Susan M. Jack

Qualitative case study methodology in nursing research: an integrative review

AIM This paper is a report of an integrative review conducted to critically analyse the contemporary use of qualitative case study methodology in nursing research. BACKGROUND Increasing complexity in health care and increasing use of case study in nursing research support the need for current examination of this methodology. DATA SOURCES In 2007, a search for case study research (published 2005-2007) indexed in the CINAHL, MEDLINE, EMBASE, PsychINFO, Sociological Abstracts and SCOPUS databases was conducted. A sample of 42 case study research papers met the inclusion criteria. METHODS Whittemore and Knafls integrative review method guided the analysis. RESULTS Confusion exists about the name, nature and use of case study. This methodology, including terminology and concepts, is often invisible in qualitative study titles and abstracts. Case study is an exclusive methodology and an adjunct to exploring particular aspects of phenomena under investigation in larger or mixed-methods studies. A high quality of case study exists in nursing research. CONCLUSION Judicious selection and diligent application of literature review methods promote the development of nursing science. Case study is becoming entrenched in the nursing research lexicon as a well-accepted methodology for studying phenomena in health and social care, and its growing use warrants continued appraisal to promote nursing knowledge development. Attention to all case study elements, process and publication is important in promoting authenticity, methodological quality and visibility.

An integrative review of the factors influencing new graduate nurse engagement in interprofessional collaboration

AIM To analyse critically the barriers and facilitators to new graduate nurse engagement in interprofessional collaboration. BACKGROUND The acculturation of new graduate nurses must be considered in strategies that address the global nursing shortage. Interprofessional collaboration may support the transition and retention of new graduate nurses. DESIGN Whittemore and Knafls revised framework for integrative reviews guided the analysis. DATA SOURCES A comprehensive multi-step search (published 2000-2012) of the North American interprofessional collaboration and new graduate literature indexed in the CINAHL, Proquest, Pubmed, PsychINFO and Cochrane databases was performed. A sample of 26 research and non-research reports met the inclusion criteria. REVIEW METHODS All 26 articles were included in the review. A systematic and iterative approach was used to extract and reduce the data to draw conclusions. RESULTS The analysis revealed several barriers and facilitators to new graduate engagement in interprofessional collaboration. These factors exist at the individual, team and organizational levels and are largely consistent with conceptual and empirical analyses of interprofessional collaboration conducted in other populations. However, knowledge and critical thinking emerged as factors not identified in previous analyses. CONCLUSION Despite a weak-to-moderate literature sample, this review suggests implications for team and organizational development, education and research that may support new graduate nurse engagement in IPC.

Improving the Nurse–Family Partnership in Community Practice

BACKGROUND: Evidence-based preventive interventions are rarely final products. They have reached a stage of development that warrant public investment but require additional research and development to strengthen their effects. The Nurse-Family Partnership (NFP), a program of nurse home visiting, is grounded in findings from replicated randomized controlled trials. OBJECTIVE: Evidence-based programs require replication in accordance with the models tested in the original randomized controlled trials in order to achieve impacts comparable to those found in those trials, and yet they must be changed in order to improve their impacts, given that interventions require continuous improvement. This article provides a framework and illustrations of work our team members have developed to address this tension. METHODS: Because the NFP is delivered in communities outside of research contexts, we used quantitative and qualitative research to identify challenges with the NFP program model and its implementation, as well as promising approaches for addressing them. RESULTS: We describe a framework used to address these issues and illustrate its use in improving nurses’ skills in retaining participants, reducing closely spaced subsequent pregnancies, responding to intimate partner violence, observing and promoting caregivers’ care of their children, addressing parents’ mental health problems, classifying families’ risks and strengths as a guide for program implementation, and collaborating with indigenous health organizations to adapt and evaluate the program for their populations. We identify common challenges encountered in conducting research in practice settings and translating findings from these studies into ongoing program implementation. CONCLUSIONS: The conduct of research focused on quality improvement, model improvement, and implementation in NFP practice settings is challenging, but feasible, and holds promise for improving the impact of the NFP.

Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes

BackgroundThere is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and womens perceptions of benefits for themselves and their children.MethodsA comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of womens experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts.ResultsA total of 15 documents were included in the meta-synthesis. Women experienced a number of psychosocial processes during treatment that played a role in their recovery and contributed to favourable outcomes. These included: development of a sense of self; development of personal agency; giving and receiving of social support; engagement with program staff; self-disclosure of challenges, feelings, and past experiences; recognizing patterns of destructive behaviour; and goal setting. A final process, the motivating presence of children, sustained women in their recovery journeys. Perceived outcomes included benefits for maternal and child well-being, and enhanced parenting capacity.ConclusionA number of distinct but interconnected processes emerged as being important to womens addiction recovery. Women experienced individual growth and transformative learning that led to a higher quality of life and improved interactions with their children. The findings support the need for programs to adopt practices that focus on improving maternal health and social functioning in an environment characterized by empowerment, safety, and connections. Womens relationships with their children require particular attention as positive parenting practices and family relationships can alter predispositions toward substance use later in life, thereby impacting favourably on the cycle of addiction and dysfunctional parenting.

Development of a nurse home visitation intervention for intimate partner violence

BackgroundDespite an increase in knowledge about the epidemiology of intimate partner violence (IPV), much less is known about interventions to reduce IPV and its associated impairment. One program that holds promise in preventing IPV and improving outcomes for women exposed to violence is the Nurse-Family Partnership (NFP), an evidence-based nurse home visitation program for socially disadvantaged first-time mothers. The present study developed an intervention model and modification process to address IPV within the context of the NFP. This included determining the extent to which the NFP curriculum addressed the needs of women at risk for IPV or its recurrence, along with client, nurse and broader stakeholder perspectives on how best to help NFP clients cope with abusive relationships.MethodsFollowing a preliminary needs assessment, an exploratory multiple case study was conducted to identify the core components of the proposed IPV intervention. This included qualitative interviews with purposeful samples of NFP clients and community stakeholders, and focus groups with nurse home visitors recruited from four NFP sites. Conventional content analysis and constant comparison guided data coding and synthesis. A process for developing complex interventions was then implemented.ResultsBased on data from 69 respondents, an IPV intervention was developed that focused on identifying and responding to IPV; assessing a clients level of safety risk associated with IPV; understanding the process of leaving and resolving an abusive relationship and system navigation. A need was identified for the intervention to include both universal elements of healthy relationships and those tailored to a womans specific level of readiness to promote change within her life. A clinical pathway guides nurses through the intervention, with a set of facilitators and corresponding instructions for each component.ConclusionsNFP clients, nurses and stakeholders identified the need for modifications to the existing NFP program; this led to the development of an intervention that includes universal and targeted components to assist NFP nurses in addressing IPV with their clients. Plans for feasibility testing and evaluation of the effectiveness of the IPV intervention embedded within the NFP, and compared to NFP-only, are discussed.

Knowledge Transfer and Exchange Processes for Environmental Health Issues in Canadian Aboriginal Communities

Within Canadian Aboriginal communities, the process for utilizing environmental health research evidence in the development of policies and programs is not well understood. This fundamental qualitative descriptive study explored the perceptions of 28 environmental health researchers, senior external decision-makers and decision-makers working within Aboriginal communities about factors influencing knowledge transfer and exchange, beliefs about research evidence and Traditional Knowledge and the preferred communication channels for disseminating and receiving evidence. The results indicate that collaborative relationships between researchers and decision-makers, initiated early and maintained throughout a research project, promote both the efficient conduct of a study and increase the likelihood of knowledge transfer and exchange. Participants identified that empirical research findings and Traditional Knowledge are different and distinct types of evidence that should be equally valued and used where possible to provide a holistic understanding of environmental issues and support decisions in Aboriginal communities. To facilitate the dissemination of research findings within Aboriginal communities, participants described the elements required for successfully crafting key messages, locating and using credible messengers to deliver the messages, strategies for using cultural brokers and identifying the communication channels commonly used to disseminate and receive this type of information.

Supporting the Uptake of Nursing Guidelines: what you really need to know to move nursing guidelines into practice.

BACKGROUND There is a current push to use best practice guidelines (BPGs) in health care to enhance client care and outcomes. Even though intensive resources have been invested internationally to develop BPGs, a gap in knowledge exists about how to consistently and efficiently move them into practice. METHODS Constructivist grounded theory was used to explore the complex processes of a breastfeeding BPG implementation and uptake in three acute care hospitals. Interviews (n = 120) with 112 participants representing clients, nurses, lactation consultants, midwives, physicians, managers, administrators, and nurse educators as well as document and field note analysis informed this study. Data were analyzed using constant comparison and coding steps outlined by Charmaz: initial coding, selective (focused) coding, then theoretical coding. Triangulation of data types and sources were used as well as theoretical sampling. Data were collected from 2009 to 2010. RESULTS Two sites showed BPG uptake while one did not. Factors present in the uptake sites included, ongoing passionate frontline leaders, the use of multifaceted strategies, and processes that occurred at organizational, leadership, individual and social levels. Particularly noteworthy was the transformation of individual nurses to believing in and using the BPG. Impacts occurred at client, nurse, unit, inter-professional, organizational and system levels. CONCLUSIONS A conceptual framework: Supporting the Uptake of Nursing Guidelines, was developed that reveals essential processes used to facilitate BPG uptake into nursing practice and a process of nurse transformation to believing in and using the BPG.

Exploring new graduate nurse confidence in interprofessional collaboration: A mixed methods study

BACKGROUND Confidence is required for effective engagement in interprofessional collaboration. New graduate nurses often lack confidence in interprofessional interactions, and this may compromise the delivery of safe and effective healthcare. OBJECTIVES The overall objective of this study was to explore new graduate nurse confidence in interprofessional collaboration. DESIGN An explanatory sequential mixed methods design was used. METHODS New graduate nurses from Ontario, Canada (N=514) completed a cross-sectional descriptive survey in 2012. The survey measured perceived confidence in interprofessional collaboration, and it included items that were proposed to have a relationship with new graduate nurse confidence in interprofessional collaboration. Follow-up qualitative telephone interviews were conducted with 16 new graduate nurses. RESULTS The quantitative findings suggested that several factors have a positive relationship with new graduate nurse confidence in interprofessional collaboration: availability and accessibility of manager, availability and accessibility of educator, number of different disciplines worked with daily, number of team strategies, and satisfaction with team. The qualitative phase supported the quantitative findings and also provided new information about factors that facilitated and challenged new graduate nurse confidence when engaging in interprofessional collaboration. The facilitators were: experience, knowledge, respect, supportive relationships, and opportunities to collaborate. Challenges included: lack of experience, lack of knowledge, communication challenges, and balancing practice expectations. The overall findings relate to team and organizational support, and new graduate nurse development. CONCLUSION Interventions that provide support for interprofessional collaboration at the team and organizational levels, and develop new graduate nurse knowledge and experiences regarding collaborative practice, are essential for enhancing new graduate nurse confidence in interprofessional collaboration.

Canadian adolescent mothers' perceptions of influences on breastfeeding decisions: a qualitative descriptive study.

BackgroundThere is increased recognition of the importance of breastfeeding at a national level as evidenced by the increased number of Canadian mothers initiating breastfeeding. However, adolescent mothers (<19 years), compared to all other mothers, have lower rates of breastfeeding initiation and duration. The purpose of this study was to examine the facilitating influences and barriers to initiating, and continuing breastfeeding, as perceived by adolescent mothers in Durham Region, Ontario, Canada.MethodsThe principles of interpretive description guided this qualitative study. A purposeful, homogenous sample of 16 adolescent mothers (15–19 years) were recruited to complete individual, semi-structured, face-to-face interviews. Conventional content analysis was used to code data, identify concepts and synthesize them into overall themes.ResultsAdolescent mothers in this study expressed that the decision to breastfeed was made prenatally and while partner and family member opinions about breastfeeding initiation were influential, the decision was made independently. Mothers were primarily motivated to initiate breastfeeding due to the health benefits for the infant. Lower breastfeeding duration rates were found among mothers who decided to only “try” breastfeeding when compared to the mothers who committed to breastfeeding. Influences on continued breastfeeding included: 1) the impact of breastfeeding on social and intimate relationships; 2) the availability of social support; 3) the physical demands of breastfeeding; 4) mothers’ knowledge of breastfeeding practices and benefits; and 5) mothers’ perceived sense of comfort in breastfeeding.ConclusionsThe results of this study provide health care providers new conceptual insight and understanding of the factors that influence adolescents’ decisions to “try” breastfeeding and to continue providing breastmilk to their infants. Professional implications drawn from this study include active engagement of adolescents in the pre and postnatal periods, including early assessment of potential barriers surrounding breastfeeding decisions. This early professional interaction highlights the professional as a form of support, and allows for sharing of evidence-informed breastfeeding information and practical breastfeeding skills. Inclusion of adolescents’ positive social support networks should be emphasized in professional breastfeeding support. Motivational interviewing is a promising prenatal strategy to influence behavior change and reduce ambivalence in decision-making about breastfeeding, creating opportunities for health care providers to tailor interventions.

The orphaning experience: descriptions from Ugandan youth who have lost parents to HIV/AIDS

The HIV/AIDS epidemic has continued to pose significant challenges to countries in Sub-Saharan Africa. Millions of African children and youth have lost parents to HIV/AIDS leaving a generation of orphans to be cared for within extended family systems and communities. The experiences of youth who have lost parents to the HIV/AIDS epidemic provide an important ingress into this complex, evolving, multi-dimensional phenomenon. A fundamental qualitative descriptive study was conducted to develop a culturally relevant and comprehensive description of the experiences of orphanhood from the perspectives of Ugandan youth. A purposeful sample of 13 youth who had lost one or both parents to HIV/AIDS and who were affiliated with a non-governmental organization providing support to orphans were interviewed. Youth orphaned by HIV/AIDS described the experience of orphanhood beginning with parental illness, not death. Several losses were associated with the death of a parent including lost social capitol, educational opportunities and monetary assets. Unique findings revealed that youth experienced culturally specific stigma and conflict which was distinctly related to their HIV/AIDS orphan status. Exploitation within extended cultural family systems was also reported. Results from this study suggest that there is a pressing need to identify and provide culturally appropriate services for these Ugandan youth prior to and after the loss of a parent(s).