Wendy Duggleby

What About Focus Group Interaction Data

The purpose of this article is to discuss issues related to group interaction data in focus groups. How should it be analyzed and reported? The author addresses these questions using qualitative research approaches with examples from her research to foster further discussion regarding focus group research.

Cognitive status and postoperative pain: Older adults

The purpose of this study was to assess older adults to determine (a) the course of postoperative pain, (b) influences of pain and analgesics on mental status, and (c) relationships among age, mental status and pain. Sixty adults, aged 50-80 yr, who had total hip replacement surgery were included in this study. All subjects had met a preoperative criterion for mental status. Data collection took place over 5 days following surgery. Pain intensity and distress were assessed three times a day for 5 days. Recalled night pain intensity, pain distress, and sleep disturbance from pain were assessed daily in the early morning prior to assessment of mental status. Although no within day or day-to-day pain patterns were observed, the greatest decreases in pain occurred during the first 2 days. Night pain also improved after the third day. One-third of subjects recorded one or more episodes where mental status declined below criterion after surgery. Multivariate analysis indicated that pain, not analgesic intake, predicted mental status decline. Age was not related to pain or mental status. In general, pain was poorly managed in this group of subjects. The results suggest an explanation for acute confusion in older patients after surgery and recommend improved pain management.

Metasynthesis of the Hope Experience of Family Caregivers of Persons With Chronic Illness

The purpose of this metasynthesis was to describe the hope experience of family caregivers of persons with chronic illness. Fourteen studies were included in the metasynthesis. All studies described the importance of hope to the family caregivers of relatives with chronic illness regardless of age, relationship, or setting. Several derived themes arose from the metasynthesis, including (a) transitional refocusing from a difficult present to a positive future, (b) dynamic possibilities within uncertainty, (c) pathways of hope, and (d) hope outcomes. Hope was defined as transitional dynamic possibilities within uncertainty. A new conceptual model of hope was developed that provides a foundation for future research and practice. The metasynthesis findings indicate factors influencing hope have a role in assessing hope and differing pathways of hope provide a foundation for future hope interventions.

Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life

BACKGROUND Previous studies have documented similar levels of end-of-life symptom burden for lung cancer and chronic obstructive pulmonary disease (COPD) patients, yet there has been little comparison of health care utilization during this period. This study contrasts health care utilization by people with COPD and those with lung cancer in the 12 months prior to death. METHODS We performed a retrospective cohort study of 1098 patients who died in 2004 with a cause of death recorded as COPD or lung cancer using administrative health data. Our outcomes of interest included acute, long-term and home care service utilization. RESULTS The study population was 42% female with a mean age of 77 years (S.D.=11). In the last 12 months of life, decedents with COPD were more likely to be institutionalized in a LTC setting (41% vs. 12.5%, p<0.05) and to receive long-term home care (26% vs. 9.7%, p<0.05), but were much less likely to receive palliative care in hospital (47.6% vs. 5.1%, p<0.001) or at home (37.4% vs. 2.8%, p<0.05) than people with lung cancer. In contrast, decedents with lung cancer made greater use of acute care services than those with COPD in that they were more likely to be hospitalized (94.2% vs. 80.4%, p<0.05) and had longer median LOS (7.0 vs. 5.7 days, p<0.05) than those with COPD. No differences in the number of out-patient physician visits were noted. CONCLUSIONS Patterns of end-of-life health care utilization differ significantly between people with lung cancer and those with COPD. Further research is needed to establish need and determine gaps in services to better address the needs of people dying with COPD.

Renewing everyday hope: the hope experience of family caregivers of persons with dementia.

The purpose of this grounded theory study was to explore the experience of hope for family members caring for a person with dementia. Seventeen family members caring for persons with dementia were interviewed. The participants described their hope as the possibility of a positive future within their daily lives and in the social context of grief and loss, stress, fatigue, and constantly dealing with challenging behaviours of the person with dementia. The main concern of the study participants was “fading hope,” which they dealt with by “renewing every day hope” through (a) coming to terms, (b) finding positives, and (c) seeing possibilities.

Developing a living with hope program for caregivers of family members with advanced cancer.

A theory-based intervention, the Living with Hope Program (LWHP), was designed to foster hope in caregivers of family members with advanced cancer. The LWHP was developed from qualitative data and using Harding and Higginsons recommendations for family caregiver interventions as a guide. The LHWP is: (a) focused specifically on the caregivers themselves, (b) theory based, (c) feasible, (d) acceptable, and (e) pilot tested. The program consists of a hope video and a hope activity titled Stories of the Present. A mixed-method, concurrent triangulation, pre- and post-test design was used to pilot test the LWHP The results of the pilot test suggest the LWHP is easy to use, flexible, and feasible, and shows promise in increasing hope and quality of life scores in family caregivers.

Transitions and shifting goals of care for palliative patients and their families.

Terminally ill patients and their families experience many confusing and, at times, traumatic transitions. Examples of such transitions include transitions from cure to comfort care, transitions related to loss, changes in care settings, and psychosocial and spiritual transitions. The purpose of this article is to discuss the experiences of palliative patients and their families as they journey through transitions and how oncology nurses can provide support. Using a composite case study from actual clinical cases as a framework for discussion, the authors present examples of evidence-based strategies that can be used by oncology nurses. Critical points from the case study are Adjustment to death is a process and cannot be rushed. The needs of a palliative patient and family should be heard, honored, and not questioned or challenged. A patient and family should remain in control of decision making, with the hospice and palliative care team acting as guides and facilitators.

Helping Hispanic/Latino home health patients manage their pain.

The research focusing on pain in Hispanic/Latino populations suggests that their cultural values and beliefs of stoicism, fatalism, the importance of family, spirituality, and folk healing have an impact on their pain experience. Based on research findings this article suggests strategies nurses can use to assess and suggest pain management interventions for patients of Hispanic/Latino culture.

Factors that Affect Quality of Life from the Perspective of People with Dementia: A Metasynthesis

To comprehensively and systematically identify, appraise, and synthesize qualitative research findings on factors that affect quality of life from the perspective of people with dementia.

The stress of dementia: View from the inside

This descriptive exploratory study used thematic analysis to interpret short videotaped speech samples produced by persons with dementia in response to the question, “How have things been going for you lately?” The researchers were able to identify themes in 50 of the 56 interviews with men and women with Mini-Mental State Examination (MMSE) scores that ranged from five to 28. The major themes across all MMSE levels were losses, feelings about losses, and attempts to manage losses. The individuals’ choice of themes as well as their verbal and nonverbal expressions suggested that they were experiencing a significant amount of stress, especially related to their relationships with family and friends.