Lorraine Holtslander

Metasynthesis of the Hope Experience of Family Caregivers of Persons With Chronic Illness

The purpose of this metasynthesis was to describe the hope experience of family caregivers of persons with chronic illness. Fourteen studies were included in the metasynthesis. All studies described the importance of hope to the family caregivers of relatives with chronic illness regardless of age, relationship, or setting. Several derived themes arose from the metasynthesis, including (a) transitional refocusing from a difficult present to a positive future, (b) dynamic possibilities within uncertainty, (c) pathways of hope, and (d) hope outcomes. Hope was defined as transitional dynamic possibilities within uncertainty. A new conceptual model of hope was developed that provides a foundation for future research and practice. The metasynthesis findings indicate factors influencing hope have a role in assessing hope and differing pathways of hope provide a foundation for future hope interventions.

Developing a living with hope program for caregivers of family members with advanced cancer.

A theory-based intervention, the Living with Hope Program (LWHP), was designed to foster hope in caregivers of family members with advanced cancer. The LWHP was developed from qualitative data and using Harding and Higginsons recommendations for family caregiver interventions as a guide. The LHWP is: (a) focused specifically on the caregivers themselves, (b) theory based, (c) feasible, (d) acceptable, and (e) pilot tested. The program consists of a hope video and a hope activity titled Stories of the Present. A mixed-method, concurrent triangulation, pre- and post-test design was used to pilot test the LWHP The results of the pilot test suggest the LWHP is easy to use, flexible, and feasible, and shows promise in increasing hope and quality of life scores in family caregivers.

The Psychosocial Context of Bereavement for Older Women Who Were Caregivers for a Spouse With Advanced Cancer

The psychosocial context of bereavement for older women who were caregivers for a spouse with advanced cancer was explored qualitatively with 13 older women. Interviews and diaries were analyzed using constant comparison. The psychosocial context emerged as the intrapersonal : exhaustion, loneliness, pain, and recovering physical health; the interpersonal: finding a new way through both supportive and difficult relationships; and the community/societal: a loss of identity, pressure to move on, financial concerns, and relying on formal supports. The psychosocial context of bereavement for older women who were caregivers is uniquely challenging and must be considered when providing care and programs of support.

Discursive meaning of hope for older persons with advanced cancer and their caregivers.

Cette étude a utilisé l’approche du discours critique de van Dijik afin d’explorer le discours sociétaux actuel sur l’espoir, et d’explorer l’espoir des patients agées avec cancer terminale, leurs soignants et leurs infirmières primaires. Quarante-trois articles de presse traitant de l’espoir et de cancer ont été recueillies et analysées pour explorer comment l’espoir est socialement construite par les médias de presse. Des entrevues individuelles de face à face, qualitatives et ouvertes ont été menées avec trois triades, constitués d’un patient de cancer palliatif âgé, un conjoint, et une infirmière primaire. Le discours prédominant de l’espoir et de cancer dans les articles de presse a été considérée comme discriminatoire à raison de l’âge; il a transmit le message que le seul espoir légitime qui existe pour les personnes atteintes d’un cancer est d’espérer un remède. Ce message a causé de la confusion et de la détresse pour les patients, leurs conjoints, et leur infirmières primaires, étant donné que leurs propre discours d’espoir ont été axés sur le confort, la paix et le maintien des relations à la fin de vie.

Understanding Parental Experiences Through Their Narratives of Restitution, Chaos, and Quest Improving Care for Families Experiencing Childhood Cancer

The purpose of this secondary analysis was to develop an enhanced understanding of the experiences of parents who have children in treatment for cancer. Data collected from 16 parents (12 mothers and 4 fathers) were analyzed using Frank’s dialogical narrative analysis. Findings demonstrated that parents’ experiences were represented in chaos, restitution, and quest narratives. Each of these narratives was only one instance of a very complex and changing parental experience that cannot be understood in isolation from the others. The holistic understanding provided by these findings contributes to a more comprehensive understanding of parental experiences of their child’s illness and highlights the need for health professionals to invite conversations about parents’ illness experience and attend to the specific narrative type parents are presenting to support them adequately. Additional research is required to develop supportive approaches for each narrative which takes into account the complexities of parents’ experiences.

Ways of knowing hope: Carper’s fundamental patterns as a guide for hope research with bereaved palliative caregivers

Carpers ways of knowing in nursing, empirics, esthetics, personal knowing, and ethics, provide a guide to holistic practice, education, and research. The origin and evolution of the ways of knowing are discussed and applied to current and proposed hope research with bereaved palliative caregivers, with the ultimate goal of promoting healthy, positive outcomes for this unique population. Bereaved palliative caregivers have unmet needs that may be addressed by research exploring hope during grief. For example, research from an empirical perspective identifies hope as a variable in grief resolution, esthetic knowing guides qualitative research on hope, personal knowing provides a constructivist philosophy to a qualitative inquiry, and ethical knowing includes the moral obligation for evaluation research. Unknowing and sociopolitical knowing offer a critical perspective as research is developed and applied, while considering complexity and social context. Nursing research from diverse epistemological perspectives will enhance the effectiveness and appropriateness of evidence-based practice.

Developing and Piloting an Online Graduate Nursing Course Focused on Experiential Learning of Qualitative Research Methods

Despite the turmoil of a worldwide economic crisis, the health sector remains largely understaffed, and the nursing shortage represents a major issue that jeopardizes graduate nursing education. Access to education remains a challenge, particularly in rural and remote areas. This article reports the process of developing an asynchronous online qualitative research course. This online course was piloted among 16 interdisciplinary students. Participants agreed that experiential learning was useful to understand the intricacies of qualitative research. Within this constructivist approach, students were immersed in real-life experiences, which focused on the development of skills applicable to qualitative research. Based on the findings, we suggest that constructivism and the Four-Component Instructional Design (4C/ID) model (a four-part approach for fostering the development of complex skills) represent valuable ontological and pedagogical approaches that can be used in online courses. Triangulating these two approaches is also congruent with the student-centered philosophy that underpins nursing graduate programs.

Clinical Application of the 15-Minute Family Interview: Addressing the Needs of Postpartum Families

The purpose of this article is to describe the application of the 15-minute family interview to family-centered nursing practice on a postpartum unit. Guided by the five key components of the 15-minute family interview (manners, therapeutic conversation, genogram or ecomap, therapeutic questions, and commendations), clinical excerpts of interviews with families illustrate application to practice. The 15-minute family interview is not a strategic, decontextual nursing tool; rather, it is a flexible interview guide that is embedded in family nursing practice, in the relationship between the nurse and family and in the nurse’s philosophical assumptions and obligations to do well by families.

Keeping hope possible: a grounded theory study of the hope experience of parental caregivers who have children in treatment for cancer.

Background: Hope has been found to support parents as they care for their child with a life-limiting or life-threatening illness. However, very little research focuses on the nursing care of parents of pediatric oncology patients, and therefore, nurses may have difficulty in understanding and supporting parental well-being. Objective: The purpose of this qualitative study was to gain an understanding of the experience of hope for parents who care for their child in treatment for cancer. Methods: Using purposive theoretical sampling, 16 parents participated in this study. Thirty-three open-ended, face-to-face interviews were conducted, and 14 parent journals were collected. Analysis of the data was conducted using Charmaz’s constructivist grounded theory approach. Results: A developing, substantive grounded theory was constructed. Parental hope was described as an essential, powerful, deliberate, life-sustaining, dynamic, cyclical process that was anchored in time; was calming and strengthening; and provided inner guidance through the challenging experience of preparing for the worst and hoping for the best. Parents’ main concern was “fearing the loss of hope,” which was ameliorated by the basic social process of “keeping hope possible” through accepting reality, establishing control, restructuring hope, and purposive positive thinking. Conclusions: Parents journeyed through numerous transitions related to the treatment of cancer that caused feelings of uncertainty, anxiety, stress, and loss of control. Hope was identified as vital to parents. Implications for Practice: To minimize these adverse experiences, nurses can support parents’ ability to keep hope possible and thus to optimize their well-being by understanding, assessing, and supporting parental hope.

Finding straight answers: identifying the needs of parents and service providers of adolescents with type 1 diabetes to aid in the creation of an online support intervention

AIMS AND OBJECTIVES To explore the needs and preferences of parents and service providers of adolescents with type 1 diabetes in an online support intervention. BACKGROUND Parents experience stress during this time of transition as adolescent conflict is common and the consequences of risk-taking behaviour in combination with type 1 diabetes can be severe. Parents are in need of social support and desired an online intervention. Online support interventions have not been previously designed from the perspective of the users of these interventions. METHODS Participatory, qualitative design. Fourteen group interviews across Canada (n=60). RESULTS Participants identified four main themes (Finding straight answers, Making transitions, Struggling with parenting and Connecting with others) within the context of accessibility. Parents described their needs for credible Canadian information, support from other parents, fostering positive family dynamics while shifting parenting roles during adolescence. Connecting with others included finding a social support system and venue to share stories and resources. DISCUSSION These findings are innovative as these experienced participants desired a blend of professional information and peer informal knowledge and support in an accessible, online format. CONCLUSION The results of this study will form the foundation of an online support intervention while providing unique insight into the experiences of parents of adolescents with type 1 diabetes. RELEVANCE TO CLINICAL PRACTICE Parents and service providers indicate the need for information that is trusted, accurate and on a wide range of topics, within a preferred online environment. Supporting parents during this difficult time includes directing them to appropriate and accessible resources, facilitating a positive, healthy process of transition to interdependence, in their parenting of adolescents with type 1 diabetes.