Danuta Wojnar

Phenomenology An Exploration

Investigators who use phenomenological approaches to understand experiences of human healing, caring, and wholeness need to consider the differences that exist between descriptive and hermeneutic phenomenology. In this article, these two approaches are compared and contrasted with respect to roots, similarities, and differences. Guidelines are offered to assist prospective investigators in selecting the approach most suitable to personal cognitive style and beliefs about the ways humans experience and find meanings during transitions through wellness and illness to advance nursing knowledge in a holistic view.

Role of the registered nurse in primary health care: meeting health care needs in the 21st century.

There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered.

Confronting the Inevitable: A Conceptual Model of Miscarriage for Use in Clinical Practice and Research

In spite of scientific evidence that miscarriage has negative psychological consequences for many individuals and couples, silence and dismissal continue to surround this invisible loss in North American culture and beyond. The grief and sorrow of miscarriage has important implications for clinical practice. It indicates a need for therapeutic interventions delivered in a caring, compassionate, and culturally sensitive manner. This research, based on data from 3 phenomenological investigations conducted with 42 women from diverse geographical locations, sexual orientations, and cultural backgrounds offers a theoretical framework for addressing miscarriage in clinical practice and research.

Infant feeding buddies: a strategy to support safe infant feeding for HIV-positive mothers.

Background: Prior to 2010, the World Health Organization recommended that HIV-positive mothers exclusively breastfeed for the first 6 months of life unless replacement feeding was acceptable, feasible, affordable, sustainable, and safe. Community pressure to practice mixed feeding, lack of knowledge on safe feeding, and shame regarding HIV status discourage mothers from breastfeeding exclusively and contribute to South Africa’s low exclusive breastfeeding prevalence of 7% for infants under 6 months. Objective: This pilot study explored the feasibility of implementing a feeding buddy system to provide a mother with support to achieve her infant feeding goal. Methods: A convenience sample of 14 HIV-positive mothers and their buddies was recruited from the Butterworth Gateway Clinic in South Africa. HIV-positive mothers selected a buddy who accompanied them on clinic visits and counseling sessions on safe infant feeding. The research team conducted in-depth interviews to gather qualitative information on participants’ experiences at 3 points in time. Results: Buddy selection was influenced by the mother’s relationship to the buddy, trust, and previous disclosure of HIV status. The 3 most cited forms of support were the buddy’s accountability, teaching, and help in feeding the infant correctly. Conclusions: Buddies were successfully integrated into routine Prevention of Maternal-to-Child Transmission visits. Study participants confirmed that having a buddy was a helpful support for HIV-positive mothers.

Evaluating the impact of organizational learning initiatives.

This article describes the process used to develop an evaluation model for organizational learning in a healthcare environment. This model moves away from the traditional focus on learner satisfaction and places greater emphasis on performance and impact evaluation. The evaluation model is grounded in the work of Kirkpatrick (1998) and Phillips (1991) and can be applied to a variety of programs. Using a highly practical approach, the model enables educators to determine the most appropriate level of evaluation for a learning opportunity and to identify effective and efficient strategies. This model could be readily adopted by healthcare organizations interested in enhancing the evaluation of the learning initiatives.

Preparing nursing students for enhanced roles in primary care: The current state of prelicensure and RN-to-BSN education

BACKGROUND With the current emphasis on including registered nurses (RNs) on the primary care teams, it is essential that nursing programs prepare students for employment in these settings. PURPOSE This study explored the current state of prelicensure and RN-to-Bachelor of Science in Nursing (BSN) online education regarding the implementation of primary care content in the curricula. METHODS A sample of 1,409 schools and/or colleges from across the United States was invited to participate in an online survey. About 529 surveys were returned for an overall response rate of 37.5%. Summative content analysis was used to analyze survey data. DISCUSSION Although most respondents have implemented some primary care content, some found it challenging and others have demurred from incorporating primary care content altogether. CONCLUSION Nursing leaders and faculty in academia must collaborate with clinical partners to design and expand didactic and clinical learning experiences that emphasize primary care content in the prelicensure and RN-to-BSN education.

Somali Families’ Experiences of Parenting in the United States

The purpose of this study was to gain an understanding of first-generation Somali families’ experiences of parenting in the United States to discover potential barriers to effective parenting with the goal to design supportive interventions. Using descriptive phenomenological design, 20 Somali families in Seattle, Washington, were interviewed. Interview transcripts were then analyzed using steps outlined by Colaizzi. The overarching theme that emerged was “Parenting: A Balancing Act,” which represents Somali parents trying to balance traditional cultural values and parenting traditions with dominant cultural expectations. Participants expressed fear of losing their children to American lifestyle choices, such as drugs or gangs, and misuse of the American system to turn on their parents. Parents also acknowledged the benefits of access to education and health care for children. To cope with the stressors of their new life, participants sought to preserve traditional cultural and religious values, thus strengthening their Somali community.

Becoming a person with HIV: experiences of Cambodian women infected by their spouses

Abstract We conducted an interpretive phenomenological investigation in order to understand, within a Cambodian sociocultural context, the lived experiences of women infected with HIV by their husbands as they navigated the tasks of discovering, disclosing and dealing with the diagnosis. Using an open-ended interview protocol and an interpretive phenomenological approach, data were analysed from 15 women (aged 28–42 years) who self-identified the HIV transmission as coming from their spouses. Using qualitative inductive analysis, we were able to identify three main themes: (1) finding oneself to be HIV-positive, (2) encountering HIV – accepting an unwelcomed guest and (3) going public – dealing with the fear of discrimination. Participants consistently delayed testing for HIV and, after receiving an HIV-positive diagnosis, had to deal with painful emotions and discrimination within their social network. The complexity of gender roles and the sociocultural status of the women acted as behavioural determinants of their responses to HIV transmission from their spouses.

Why shouldn't lesbian women who miscarry receive special consideration? A viewpoint

Abstract Over the past 20 years investigators have explored the incidence, experience, and extent of grieving following miscarriage for heterosexual partnered women and, to some degree, for men. Prior investigations confirm an increase in disturbed emotions following unexpected pregnancy loss and suggest a variety of predisposing social and obstetrical factors that lead to such responses. Little is known, however, about the ways in which lesbian women experience and respond to miscarriage. An argument is made that given the increased number of lesbian women attempting pregnancy through alternative methods of conception, research is warranted that explores their experiences and potentially unique caring needs following miscarriage.

Outcomes of the Evidence-Based Pitocin Administration Checklist at a Tertiary-Level Hospital.

Pitocin, a synthetic form of the hormone oxytocin, is a high-alert medication that heightens patient harm when used incorrectly. This investigation examined the outcomes of an evidence-based Pitocin administration checklist used for labor augmentation at a tertiary-level hospital. Data came from patient records. Using the Perinatal Trigger Tool, N = 372 clinical records (n = 194 prior to and n = 178 following checklist implementation) were reviewed. Checklist implementation resulted in statistically significant reductions in the duration of hospitalization (1.72 vs. 2.02 days, p = .0005), presence of meconium (23.7% vs. 6.7%, p < .001), maternal fevers (7.2% vs. 2.3%, p = .030), and episiotomies (8.8% vs. 1.7%, p = .002), and clinically important reduction in APGAR scores < 7 at 5 min (3.6%-0.6%, p = .069) and instrumented deliveries (11.9%-8.4%, p = .307). A universal Pitocin checklist implementation can improve birth outcomes and costs of care.