Susan E. Fleming

Philosophical Hermeneutic Interviewing

This article describes, exemplifies and discusses the use of the philosophical hermeneutic interview and its distinguishing characteristics. Excerpts of interviews from a philosophical hermeneutic study are used to show how this particular phenomenological tradition is applied to research inquiry. The purpose of the article is to lay out the foundational background for philosophical hermeneutics in a way that clarifies its unique approach to interviewing and its usefulness for advancing health care knowledge. Implications for health care research and practice are addressed.

First-time mothers preparing for birthing in an electronic world: internet and mobile phone technology

Background: As the twenty-first century moves forward, we are witnessing a surge of self-educating with electronic media (e.g. internet sites, mobile phone technology, television and/or videos). This phenomenon is deeply embedded in perinatal education and warrants an in-depth investigation to uncover the meaning of how mothers self-prepare with electronic media for birthing in hospitals. Methods: A sequential mix of two qualitative designs commenced. A preliminary descriptive design, involving three focus groups (childbirth educators, n = 5; obstetric providers, n = 6; and labour and delivery nurses, n = 1), was conducted to inform researchers of provider perceptions of childbearing women self-preparing with electronic media. Then, a primary hermeneutic (interpretive) design was used to conduct one-to-one in-depth interviews from a purposive sample (n = 7) of young first-time mothers (FTMs). Results: The preliminary descriptive findings suggested that interviewing young FTMs self-preparing for birthing in hospitals was warranted. A primary hermeneutic (interpretive) design revealed that FTMs were preparing with electronic media for what ifs based on what is known about birthing. At times, this educated the mothers and some became more knowledgeable or informed; however, there was also a debilitating effect, which increased the mothers’ level of anxiety and fear. Conclusions: Providing credible electronic linkages, mobile phone technology, videos and access to provider and hospital websites, guided by their care providers, is imperative for educating mothers. By addressing mothers’ needs, women may be better able to birth with confidence as they enter the electronic world of preparing for birthing in a hospital.

Grand Multiparous Women’s Perceptions of Birthing, Nursing Care, and Childbirth Technology

This qualitative descriptive study explored grand multiparous women’s perceptions of the evolving changes in birthing, nursing care, and technology. A purposive sample of grand multiparous women (N = 13) from rural, eastern Washington State were interviewed as they shared their 105 birth stories. Eight themes were identified: (1) providing welcome care, (2) offering choices, (3) following birth plans, (4) establishing trust and rapport, (5) being an advocate, (6) providing reassurance and support, (7) relying on electronic fetal monitors and assessments versus nursing presence, and (8) having epidurals coupled with loss of bodily cues. Results from this study may be used to educate women, intrapartum nurses, and childbirth educators on nursing care and on the evolving use of technology to better manage intrapartum care in hospitals. The results can also add to the extant knowledge of childbirth nursing practices.

Psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R) for US mothers

Objective: The aims of this study were to continue the scale development process of the Birth Satisfaction Scale-Revised (BSS-R) by refining the scale to make it culturally relevant for US participants, examining the factor structure of the BSS-R, and describing the level of birth satisfaction in a sample of US mothers. Background: The Birth Satisfaction Scale (BSS) was developed in the UK to assess satisfaction of the childbearing women’s experiences of labour and its outcomes. One of the goals of the development of the BSS was to make comparisons across cultures. Methods: One hundred and eighty-one first-time US mothers participated in this study. Confirmatory factor analysis was used to examine a one-factor higher-order model containing three lower-order factors. The higher-order factor was hypothesised to be Experience of childbearing; the lower-order factors were hypothesised as Stress, Quality of Care and Women’s attributes. Results: The results of the higher-order factor model indicated good fit, χ2 = 37.72, p = .22; comparative fit index (CFI) = .99; root mean square error of approximation (RMSEA) = .03; standardised root mean square residual (SRMR) = .04. Cronbach’s α indicated the subscales and total scale were reliable for the US sample (α ranged from .74 to .89). The BSS-R total score was 15.52 (SD = 8.35), and the stress, quality of care, and women’s attributes subscales were 7.15 (SD = 3.80), 4.61 (SD = 3.83) and 3.79 (SD = 2.26), respectively. Conclusion: The BSS-R can provide maternal health professionals and researchers with an instrument to quantify childbearing women’s birthing satisfaction, which in turn can assist in heightening the overall patient care experience.

Goal Setting With Type 2 Diabetes A Hermeneutic Analysis of the Experiences of Diabetes Educators

Purpose The purpose of this study was to explicate and interpret common experiences of diabetes educators (DEs) with patient goal setting for patients with type 2 diabetes in diabetes education. Methods Transcripts (n = 10) from semi-structured interviews were analyzed using a hermeneutic phenomenological approach to more deeply explore the accounts of DEs’ goal setting with patients with type 2 diabetes. Results The overarching pattern that emerged was “Striking a Balance,” which subsumed 4 subthemes: Applying Theoretical-Practical Principles When Setting Goals, Identifying Idealistic-Realistic Expectations, Creating Patient-Educator–Centered Plans, and Readying-Living With Goal Setting. The pattern, “Striking a Balance,” revealed a common meaning of DEs as experiences requiring balance and nuance in goal setting with patients. Implications The results of this study combined with the tenets of the self-determination theory can provide the DEs with real-life exemplars and a theoretical framework to encourage their patients to self-manage, increase intrinsic motivation, and improve adherence related to their lifestyle changes and glycemic control. DEs, as facilitators of change, can implement these changes with flexible and reciprocal activities with their patients. The DEs owned these activities and they are: “building the bond,” “sharing the session,” “readying for change,” “sending them home,” and “bringing them back.”

Birth Satisfaction Scale/Birth Satisfaction Scale-Revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey

OBJECTIVE to explore the prevalence of birth satisfaction for childbearing women planning to birth in their home or birth centers in the United States. Examining differences in birth satisfaction of the home and birth centers; and those who birthed in a hospital using the 30-item Birth Satisfaction Scale (BSS) and the 10-item Birth Satisfaction Scale-Revised (BSS-R). STUDY DESIGN a quantitative survey using the BSS and BSS-R were employed. Additional demographic data were collected using electronic linkages (Qualtrics™). PARTICIPANTS a convenience sample of childbearing women (n=2229) who had planned to birth in their home or birth center from the US (United States) participated. Participants were recruited via professional and personal contacts, primarily their midwives. RESULTS the total 30-item BSS score mean was 128.98 (SD 16.92) and the 10-item BSS-R mean score was 31.94 (SD 6.75). Sub-scale mean scores quantified the quality of care provision, womens personal attributes, and stress experienced during labour. Satisfaction was higher for women with vaginal births compared with caesareans deliveries. In addition, satisfaction was higher for women who had both planned to deliver in a home or a birth centre, and who had actually delivered in a home or a birth center. KEY CONCLUSIONS total and subscale birth satisfaction scores were positive and high for the overall sample IMPLICATIONS FOR PRACTICE: the BSS and the BSS-R provide a robust tool to quantify womens experiences of childbirth between variables such as birth types, birth settings and providers.

Intervention with substance-abusing mothers: are there rural-urban differences?

OBJECTIVE The purpose of this study was to examine rural-urban differences among substance-abusing mothers enrolled in the Parent-Child Assistance Program (PCAP) from 1998 to 2008 in Washington State. METHODS This was a longitudinal study utilizing PCAP data reports of 773 women enrolled from 1998 to 2008. Differences across urban-rural PCAP participants were examined. RESULTS Rural participants were more likely to report alcohol use and binge drinking at program intake and at the 3-year program exit. In addition, throughout the program, rural women were less likely to complete outpatient substance abuse treatment compared to urban participants. Rural women also used less services during the last year including alcohol/drug support and mental health provider services. Findings are troubling when we consider that at program exit, rural participants also reported higher use of alcohol and more suicidal thoughts than those residing in urban areas. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Data presented indicate there are important differences between urban and rural residing participants. Findings highlight the importance of considering the barriers that rural or remote locations might create. Identifying community-specific needs of substance abusing pregnant or parenting women in both rural and urban settings is crucial for the successful development and improvement of treatment and intervention programs for this vulnerable population of women. (Am J Addict 2014;XX:1-9).

Leveling the playing field for nursing students with disabilities: implications of the amendments to the Americans with Disabilities Act.

Faculty have reported a significant increase in the number of nursing students with disabilities; however, misinformation regarding legislated changes in the definition of a disability, as enacted in 2008 under the American with Disabilities Act Amendments Act, has contributed to faculty confusion when working with students with disabilities. This article identifies the circumstances under which nursing faculty are legally required to provide reasonable accommodations for students with disabilities, as defined under the Americans with Disabilities Act of 1990 as amended in 2008, and the strategies faculty may use to assist students to successfully complete core requirements. When this knowledge is integrated into a nursing programs culture and curriculum, students with sensory loss, paralysis, mental illness, learning disabilities, limb differences, chronic illnesses, or other disabilities associated with impaired bodily functions can successfully complete nursing programs and provide excellent care to clients, the profession, and their communities.

Measurement and structural invariance of the US version of the Birth Satisfaction Scale-Revised (BSS-R) in a large sample

BACKGROUND The 10-item Birth Satisfaction Scale-Revised (BSS-R) is being increasingly used internationally. The use of the measure and the concept has gathered traction in the United States following the development of a US version of the tool. A limitation of previous studies of the measurement characteristics of the BSS-R is modest sample size. Unplanned pregnancy is recognised as being associated with a range of negative birth outcomes, but the relationship to birth satisfaction has received little attention, despite the importance of birth satisfaction to a range of postnatal outcomes. AIM The current investigation sought to evaluate the measurement characteristics of the BSS-R in a large postpartum sample. METHODS Multiple Groups Confirmatory Factor Analysis (MGCFA) was used to evaluate a series of measurement and structural models of the BSS-R to evaluate fundamental invariance characteristics using planned/unplanned pregnancy status to differentiate groups. FINDINGS Complete data from N=2116 women revealed that the US version of the BSS-R offers an excellent fit to data and demonstrates full measurement and structural invariance. Little difference was observed between women on the basis of planned/unplanned pregnancy stratification on measures of birth satisfaction. DISCUSSION The established relationship between unplanned pregnancy and negative perinatal outcomes was not found to extend to birth satisfaction in the current study. The BSS-R demonstrated exemplary measurement and structural invariance characteristics. CONCLUSION The current study strongly supports the use of the US version of the BSS-R to compare birth satisfaction across different groups of women with theoretical and measurement confidence.

Creating disability inclusive work environments for our aging nursing workforce.

The workforce is aging, and the implications of an older nursing workforce are profound. As nurses age, injuries and disabilities are more prevalent. If disabilities were more commonly recognized and accommodated in the design of our nursing work environments, we could meet future needs. This article explores the literature on accommodations for an aging workforce, reports disabilities commonly seen in this population, and introduces universal design.