Marion Allen

Meta-Synthesis of Qualitative Findings

A framework for synthesizing qualitative findings is described, and issues surrounding employment of this technique are discussed. Further debate on these issues is encouraged to develop and refine this framework. The practical importance of interpretive meta-synthesis is highlighted in relation to theory development.

The Road Less Traveled: Nursing Advocacy at the Policy Level

A frequent observation made about nursing advocacy at the policy level is its absence—or at least its invisibility. Yet there is a persistent belief that nurses will participate in advocacy at the societal level in matters of health. Although gaps exist in our knowledge about how to advocate at the policy level, the authors suggest that a number of other factors contribute to the disconnect between what nurses are expected to do in terms of policy advocacy and what they actually do. There are two main purposes in this article: to review the epistemological foundations of advocacy in nursing, and to present a discussion of other factors that limit our participation in policy advocacy. The authors discuss challenges within the discipline, in the practice context, and at the interface of the worlds of policy and nursing practice. The article concludes with a discussion of possible strategies for moving forward.

Ethical Considerations for Nurses in Clinical Trials

Ethical issues arise for nurses involved in all phases of clinical trials regardless of whether they are caregivers, research nurses, trial co-ordinators or principal investigators. Potential problem areas centre on nurses’ moral obligation related to methodological issues as well as the notions of beneficence/non-maleficence and autonomy. These ethical concerns can be highly upsetting to nurses if they are not addressed, so it is imperative that they are discussed fully prior to the initiation of a trial. Failure to resolve these issues can place both the conduct and the results of research in jeopardy.

The Notion of Evidence in Evidence-Based Practice by the Nursing Philosophy Working Group

Questions concerning the nature of evidence in evidence-based practice have kindled debate within nursing and other health care disciplines. Such questions include the ends for which evidence is sought, the form(s) of evidence, and the values underlying evidence-based practice. In this article, some of the issues, contradictions, and tensions implicit in these questions are highlighted. It is imperative that the nursing profession continue to explore the philosophic perspectives that underscore evidence-based practice and their implications for decision making in nursing practice.

Factors that influence case managers' resource allocation decisions in pediatric home care: an ethnographic study.

BACKGROUND Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care. METHODS Using Spradleys methodology, we designed an ethnographic study of a childrens home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis. RESULTS One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the teams role been reported as an influencing factor. CONCLUSION The findings of this study are examined in light of Daniels and Sabins Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.

Elk Velvet Antler in Rheumatoid Arthritis: Phase II Trial

The purpose of this phase II clinical trial was to examine safety of elk velvet antler taken concurrently with rheumatoid arthritis medications and to determine efficacy by dose to enable sample size estimation and dose standardization for a larger study. Forty patients with stage II rheumatoid arthritis were randomly assigned to 1 of 4 arms of 10 patients each. One group received placebo and the other 3 groups received 2, 4, or 6 capsules (215 mg) of elk velvet antler with appropriate placebos to total 6 capsules daily. All subjects continued to take their arthritis medications. Outcome variables were reported adverse events and health status. At 1 month, there were no significant differences between groups in number of adverse events or health status. The greatest improvement was in the 6 elk velvet antler group, the least was in the placebo group. Differences were not statistically significant. It was concluded that elk velvet antler can be taken safely in conjunction with a number of rheumatoid arthritis medications and should be studied further to assess efficacy.

Learning to Care for Spiritual Needs: Connecting Spiritually

Despite mandates to provide spiritual care, confusion persists among nurses about spirituality, spiritual needs, and related roles. To discover how practicing nurses acquire knowledge for spiritual care, the authors chose a grounded theory design. They constantly compared and analyzed verbatim transcribed interview data to find the core variable, categories, and properties. Connection, manifesting as a state, act, or process, appeared throughout the data. Categories emerged as Needing Connection, Nurturing Connection, Learning Connection, and Living Connection. Nurses used a cyclical, intertwined, and progressive learning process of opening to, struggling with, and making connections between numerous discrete personal and professional experiences. Shifting attention between these interconnected experiences fueled knowledge acquisition. Whether referring to how nurses learn, what they do, or with whom, the theory Connecting Spiritually joined categories into a cumulative experiential learning process that explained how nurses learn to care for spiritual needs.

The relational nature of case manager resource allocation decision making: an illustrated case.

We used ethnographic methods in the tradition of Spradley (1979) and constant comparative analysis to explore case manager resource allocation decision making. We interviewed, observed, and shadowed 11 case managers within a children’s home care program in a regional health authority in western Canada as they went about their daily work over a 5-month period. Our findings provide knowledge about the little-understood set of processes at the micro level of resource allocation. Although the case manager considers many factors, reported elsewhere (Fraser, Estabrooks, Allen, & Strang, 2009), they balance and weigh these factors within a relational context. The purpose of this article is to use Jenna’s story as a case example to illustrate how the case manager balances and weighs the factors that influence their resource allocation decisions within this context. Jenna’s story demonstrates the complex and multidimensional processes that are embedded in the relational nature of resource allocation decisions. We discuss home care case manager resource allocation decisions as viewed through the lens of relational ethics.

A Randomized Clinical Trial of Elk Velvet Antler in Rheumatoid Arthritis

This article examines the effects of elk velvet antler on joint pain and swelling, patient/physician global assessment of disease activity, functional ability, quality of life, blood levels of C-reactive protein, and adverse events in persons with stage 2 to 3 rheumatoid arthritis experiencing residual symptoms after standard treatment. Patients (N=168) were enrolled in a 6-month randomized, triple-blind, placebo-controlled clinical trial. Instruments included the Arthritis Impact Measurement Scale, the Health Assessment Questionnaire, tender and swollen joint counts, and 100 mm-length visual analogue scales, along with blood tests. There were no significant differences between groups on any measures. The pattern of change of the measures across time points was essentially the same for both groups. Although some patients reported clinical improvements in their symptoms, there were no statistically significant differences between groups. Overall, elk velvet antler does not effectively manage residual symptoms in patients with rheumatoid arthritis.

Clinical Trials With Complementary Therapies

As interest in complementary and alternative therapies grows, nurses can expect to be asked for advice regarding their use, but there are few clinical studies on which nurses can base their responses. Conducting research with complementary therapies is therefore important for nursing, but there are some pitfalls in doing research with these products, particularly if one is using standard clinical-trials methods. In this article, the authors outline some of those pitfalls based on their experience conducting a clinical trial to examine the effects of elk velvet antler on symptoms of rheumatoid arthritis. They discuss design issues related to justification, method, and ethics and explore some important regulatory issues of which nurses should be aware. Some recommendations are presented to help nurses engaging in such research to avoid problems that could interfere with the smooth conduct of their studies.