Laurene Sheilds

Women's Experiences of the Meaning of Empowerment

The purpose of this exploratory study is to understand and develop the concept of empowerment from a theoretical and a practical perspective with a particular focus on womens perception of the meaning of empowerment in their lives. The 15 study participants consisted of women aged 21 to 71 who self-identified with the concept of empowerment in response to a recruitment flyer. The women participated in semistructured in-depth interviews with a follow-up opportunity for group participation. Qualitative analysis of the results indicated that women experience empowerment as a multifaceted expansive process with three central themes: the development of an internal sense of self, the ability to take action based on their internal sense of self, and a salient theme of connectedness. The subcomponents of the transformational process will be defined and results will be discussed in the context of current understanding of empowerment and womens health.

Stories of Liminality Living With Life-Threatening Illness

Purpose: The purpose of the study is to examine liminal experiences of living with the uncertainty of life-threatening illness. Increasing numbers of people with life-threatening illness live in-between the promise of treatment and the threat of recurrence or progression of disease, and yet this experience is not well understood. Design: A narrative inquiry methodology within a constructionist frame was used. Method: Semistructured in-depth interviews were conducted with 32 participants from three populations of interest: (a) 10 people living with cancer, (b) 13 people with chronic renal disease, and (c) 9 people living with HIV/AIDS. Findings: An overarching theme of “pervasive liminality” and four narratives are identified: storying into fear(lessness), being alive but not living; knowing and not knowing, and the (in)visibility of disease. Conclusions: Over time, living with a life-threatening illness produces complex and paradoxical experiences that do not easily fit within familiar categories of experience. Findings highlight pervasive liminal experiences as in-between narratives that are neither problematic nor need to be resolved, and endure over time.

Contrasting stories of life-threatening illness: a narrative inquiry.

BACKGROUND Advances in science and technology have resulted in longer lives for people with life-threatening illnesses. However, little research compares the stories of people with different life-threatening illnesses. OBJECTIVES The objectives of this study were to explore and contrast how people story and re-story life-threatening illness specifically cancer, chronic kidney disease (CKD) and HIV. DESIGN Narrative inquiry within a social constructionist perspective was used. METHODS A total of 113 in-depth interviews were conducted with 32 participants over a period of three years. PARTICIPANTS Study participants included 32 people: 10 with cancer, 14 with CKD and 8 with HIV/AIDS. Participants varied in age (37-83 years old, mean=61.2 years), gender (17 men and 14 women), location (urban and rural), time post-diagnosis (median=8 years), intensity or invasiveness of treatment, and prognosis (continuous treatment, remission, cure, palliative). RESULTS Participants described living with a life-threatening illness as a delicate balance. They focused on living their lives yet were fully and acutely aware of their own mortality. There was an undercurrent of sustained uncertainty that permeated their lives. Stories of life-threatening illness differed across the three illness groups and shifted over time as disease trajectories changed. Each disease brought specific challenges. With cancer, turning points and uncertainty were prominent. With CKD, a stealthy beginning to life-extending treatment through dialysis or transplant was evident, and with HIV, a shift from a perceived death sentence to a focus on hope and living was notable. CONCLUSIONS Findings revealed that trajectories of illness for participants living with cancer, CKD and HIV are complex and differ markedly across the groups. Narratives shifted across all of the illness groups as participants navigated and re-storied the terrains of their life-threatening illness. Findings illuminated the need for health care providers to focus on person specific and contextualized aspects of the illness experience.

Storylines of Aging With HIV: Shifts Toward Sense Making

Aging with HIV is a new phenomenon. It is expected that by 2015, approximately half of adults living with HIV in the United States will be age 50 and older. We used narrative inquiry to explore how older adults with HIV storied their experience and made sense of aging. Over a 3.5-year period, we interviewed 5 older adults living with HIV for 13 to 24 years. In analyzing the coconstructed stories, we identify six storylines that enhance understanding and guide listening: embodiment of the illness, sense making, death and loss, secrets and stigma, identity, and seeking connection. We theorize that the degree to which one reconciles each storyline influences how well one lives with illness. We share a storied exemplar to illustrate these storylines in one participant’s experience of aging with HIV. These findings emphasize how vital is telling one’s illness story, because sense making happens in the telling.

Language and the (Im)possibilities of Articulating Spirituality

Despite growing interest in spiritual matters throughout society, definitions and descriptions of spirituality seem incomplete or otherwise unsatisfactory. In this article, the authors consider the possibility that such incompleteness is perhaps necessary and welcomed in addressing spirituality. In particular, they investigate the challenges of using metaphor and metonymic approaches to “languaging” spirituality. By exploring these figures of speech they hope to diversify how nurses articulate deeply personal and perhaps enigmatic human phenomena such as spirituality. Metaphoric language uses everyday structures to help make sense of complex, emotional, and abstract experience. Whereas metaphor creates substitutive relationships between things and provides insights into conceptualizing spirituality, metonymy and metonymic writing establish relationships of contiguity. Whereas metaphor functions to represent and facilitates understanding and feelings about spirituality, metonymy disrupts while opening possibilities of moving beyond binary thinking. Attending to language and its various ontological assumptions opens diverse and potentially more inclusive possibilities.

Challenges and opportunities in graduate nursing education by distributed learning in Canada and Brazil

Neste trabalho, os autores partilham suas experiencias na pos-graduacao em Enfermagem no Canada e Brasil oferecidas por meio de aprendizagem distribuida (AD). Embora a AD seja frequentemente objeto de criticas, a experiencia dos autores tem sido de resultados positivos. No entanto, uma serie de desafios e oportunidades e discutida, incluindo: flexibilidade do programa, possibilidade de oferecimento de cursos praticos a distância, necessidade de facilitar a interacao professor/alunos, sobrecarga de trabalho dos docentes, preparo dos docentes para este tipo de atividade e apoio aos estudantes. Novas tecnologias que podem apoiar o desenvolvimento da AD sao apresentadas. Apesar dos desafios identificados, os estudantes avaliam positivamente a AD e esforcos tem sido feitos para assegurar, de modo inovativo e flexivel, a excelencia de programas de pos-graduacao em enfermagem. Os autores argumentam que apesar dos desafios existentes, os programas de AD oferecem alta qualidade para o ensino de pos-graduacao na area de enfermagem e atendem as necessidades de muitos enfermeiros.

Narrative Research Evolving: Evolving Through Narrative Research

Narrative research methodology is evolving, and we contend that the notion of emergent design is vital if narrative inquiry (NI) is to continue flourishing in generating new knowledge. We situate the discussion within the narrative turn in qualitative research while drawing on experiences of conducting a longitudinal narrative study. The philosophical tensions encountered are described, as our understanding and application of narrative approaches evolved. We outline challenges in data collection and analysis in response to what we were learning and identify institutional barriers within ethics review processes that potentially impede emergent approaches. We conclude that researchers using NI can, and must, pursue unanticipated methodological changes when in the midst of conducting the inquiry. Understanding the benefits and institutional barriers to emergent aspects of design is discussed in this ever-maturing approach to qualitative research.

Retos y oportunidades en la educación de postgrado en enfermería por aprendizaje distribuida en Canada y Brasil

Neste trabalho, os autores partilham suas experiencias na pos-graduacao em Enfermagem no Canada e Brasil oferecidas por meio de aprendizagem distribuida (AD). Embora a AD seja frequentemente objeto de criticas, a experiencia dos autores tem sido de resultados positivos. No entanto, uma serie de desafios e oportunidades e discutida, incluindo: flexibilidade do programa, possibilidade de oferecimento de cursos praticos a distância, necessidade de facilitar a interacao professor/alunos, sobrecarga de trabalho dos docentes, preparo dos docentes para este tipo de atividade e apoio aos estudantes. Novas tecnologias que podem apoiar o desenvolvimento da AD sao apresentadas. Apesar dos desafios identificados, os estudantes avaliam positivamente a AD e esforcos tem sido feitos para assegurar, de modo inovativo e flexivel, a excelencia de programas de pos-graduacao em enfermagem. Os autores argumentam que apesar dos desafios existentes, os programas de AD oferecem alta qualidade para o ensino de pos-graduacao na area de enfermagem e atendem as necessidades de muitos enfermeiros.

Desafios e oportunidades na educação de pós-graduação em enfermagem por aprendizagem distribuída no Canadá e Brasil

Neste trabalho, os autores partilham suas experiencias na pos-graduacao em Enfermagem no Canada e Brasil oferecidas por meio de aprendizagem distribuida (AD). Embora a AD seja frequentemente objeto de criticas, a experiencia dos autores tem sido de resultados positivos. No entanto, uma serie de desafios e oportunidades e discutida, incluindo: flexibilidade do programa, possibilidade de oferecimento de cursos praticos a distância, necessidade de facilitar a interacao professor/alunos, sobrecarga de trabalho dos docentes, preparo dos docentes para este tipo de atividade e apoio aos estudantes. Novas tecnologias que podem apoiar o desenvolvimento da AD sao apresentadas. Apesar dos desafios identificados, os estudantes avaliam positivamente a AD e esforcos tem sido feitos para assegurar, de modo inovativo e flexivel, a excelencia de programas de pos-graduacao em enfermagem. Os autores argumentam que apesar dos desafios existentes, os programas de AD oferecem alta qualidade para o ensino de pos-graduacao na area de enfermagem e atendem as necessidades de muitos enfermeiros.