Kristen M. Swanson

Empirical development of a middle range theory of caring

A middle-range theory of caring was inductively derived and validated through phenomenological investigations in three separate perinatal contexts. Caring was described in Study I by 20 women who had recently miscarried, in Study II by 19 careproviders in the newborn intensive care unit, and in Study III by 8 young mothers who had been the recipients of a long-term public health nursing intervention. The empirical development and refinement of the theory is discussed. The five caring processes and an overall definition of caring are presented. Finally, study findings are compared and contrasted with Cobbs (1976) definition of social support, Watsons (1979, 1985) “carative” factors, and Benners (1984) description of the helping role of the nurse.

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.

Effects of caring, measurement, and time on miscarriage impact and women's well-being.

BACKGROUND Responses to miscarriage range from relief to devastation, yet there have been no randomized controlled studies that demonstrate significant effects of counseling with women who miscarry. OBJECTIVE To test the effects of caring-based counseling, measurement, and time on the integration of loss (miscarriage impact) and womens emotional well-being (moods and self-esteem) in the first year after miscarrying. METHOD ANCOVA was used in this randomized, longitudinal Solomon four-group experimental investigation. Enrolled were 242; 185 completed. Outcomes included: self-esteem, overall emotional disturbance, anger, depression, anxiety, confusion, overall miscarriage impact, personal significance, devastating event, lost baby, and isolated. RESULTS During the first year after loss (a) caring was effective in reducing overall emotional disturbance, anger, and depression; and (b) time passing led to increased self-esteem and decreased anxiety, depression, anger, confusion, and personal significance of loss. CONCLUSION Caring, measurement, and time had some positive and significant effects on the integration of loss and enhancement of well-being in the first year subsequent to miscarrying.

Predicting depressive symptoms after miscarriage: a path analysis based on the Lazarus paradigm.

Twenty percent of all pregnancies end in miscarriage. Findings are mixed about who is most at risk for a depressive response. The purpose of this study was to develop and test a theory-based path model that would enable prediction of the intensity of womens depressive symptoms at 4 months and at 1 year after miscarriage. The model is based on Lazaruss theory of emotions and adaptation. Model constructs examined included stage I contextual variables (gestational age, number of miscarriages, number of children, maternal age, perceived provider caring at the time of loss, and family income), stage II interceding variables (perceived social support, emotional strength, and subsequent pregnancy/birth), stage III primary appraisal of meaning (personal significance of miscarrying), stage IV secondary appraisal (active or passive coping), and stage V emotional response (depressive symptoms). Path analysis employing a series of stepwise, multiple regression equations was used to test the hypothesized model. The sample consisted of 174 women whose pregnancies ended prior to 20 weeks gestation (mean = 10.51, SD = 3.32). The model accounted for 63% of the variance in womens depressive symptoms at 4 months and 54% at 1 year. Findings support the utility of the Lazarus model and confirm that women most at risk for increased depressive symptoms after miscarriage are those who attribute high personal significance to miscarriage, lack social support, have lower emotional strength, use passive coping strategies, have lower incomes, and do not conceive or give birth by 1 year after loss.

Miscarriage Effects on Couples' Interpersonal and Sexual Relationships During the First Year After Loss: Women's Perceptions

Objectives To describe inductively women’s perceptions of the effects of miscarriage on their interpersonal and sexual couple relationships (IR and SR); and, guided by the Lazarus Emotions and Adaptation Model, to compare IR and SR patterns 1 year after loss for differences in backgrounds, contexts, appraisals, reappraisals, and emotions. Methods This was a secondary analysis of data gathered at 1, 6, 16, and 52 weeks postmiscarriage from 185 women. Text data were content-analyzed. Relationship differences were examined using MANCOVA with Bonferroni adjusted pairwise comparisons. Results There were three relationship patterns: closer, as it was, and more distant. At 1 year, women whose IR (44%) was as it was (vs. closer [23%] or more distant [32%]) or whose SR (55%) was as it was (vs. more distant [39%]) coped less passively and appraised less miscarriage impact. Women whose IR or SR was as it was (vs. closer) were more likely to have children and (vs. more distant), miscarried at an earlier gestation, conceived again, and experienced fewer negative events. Those whose IR was closer or as it was and whose SR was as it was (vs. IR or SR more distant) had less disturbed emotions, more emotional strength, and partners who performed more caring acts. Women whose IR was closer and whose SR was as it was (vs. more distant) had partners who engaged in more mutual sharing. Conclusions Women differed in perceptions of how miscarriage affected their IR and SR. The Lazarus Model helped explain those differences.

Providing care in the NICU: sometimes an act of love.

The final phase of a research project is the communication of findings in a manner that is acceptable within the scholarly norms of a scientific community. While there exists in nursing a willingness to embrace many forms of inquiry, there remains a hesitancy to communicate study outcomes in alternative formats that are congruent with the innovative methods employed. This article serves a dual purpose. It presents a phenomenologic investigation of care provision in the NICU, and it serves as a forum for discussion of issues related to the conduct and communication of phenomenologic research.

Parents’ Experiences Following Children’s Moderate to Severe Traumatic Brain Injury: A Clash of Cultures

Little is understood about parents’ experiences following children’s moderate to severe traumatic brain injury (TBI). Using descriptive phenomenology, we explored common experiences of parents whose children were diagnosed with moderate to severe TBI. Parents from across the United States (N = 42, from 37 families) participated in two semistructured interviews (~ 90 minutes in length and 12 to 15 months apart) in the first 5 years following children’s TBI. First interviews were in person. Second interviews, done in person or by phone, facilitated updating parents’ experiences and garnering their critique of the descriptive model. Parent themes were (a) grateful to still have my child, (b) grieving for the child I knew, (c) running on nerves, and (d) grappling to get what my child and family need. Parents reported cultural barriers because of others’ misunderstandings. More qualitative inquiry is needed to understand how the knowledge, attitudes, beliefs, and culture-based expectations of others influence parents’ interactions and the family’s adjustment and well-being.

What Really Matters to Healthcare Consumers

Consumer satisfaction with healthcare is an important quality and outcome indicator. Satisfaction may be at the crux of survival for healthcare delivery systems because it creates the competitive edge in healthcare. To better understand patient satisfaction by examining consumer healthcare experiences and expectations, a study was conducted. An important concept identified in the data, MY CARE, refers to a constellation of quality healthcare features that were wished for by all participants and realized by only some of them. The features of MY CARE offer lessons for all healthcare leaders to use when making improvements in care delivery systems—improvements that could create a more patient-centered healthcare system and boost patient satisfaction.

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.

Children's longing for everydayness: Life following traumatic brain injury in the USA

Primary objective: Little is known about life after traumatic brain injury (TBI) from the childs perspective. Research design: This descriptive phenomenological investigation explored themes of childrens experiences following moderate-to-severe TBI. Methods and procedures: Inclusion criteria: (1) 6–18 years of age at injury; (2) moderate-to-severe TBI; (3) ≤3 years since injury; and (4) English speaking and could participate in an interview. Children participated (n = 39) in two interviews at least 1 year apart. A preliminary model was developed and shared for participants’ input. Main outcomes and results: Six themes emerged: (1) it is like waking up in a bad dream; (2) I thought going home would get me back to my old life, but it did not; (3) everything is such hard work; (4) you feel like you will never be like the person you were before; (5) it is not all bad; and (6) some people get it, but many people do not. Conclusions: Social support was important to how children adjusted to changes or losses. Most children did adjust to functional changes by second interviews. Children had a more difficult time adjusting to how others defined them and limited their possibilities for a meaningful life.