condition can effectively be co-strategists in their helping them to age well.

Health disparities, social injustice, and the culture of nursing.

BACKGROUND: Nurses are well positioned to challenge institutionalized social injustices that lead to health disparities. OBJECTIVE: The aim of this cross-cultural study was to collect stories of difference and fairness within nursing. METHODS: The study used a life history methodology informed by feminist theory and critical social theory. Life story interviews were conducted with 26 women nurses of varying racial, cultural, sexual identity, and specialty backgrounds in the United States (n = 13) and Aotearoa New Zealand (n = 13). Participants reported having some understanding of social justice issues. They were asked to reflect on their experience of difference and fairness in their lives and specifically within nursing. Their stories were analyzed using a life history immersion method. RESULTS: Nursing remains attached to the ideological construction of the "White good nurse." Taken-for-granted ideals privilege those who fit in and marginalize those who do not. The nurses experienced discrimination and unfairness, survived by living in two worlds, learned to live in contradiction, and worked surreptitiously for social justice. DISCUSSION: For nurses to contribute to changing the systems and structures that maintain health disparities, the privilege of not seeing difference and the processes of mainstream violence that support the construction of the "White good nurse" must be challenged. Nurses need skills to deconstruct the marginalizing social processes that sustain inequalities in nursing and healthcare. These hidden realities--racism, sexism, heterosexism, and other forms of discrimination--will then be made visible and open to challenge.