Barbara Downe-Wamboldt

Content analysis: Method, applications, and issues

Content analysis research methodology is detailed, its procedures are described, some examples of its application are provided, and the controversial issues surrounding its use are discussed. Unlike strictly qualitative designs, content analysis has external validity as a goal. Because of its focus on human communication, content analysis offers practical applicability, promise, and relevance for research involving the practice and education of nurses and other helping professionals.

Conceptualizing Sexual Health in Cancer Care

This qualitative study was designed to describe womens experiences with changes in sexual function related to physical comfort, sexual satisfaction, and fielings of intimacy post-treatment for gynecological cancer. The 17 women who participated in this study described sexuality as a much broader construct. Contrary to existing literature, sexual functioning was found to be one aspect that contributed to the view of the self as a sexual being, but the womens perceptions were not limited to this single dimension. The identification of multidimensional components to be considered in developing a conceptual model to describe sexual health are presented. This study indicates that sexuality should be viewed as a health issue that has an impact on quality of life.

Factors affecting nurse practitioner role implementation in Canadian practice settings: an integrative review.

AIM To review the literature about the Canadian experience with nurse practitioner role implementation and identify influencing factors. BACKGROUND Although nurse practitioners have been in existence for more than 40 years, their integration into healthcare systems has been challenging. While frameworks exist to guide implementation of these roles, clear identification of factors influencing role implementation may inform best practices. Given that Canada has witnessed considerable growth in nurse practitioner positions in the past decade, an exploration of its experience with role implementation is timely. DATA SOURCES A review of Canadian literature from 1997 to 2010 was conducted. Electronic databases including CINAHL, Cochrane Database of Systematic Reviews, Health Source: Nursing Academic Edition, Medline, Social Science Index, PubMed, Web of Science and PsychINFO and government and professional organization websites were searched. METHODS An integrative review was performed guided by Whittemore and Knafls method. RESULTS Ten published studies and two provincial reports were included. Numerous facilitators and barriers to implementation were identified and analysed for themes. Three concepts influencing implementation emerged: involvement, acceptance and intention. Involvement is defined as stakeholders actively participating in the early stages of implementation. Acceptance is recognition and willingness to work with nurse practitioner. Intention relates to how the role is defined. CONCLUSION This integrative review revealed three factors that influence nurse practitioner role implementation in Canada: involvement, acceptance and intention. Strategies to enhance these factors may inform best practice role implementation processes.

Acceptance, cognitions, and resourcefulness in women with diabetes.

The coexistence of diabetes and depression occurs frequently among young and middle-age women. Unless one is resourceful, simultaneous management of the symptoms of both conditions is especially challenging. Skills constituting resourcefulness are learned throughout life and are important for the optimal performance of daily activities. Little is known about specific factors that influence resourcefulness. In this study, contextual factors (diabetic and depressive symptoms) and cognitive factors (positive cognitions and acceptance of diabetes) were examined as antecedents of learned resourcefulness in 82 women with type 2 diabetes. Regression analyses showed that depressive symptoms and positive cognitions were significant antecedents of learned resourcefulness: Positive cognitions mediated the effects of depressive symptoms on learned resourcefulness. The findings suggest the need for interventions that focus on development of positive cognitions to better promote resourcefulness in women with type 2 diabetes who are at risk for depression.

Cost effectiveness and outcomes of a nurse practitioner–paramedic–family physician model of care: the Long and Brier Islands study

Aim This longitudinal study was designed to address four research questions and the hypothesis; that adults living in a rural community receiving primary health care and emergency services from a team that included an on-site nurse practitioner (NP) and paramedics and an off-site family physician would, over time, demonstrate evidence of improved psychosocial adjustment and less expenditure of health care resources. Background In Canada, there is a growing awareness and commitment to addressing the challenges of providing primary health care services in rural areas. A literature review supported the role of NPs in primary health care and a potential role for paramedics. No studies were found that evaluated the combination of NPs, paramedics and physicians as providers of primary health care. Methods Structured questionnaires, individual and group interviews with patients, health and social service care providers and administrators and community members were used to describe and evaluate the impact of the model of care over the three years of the study. Findings The innovative model of care resulted in decreased cost, increased access, a high level of acceptance and satisfaction and effective collaboration among care providers. Organizational structures to support the innovative model of primary health care were identified.

The Relationship Between Meaning of Illness, Social Support, Coping Strategies, and Quality of Life for Lung Cancer Patients and Their Family Members

This article explores the relationship between meaning of illness, perceived social support resources, coping strategies used, and quality of life (QOL) by patients with lung cancer and their family members. The study was cross-sectional using interview data from 85 patients and associated family members. Regression results showed that total QOL in patients with lung cancer is predicted most by meaning of illness, specifically, the illness being perceived as manageable. QOL in family members is predicted most by meaning of illness, specifically, less adverse impact. Interestingly, the overall meaning of illness, coping strategies used, and social support were similar in the 2 groups. The results of the study emphasize the importance of acknowledging the circumstances of peoples lives, both patients surviving lung cancer and their family members, which contribute to QOL.

Emotions, Coping, and Psychological Well-Being in Elderly People with Arthritis

Rheumatoid arthritis, the most destructive and crippling of allforms of arthritis, poses a number of stressful demands on individuals. In a sample of elderly women (N = 59) and men (N = 19) with rheumatoid arthritis, the relationship between social economic status, severity of impairment, sex, stress emotions, type of coping strategy, and psychological well-being was explored. Path analysis results indicated that higher social economic status was directly related to greater use of confrontive types of coping strategies. Severity of impairment had a direct, negative influence on psychological well-being, but sex was not an important factor Optimistic coping strategies were used most often and emotive coping strategies the least.

Confronting life with rheumatoid arthritis

Background.  Older people with rheumatoid arthritis are confronted with a variety of chronic stressors on a daily basis. Living with rheumatoid arthritis means learning to cope with physical limitations, fatigue, losing mobility and independence, pain, uncertainty and role changes related to periods of exacerbation and remission. There is a paucity of literature that addresses the stress and coping processes over time for older people who have had rheumatoid arthritis since midlife. Aim.  The purpose of this study was to identify and describe, at three points in time and over two 6-month intervals, the illness-related stressors perceived by older people diagnosed with rheumatoid arthritis since midlife; their stress-related emotions and the coping strategies they used to manage the illness-related stressors. Methods.  A longitudinal, descriptive design was used to assess older peoples perceptions of illness-related stress, their stress emotions and the coping strategies used to manage the illness-related stressors. Findings.  The majority of participants most frequently identified physical limitations as their illness-related stressors, harm as the stress emotion they experienced, and use of confrontive coping strategies to manage the stress associated with rheumatoid arthritis. Conclusions.  The findings provide nurses with a better understanding of the experiences, emotions and coping strategies used by older people to manage the adversity of rheumatoid arthritis in daily living.

The effects and expense of augmenting usual cancer clinic care with telephone problem-solving counseling.

This study was done to assess the effectiveness and efficiency of individualized, problem-solving counseling provided by baccalaureate nurses over the telephone to prevent the onset of depression in persons with breast, lung, or prostate cancer. Of 175 persons randomized, 149 completed the 8-month follow-up. The primary outcome measures were changes in the Jalowiec Coping Scale, the Centre for Epidemiologic Studies in Depression Scale, and the Derogotis Psychosocial Adjustment to Illness Scale. In addition, expenditures for peoples use of all health and social services were computed at baseline and follow-up. Telephone counseling improved the use of more favorable coping behaviors, prevented a clinically important but not statistically significant decline into depression, and poor psychosocial adjustment in a group of people with mixed cancer. These results were associated with a greater total per person per annum expenditure for use of all other health and social services in the community compared with the control group. In a situation of limited resources and a service producing more effect for more costs, one needs either to examine what services to forgo to offer this service or to carefully target the new service to those most likely to benefit.

Prevalence, correlates, and costs of patients with poor adjustment to mixed cancers.

Approximately 2% to 3% of the Canadian society has experienced cancer. Literature indicates that there is poor adjustment to chronic illness. Individuals with poor adjustment to chronic illness have been found to disproportionately use more health services. The purpose of this study was to determine the prevalence, correlates, and costs associated with poor adjustment to mixed cancer. A consecutive sample (n = 171) of breast, lung, and prostate cancer patients at the Nova Scotia Regional Cancer Center were surveyed. Twenty-eight percent of the cancer group showed fair to poor adjustment to illness using the Psychological Adjustment to Illness Self-report Scale Psychological Adjustment to Illness Self-Report Scale raw score. Poor adjustment was moderately correlated with depression (r = 0.50, P < .0001) and evasive coping (r = 0.38, P < .0001) and unrelated to demographic variables. Depression explained 25% of the variance in poor adjustment to illness in regression analysis. Cancer patients with fair to poor adjustment to illness had statistically significantly higher annual healthcare expenditures (P < .002) than those with good adjustment to illness. Expenditure findings agree with previous literature on chronic illnesses. The prevalence of fair to poor adjustment in this cancer population using the Psychological Adjustment to Illness Self-Report Scale measure is similar to that reported for chronic illness to date, suggesting that only those with better adjustment consented to this study.