Susan K. Chase

Validity in Qualitative Research

Much contemporary dialogue has centered on the difficulty of establishing validity criteria in qualitative research. Developing validity standards in qualitative research is challenging because of the necessity to incorporate rigor and subjectivity as well as creativity into the scientific process. This article explores the extant issues related to the science and art of qualitative research and proposes a synthesis of contemporary viewpoints. A distinction between primary and secondary validity criteria in qualitative research is made with credibility, authenticity, criticality, and integrity identified as primary validity criteria and explicitness, vividness, creativity, thoroughness, congruence, and sensitivity identified as secondary validity criteria.

Lifestyle change in type 2 diabetes a process model.

BackgroundIntegration is an emerging concept in the study of self-management and chronic illness, yet this process and how it occurs is not well understood. ObjectivesThis investigation, part of a triangulated study, focused on the experience of integrating type 2 diabetes treatment recommendations into an existing lifestyle while participating in a nurse-coaching intervention. MethodAn interpretive method elicited data from nurse-coaching sessions (4), field notes, and an interview in 9 women with type 2 diabetes. The process of data reduction and analysis (Miles & Huberman, 1994) was used to interpret data. ResultsThe core process of integrating lifestyle change in type 2 diabetes was multifaceted and complex. Challenges to the process of integrating lifestyle change included reconciling emotions, composing a structure, striving for satisfaction, exploring self and conflicts, discovering balance, and developing a new cadence to life. These challenges required acknowledgment in order for participants to progress toward integration. DiscussionBalance was an integral component to the experience of integration, between structure and flexibility, fear and hope, conflict and acceptance, diabetes and life. Conceptualizations identified with this investigation extend understanding of theories of integration and lifestyle change and invite the development and testing of nursing interventions.

The social context of crtical care clinical judgment

BACKGROUND Clinical judgment in critical care is supported by a rich social network of care providers. The purpose of this study was to describe the social context in which the process of critical care clinical judgment occurs from the nurses perspective. METHODS An ethnographic study was conducted that included interviews with 10 nurses and participant observation in an open heart surgery unit with 59 nurses and two surgical teams during a 2-year period. RESULTS Nurses and physicians were organized in hierarchies of nurse manager, resource nurse, charge nurse, and staff nurse or attending surgeon, fellow, chief resident, and resident. These parallel hierarchies allowed for checks on judgment both within and across professional lines. Rituals, such as nursing report, physician rounds, and flow sheet use, provided a context for a critique on judgment processes. Communication of judgment was frequently a casual, open conversation. At other times, differences in perspective could result in conflict. Communication between nurses and physicians has been associated with better patient outcomes. Critical care unit directors and managers can use an analysis of communication patterns to develop supports to clinical judgment.

Nursing presence. As real as a milky way bar.

Data sets from three individual studies on nursing judgment were reviewed from a wider perspective. This yielded meanings and phenomena not readily identified in the individual studies, and it was tentatively labeled presence. A hermeneutic study using 10 transcripts from each data set asked: What are the common features of the context of nursing judgment? and, What are the features of the nurses’ connection with the patient that contribute to nursing judgment? The analysis yielded six features of nursing presence: uniqueness, connecting with the patient’s experience, sensing, going beyond the scientific data, knowing (what will work and when to act), and being with the patient. These features of nursing presence are logical distinctions and serve as ways to grasp the idea of nursing presence.

A Methodological Review of Faith-Based Health Promotion Literature: Advancing the Science to Expand Delivery of Diabetes Education to Black Americans

Non-traditional avenues, such as faith-based organizations (FBOs), must be explored to expand delivery of diabetes self-management education (DSME) to benefit Black Americans with type 2 diabetes (T2D). The purpose of this study was to methodologically review the faith-based health promotion literature relevant to Blacks with T2D. A total of 14 intervention studies were identified for inclusion in the review. These studies detailed features of methods employed to affect health outcomes that DSME similarly targets. Analysis of the faith-based studies’ methodological features indicated most studies used (1) collaborative research approaches, (2) pre-experimental designs, (3) similar recruitment and retention strategies, and (4) culturally sensitive, behaviorally oriented interventions with incorporation of social support to achieve positive health outcomes in Black Americans. Findings indicate FBOs may be a promising avenue for delivering DSME to Black Americans. Informed by the findings, a focused discussion on advancing the science of faith-based interventions to expand delivery of DSME to Black Americans with diabetes is provided.

The Content, Integrity, and Efficacy of a Nurse Coaching Intervention in Type 2 Diabetes

PURPOSE the purpose of this study was to systematically evaluate the content, integrity, and efficacy of a nurse coaching intervention provided after diabetes education that focused on dietary and exercise lifestyle change in persons with type 2 diabetes. METHODS A multimethod design incorporated an interpretive approach to examine the content and integrity of the intervention and a multiple-baseline, single-subject method to determine the preliminary efficacy of the intervention. RESULTS The primary strategies of the nurse coaching intervention consisted of facilitating lifestyle change through educational reinforcement, psychosocial support, and motivational guidance. Aggregate quantitative outcomes revealed a modest increase in health-promoting behaviors and a decrease in fasting blood glucose, indicating a trend toward physiologic adaptation. Participants demonstrated a significant increase in integration reflective of psychosocial adaptation. CONCLUSIONS Providing individualized nursing care after diabetes education may improve health outcomes and the quality of life of persons newly diagnosed with type 2 diabetes. This multimethod design is a cost-effective approach for preliminary evaluation of complex and/or novel interventions.

Learning Caring: The Student’s Experience

Caring has been identified as essential for baccalaureate nursing education across all programs of study. This study investigated the lived experience of students learning caring in a college of nursing grounded in a caring philosophy. Two major themes were identified from the research data: Innate Knowing of Self as Caring and Caring in the Curriculum. One student shared this thought, “I knew who I was and I knew I could care about people, but I didn’t know how to use caring in nursing. The educational process helped me to transfer caring to nursing.”

Sustaining health in faith community nursing practice: emerging processes that support the development of a middle-range theory.

This article reveals processes that support theoretical development for holistic nursing in the context of a faith community. The emerging processes enhance the articulation of the holistically focused practice, add clarity to faith community nursing activities and outcomes, and contribute to theoretical clarification and development. Theoretical clarity is essential to guide faith community nursing practice, research, and education because there is tremendous potential for the specialty practice to contribute to the health of a community across the continuum of caring and because to date there has been no unifying model for this practice proposed. A lack of a theoretical basis can result in disparate and disconnected approaches to studying, testing, and promoting the practice.

Early and Intermediate Hospital-to-Home Transition Outcomes of Older Adults Diagnosed With Diabetes

Purpose The purpose of this study was to identify factors affecting early and intermediate hospital-to home transition outcomes of older adults with preexisting diabetes mellitus. Methods A mixed-methods design was used. A sample of 96 hospitalized older adults with a prior diagnosis of diabetes were recruited within 4 hours of discharge. Data reflective of general health status, diabetes status, perceived discharge readiness (Readiness for Hospital Discharge Scale), hospitalization, and anticipated postdischarge support were gathered upon enrollment. Transition outcome data including unplanned care encounter occurrences, perceived transition quality (Care Transition Measure-15), and postdischarge difficulty (scale and free responses to the Post-Discharge Coping Difficulty Scale [PDCDS]) were obtained by telephone interview 7 and 30 days after discharge. Three unique, dichotomous variables were created from recurrent subthemes that emerged during content analysis of free-response data and were used in statistical testing. Binary logistic regression was performed to identify predictive factors for an unplanned care encounter within 30 days of discharge. Results Multimorbidity was prevalent in participants. Difficulties managing medications, blood glucose, and chronic illnesses other than diabetes were common problems. Higher PDCDS scores 7 and 30 days following discharge and difficulty managing a nondiabetes chronic health problem were predictive of an unplanned care encounter within 30 days of discharge. Conclusions Multimorbidity complicates home recovery of older adults with diabetes. Diabetes adds complexity to hospital-to-home care transitions. Transition difficulties predict higher risk for an unplanned care encounter. More intensive follow-up of older adults with diabetes during the first month following discharge is recommended.

Decisions and caregiving: end of life among blacks from the perspective of informal caregivers and decision makers.

This focus group study describes end-of-life caregiving and decision making among blacks from the perspective of the informal caregivers and decision makers. The Behavioral Model of Health Services Use framed the study. Five focus groups with a total of 53 informal caregivers/decision makers were conducted. A qualitative phenomenological approach was used for the data analysis. Findings are presented under the themes of end of life caregiving and decision making roles, dynamics and process, and beliefs and values. The common thread of care giving and decision-making within relationship and six subthemes were identified. Findings also suggest the need for support and inclusion of designated informal caregivers and decision-makers in the advance care planning process early in the disease trajectory.