Graham McCaffrey

Grandparents’ Experiences of Childhood Cancer, Part 1: Doubled and Silenced

In this study, the authors examined the experiences of grandparents who have had, or have, a grandchild with childhood cancer. Sixteen grandparents were interviewed using unstructured interviews, and the data were analyzed according to hermeneutic–phenomenological tradition, as guided by the philosophical hermeneutics of Hans-Georg Gadamer. Interpretive findings indicate that grandparents suffer and worry in many complex ways that include a doubled worry for their own children as well as their grandchildren. According to the grandparents in this study, this worry was, at times, silenced in efforts to protect the parents of the grandchild from the burden of concern for the grandparent. Other interpretations include the nature of having one’s universe shaken, of having lives put on hold, and a sense of helplessness. The grandparents in this study offer advice to other grandparents as well as to the health care system regarding what kinds of things might have been more helpful to them as one level of the family system, who, like other subsystems of the family, are also profoundly affected by the event of childhood cancer.

Grandparents’ Experiences of Childhood Cancer, Part 2 The Need for Support

In this study, the authors examined the experiences of grandparents who have had, or have, a grandchild with childhood cancer. Sixteen grandparents were interviewed using unstructured interviews, and the data were analyzed according to a hermeneutic–phenomenological tradition, as guided by the philosophical hermeneutics of Hans-Georg Gadamer. In Part 1 of this report, interpretive findings around worry, burden, silence, the nature of having one’s universe shaken, of having lives put on hold, and a sense of helplessness were addressed. In Part 2, the authors discuss interpretations related to the notions of support, burden, protection, energy, standing by, buffering, financial shouldering, and relationship. The study concludes with implications that the grandparents in the study bring to pediatric nurses in their practices with families in pediatric oncology.

Compassion: a critical review of peer‐reviewed nursing literature

AIMS AND OBJECTIVES To provide a critical review of nursing literature about compassion, identifying major themes, questions arising and directions for future investigation of the topic. BACKGROUND Compassion has emerged as a topic of broad social concern in recent years and is particularly pertinent to nurses. DESIGN Critical review was selected as the most appropriate way of analysing literature from both qualitative research studies and conceptual articles. METHODS An electronic database search was conducted, discovering articles published between 1952 and 2013. The search was then limited to publications since 2000 to capture recent development of the concept. The search was limited to peer-reviewed literature, excluding a large body of editorial material, resulting in 20 relevant articles. Two books were also added that contributed important perspective to the analysis. Critical analysis of the resulting material was undertaken to identify themes, tensions and implications in the literature. RESULTS Major themes were compassion as practice and compassion as a moral virtue, holding implications for how nurses can demonstrate compassion in relation to contemporary healthcare values. A third major theme was the influence of institutional environments in facilitating or limiting the expression of compassion. CONCLUSIONS Compassion is a human experience of deep significance to nursing and needs understanding in the context of healthcare environments dominated by discourses of efficiency and rationalisation. There is an emergent literature about how compassion may be understood, taught and sustained among nurses but it is a topic that requires continued attention. RELEVANCE TO CLINICAL PRACTICE More precise understanding of compassion will support nurses in advocating for compassionate care, participating in interdisciplinary dialogue, and contributing to the design of healthcare environments that are conducive to compassionate care.

Buddhist thought and nursing: a hermeneutic exploration

In this paper I lay out the ground for a creative dialogue between Buddhist thought and contemporary nursing. I start from the observation that in tracing an arc from the existential human experience of suffering to finding compassionate responses to suffering in everyday practice Buddhist thought already appears to present significant affinities with nursing as a practice discipline. I discuss some of the complexities of entering into a cross-cultural dialogue, which is already well under way in the working out of Western forms of Buddhism, and which is beginning to be reflected in nursing literature. I introduce philosophical hermeneutics as a useful framework for elaborating an open and constructive exchange. I then discuss key Mahayana Buddhist concepts of emptiness and two truths that lead to a dynamic and open way of understanding reality and responding in the world. I turn to examples of original texts to give a flavour of the varied and distinctive forms of literature in the Buddhist tradition. This is intended partly to keep the reader alert to cultural difference (from a Western standpoint, that is) while exploring the creative potential of Buddhist thought. Hermeneutics again provides a framework for interpretation. This paper establishes a philosophical ground for a critical and creative dialogue between Buddhist thought and nursing.

Examining the Effects of Childhood Cancer on the Parental Subsystem: Implications for Parents and Health Care Professionals—Part 3

This article is the third part of a hermeneutic research study examining the impact of childhood cancer experiences on the parental relationship. In Part 1, we offered an exploration of the phenomenon with background literature; a description of the research question, method, and design; and finally a discussion of relationships that survived, thrived, or demised, with an emphasis on the notions of difference and trading. In Part 2, we furthered the interpretations to look at the complexities of issues such as teams, roles, focus, protection, intimacy, grieving, putting relationships on hold, and reclaiming them. In this article, we discuss the advice that the participants offered us and how that advice might have implications for other parents in similar situations and health care professionals working with families experiencing childhood cancer.

Differences and Trading: Examining the Effects of Childhood Cancer on the Parental Subsystem-Part 1.

This article is the first of a three-part report of a research study that used hermeneutic inquiry to examine the effects of childhood cancer on the relationship between the parents of the child. In Part 1, we identity the topic of investigation and the relevant literature; describe the research question, method, and design; and begin our interpretations of the data with a focus on the couples who remained together and those who experienced relationship demise. In this analysis, we discovered that issues of difference and trading played a strong role in how the couples fared in their relationships. In Part 2 of this series, we focus on further interpretations, and in Part 3, we discuss the implications of the study for other parents and for health care professionals.

Taking One for the Team Examining the Effects of Childhood Cancer on the Parental Subsystem—Part 2

In this Part 2 of a three-part research paper, we further our interpretations from our hermeneutic study examining how having a child who has experienced cancer had an impact on the relationship between the parents. In Part 1, we identified the focus of the study and provided background to the topic. We also described the research question, method, and design before offering an interpretive analysis of couples whose relationships survived, thrived, or demised. In this article, we extend the interpretations under an overarching theme of “taking one for the team.” Here, we discuss issues of changes in focus and roles, and the notions of tag teaming, protection, intimacy, and grieving. We examine the phenomenon of putting relationships on hold, then finding reclamation later. In Part 3, we offer implications of these findings for other parents in similar situations and for health care professionals working with these families.

The suffering of chronic pain patients on a wait list: Are they amenable to narrative therapy?

ABSTRACT Background: Chronic pain affects one in five Canadians. People with chronic pain frequently experience loss in their lives related to work, relationships, and their independence. They may be referred to a chronic pain program, which aims to strengthen coping through medical intervention and self-management skills. Data suggest that, even when individuals begin their pain program, many feel overwhelmed and do not continue. Aims: The aim of this study was to conduct a needs assessment to explore the acceptability and feasibility of developing a psychosocial intervention, narrative therapy (NT), to address loss for chronic pain patients on the wait list of a chronic pain program. Methods: Two focus groups were conducted with ten patients who had experienced being on a wait list for a provincial chronic pain management program (CPMP). Transcribed interviews were subjected to thematic and interpretive analysis. Results: Two major themes emerged from the analysis: loss of identity and sharing a story of chronic pain. All patients were enthusiastic toward an NT intervention, although individual preferences differed regarding mode of delivery. Conclusions: Loss is a significant part of the chronic pain experience. NT seems to be an acceptable intervention to address loss for patients on the wait list for a chronic pain program.

Youth strengths arise from the ashes of adversity

ABSTRACT With problem-oriented approaches to practice, policy and research, youth considered to be ‘at-risk’ are not often viewed from a strengths-based perspective. Explorations of youths’ strengths are critical to help create environments where youth can flourish. The purpose of this research was to explore the resilience, healthy capabilities and strengths of youth at risk; from youth and staff perspectives across three community-based organizations in Western Canada. Through 17 interviews analyzed using hermeneutics, and further interpretation using metaphor development, stories arose of a journey progressing from loss and despair to fostering hope. The importance of youth having a voice and being included in decision-making was both a strength and a way of building strengths in youth. Multiple-level recommendations to help mediate the challenges and systems failures identified in these youths’ journeys were identified; with an end goal of creating healthier futures for youth and a society in which they feel they belong.

Factors associated with pregnancy-related anxiety in Tanzanian women: a cross sectional study

Objective To identify factors predictive of pregnancy-related anxiety (PRA) among women in Mwanza, Tanzania. Design A cross-sectional study was used to explore the relationship between psychosocial health and preterm birth. Setting Antenatal clinics in the Ilemela and Nyamagana districts of Mwanza, Tanzania. Participants Pregnant women less than or equal to 32 weeks’ gestational age (n=212) attending the two antenatal clinics. Measures PRA was measured using a revised version of the 10-item PRA Questionnaire (PRA-Q). Predictive factors included social support (Multidimensional Scale of Perceived Social Support), stress (Perceived Stress Scale), depression (Edinburg Postpartum Depression Scale) and sociodemographic data. Bivariate analysis permitted variable selection while multiple linear regression analysis enabled identification of predictive factors of PRA. Results Twenty-five per cent of women in our sample scored 13 or higher (out of a possible 30) on the PRA-Q. Perceived stress, active depression and number of people living in the home were the only statistically significant predictors of PRA in our sample. Conclusions Our findings were contrary to most current literature which notes socioeconomic status and social support as significant factors in PRA. A greater understanding of the experience of PRA and its predictive factors is needed within the social cultural context of low/middle-income countries to support the development of PRA prevention strategies specific to low/middle income countries.