Methodological issues conducting sensitive research on lesbian and gay men's experience of nursing care

Party Drug Use Among Gay Men: Expanding Contemporary Understandings for Nursing Practice

BACKGROUND

The extant literature about party drug use among gay men primarily produces a list of negative health sequelae that correlate with using these substances. Missing from the current research are explorations about why people consume party drugs. In other words, researchers have not systematically collected people's narratives about "what they get out of" party drugs.

METHODS

Using Deleuze's and Bataille's work, exploratory semistructured interviews were undertaken with gay men who reported attending circuit parties, using party drugs, and engaging in condomless sex.

RESULTS

Seventeen men fit the study inclusion criteria and engaged in an interview. Two main themes emerged: party drugs were used to achieve desired sensations, and party drugs provided respite. The findings suggested that the relationships between party drugs and condomless sex are not necessarily causal.

CONCLUSION

It is important for nurses to differentiate the competing uses of pleasure seeking and respite, and design and provide interventions based on each patient's or patient groups' reasons for using party drugs.

The intersection of professionalism gay men, bodies and power

Purpose

The purpose of this paper is to build upon the paucity of UK research on gay men and how they manage their identities, bodies and selves in the workplace. Particular focus is placed on gay male professionals working in positions of authority and how they make sense of themselves against the dominant expectations of professionalism.

Design/methodology/approach

The study draws upon in-depth interview data with eight gay male professionals working in positions of authority.

Findings

Overall, the research reveals that although the majority of participants had disclosed their sexuality in the workplace, they actively sought to integrate and normalise their gay identities. Gendered organisational norms significantly impacted upon the ways they presented their identities, bodies and selves. This was brought into focus where participants had to exercise authority. There were limited opportunities to present non-normative forms of masculinity.

Originality/value

This paper adds to a dearth of studies on gay men, professionalism and managing their bodies, selves and identities in the workplace. The paper builds upon and contributes to our understanding of how gay men use and construct their bodies and their self-identities as professionals. An area that has had little empirical investigation. Furthermore, the paper contributes to our understanding of organisational heteronormativity and professionalism in the workplace. The paper draws attention to issues of diversity and inclusion challenging heteronormative discourses of professionalism which are draped in masculinity. This paper highlights how professionalism serves as a normalising process that pressurises gay men to perform a specific type of masculinity. The paper argues for a more inclusive reappraisal of the meanings attached to the term professionalism.

The Social Determinants of Nursing Retention in a Pediatric Hematology/Oncology Unit

Pediatric hematology/oncology units (PHOUs) are highly paced, stressful environments and can be difficult areas to work. Thus, these units can present issues when it comes to both recruiting and retaining health care professionals (HCPs). There is scant research addressing how the environment of a PHOU contribute to a HCP's desire to stay or leave this environment. To conduct this project, a critical ethnographic approach was used. The researcher conducted semistructured interviews ( n = 29), which included nurses ( n = 21), physicians ( n = 4), and allied health care staff ( n = 4). This sample represented approximately one third of staff in each category. Participants identified that their ability to develop long-term relationships with children and families as a significant source of satisfaction. Belonging to the oncology team was seen as extraordinarily important to all the participants. The majority of the participants also felt that working in this ever-evolving dynamic medical field afforded them with ongoing learning opportunities. The main frustration described by participants pertained to administrative involvement in the everyday workings of the PHOU, potentially leading to attrition. It is important to note that there was also diversity among and between the categories of HCPs when describing the work environment and the issues that most influence them. While similarities among participants were found between satisfaction and dissatisfaction, significant differences between them led us to believe it would be unreasonable to attempt to compare the three groups here. Thus, in this article the author focused primarily on nursing while noting related observations from physicians and allied health professions.

Chinese immigrants’ occupational well-being in Finland: the role of paternalistic leadership

Purpose

The purpose of this paper is to enhance the understanding of paternalistic leadership behaviour in the Finnish organisational context by investigating its relationship with Chinese immigrant employees’ occupational well-being.

Design/methodology/approach

This research was based on a survey of 117 Chinese immigrants working in Finland. The snowball sampling method was adopted in the present research.

Findings

The findings show that the dimensions of paternalistic leadership, specifically benevolent leadership behaviour, can be influential in Chinese immigrant knowledge workers’ occupational well-being in the Finnish organisational context.

Research limitations/implications

Paternalistic leadership style can also make sense in a Western organisational context, especially when dealing with well-being among immigrant employees from China or other Asian countries.

Originality/value

Some misunderstanding of paternalistic leadership behaviour in Western societies may impede the theory’s further development. The study enhanced the understanding of paternalism in the Finnish organisational context by illuminating the effect of paternalistic leadership on Chinese immigrant employees’ occupational well-being.

Lesbians' experiences of healthcare

This paper reports on the findings of part of an interview study of lesbian and gay men's experiences of nursing care which was conducted to develop nursing guidance for members of the Royal College of Nursing (RCN). The RCN recognises that discrimination and prejudice against lesbians and gay patients occurs in nursing and it is committed to developing and promoting good practice for this group of patients (RCN, 1994). One area where such discrimination and prejudice exists is in the ways that nurses approach lesbian patients when questioning them about their sexual or reproductive health. Nurses and other healthcare professionals often ask about sexual and reproductive health, and respond in a way that implies a lack of respect for individuals, heterosexism and homophobia. Guidance on the nursing and health needs of lesbian women is being produced (RCN, 2000). A more detailed discussion of the research findings used to develop the guidance is presented here.

The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives

Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy.

Negotiating sexuality in home care settings: older lesbians and bisexual women's experiences

There is evidence that lesbians and bisexual women often face prejudice and stigma when accessing routine primary healthcare services. However, limited research to date has examined their experiences outside of primary healthcare contexts or the perspectives of older healthcare users. This paper presents findings from a qualitative study of older lesbians and bisexual women in Ontario who accessed publicly-funded home care services. In qualitative in-depth interviews, 16 women responded to questions about their decision making around disclosure of their sexuality, home care workers' reactions to disclosure and their experiences of receiving care. The thematic analysis of participants' responses demonstrated that they experienced isolation and ongoing anxiety, as well overt and subtle examples of heterosexism and discrimination. However, there was also evidence of participants' resilience and resistance to heteronormativity and sexual minority stress. These findings have implications for our understanding of lesbians' and bisexual women's healthcare experiences and for policy recommendations.

Gaining access to a research site and participants in medical and nursing research: a synthesis of accounts

OBJECTIVES

The literature contains few accounts of how access to a research site and participants in medical and nursing research is gained, and few efforts to synthesise the existing accounts. Therefore, this article has two main goals: (i) to synthesise our own account of access with others in the medical and nursing literature, and (ii) to derive from this synthesis considerations of access and implications for health professions education.

METHODS

Based on field notes from a study conducted in an orthopaedic surgical section of a Norwegian university hospital, we provide an account of how access to the operating theatre (research site) and surgical teams (participants) was achieved. We synthesise the findings by comparing our account with existing accounts on access.

RESULTS

Our synthesis translates into a number of considerations related to the gaining of access to a research site and participants in medical and nursing research. These include conducting continuous negotiations to ensure the agreement and consent of participants and gatekeepers, and demonstrating transparency regarding the researcher's identity and the nature of the particular project and findings. These considerations can raise awareness and preparedness for the process of gaining access, which will benefit health professions education researchers planning or undertaking studies in educational or clinical settings. Health professions educators can also include the considerations in structured educational programmes, specifically methods courses, to instil similar awareness and preparedness in students.

CONCLUSIONS

We suggest that future medical and nursing research should emphasise a detailed, unvarnished documentation of the access process that incorporates existing accounts of the process.

“Out” in the field. Reflecting on the dilemmas of insider status on data collection and conducting interviews with gay men

Purpose

– The purpose of this paper is to explore using a reflexive approach the impact of author's personal positioning on issues of power balance between the interviewer and the interviewee, dealing with sensitive stories and concerns of difference and sameness between participants and the researcher in both the data collection process and also during the interviews.

Design/methodology/approach

– Initial data were gathered from 45 semi-structured interviews with self-identified gay men in a wide range of occupations and ages working in the seaside resort of Bournemouth on the south coast of England.

Findings

– The paper highlights some of the dilemmas of insider status and doing research on gay men. These include: ethical issues of closeness and involvement with participants, dealing with author's own personal frustrations, tackling the power imbalance between the interviewer and the interviewee and the impact of author's personal positioning on the data collection.

Originality/value

– Little research has been done on the impact of men doing research on issues of diversity. In particular, this paper re-examines the power balance between the interviewer and interviewee as being one sided as previous studies have suggested in the researcher's favour. It also uncovers ethical dilemmas such as sexual attraction and involvement that has had scant coverage in the literature.

Exploring how gay men manage their social identities in the workplace

Purpose

The purpose of this paper is to look beyond the issue of disclosure/non‐disclosure in the workplace, to explore the ways gay men challenge, negotiate and conform in the two‐way process of managing their identities in what Jenkins terms the interaction order. In the validation of their external identities, the author aims to identify critical incidents and experiences in gay men's working lives in which they have resisted or challenged identities, labels and stereotypes ascribed by others.

Design/methodology/approach

Data were gathered through ten semi‐structured interviews with self‐identified gay men in a wide range of occupations and age ranges working in Bournemouth, UK.

Findings

The data focus on the fluidity of identity and the impact of organisational context. In their self‐presentations a number of strategies were deployed. The respondents experienced exclusion, stereotyping, being viewed as a piece of curiosity, silence, discomfort and a marked identity in the eyes of others. In response to these reactions, themes of compliance, conformity and adopting an educator role were uncovered.

Research limitations/implications

Although the findings presented are not necessarily generalizable, themes of exclusion, silence and marked identities were uncovered that echo many previous studies of gay men's experiences in the workplace.

Originality/value

Little research has been done on identity management in the workplace beyond the issue of disclosure of sexual identity. In particular, there has been limited focus on how gay men challenge, negotiate and modify the labels and social identities ascribed by others in what Jenkins terms the interaction order. Nor does there seem to be any research on whether gay men have modified the management of their social identities throughout their working lives.

Nomadic sexualities: an in-depth case study about unsafe sex

In an era when researchers are identifying increased rates of unsafe sex among gay and bisexual men, it is important that the practice of unsafe sex be adequately explored. While much literature is already dedicated to this topic, only recently have researchers begun to develop in-depth understandings of the personal meanings that people ascribe to unsafe sex. This study continues such explorations by examining (i) why one self-defined gay man engaged in unsafe sex, and (ii) how he defined unsafe sex. The findings suggest that, for this man, his sexuality is nomadic and that what he feels is unsafe sex is the outcome of his nomadic sexuality conflicting with social imperatives for sexual stratification.

Drug use as boundary play: a qualitative exploration of gay circuit parties

Research findings have revealed that gay circuit parties may be locations that are disproportionately responsible for the increasing rates of many STIs/HIV among gay/bisexual men. Theories have been put forth that this may be the case because circuit parties are locales of prevalent drug use and unsafe sex. To explore the relationship between these two phenomena, in-depth qualitative interviews were undertaken with 17 men who (1) have sex with other men, (2) attended gay circuit parties in Montréal, Canada, in 2007. These revealed that drugs (including alcohol) were used intentionally to engage in unsafe sex, and then to justify this behavior after the fact. This process we called boundary play.

Qualitative Research on the Attitudes Toward Teenage Sexual Behavior of Chinese British Families

Qualitative approaches have been increasingly used to explore ethnic differences in teenage sexual behavior, and methodological issues of conducting such research often remain unaddressed. This article discusses issues related to sampling, rapport, language, and ethnical considerations arising while undertaking research on attitudes toward teenage sexual behavior held by Chinese British families. It highlights the value of using snowball sampling, the importance of establishing rapport, and some advantages of matching the ethnic background between researcher and participants. The researcher's gender and social and cultural backgrounds affect research processes and findings, and this itself merits further reflection.

A lesbian identity disclosure assessment: ALIDA instrument

BACKGROUND AND PURPOSE

Disclosure of lesbian sexual identity has been associated with greater self-esteem, less anxiety, and greater relationship satisfaction. Nondisclosure interferes with supportive, congenial, and intimate relationships with important people in their lives. Lesbian mothers choose nondisclosure to protect their children from social, psychological, and physical harm. Since disclosure is a health concern, ALIDA was designed to measure disclosure for lesbian mothers.

METHODS

ALIDA is a written, self-administered instrument with 15 questions that fall under 6 categories. It was tested on 360 lesbian mothers from 38 U.S. states.

RESULTS

ALIDA was one-dimensional, reliable (.79), and had face and concurrent validity. Regression indicated that 58% of the scores were predicted by eight variables.

CONCLUSIONS

ALIDA measures disclosure and should be used in more studies.

To hide or not to hide, that is the question! Lesbians and gay men describe experiences from nursing work environment

Homosexual nursing staff (n = 21) from different parts of Sweden were interviewed about experiences from their psychosocial work environment and about what they consider important points to communicate about lesbians and gay men in nursing. The findings show that most of the informants were partly open about their sexual orientation at work, the women less so than the men. All informants spoke of the fear of being socially excluded. Reported negative experiences included being neglected, harassment, and verbal discomfort based on sexual prejudices. The informants regarded responsibility, the need for knowledge, the consequences of invisibility, and the lesbian's specific situation, important points to communicate regarding homosexuality and nursing.

Heterosexual assumptions in verbal and non-verbal communication in nursing

AIM

This paper reports a study of what lesbian women and gay men had to say, as patients and as partners, about their experiences of nursing in hospital care, and what they regarded as important to communicate about homosexuality and nursing.

BACKGROUND

The social life of heterosexual cultures is based on the assumption that all people are heterosexual, thereby making homosexuality socially invisible. Nurses may assume that all patients and significant others are heterosexual, and these heteronormative assumptions may lead to poor communication that affects nursing quality by leading nurses to ask the wrong questions and make incorrect judgements.

METHOD

A qualitative interview study was carried out in the spring of 2004. Seventeen women and 10 men ranging in age from 23 to 65 years from different parts of Sweden participated. They described 46 experiences as patients and 31 as partners.

FINDINGS

Heteronormativity was communicated in waiting rooms, in patient documents and when registering for admission, and nursing staff sometimes showed perplexity when an informant deviated from this heteronormative assumption. Informants had often met nursing staff who showed fear of behaving incorrectly, which could lead to a sense of insecurity, thereby impeding further communication. As partners of gay patients, informants felt that they had to deal with heterosexual assumptions more than they did when they were patients, and the consequences were feelings of not being accepted as a 'true' relative, of exclusion and neglect. Almost all participants offered recommendations about how nursing staff could facilitate communication.

CONCLUSION

Heterosexual norms communicated unconsciously by nursing staff contribute to ambivalent attitudes and feelings of insecurity that prevent communication and easily lead to misconceptions. Educational and management interventions, as well as increased communication, could make gay people more visible and thereby encourage openness and awareness by hospital staff of the norms that they communicate through their language and behaviour.

Postabortion research: methodological and ethical issues

The author conducted research on long-term postabortion experience guided by the principles of phenomenology, and she describes the ethical and methodological issues encountered during the study, in which she interviewed 17 women who were more than 5 years postabortion, in this article. Discussed here, in the context of abortion as a sensitive topic for researcher and participant, are personal bias; recruitment, protection, and interviewing of participants; data analysis; and communication of findings. During the research process, the author gave particular attention to the formulation of the consent form, contact with the participants, the interview technique, the choice of a transcriptionist, and the use of a second reader. She also acknowledged her personal position on abortion, the reality of role conflict, and the importance of debriefing.

Health Related Behaviors and Cancer Screening of Lesbians: Results of the Boston Lesbian Health Project II

This paper reports data on health related behaviors and cancer screening from the Boston Lesbian Health Project II (BLHP II), a replication of a national survey of lesbians on a variety of health-related variables completed in 1987. The findings suggest that lesbians have increased their use of primary care, including routine physical examinations, pap smear screening for cervical cancer, and mammography for breast cancer, but that rates continue to be lower than would be expected for women in general. Younger lesbians in this sample smoked at high rates. Smoking rates continue to be of concern in other age groups, although they are lower than national data from women in general. BLHP II data confirm other findings that lesbians are more likely to drink alcohol and to drink more heavily than other women. Implications for health care of lesbians and future research with this population are discussed.

Involvement and detachment in researching sexuality: reflections on the process of semistructured interviewing

In this article, the authors reflect on the utility of the concept of involvement-detachment for researchers involved in a study of the lifeworlds of gay, lesbian, and bisexual young people where one of the researchers was lesbian. They focus in particular on the process of semistructured interviewing in qualitative research and the analysis of material generated by the interviews, noting that complete detachment from the subject of study is neither achievable nor desirable. They discuss the benefit of teamwork in supporting researchers and enhancing the integrity of the research, particularly when the subject is sensitive, the importance of researchers' active management of their own ideological leanings, and the understanding of project management as a conceptual and cognitive process that is fundamental to enhancing research rigor.

Exploring doctor and patient views about risk communication and shared decision-making in the consultation

BACKGROUND

There have been significant conceptual developments regarding shared decision-making (SDM) and assessments of people's hypothetical preferences for involvement in treatment or care decisions. There are few data on the perceptions of patients and professionals about SDM in actual practice.

OBJECTIVE

To explore, from paired doctor-patient interviews, participants' perceptions of SDM in the consultation and the level of consensus between the participants in the consultation process.

DESIGN

Qualitative analysis of semi-structured interview data.

SETTING AND PARTICIPANTS

Twenty general practitioners received training packages in 'risk communication' (RC) and 'SDM' to use as tools within the consultation. Forty patients with one of four conditions, for which a range of treatment options is available, were selected. Patient/doctor pairs were interviewed separately following consultations at four stages -'baseline' [general practitioner's (GP) usual consultation style], SDM training, RC alone, and both RC and SDM training. Interviews were transcribed and analysed using NVivo software.

RESULTS

Risk communication interventions by doctors appeared to result in a greater perception of decisions being made in the consultation. High levels of satisfaction with consultations were evident before application of the interventions and did not change after the interventions. Doctors' and patients' perceptions of the consultations were highly congruent at all phases of the study.

CONCLUSION

Shared decision-making and RC approaches were helpful in selected consultations and showed no detrimental effects to patients. However, the use of RC and SDM made only small differences to decision-making in consultations within the population studied. Increasing patient participation may be seen as more ethically justifiable than the traditional paternalistic approach but this needs to be set against the additional training costs incurred.

A discussion of chain referral as a method of sampling hard-to-reach populations

Nursing research often requires inquiry into sensitive topics that involve hidden or hard- to reach populations. However, identifying and sampling these populations for research purposes is often fraught with difficulties. Barriers include society's lack of tolerance of diverse groups, social stigma, concern for issues of confidentiality, and fear of exposure because of possible threats to security. Chain referral sampling techniques are proposed to minimize bias while maintaining privacy and confidentiality. Techniques of chain referral sampling are detailed for use in researching sensitive topics and hidden populations. When carefully planned and executed, this sampling design offers transcultural nurse researchers a reasonable method for accessing and studying special populations that are particularly hard-to-reach.

Lesbian health research: a review and recommendations for future research

Prior to 1990 lesbians were "invisible" in health care research. Researchers who asked questions specifically about lesbian health concerns were rare, and the burgeoning research on women's health seldom included variables that measured sexual orientation or behavior. In the last decade, however, lesbian health has emerged as a major area of study. A 1999 Institute of Medicine (IOM) report on Lesbian Health has outlined the challenges and gaps in this area of research and has called for focus and funding on specific areas of need. In this article I review research on lesbian health, discuss methodological issues specific to this area of research, and summarize the recommendations of the IOM report.

The well-being of gays, lesbians and bisexuals in Botswana

AIMS

To investigate the level of well-being of gays, lesbians and bisexuals (GLBs) in Botswana, how this level of well-being could be promoted and whether their health care needs were met by health care professionals.

RATIONALE

It is illegal to engage in same-sex activities in Botswana, punishable by imprisonment. Although Botswana's citizens have one of Africa's best health care systems, little is known about the health status, health care needs and general well-being of Botswana's GLBs. This survey attempted to uncover some of these potential health care needs, impacting on the GLBs' well-being.

DESIGN/METHODS

The research framework adopted was the health and human rights approach, placing dignity before rights. A survey design, with structured questionnaires, was used. Snow-ball sampling techniques were used.

RESULTS

Results indicated that varying degrees of distress were experienced by 64% of the GLBs in this study. The GLBs identified a need for human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) education and had concerns about their general health, discrimination against them and vulnerability to violence including sexual assaults.

CONCLUSIONS

The well-being of the GLBs in Botswana was influenced by both positive internal acceptance of their sexual orientation and negative external acceptance by society. Health care professionals played insignificant roles in the promotion of GLBs' well-being, and could make greater inputs into health education efforts, and more significant contributions towards enhancing the GLBs' levels of well-being. Enhanced collaboration between health professionals and human rights activists are recommended to reduce violations of Botswana's GLBs' dignity and to improve their quality of life, including enhanced access to and utilization of health care services.

Ethical considerations in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others

The purpose of this article is to describe and reflect ethical challenges in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. It concentrates on the justification of a research problem, sensitive research and the relationship between the researcher and the participants in data collection. The basis of ethically sound nursing research on the dynamics of hope in these two vulnerable groups lies in the relationship between the researchers and the participant. However, it is also obvious that the content, the process, the methods used and the ethics of the study cannot be divorced from this relationship. In conducting grounded theory research on the dynamics of hope in this research population, the researcher has to consider the surrounding world, that is, the reality in which these people live in hope or despair.

Maintaining client safety and scientific integrity in research with battered women

PURPOSE

To increase awareness of considerations of privacy and safety as well as the potential for scientific misconduct in research with battered women and other groups especially vulnerable to these concerns. Research with such vulnerable populations demands consideration of privacy and safety of participants in order to limit any potentially negative consequences while also ensuring scientific integrity.

ORGANIZING FRAMEWORK

Maintaining scientific integrity and protecting vulnerable groups are important but potentially contradictory. Battered women are the examples to illustrate instances of conflict in which protecting participants may undermine scientific integrity.

SOURCES

Literature on scientific integrity and misconduct, battered women, and vulnerable populations, and socially sensitive topics from nursing, other biomedical and social sciences, and the U.S. Public Health Service, 1978-1998.

METHOD

Integrative literature review.

FINDINGS

Conducting research with battered women in an ethically responsible manner that maintains scientific integrity without compromising advocacy or safety is possible when scientists are aware of potential conflicts and methods to ensure integrity.

CONCLUSIONS

Nurses frequently do research with vulnerable groups such as battered women. Being proactive can help promote scientific integrity, avoid scientific misconduct, and decrease negative outcomes.

Ethical considerations in qualitative research with vulnerable groups: exploring lesbians' and gay men's experiences of health care--a personal perspective

It is rare to find honest accounts of the difficulties and dilemmas encountered when conducting sensitive research with vulnerable research populations. This account explores some of the ethical issues raised by a qualitative interview study with lesbians and gay men about their experiences of nursing care. There is tension between the moral duty to conduct research with vulnerable and stigmatized groups in order to improve care, and the inevitable lack of resources that go with such a venture. This increases the risk of harm during the process of research. The risk of harm to both the researchers and the researched is explored and the need for a support structure for both groups is raised. There is a pressing need to develop further understanding about the ways in which the dissemination of research can potentially harm already vulnerable research populations.