Marlene Zichi Cohen

Explanatory Models of Diabetes - Patient Practitioner Variation

Most cases of diabetes, a complex disorder that requires many lifestyle changes, can be controlled if persons adhere to their prescribed regimen. However, compliance is difficult to attain. Differences in explanatory models between client and practitioner have been suggested as one reason for non-compliance in several disorders. In this ethnographic investigation, individual explanatory models were elicited from persons with diabetes and from health professionals working with these patients. Professionals described models of diabetes in general and their model of a particular patients diabetes. A composite professional model was constructed and compared with each of the patients models. The models were most congruent regarding treatment. Etiology, pathophysiology, and severity had less congruence, and time and mode of symptom onset were least congruent. The Spearman correlation coefficient showed a positive but non-significant association of explanatory model congruence between professionals and patients with normal glycosylated hemoglobin levels. Patients and professionals seem to emphasize different domains; patients emphasized difficulties in the social domain and the impact of diabetes on their lives while staff saw diabetes primarily as a pathophysiological problem with impact on patients physical bodies. This studys importance rests on its clear articulation of significant differences between patients and staffs models even when they are similar in demographic characteristics.

Reliability and Validity Issues in Phenomenological Research

Reliability and validity are two areas where the criteria of logical empiricism appear to be imposed upon phenomenology as a research method. Cross-paradigmatic communication can result in difficulties because the same words may have different meanings. It cannot be assumed that reliability and validity have the same meaning in logical empiricism and phenomenology. Even among the three mostfrequently used phenomenological methods in nursing research, lack of consensus exists regarding the issues of reliability and validity. In order to help clarify reliability and validityfrom the phenomenological perspective, Colaizzi, Giorgi, and Van Kaam s methodologies are compared and contrasted regarding their stance on these issues. Lincoln and Guba four major criteriafor rigor in qualitative inquiry, truth value, applicability, consistency, and neutrality may offer phenomenologists an appropriate alternative to logical positivists terminology.

Multimeasure pain assessment in an ethnically diverse group of patients with cancer.

The purposes of this study were (a) to describe the relationship between pain perception and ethnic identity and socioeconomic status, (b) to evaluate the intercorrelations between pain measures in different ethnic groups, and (c) to determine whether ethnicity or socioeconomic status influences patient’s pain control beliefs and satisfaction with the pain management provided. The sample consisted of 51 English-, Korean-, or Spanish-speaking participants experiencing cancer pain who were 18 years and older and were having a Karnofsky score of no less than 30. The Visual Analogue Scale (VAS), Memorial Pain Scale (MPS), and Face Scale (FS) were used to measure pain perception. In all pain analyses, Hispanics, African Americans, and Anglos did not differ significantly. The data suggest that the pain scales used in this study are appropriate for use in a multicultural population.

Healthcare reform. Its effects on nurses.

Healthcare reform has been a major economic and political focus throughout the 1990s. In a national survey of registered nurses about work life and health, many narrative comments addressed changes in the healthcare system. This qualitative study an analysis of these comments, identified themes related to nurses perceptions of changes and the effect of healthcare reform on the practice of nursing.

Knowledge and presence: Accountability as described by nurses and surgical patients☆

Accountability was an integral part of phenomenological descriptions of 24 patients experience of having surgery and 24 nurses understanding of their experiences. Patients and nurses discussed two major elements, knowledge and presence, although the emphasis on categories within these elements differed. Within the element of knowledge, nurses emphasized lacking knowledge, using professional knowledge, teaching, and leadership. Patients talked most about receiving teaching and individualized knowledge. Nurses also emphasized structure and process, and patients emphasized outcomes. Within the element of presence, nurses talked most about environmental barriers and interaction, and patients emphasized attentive attitude. This view of accountability may help restructure work environments to allow nurses to meet the needs that patients perceive themselves as having.

The meaning of cancer and oncology nursing: Link to effective care

A better understanding of the meaning of cancer and oncology nursing may yield insights that will help identify ways in which nurses can obtain the resources they need to meet their own needs and to provide effective care. This article briefly reviews literature on job stress, burnout, coping, and job satisfaction and summarizes our research on nurses descriptions of the meaning and nature of their work with cancer patients. Nurses described having three important roles: maintaining the goals and values of health care; participating in the patients experiences; and reconciling the health care values and the patients experiences (ie, the other two roles). Aspects that are rewarding are also difficult and individual experiences and perceptions changed the meaning of work, the needs nurses have, and the care they provide. The work of nursing may be most satisfying when nurses can articulate the meaning of their work and most effective when they understand how these meanings affect patient care.

Experiences in children of critically ill parents: A time of emotional disruption and need for support

The purpose of this phenomenologic study was to describe effects of a parental critical care hospitalization on the family as viewed by children. Interviews were conducted with eleven male phenomenologic techniques and showed these four major themes: (1) emotional turmoil, (2) family disruption, (3) need for support, and (4) minor illnesses. These disruptions are strong and need to be treated through nursing interventions.