Patricia E. Stevens

Rigor in feminist research.

Verifying the scientific adequacy of feminist studies is necessary to assure that research processes and outcomes are well grounded, cogent, justifiable, and relevant. The authors analyze what scientific adequacy means in feminist inquiry and propose standards of rigor by which nurse investigators can plan and evaluate their studies. In the process, conventional empiricist criteria of reliability and validity are critiqued, and more appropriate concepts representing dimensions of adequacy in feminist research are presented.

Marginalization: a guiding concept for valuing diversity in nursing knowledge development.

This article explicates marginalization as a guiding concept for the development of nursing knowledge that values diversity. The seven key properties of marginalization as it applies to the domain of nursing are (1) intermediacy, (2) differentiation, (3) power, (4) secrecy, (5) reflectiveness, (6) voice, and (7) liminality. Through examination of each of these properties, the relationship between marginalization and vulnerability is clarified, and by this means the relevance of marginalization for health is established. The implications for shaping future nursing research, theory, and practice related to the health of diverse populations are discussed.

Prevalence, characteristics, and impact of postmastectomy pain syndrome: an investigation of women's experiences

&NA; Postmastectomy pain (PMP), a distinctive postsurgical neuropathic pain syndrome, has been thought to be a consequence of 4–6% of surgical procedures for cancer of the breast, but remains understudied and poorly documented. In this cross‐sectional descriptive study, a convenience sample of 95 women who had undergone breast cancer surgery was recruited from 16 ambulatory care sites. Prevalence, characteristics, and impact of the PMP syndrome were investigated using a medical record review, a patient information questionnaire, a cancer pain questionnaire and the McGill Pain Questionnaire. A 20% prevalence rate of the PMP syndrome was found. Women experiencing the syndrome reported chronic, stable pain of long duration that began shortly after surgery. They described paroxysms of lancinating pain against a background of burning, aching, tight constriction in the axilla, medial upper arm, and/or chest that significantly interfered with the performance of daily occupational and domestic activities. Data suggest that these women were undertreated and generally obtained poor pain relief from their symptoms.

Life changing words: women's responses to being diagnosed with HIV infection.

In this longitudinal study, we investigated the diagnosis experiences of 55 human immuno-deficiency virus (HIV)-infected women. Womens immediate reactions upon hearing that they were infected with HIV were devastation, shock, and indignation. Long-term responses included depression, submersion of the HIV infection diagnosis, escalated drug and alcohol use, shame, and suicidality. It was usually months and sometimes years before women could extricate themselves from these patterns of response. It is critical to make HIV infection diagnosis the first intervention in a protocol of seamless support that sees women through the initial trauma of being diagnosed until longer term primary care and social services can be activated.

HIV prevention education for lesbians and bisexual women: A cultural analysis of a community intervention

AIDS is increasing almost four times as fast among women, yet lesbians and bisexual women are among the least studied, least understood and most elusive populations affected by the AIDS epidemic. This paper reports the results of community-level HIV prevention research designed: (a) to examine the knowledge, perceptions, social contingencies and political constraints affecting the HIV risk taking of lesbians and bisexual women; and (b) to offer them context specific HIV prevention education. The study was a peer educator-based intervention project situated in San Franciscos womens bars, dance clubs, and sex clubs to reach socially and sexually active lesbians and bisexual women in natural settings. Between June 1992 and May 1993, ethnographic interviews were conducted with 626 women attending the bars and clubs; group presentations at these locales reached 1,315 women. The structure of the intervention was effective in prompting interest in HIV prevention information and intent to change behavior. The resultant cultural analysis details risk behaviors lesbians and bisexual women participate in, myriad constraints they face in trying to enact safer behaviors, gaps in knowledge, difficulties comprehending the relevance of HIV prevention, and risk reduction strategies commonly employed.

Self-Care of Women Growing Older With HIV and/or AIDS

The purpose of this report is to describe the ways older women living with HIV perceive of and practice self-care. Data are taken from a culturally diverse subsample of 9 women age 50 years or older who participated in a larger longitudinal qualitative study of women who were HIV infected. During a period of 2 years, 10 semistructured narrative interviews were conducted with each of the 9 participants to gain an in-depth understanding of their experiences with symptom management, adherence to medical regimens, reduction of HIV risk, access to health care and social services, and personal efforts to maintain their health. Transcribed data were managed using Nvivo software and analyzed using multistaged narrative analysis. Findings suggest that mature women living with HIV integrate actions to maintain bodily comfort and improve physical well-being with actions that champion and conserve the existential self. Excerpts from their interviews illustrate this dialectical understanding of self-care.

Pill Taking From the Perspective of HIV-Infected Women Who Are Vulnerable to Antiretroviral Treatment Failure

We conducted this longitudinal qualitative study to gain in-depth understanding of HIV-infected womens experiences with antiretroviral (ARV) regimens, exploring from their perspective what medication taking was like for them and what it meant in the context of their everyday lives. We engaged 55 participants over a 2-year period in 10 narrative-eliciting interviews. From their medication stories, we were able to track a 2-year prospective pattern of self-reported adherence for each individual who was prescribed ARVs. In this article we focus on the medication experiences of a subsample of 14 women who persistently had difficulties taking ARVs as prescribed, detailing their descriptions and evaluations of pill taking. Results suggest that rather than judging themselves harshly for nonadherence, they perceived their at-odds pill taking to be personally meaningful and accomplished for good purpose. Their rationales provide insights for more nuanced, empowerment-based interventions for individuals who are vulnerable to ARV treatment failure.

Impoverished Women With Children and No Welfare Benefits: The Urgency of Researching Failures of the Temporary Assistance for Needy Families Program

In the United States, the numbers of impoverished women with children and no cash safety net are increasing and constitute an emerging population. Many have exhausted cash benefits from Temporary Assistance for Needy Families, the work-based welfare program that replaced Aid to Families With Dependent Children in 1996. We examine empirical evidence about poverty and use of welfare programs in the United States, jobs for women on welfare, the consequences of leaving welfare, health disparities disproportionate to those of the general population, and outcomes for children of needy families. It is important that public health researchers investigate the experiences of the families for whom Temporary Assistance for Needy Families has failed.

NARRATIVE CASE ANALYSIS OF HIV INFECTION IN A BATTERED WOMAN

The narrative case analysis of HIV infection in a battered woman, taken from a qualitative study of womens experiences living with HIV/AIDS, conveys unusual insights into the context of violence that surrounded this womans exposure to HIV. In her narrative, she describes the complex web of abuse she lived with day-to-day and the road she travels with AIDS as a result. Her abuse perpetrator infected her with HIV, and the whole atmosphere of violence, annihilation of self-worth, and oppressive restrictions likely contributed to the late-stage identification and treatment of her HIV-related disease. The discussion explores how domestic violence may place battered women at increased risk of becoming HIV infected. Clinical recommendations suggest that efforts to stop the battering of women and to prevent the spread of HIV in women must be combined to offer effective protection for women.

Experiences of women clerical workers in patient care areas.

Nurse managers at all levels have a stake in the well-being and job satisfaction of clerical workers in patient care areas. The authors discuss the results of a qualitative interview study of 46 women employed as unit clerks and clinic clerks. As these women described their work experiences, they identified interactional dynamics in the workplace, issues of relative powerlessness, stresses involved in dealing with ill clients, organizational problems, and occupational hazards.