Catherine A. Chesla

From beginner to expert: gaining a differentiated clinical world in critical care nursing.

The purpose of this study was to further explicate the Dreyfus Model of Skill Acquisition in the practice of critical care nursing. For this analysis data were used from a sample of 105 nurses practicing in the adult, pediatric, and newborn intensive care units of eight hospitals in three metropolitan areas. The data were composed of group interviews in which nurses gave narrative accounts of exemplars from their practice and close observations and intensive personal history interviews of a subsample of nurses. Two interrelated aspects were found to distinguish four levels of practice, from advanced beginner through expert. First, practitioners at different levels of skill literally live in different clinical worlds, noticing and responding to different directives for action. Second, a sense of agency is determined by ones clinical world and shows up as an expression of responsibility for what happens with the patient.

The Family and Type 2 Diabetes: A Framework for Intervention:

Four broad groups of factors have been linked with self-management behavior in type 2 diabetes over time: (1) characteristics of patients, (2) amount and management of stress, (3) characteristics of providers and provider-patient relationships, and (4) characteristics of the social network/context in which disease management takes place. Of these four, social network/context has received the least amount of study and has been described in terms not easily applicable to intervention. In this paper, we identified the social network/context of diabetes management as residing within the family. We defined the family for clinical purposes, reviewed the literature concerning what is known about the link between properties of the family context of care and outcomes in type 2 diabetes and other chronic diseases, and identified areas of family life that are relevant to diabetes management. This information was then used to demonstrate how a family context of care can serve as a clinical framework for integrating all four groups of factors that affect disease management. Implications of this approach for practice and research are described.

Revisiting Confucianism as a Conceptual Framework for Asian Family Study

Confucianism is the central philosophic background for much of the culture in East Asia (EA), particularly for understanding family and social context. The purpose of this article is to examine more fully Confucianism as a conceptual framework for understanding EA family processes and health practices. Confucianism stresses the traditional boundaries of ethical responsibility and the ideal of good human life as a whole. Embedded within Confucian values are five principal relationships, through which each person defines a sense of identity, duty, and responsibility. Current studies of EA families that consider Confucianism as a theoretical base focus almost exclusively on filial piety and collectivism. Focusing only on these two aspects prevents scholars from exploring more complex interpretations of EA family life. A broader inclusion of multiple concepts from Confucianism can provide guidance in exploring the complex and multidimensional aspects of EA family life and allow for broader articulation of family processes.

Hermeneutic Phenomenology: An Approach to Understanding Families

Hermeneutic phenomenology is offered as an approach to study families that enables the study of phenomena that are difficult to address using a science based in rationalism or empiricism: shared family meanings and family concerns. Heideggerian concepts that serve as the foundation of a hermeneutic phenomenology offamilies are that humans are situated in their worlds, constituted by their worlds, engaged in everyday activity, and moved by their concerns in day-to-day life. Each concept is discussed in terms of how it affects the hermeneutic phenomenological study of thefamily and structures the relationship of the researcher to the project.

The lived body in dementia

Abstract Little is known about how people with dementia live day to day with this illness and the meaning it has for them. To explore this question, three in-depth interviews and participant observation were conducted with nine people experiencing mild to moderate dementia (MMSE 16–23) and their family caregivers. An interpretive phenomenological analysis revealed how dementia symptoms were experienced in and through the lived body: (1) “Being slow” is about the body slowing down as taken-for-granted activities become halting and tentative; (2) “Being lost” is about being unable to find ones way in an unfamiliar world; and (3) “Being a blank” is about being in an empty world wherein meaningful habits and practices fall by the wayside. These findings challenge the problematic mind–body dualism that pervades current understanding of dementia, thus opening the possibility for developing a vocabulary of care that takes more complete account of the lived experience of dementia.

Growing up with congenital heart disease: the dilemmas of adolescents and young adults

Advances in diagnosis, medical management and surgical intervention have improved the longevity and quality of life for children with congenital heart disease. Despite this, research studies specifically examining the psychosocial concerns of adolescents and young adults with congenital heart disease are few. To explore the subjective experiences and dilemmas of this population during the transition from adolescence to young adulthood, we interviewed, using a semi-structured protocol, a convenience sample of nine adolescents and young adults. Using analytic procedures inherent in Grounded Theory methodology, seven themes were identified: the dilemma of normality; dilemmas in disclosure; dilemmas in strategies for management of illness; the challenge of social integration versus social isolation; the challenge of dependence versus independence; the challenge of uncertainty; and strategies for coping. An understanding of these experiences by health professionals can be beneficial in helping this clinical population as they grow up and face the challenges of an uncertain, yet promising, future.

Do Family Interventions Improve Health

The central aim of this article is to examine the evidence that family interventions improve health in persons with chronic illness and their family members, across the life span. The review focuses on recent meta-analyses of randomized controlled trials of family intervention research. In adults, evidence supports the salutary effects of family interventions versus usual medical care for patient health and mental health, and for family member health. In children, robust evidence supports family-based multimodal interventions for obesity treatment. Reasonable evidence supports family approaches to type 1 diabetes treatment in children. Nurses led the research or were members of interdisciplinary research teams in several of these literatures, representing one quarter to one third of the research cited, but were absent in other literatures, such as family treatment of childhood obesity.

Accommodating Type 2 Diabetes in the Chinese American Family

In this interpretive study, the authors aimed to describe family responses to type 2 diabetes in Chinese Americans as reported by persons with diabetes (PWD) and spouses. Twenty participants representing 16 families completed multiple group interviews. The authors elicited positive and difficult diabetes care narratives and conducted narrative and thematic analysis of transcribed interview texts. Accommodation, the key family response, comprised the enactment of social concerns and practices to balance quality of life for individuals and families with quality of diabetes care. PWDs’ accommodation included negotiating disease disclosure, protecting the family’s meals, and maintaining ease in family relations despite diabetes symptoms. Accommodation by family members included developing shared diabetes care practices and indirect approaches to disagreements about diabetes management.

Patient-appraised couple emotion management and disease management among Chinese American patients with type 2 diabetes.

Family context exerts a strong influence on disease management among patients with chronic disease, but it is not clear which aspects of family life are most influential. This study examined the linkages between patient-appraised couple emotion management (conflict resolution, expressiveness, and respect) and disease management (biological, morale/depression, quality of life, and behavioral) among a relatively understudied group, Chinese American patients with type 2 diabetes. Significant main effects were found between patient-appraised couple emotion management, especially conflict resolution, and the morale component of disease management, but not the biological or behavioral components; both diabetes-specific and general relationship qualities (marital satisfaction) were independently linked to disease management. Acculturation did not qualify the findings. Similarities among ethnic groups in family and disease management relationships may be more common than differences.

Nursing Science and Chronic Illness: Articulating Suffering and Possibility in Family Life:

Families living with a member who has a chronic illness vacillate between hope and despair, suffering and possibility. How this living “between” evolves in families and how family relations are affected has received insufficient attention. As nurses we can learn families’ experiences of suffering and situated possibility through family narratives about and reflections on the everyday. Articulating this experience in thick, alive, complex, and practical texts promises to enhance our understanding, our practice with families, and our own lived possibilities.