Magi Sque

Secondary analysis of qualitative data: a valuable method for exploring sensitive issues with an elusive population?

This paper aims to demonstrate the process of conducting a secondary analysis of primary qualitative datasets. Whilst there is a well-established tradition of carrying out a secondary analysis of quantitative datasets within social and health research, this has not been the case with qualitative datasets. Despite a recent growth in interest in the secondary analysis of qualitative data, very little information is available regarding the process, as publications tend to focus on the outcomes of analyses. A secondary analysis of 28 transcripts, sorted from two primary datasets containing longitudinal and cross-sectional interview data, was carried out. The choice of applying a secondary analysis fulfilled the aims of: (i) addressing a sensitive area of research; and (ii) accessing a research population that was elusive, factors that may be barriers to carrying out research in areas that are considered to be of a sensitive nature, or topic. Secondary analysis has potentially important implications for qualitative researchers who seek to investigate sensitive topics within health, not least of which is the opportunity it offers to facilitate the training of researchers at all levels.

Researching the Bereaved: an investigator’s experience

The issues discussed in this article concern the process of interviewing the bereaved relatives of organ donors, the personal impact, and the potentially painful nature of such research. Narrative interviews were carried out with 24 donor relatives. The relatively small number of donating families and their anonymity mean that little is understood about the experience of having a relative in a critical care situation that ends in donation. The purpose of this study was to develop a theory that explained the organ donation process for relatives of ‘major organ’ donors. A central concern of implementing the investigation was the possible threat it posed to the participants and myself. The sensitive nature of the research made access to relatives difficult. Undoubtedly, my nursing background and personal attributes had an impact on interactions with participants and the pursuance of the research agenda.

Factors Influencing Bereaved Families’ Decisions About Organ Donation An Integrative Literature Review

This article reports on the process and outcomes of a systematic integrative literature review, designed to enhance understanding of the factors influencing bereaved families’ decisions to agree or decline the donation of their deceased relative’s organs for transplantation. Research originating from eight Western countries (N = 20 studies) provided an international perspective to the review. Thematic analysis and synthesis of textual data culminated in the development of three global themes (past, present, and future) that captured the temporal dimensions of family decision making. The review findings provide valuable insight into ways of increasing the rate of consent to organ donation through the development family-centered care interventions that reflect the needs of the bereaved. Further research to explore the pathway of donation after circulatory death and the experiences of bereaved families who decline organ donation is essential to providing a more complete understanding of the factors affecting donation decisions.

The culture of cancer and the therapeutic impact of qualitative research interviews

This paper is an account of the potential therapeutic impact of research interviews encountered while conducting a qualitative research study. Similarities between the therapeutic (or psychoanalytic) interview and the qualitative research interview are discussed and explored, with examples drawn from a current study. It is suggested that, as a listener, the nurse researcher may offer the participant a mechanism for reflection, greater self-awareness, finding a voice, obtaining information, and venting repressed emotions. Within the context of cancer the participant might have multiple care and information needs to which he/she may expect a therapeutic interaction from a nurse researcher. The potential therapeutic component of the nurse researcher role in the context of cancer care is described and considered. The paper suggests that there may be positive and negative aspects of a therapeutic component to the researcher role and that the researcher should think carefully concerning the stance that he/she will take in the field.

Split personalities: Role conflict between the nurse and the nurse researcher

This paper is a personal account of the nurse-nurse researcher role conflict encountered while conducting a qualitative research study. Difficulties in the transition from a clinical post to a nurse researcher role are described and the experiences of other authors dealing with such a role change are used to illustrate potential resolutions. An understanding of the concept of reflexivity is offered and a description of how this can be applied to consider the impact of ‘the self’ on the research. The paper suggests a solution to the well-known role conflict encountered by nurse researchers: including the nurse in the process of research, and being confident about taking a personal investigative approach. It is argued that drawing on the interactive skills of the nurse can benefit and not detract from the research process.

Decision-making processes used by nurses during intravenous drug preparation and administration.

AIM   The aim of this study was to explore the decision-making processes that nurses use during intravenous drug administration and how this influences risk taking and errors. BACKGROUND   Intravenous drug errors have been estimated to be a third of all drug errors. Previous drug error research has focused on observation of nurses and errors they make but has not attempted to understand the decision-making processes used during the preparation and administration of intravenous drugs. METHOD   A three-phased ethnographic study was carried out in a specialist cancer hospital in 2007 using focus groups, observation and interviews. This article is concerned with the observation and interview phase. Observation took place on two wards, each over a week. Twenty nurses were observed preparing and administering intravenous drugs; then interviewed about their procedure. Data analysis was carried out using a five stage approach. FINDINGS   Major themes identified include: interruptions; identification and knowing the patient; routinized behaviour, prevention of errors. These represent the findings of the observation and interviews with the nurses. One key finding was the lack of checking of patient identity prior to IV drug administration, which appeared to be based on nurses feeling they knew the patient well enough, although this was in contrast to how they checked even familiar drugs. This article will focus on identification and knowing the patient. CONCLUSION Implications for practice included: exploring new and effective methods of education based on behavioural theories; involving staff in updating policies and procedures; formal assessment of staff during intravenous preparation and administration.

Balancing hope and despair at the end of life: The contribution of organ and tissue donation.

PURPOSE Concern for the grieving family can moderate the intentions of critical care staff to advocate deceased organ and tissue donation. Conversely, benevolent actions may provoke distress through missed opportunities to save or transform lives. This article provides insight into the perceived benefits of organ and tissue donation for grieving families who experienced end-of-life care in the intensive care unit. METHODS Data were collected via semistructured, face-to-face or telephone interviews with 43 participants from 31 donor families. Audio recordings were transcribed verbatim and subjected to qualitative content analysis. RESULTS The study findings affirmed the importance of person-centered end-of-life care. Donor families shared examples of good-quality care and communication that contained the hallmarks of compassion, respect, dignity, and choice. We uncovered a trajectory of hope and despair in which the option of organ and tissue donation appeared to give meaning to the life and death of the deceased person and was comforting to some families in their bereavement. CONCLUSIONS Our study findings underlined the significance of donation decision making for grieving families. Organ and tissue donation has the potential to balance hope and despair at the end of life when the wishes of the dying, deceased, and bereaved are fulfilled.

Research with bereaved families: A framework for ethical decision-making

Theoretical debates about the nature of grief and bereavement draw attention to the sensitivity of carrying out research with bereaved people, the possible threats that this may pose and the ethical considerations required to ameliorate potentially damaging outcomes. The authors of this article present a framework for ethical decision-making that has been successfully developed in the context of research with bereaved families. The discussion focuses on application and evaluation of the framework during research with family members who were approached about the donation of a deceased relative’s organs and/or tissues for transplantation. Practical strategies of relevance to the processes of participant recruitment, the interview encounter and follow-up care in the post-interview period are identified and discussed. Concerns about the possible impact of bereavement research are balanced with the views of family members who gave credence to the therapeutic and cathartic benefits of participating in sensitive, death-related research.

Evaluation of the experiences of family members whose deceased relative donated tissues at the NHSBT dedicated donation facility in Speke, Liverpool

Donation of human tissue for transplant and research has historically been facilitated within the hospital mortuary. In 2006 NHSBT Tissue Services opened the Dedicated Donation Facility [DDF], the first facility in the UK dedicated to the donation of tissues under strictly controlled conditions. Nine family members who had agreed and experienced the transfer of their deceased relative to the DDF for tissue donation participated in a service evaluation applying qualitative data collection methods and framework analysis. The evaluation aimed to: understand the decision-making process of family members who agreed to their deceased relative being moved to the DDR for tissue donation; identify any concerns that family members had; gather the views of family members regarding the ‘service’ provided to them by NHSBT Tissue Services. Family members were unaware of the possibility of tissue donation. The process of reasoning behind both agreeing to tissue donation and movement of the deceased to the DDF by family members was fundamentally, ‘the benefit to others’ that tissue donation would bring, and fulfilling the wishes of the deceased [when known]. Family decision making was facilitated by: (i) a positive rapport with the requester, (ii) satisfaction with the information provided to the family about what would happen, and (iii) trust in that what was being said would happen. Family members were satisfied with the service provided to them by Tissue Services and confident in agreeing to the transfer of their deceased relative to the dedicated facility for tissue donation.

Current issues in organ donation and transplantation

Human organ transplantation was undoubtedly one of the outstanding medicosurgical advances of the twentieth century offering individuals, facing certain death from end stage organ failure, a second chance of life. The world celebrated the 50th anniversary of the first successful kidney transplant in December 2004 and the 100th anniversary of the first corneal transplant in December 2005 (UK Transplant, 2005a). So it is certainly timely for a publication of a special issue of Mortality devoted to organ donation and transplantation that concerns individuals facing death or a severely compromised quality of life if they do not receive an organ, the families that are asked to make end of life decisions that affect the scale of organ donation, and the new methods that have been harnessed in an attempt to increase the supply of viable organs. This special edition therefore focuses on exploring organ donation and transplantation from a number of social, cultural, and psychological perspectives. The technological development of transplant procedures moved rapidly following the first successful kidney transplant from one identical twin brother to another, in 1954, at the Peter Bent Brigham Hospital in Boston (Tilney, 2003). There are a number of intriguing events that Tilney (2003) labels as ‘‘emblematic’’ marking the early development of transplantation procedures during this era. In the opening of his authorative book on the history of human transplantation, Transplant from myth to reality, Tilney (2003) recounts the case of Joe Palazzola who, in August 1964, was discharged from Peter Bent Brigham hospital following a successful kidney transplant and who was subsequently arrested as a suspected bank robber. The story goes that Joe was spotted in his car wearing a mask and porkpie hat, pulled low over his eyes, by a passing state trooper. He was forced to stop and was taken to the police station for questioning.