Tina Koch

Establishing rigour in qualitative research: the decision trail

The aim of this paper is to show the way in which the decision trail of a qualitative research process can be maintained. It is argued that the trustworthiness (rigour) of a study may be established if the reader is able to audit the events, influences and actions of the researcher. The actual study containing the recording of this decision trail aimed to express the concerns of older patients who were admitted to the acute care sector. The study took place in two care of the elderly wards in a 1000-bed National Health Service hospital in the UK, in 1991. Eventually, 14 patients were interviewed, each on several occasions, and their concerns are expressed in themes, namely: routine geriatric style of care, depersonalization, care deprivation and geriatric segregation. I describe the preparations that were undertaken before patient interviews could commence. The literature recording the process of the interviewers experience as data in qualitative research is scarce. I show the researchers participation in making the data as part of an existential phenomenological research process. Existential phenomenology relies on recording influences while generating data such as significant literature, media reports, my value position and journal data.

Client relevant care and quality of life: the trial of a Client Generated Index (CGI) tool for community nursing

Community nursing organisations worldwide seek optimal ways to ensure adequate measurement of health outcomes for the client following nursing care, and to facilitate a consumer focus. This article presents a trial of the Client Generated Index (CGI) tool that subjectively assesses and measures the quality of life outcomes pertaining to a clients health status, whilst also facilitating individualised care. Sixty district nursing clients participated in the trial, which ascertained that the CGI tool effectively directs the client to list, grade and prioritise personally relevant quality of life issues. Consequently, this tool is being incorporated into client admission and discharge assessment within the organisation.

‘The real stuff’: implications for nursing of assessing and measuring a terminally ill person’s quality of life

• Two quality of life (QoL) assessment and measurement tools, the Client Generated Index (CGI) and the McGill Quality of Life (MQOL) questionnaires, were trialled within district nursing palliative care to test usefulness and feasibility for holistic intervention selection, individualized palliative care planning, and measurement of the quality of dying. • The specific focus of this paper is to discuss the less tangible outcomes of the trial, which illuminate the partly ‘hidden’ value and nature of clinical nursing. • These outcomes include awareness that the use of such tools may: by actual administration of the tool be, in and of itself, a therapeutic nursing action; focus on ‘the real stuff’ from the client’s perspective, that which matters most to the terminally ill client, but may not be classically considered as prompting nursing intervention; and facilitate ‘the real stuff’ of nursing, perhaps known but not usually articulated by nurses, and which usually does not feature on care plans nor in time allocation schedules.

Lovestruck : women, romantic love and intimate partner violence

Abstract Intimate Partner Violence remains a significant problem globally despite health promotion aimed at raising awareness. In particular, there is a current trend for many young women to view some abusive/violent behaviours as acceptable in their relationships. Intimate Partner Violence has serious implications for its short and long term impacts on the health of women and children. Health workers may find working with women a challenging and sometimes frustrating experience. A way forward is to develop clearer understandings of the complexities of Intimate Partner Violence and to better understand women’s investments in romantic relationships. In this paper a secondary analysis of data from a narrative study of women’s recovery from IPV relationships is presented in order to illustrate discourses that inform underpinnings of romantic relationships. Transcriptions of audio-taped interviews were analysed using a feminist post-structural approach in order to make visible the ways in which the women negotiated their identities in the discourses of femininity. A critical review of current literature was also undertaken to develop the construct of romantic love. Women revealed that cues for Intimate Partner Violence were present early in the relationship but were not recognised at the time. Two positions within the discourse of romantic love were identified that underpinned their desires to establish and invest in the relationship despite the presence of cues for Intimate Partner Violence. These were ‘Desperate for a man’ and interpreting jealousy as a sign of love. Romantic love may be desirable for the sharing of warmth, safety and protection, and yet can mask behaviours that are cues for domestic violence. Understanding the complex nature of the ways that women’s desires are located in the discourse of romantic love has implications for all nurses working to prevent and reduce the incidence of Intimate Partner Violence.

Constipation and laxativeuse in older community-dwelling adults

Introduction and rationale this article reports a small exploratory study of older peoples experiences of constipation and laxative use carried out in the UK and relates this to a parallel study in Australia. The research was motivated by the lack of research into peoples own reports of these common phenomena, which consume a large volume of health services prescribing budgets. Literature review a focused literature search was carried out using tightly specifiedcriteria. This revealed little empirical research with community-dwelling older adults and numerous problems with the articles that were traced. These included disparate definitions of constipation, disagreement on whether constipation is related to ageing, lack of concern with medication regimes as a contributing factor, and a variety of suggested treatments which lack research-based evaluation. Methods in the UK arm of the study, 16 community-dwelling people over 65 years ofage were interviewed in their own homes using a structured interview schedule with probing. Findings interviewees generally preferred to have a daily or alternate daily bowel actionand reported a number of specific and general symptoms if this did not occur. They reported apparently adequate intakes of fibre, but many did not take fluids to recommended levels. The majority were taking a number of medications including codeine-containing analgesics and were limited in their mobility by a range of health conditions, especially arthritis. Discussion the findings of the UK arm of the study are discussed in terms of the literature and related to the Australian arm. Because of the small-scale exploratory nature of the two studies, the main recommendations that emerge are for future research. However, some pointers for nursing practice are advanced because consistency of the findings in the two arms and the literature review justify this.

Reflection Look, think and act cycles in participatory action research

In this paper, four researchers describe reflection as a component of a participatory action research cycle. We draw on our experiences and learning while undertaking three research inquiries. In the first inquiry we listen and respond to the voices of Australian Aboriginal people who live with diabetes and we share an alternate story, where fear is turned into courage, as told by these Elders. The second inquiry involves email communications with women and men who live with a chronic illness and gives a facilitator’s reflections. And the third study is a capacity building process with women who have experienced child sexual abuse. These women have used/misused alcohol, licit/illicit substances, or gambling, which has contributed to their homelessness. Confronted by many of life’s obstacles, we gain a glimmer of hope as women describe the way in which they use the participatory process to make sense of their lives.It is argued that reflection occupies a central place is participatory action research cycle...In this paper, four researchers describe reflection as a component of a participatory action research cycle. We draw on our experiences and learning while undertaking three research inquiries. In the first inquiry we listen and respond to the voices of Australian Aboriginal people who live with diabetes and we share an alternate story, where fear is turned into courage, as told by these Elders. The second inquiry involves email communications with women and men who live with a chronic illness and gives a facilitator’s reflections. And the third study is a capacity building process with women who have experienced child sexual abuse. These women have used/misused alcohol, licit/illicit substances, or gambling, which has contributed to their homelessness. Confronted by many of life’s obstacles, we gain a glimmer of hope as women describe the way in which they use the participatory process to make sense of their lives. It is argued that reflection occupies a central place is participatory action research cycles of ‘look, think and act’. ‘Look, think and act’ processes are appealing precisely because they are meaningful to research participants in their everyday lives. When these processes are internalised as modus operandi, they can be sustained throughout one’s life as a strategy for building capacity or ‘moving on’. ‘Moving on’ or transition is the theoretical focus that holds these inquiries together.

Using caregivers-as-proxies to retrospectively assess and measure quality of dying of palliative care clients

This study evaluated two quality-of-life assessment and measurement tools, the Client Generated Index and the McGill Quality of Life questionnaire, within palliative care nursing. Primarily tested was the feasibility of the tools to assess clients’ QOL at admission and, if necessary, when their condition altered. The reliability of the tools has previously been ascertained. Additionally, quality of dying during the last two days of life for 14 participants who died during the study was assessed and measured retrospectively by these tools, using the client’s nominated care-giver as proxy for the client. It is this second focus that we report on here. The reasons why proxy assessment and measurement of client QOD was not useful or feasible are discussed.

Core elements of programmatic research in nursing: a case study

In this invited paper Tina Koch and Debbie Kralik present the establishment of a research program outside the precincts of a university and we ask Gary Rolfe to provide a commentary from the perspective of an academic. We argue that a dedicated research unit, with a clearly articulated philosophy and in response to research questions from clients, community and practitioners, provides the focus to drive the program. Although we have infrastructure from the RDNS Foundation, obtaining external funding to support our program is a central activity. Discernable outcomes of our collaborative inquiries are described as participants with whom we research narrate aspects of their experience, leading to enhancement of self agency and quality of life. We illustrate the reform potential as groups of research participants develop sustainable people networks. Most importantly, theoretical development is ongoing describing transition (ways in which people are able to take a chronic illness into their lives and move on) and better understanding on ways in which health care professionals can facilitate transition. Evidence based news letters are written in collaboration with practitioners, however we ponder about ways to further our research findings in practice. Gary Rolfe speculates about intermural or extramural research programs. He frames his response using Brands criteria to research program decisions. In order of importance he asks: (1) will it be fun? (2) will we learn anything from it? (3) will it make the world a better place? (4) will it earn enough money to pay for the first three? Gary argues that one of the luxuries of working within the university sector as an academic is that he can occasionally ignore question four.

Quality of life issues identified by palliative care clients using two tools

Abstract Reported are issues impacting upon the Quality of Life (QoL) of 59 palliative care clients within a district nursing service. These issues reinforce the emerging conceptualisation of QoL as being subjective and multidimensional. The issues were identified during a trial of two QoL assessment and measurement tools, the Client Generated Index (CGI) and the McGill Quality of Life (MQOL). In this era of considerable concern about QoL for the terminally ill, the article’s intent is to present the QoL issues identified, the grades of impact and priority for improvement of the issues according to the clients, and to discuss these aspects. This information can inform the assessment of palliative care clients (the CGI tool was found ideal for such an assessment), and may also inform further research on the QoL of palliative care clients.