Nancy Burns

Standards for Qualitative Research

One of the greatest obstacles to the identification of excellence in qualitative studies is the lack of generally accepted criteria. The criteria developed for quantitative studies are based on a different set of as sumptions and are not appropriate. Those who critique qualitative stud ies need context flexibility, skills in inductive reasoning, skills in theory analysis, and the capacity to transform ideas across levels of abstrac tion. The following standards are proposed for critique of qualitative studies: (a) descriptive vividness; (b) methodological congruence; (c) an alytic preciseness; (d) theoretical connectedness; and (e) heuristic rele vance. Methodological congruence has four elements: rigor in documen tation ; procedural rigor; ethical rigor; and auditability. Heuristic rele vance has three elements: intuitive recognition; relationship to existing body of knowledge; and applicability. Threats to each of these standards are identified. Creative strategies for improving the published presenta tion of qualitative studies must be developed to allow adequate critique.

Hospice: a design for home care for the terminally ill.

Hospice may appropriately be understood as a model of holistic care. As a model of holistic care, hospice provides numerous insights suitable for adoption in other health care settings. In addition, hospice provides a preeminent opportunity for nurses to practice within a nursing model; at the present time, nursing goals may be pursued more freely within hospice than in any other setting.

Chronic illness and disability in the hospice setting: A study of the trends

Over the years, healthproviders and patients havebecomeincreasinglydisenchantedwith institutional or inpatient care. The disenchantment centersaroundseveralconcerns:qualityof care,effectivenessof outcomes,andcosts.Perhaps1965 is theyear during which the enthusiasmfor institutional carepeaked.Since then, it surely hasbeen waning. As enthusiasmdecreased, interestshifted to mechanismsfor providing care within a community framework with increasedpatient/family responsibilities,emphasison rehabilitation, and support of optimum functioning of the patient/family unit. From 1973 to 1978, our population grew, especiallythepopulationover age65. During this sameperiod, the numberof psychiatricbedsfell from almost330,000to 193,000,andthenumberof rehabilitation beds fell from 7,600 to 5,900. Chronicdiseasebedsfell by morethantenpercent, while the numberof bedsdevotedto patientswith tuberculosisfell to aquarterof what it hadbeen. Theproblemsreflectedby theoriginalbedlevels haveforthemostpartnotgoneaway.(Tuberculosis is, perhaps,an exception,but the diseasehasnot been eliminated.) In somecases,state-of-the-art medical treatmentfor the variousconditions has changed. However,in manyothercases,thechange hasoccurredbecauseof a shift in thevalueplaced on institutionalization versus community-based care.Someofthesechangesemergedpartlybecause of consumerdemand.

Development of the Rural-Urban Demand Indicator (RUDI)

In this article we describe development of RUDI (Rural-Urban Demand Indicator), a multivariate interval level measure of demand for health services. RUDI ranks counties by population and purchasing power and was developed for use in a wide variety of health-related research and for policy analyses. RUDI is based on microeconomic theory and Grossmans (1972) extension of the theory, that the family produces health and that the familys demand for health services is derived from the demand for health. Two factors define RUDI: DEMOS (demographics) and EWB (economic well-being). These two factors accounted for 66.2% of the variance observed in 1990 census data. A variety of other analyses offer evidence of known- groups, convergent, factorial, and predictive validity.

The Research Process and the Nursing Process: Distinctly Different

nurse is conducting research each time the nursing process is used (p. 23).&dquo; This view is the result of an extreme simplification of the research process, reflecting orrly a surface knowledge of research. Clearly, there are important differences. Unfortunately, these differences are sometimes not explicitly pointed out in nursing research texts even though the similarities between the two processes are often discussed. The authors seem to assume

Chronic illness and disability in the hospice setting

Editor’s Note: Due to an editorial error in the September/October 1985 issue, the following excerpthasbeenreprinted. Thisexcerptisfromtheend ofan article entitled “Chronic illnessanddisability in the hospicesetting,” by NancyBurnsandKim Carney. ChangesDuringHospiceCare In order to examinechangesin disability during hospiceenrollmentwe utilized a subsampleof the77 whosurvivedaminimum of 28 daysafterhospiceenrollment. With this set we examinedthe first three weeksofcarefollowinghospiceenrollmentandthelast fourweeksofcareprior to death.Thereisconsiderable overlapbetweenthefirst threeweeksandthefinal four weeks;however,theoverlapis incompletebecauseof thedifferinglengthsoftime thathospiceenrollerssurvivedfollowing hospiceadmission. Therewere36patientsin thesubsamplewholived at least 28 days.Thesepatientswere functioning at a higherlevel at thetime of hospiceadmissionthanthe patientsin the largersampleof 77. The averagescore for the36 atthetime ofadmissionwas3.78(in contrast to 4.09for the77).Weexaminedthefunctionalcapacity of patientsduring the first threeweeksof hospice enrollmentin two differentways.Thefirst methodwas basedon encountersratherthanpatients,andthesecond was basedon a functionalaverageper patient. The results from both methodssuggestthat patient functioning improved slightly (althoughnot significantly becauseof limited samplesize) in the second weekover that in the first week. Theresultssupport anecdotal evidencethatmanypatientsimprovefollowing hospiceenrollment.Betweenthe secondandthe third weekspatientfunctioning declines(Table4).

Internet Sources of Information on Hispanic Health

This article, an introductory survey of sources relevant to the Hispanic population in the United States, emphasizes Hispanic health defined broadly—for example, income, education, living standards, and health items including immunizations, major diseases, and life expectancy. The focus is Internet sources. To provide comparable data for research, national government sources are stressed. The Census Bureau and the Department of Health and Human Services are highlighted. Both agencies are increasingly providing information on Hispanics. Census publications include the decennial census, current population reports, the American Community Survey, and monographs on the Hispanic population. Two important components of the Department of Health and Human Services for researchers on Hispanic health are the National Center for Health Statistics and the Centers for Disease Control. In addition, sources cited are other federal publications including the Federal Reserve Bank, state health departments, and private sources.