Bronwynne C. Evans

Use of Theoretical Frameworks as a Pragmatic Guide for Mixed Methods Studies A Methodological Necessity

There is a growing acceptance of the utility of mixed methods in health sciences but there is no widely accepted set of ideas with regard to use of a conceptual or theoretical framework to guide inquiry. Few mixed methods health science articles report the use of such a framework. Lack of available conceptual maps provided by theoretical frameworks, necessary intricacy of design, and the qualitative “black box” tradition all contribute to a dearth of methodological guidance in such studies. This article uses a funded National Institutes of Health study as an example to explain the utility of a theoretical framework in conceptualizing a study, making design decisions such as sampling and recruitment, collecting and analyzing data, and data interpretation.

Qualitative Descriptive Methods in Health Science Research

Objective: The purpose of this methodology paper is to describe an approach to qualitative design known as qualitative descriptive that is well suited to junior health sciences researchers because it can be used with a variety of theoretical approaches, sampling techniques, and data collection strategies. Background: It is often difficult for junior qualitative researchers to pull together the tools and resources they need to embark on a high-quality qualitative research study and to manage the volumes of data they collect during qualitative studies. This paper seeks to pull together much needed resources and provide an overview of methods. Methods: A step-by-step guide to planning a qualitative descriptive study and analyzing the data is provided, utilizing exemplars from the authors’ research. Results: This paper presents steps to conducting a qualitative descriptive study under the following headings: describing the qualitative descriptive approach, designing a qualitative descriptive study, steps to data analysis, and ensuring rigor of findings. Conclusions: The qualitative descriptive approach results in a summary in everyday, factual language that facilitates understanding of a selected phenomenon across disciplines of health science researchers.

Storytelling Intervention for Patients With Cancer: Part 2—Pilot Testing

PURPOSE/OBJECTIVES To evaluate symptom reports and the impact of a nurse-led storytelling intervention in a supportive group setting on mood, stress level, coping with stress, pain, self-efficacy, and satisfaction with life in patients with cancer. DESIGN Descriptive pilot project using a pretest/post-test control group. SETTING Local regional medical center in the Pacific Northwest region of the United States. SAMPLE Convenience sample of 10 patients with various cancer diagnoses; 7 completed the intervention. METHODS Participants were randomly assigned to a storytelling or control group. Using a tool kit generated for this project, a nurse facilitator guided storytelling group participants in 12 1.5-hour sessions. Six instruments, symptom assessments, and a retrospective physician chart review were completed for each group. Data were analyzed using repeated measures analysis of variance. MAIN RESEARCH VARIABLES Mood, stress, coping, pain, self-efficacy, and satisfaction with life. FINDINGS Comparison of changes in group mean scores revealed a significant decrease in anxiety in the storytelling group despite disease progression. Documentation of psychosocial symptomatology by physicians is limited; however, nursing assessments were useful in determining psychosocial status before and after the intervention. CONCLUSIONS Results can be viewed only in context of a feasibility study and are not generalizable because of a limited sample size. A trained oncology nurse was able to use the storytelling intervention. Initial results are promising and warrant further study. IMPLICATIONS FOR NURSING After additional testing, the intervention could be used to enhance storytelling groups for patients with cancer or for individuals who are uncomfortable in or do not have access to storytelling groups.

Psychosocial, cultural, and spiritual health disparities in end-of-life and palliative care: Where we are and where we need to go

Although health disparities are well documented, the extent to which they affect end-of-life care is unknown. Limited research funding leads to sparse and often contradictory palliative care literature, with few studies on causal mechanisms. This article explores the psychosocial, cultural, and spiritual health disparities existing in palliative and end-of-life care with the goal of identifying future research needs. This article reports efforts to determine knowledge gaps related to health disparities in psychosocial, cultural, and spiritual aspects of end-of-life care in which the authors draw upon recent literature from multiple databases. Although few data are available, studies show that minorities make little use of hospice, often because of lack of knowledge about hospice or palliative care, family-centered cultures, and preferences for more aggressive end-of-life care than hospice allows. The authors conclude that future research should include a search for theoretical and causal mechanisms; prospective longitudinal investigations; diverse patients, conditions, contexts, and settings; methodological diversity and rigor; and interdisciplinary, culturally sensitive interventions.

Utility of the Life Course Perspective in Research With Mexican American Caregivers of Older Adults

Research on caregiving of elders in Mexican American families is urgently needed. We know little about family caregivers, family transitions in relation to the caregiving role, reciprocal impact of caregivers and care recipients on one another, adaptive strategies, positive benefits of caregiving (caregiver gain), specific caregiving burdens, or supportive interventions for family caregiving. Theory derivation using the concepts and structure of life course perspective provides a way to fill the knowledge gaps concerning Mexican American caregiving families, taking into account their ethnic status as an important Hispanic subgroup and the unique cultural and contextual factors that mark their caregiving experiences.

The importance of educational and social backgrounds of diverse students to nursing program success.

This article compares the educational and social backgrounds of Anglo students with those of Hispanic/Latino and American Indian students receiving stipends and other services from a Nursing Workforce Diversity Grant to determine the possible effects of such backgrounds on success in a baccalaureate nursing program. Stipend recipients provided baseline background data by interview on admission, and the results were compared with corresponding data from a volunteer sample of Anglo students to enhance understanding of the educational and social circumstances of the stipend recipients and to identify a need for individualized, tailored grant approaches. The Hispanic/Latino and American Indian students demonstrated less adequate educational backgrounds and lower social class as gauged by parental occupation, than did the Anglo students. Although overall comprehensive grant strategies maximized the potential for success of stipend recipients, strategies need to be tailored to fit each individuals unique educational and social background.

Atmosphere, Tolerance, and Cultural Competence in a Baccalaureate Nursing Program: Outcomes of a Nursing Workforce Diversity Grant

The purpose of this article is to report the results of a comparison between the educational climate of a baccalaureate nursing program and that of a Nursing Workforce Diversity Grant. Fifteen Hispanic/Latino and American Indian upper-division baccalaureate nursing students completed 37 questionnaires. A 76-item questionnaire was designed to measure the effectiveness of grant services. There was a difference (t [34] = 3.174, p = .003) in satisfaction across the two climates on “caring and respect” and “atmosphere” (t [33] = 3.267, p = .003), with the grant climate rated higher. Although there was overall satisfaction with both the nursing program and grant services, students requested improvements in atmosphere, tolerance, and cultural competency. There is a need to create an atmosphere of trust, caring, and cultural congruity to recruit and to retain diverse students.

Quality improvement practices: enhancing quality of life during mealtimes.

This article describes ten dining room problems, identified in a nursing home study, that needed quality improvement, as well as six quality practices suggested for implementation. These six quality practices provide the basis for an excellent eating experience characterized by a home-like atmosphere, high levels of staff-resident interaction, and increased attention to safety and ethical issues. The six practices also could serve as the foundation for a facility-wide, cost-effective, quality improvement program.

Storytelling Intervention for Patients With Cancer: Part 1—Development and Implementation

PURPOSE/OBJECTIVES To develop a nurse-led storytelling intervention for patients with cancer and implement the intervention using trained oncology nurses. DESIGN Descriptive pilot project using qualitative methods to assess implementation of an intervention tool kit, with investigators blinded to control and intervention group membership. SETTING Local regional medical center in the Pacific Northwest region of the United States. SAMPLE A convenience sample of 11 patients with various cancer diagnoses was used for tool kit generation. Intervention and control groups were then formed and used to study tool kit implementation. METHODS Participant exit interviews and facilitator debriefing questionnaires assessed the ability of a nurse facilitator to use a group storytelling intervention tool kit. Data from control and intervention groups were analyzed and compared with qualitative procedures. MAIN RESEARCH VARIABLES A nurse-led storytelling intervention. FINDINGS Analysis of interviews and questionnaires revealed implementation of storytelling tool kit principles and differences between storytelling and control groups in three patterns: finding a soft place to fall, understanding the cancer experience, and figuring out how (if) to get through it. CONCLUSIONS Techniques contained in the tool kit were implemented and deemed clinically useful by oncology nurses. IMPLICATIONS FOR NURSING Given the small testing groups, pilot project results must be interpreted with caution, but with additional research and instructional development, the tool kit could be useful to nurses in a variety of settings and locales.

Organizational issues related to satisfaction with food and food service in the nursing home from the resident's perspective.

Abstract This paper reviews organizational factors that potentially affect food quality and food service in the nursing home. A model is proposed for assessing the influence of organizational technology on resident satisfaction with food and food service from the residents perspective. Findings from an exploratory phenomenological case study applying the model are presented. Staff knowledge of how to prepare and serve food properly, and staff availability to serve food on time, were key constructs. Resident-staff interactions appeared to moderate resident control over food and food service. Recommendations are suggested for improved communication between residents and staff to address certain limitations and enhance empowerment of residents.