A critical appraisal of the role of triangulation in nursing research

Problems to discuss with cancer patients in palliative care: a comprehensive approach

This study presents a comprehensive overview of the problems patients experience in a palliative phase of cancer. A two-step qualitative method was used: in-depth interviews with patients and relatives (N=9 patients+7 relatives), followed by interviews (N=31patients+15 relatives) using a checklist to confirm and complete the picture. Quality of life and quality of care domains were addressed. Patients experienced problems in all of these palliative care domains, although individual patients may have experienced only a few problems. Fatigue, feelings of futility, reluctance to accept help, fear of suffering and the fear that help would not be available if needed, were common problems. Communication problems arose when a grudge against a GP had remained, or because one family member tried to spare the other a confrontation with his/her feelings of fear or grief. A comprehensive checklist of relevant problems is presented.

"They don't trust us; we're just kids:" views about community from predominantly female inner city youth

The cornerstones of health promotion are the concepts of empowerment and community participation. There has been little research, however, on how these concepts are actualized within a youth population and even less from a gender perspective. Girls are socialized to be more compliant and cooperative; thus they feel less assertive to express themselves. The benefits of community participation, such as the development of personal identity and increased self-determination, may therefore be more important for girls' development. In this qualitative study I explored youth's perceptions about community, their ability to be heard, and their power to effect community change. Responses to focus groups and an on-line sentence completion exercise by 23 well-functioning, predominantly female (83%) youth, at an inner-city school in Canada, revealed that youth perceived that they were not heard and felt disempowered in the larger community. Three subthemes explain these threats to empowerment: "grown-ups run everything" (they had no actual decision-making power), "we're just kids" (they were low in the social hierarchy), and "they don't trust us" (they felt mutual mistrust of and by adults). Boys showed some evidence of feeling more empowered than girls. Boys and girls identified that they perceived they could make a difference, particularly in their school. Five themes of empowerment help to explain this perception, including, "adults who know us, trust us" (they were trusted by some adults), in school "they ask us what should we do" (they had some participation in decision making), "we can make a difference" (they felt self-efficacy), "we can do it as a group" (they had a belief in group action), and they could "get someone big so they would listen" (they demonstrated political efficacy). Implications for community health practitioners are discussed.

A feminist critique of research on cancer pain

A number of studies on cancer pain have been conducted but the researchers rarely considered gender and ethnic differences in cancer pain. In this article, nursing research on cancer pain is critiqued from a feminist perspective, and directions for future nursing research are proposed. A total of 82 nursing articles published in the United States were retrieved through MEDLINE and MELVYL data retrieval systems, and analyzed and critiqued in terms of four basic elements of research from a feminist perspective (bias as resources, dependability, credibility and adequacy, and intersubjectivity). In this article, the critique is presented with four themes that may provide reasons why nursing research on cancer pain rarely incorporated gender and ethnic differences: absence of participants' own views and experiences, androcentrism and ethnocentrism, lack of consideration on contextual factors, and distant relationships between researchers and research participants. To overcome the limitations, six critical elements including gender and ethnic sensitivity, avoidance of distorted views, respectfor participants' own views and interests, trust and openness, empowerment, and multiple methods are suggested to be incorporated in future nursing research on cancer pain.

Facilitating and constraining factors on autonomy: the views of stroke patients on admission into nursing homes

This article describes a model changing autonomy which was developed in a grounded theory study among stroke patients on admission into nursing homes for rehabilitation. Three dimensions of autonomy were identified: self-determination, independence, and self-care. On admission, patients' conditions (disabilities, multimorbidity, emotional state, and feeling like a layperson) and patients' strategies (waiting and seeing, and acting as a subordinate) constrain autonomy. Several environmental factors facilitate patient autonomy. The nursing home sustains patient autonomy by providing a hopeful atmosphere and room for autonomy. The health professionals facilitate autonomy by giving therapy, support and information, attentiveness and respect, paternalism and teamwork, Facilitating strategies of the family encompass emotional and instrumental support Care routines, lack of privacy, an unfamiliar environment, waiting periods, boredom, and lack of information were identified as constraining environmental factors. Developing guidelines and multidisciplinary courses regarding the approach to patient autonomy on admission is recommended.

Stroke patients' needs and experiences regarding autonomy at discharge from nursing home

In this qualitative study stroke patients rehabilitating in nursing homes experienced an increase in their autonomy (particularly in self-determination, independence and self-care) in the last weeks before discharge. The change in autonomy was found to be related to regained abilities and self-confidence, and to patients' strategies (e.g. taking initiative, being assertive). The attitude of health professionals and family, and the nursing home could influence patient autonomy. Overprotection, paternalism, care routines and an inconsistent approach constrain autonomy. Conversely, attentiveness, tailored interventions and a respectful dialogue facilitate autonomy, like moderate instrumental and emotional support by the family. Nursing homes can enhance autonomy by minimizing care routines and by providing room for doing activities independently and privately. Attention to patient autonomy may improve patients' active participation in rehabilitation, quality of life, and autonomous living after discharge. Multidisciplinary guidelines based on the results may increase attention to the stroke patients' autonomy and stimulate a team approach.

Patient autonomy during rehabilitation: the experiences of stroke patients in nursing homes

This article describes the results of a grounded theory study among stroke patients (N=17, aged 50-85) in rehabilitation wards in nursing homes. Patient autonomy (dimensions: self-determination, independence and self-care) increases during rehabilitation due to patient factors (conditions and strategies of patient) and environmental factors (nursing home and strategies of health professionals and family). During rehabilitation patients are in a state of transition regarding autonomy: patients need support to enhance autonomy, gradually regain autonomy, and thereby need less support. Although facilitating environmental factors were discovered, patients also experienced constraining factors regarding patient autonomy. Health professionals should give more attention to self-determination and independence; the nursing home should offer stroke patients more opportunities to do familiar activities autonomously.