Margaret H. Kearney

Qualitative Metasynthesis: Reflections on Methodological Orientation and Ideological Agenda:

In an era of pressure toward evidence-based health care, we are witnessing a new enthusiasm for qualitative metasynthesis as an enterprise distinct from conventional literature reviews, secondary analyses, and the many other scholarly endeavors with which it is sometimes confused. This article represents the reflections of five scholars, each ofwhom has authored a distinct qualitative metasynthesis strategy. By providing the reader a glimpse into the tradition of their various qualitative metasynthesis projects, these authors offer a finely nuanced examination of the tensions between comparison and integration, deconstruction and synthesis, and reporting and integration within the metasynthesis endeavor. In so doing, they account for many of the current confusions about representation and generalization within the products of these inquiries. Through understanding the bases of their unique angles of vision, the reader is invited to engage in their commitment to scholarly integrity and intellectual credibility in this emerging methodological challenge.

Mothering on crack cocaine: a grounded theory analysis.

Mothers who use crack cocaine are commonly believed to be selfish, uncaring, and neglectful of their children. For this paper, the grounded theory method was used to analyze 68 semi-structured depth interviews with cocaine-using mothers. These womens views of motherhood, the strategies they used to manage mothering on cocaine, and the contextual influences on mothering outcomes were explored. Contrary to popular assumptions, the women highly valued motherhood and held firm standards for childrearing. Mothers were concerned about the possible risks to their children and used a process of defensive compensation to protect both their children and their maternal identities from the negative influences of crack cocaine. When unable to fulfil their maternal responsibilities by other means, some mothers placed their children with family members, and others lost custody involuntarily. When children were forcibly removed, mothers often increased their drug use to cope with the loss. Social and economic conditions influenced the outcomes of mothering on crack.

An open letter to The BMJ editors on qualitative research

Seventy six senior academics from 11 countries invite The BMJ ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission

Identity Shifts as Turning Points in Health Behavior Change

The authors used a grounded formal theory approach to synthesize the findings of 14 studies, with the goal of identifying common elements in qualitative studies of individuals’ efforts to change a variety of unhealthy behaviors. The combined sample of 399 participants had experiences of weight loss, smoking cessation, and alcohol and drug-abuse recovery. Data were extracted from published reports and analyzed using grounded-theory techniques. In the provisional model, a value conflict in response to distressing accumulated evidence prompts a small step toward behavior change. If successful, an identity shift begins. Increased self-awareness and self-confidence fuel continued change. Numerous constraints to success are noted at each step. The links to previous conceptions of identity shift are discussed.

Truthful Self-Nurturing: A Grounded Formal Theory of Women's Addiction Recovery

This grounded formal theory study was designed to develop a midrange theory of womens addiction recovery from multiple substantive reports. Ten research reports from diverse contexts were analyzed using theoretical sampling and constant comparison. The basic problem of addiction was found to be self-destructive self-nurturing. The basic process of recovery was truthful self-nurturing, which required a painful awareness shift in which addiction gained meaning as a problem. Subsequent recovery involved three areas of social-psychological change: abstinence work, self-work, and connection work. Consequences were enjoying simple pleasures, growing self-understanding, self-acceptance, and sense of belonging, and empowered connectedness. The theory was supported by findings of other qualitative studies of the same phenomenon.

Blinding in peer review: the preferences of reviewers for nursing journals

AIM This paper is a report of a study to assess the beliefs and preferences of reviewers for nursing journals about blinding of authors to reviewers, reviewers to authors, neither or both. BACKGROUND Blinding of author and reviewer names in the manuscript review process has been of interest to nursing editors, but reports that are based on data rather than simply opinion concern the editorial practices of biomedical rather than nursing journals. There has been no study of nursing journal reviewer beliefs and preferences related to blinding. METHOD A descriptive web-based survey was conducted. The sample included 1675 anonymous reviewers, recruited through 52 editors of nursing journals from their review panels. Data were collected in 2007. FINDINGS Double-blinding of reviews was the most common method reported. Ninety per cent of respondents reported that the papers they received to review did not include author names. When author names were blinded, 62% of reviewers could not identify the authors of papers; another 17% could identify authors < or =10% of the time. Double-blinding was the method preferred by 93.6% of reviewers, although some identified some advantages to an unblinded open review process. CONCLUSION Nursing journal reviewers are generally very satisfied with double-blinding and believe it contributes to the quality of papers published. Editors or editorial boards interested in a more open review process could consider alternatives such as offering authors and reviewers the option to unblind themselves. Simply announcing that the review process will henceforth be unblinded would probably lead to loss of reviewers.

SALVAGING SELF : A GROUNDED THEORY OF PREGNANCY ON CRACK COCAINE

A grounded theory was developed to describe how pregnant crack cocaine users perceived their problems and responded to them. A basic social psychological process, salvaging self, was identified from constant comparative analysis of in-depth interviews with 60 pregnant or postpartum women who used crack cocaine an average of at least once per week in pregnancy. Salvaging self included two phases, facing the situation and evading harm. Participants evaluated the value, hope, and risk of various responses to pregnancy. Actions included strategies of harm reduction and stigma management aimed at reducing damage to the fetus, their identities as individuals and mothers, and the maternal-child relationship. Personal histories and social contexts influenced the salvaging process.

Health Behaviors as Mediators for the Effect of Partner Abuse on Infant Birth Weight

BackgroundIntimate partner abuse of pregnant women has been linked to the delivery of low-birth-weight infants. Also, abused pregnant women have reported a greater prevalence of substance abuse, poor nutrition, and demographic risk factors for poor birth outcomes. These factors may play a role in the reported relation between intimate partner violence and birth weight. ObjectivesTo explore the role of substance abuse (smoking, alcohol, and drug use) and weight gain of less than 15 pounds during pregnancy as potential mediators of the relation between recent partner abuse and infant birth weight, and to investigate the role of demographic risk factors as potential moderators for the impact of abuse on birth weight. MethodsData were extracted on abuse screening results, demographics, birth outcomes, and a range of medical and obstetric risks and complications from the medical records of 1,969 women who had been screened by clinicians for domestic abuse during pregnancy. Hypotheses were tested using multiple regression analysis. ResultsRecent physical or psychological abuse had a small but significant effect on birth weight in this sample. Smoking and low weight gain were weak but significant mediators of the relation between recent abuse and infant birth weight. Single marital status was the strongest demographic predictor of decreased birth weight. No moderator effects were found. ConclusionsAlthough prospective studies are warranted, nursing care to reduce smoking and promote adequate weight gain in all women along with support for women’s efforts to seek safety from abuse may help to improve birth outcomes and promote maternal well-being.

Making evidence-based practice a reality in your institution.

There are many barriers to ensuring that nursing practice is based on research evidence. This article provides several resources to help the practicing nurse identify what evidence is available upon which to make practice changes. Additionally, strategies for supporting change are discussed and a case study of one particular evidenced-based change—1:1 support by nurses for women in labor—is examined.

SCREENING FOR ABUSE: BARRIERS AND OPPORTUNITIES

Domestic abuse is the leading cause of injuries and death among women of childbearing age in the United States. The broad purpose of this research is to discover how pregnant womens psychological and behavioral responses to abuse affect birth outcomes. To select a diverse sample of women, we identified 8 prenatal care sites and completed the human subjects approval process with each. Rates of screening for abuse range from all but 12 women over a 2-1/2-year period at one site to no screening for abuse at another site. In this article, we will review pertinent literature and discuss the supports and barriers we observed when implementing an abuse screening program using the Abuse Assessment Screen, a well-tested and valid clinical instrument. Suggestions will be made for improving the screening rates at those sites where screening is absent or inconsistent.Domestic abuse is the leading cause of injuries and death among women of childbearing age in the United States. The broad purpose of this research is to discover how pregnant womens psychological and behavioral responses to abuse affect birth outcomes. To select a diverse sample of women, we identified 8 prenatal care sites and completed the human subjects approval process with each. Rates of screening for abuse range from all but 12 women over a 2-1/2-year period at one site to no screening for abuse at another site. In this article, we will review pertinent literature and discuss the supports and barriers we observed when implementing an abuse screening program using the Abuse Assessment Screen, a well-tested and valid clinical instrument. Suggestions will be made for improving the screening rates at those sites where screening is absent or inconsistent.