The impact of home enteral tube feeding in everyday life: a qualitative study

Advances in clinical and technical areas, combined with developments in community support services, have enabled people to receive enteral tube feeding at home in the UK. Research has focused on clinical and technical aspects, and people's experiences have largely been explored through the audit of after-care services. The research reported in the present paper consisted of a qualitative study in which a small number of people under going enteral tube feeding at home and their carers were interviewed. The study took place in one area of northern England. The interviews explored aspects of daily life, focusing on decision-making and adaptation, and revealed positive feelings about the process of tube feeding, as well as areas of difficulty and concern. Opportunities to improve practice and services are identified from these accounts.     

The meaning of home visits conducted by medicine and nursing students: a qualitative study with users of family health units

Home visits (HVs) are considered an important technology to comprehend and care for the population's health requirements. Therefore, they must be a part of the health professionals' education. This study seeks to analyze HVs performed by first-year medical and nursing students from the viewpoint of family health unit users. It is a qualitative study in which data are collected by means of semi-structured interviews with users who are visited by Marilia Medical School medical and nursing students. The interpretation of meaning method is used and is based on a hermeneutic-dialectic perspective. The users find it positive that the students go beyond the biological care of the body and focus on interpersonal interrelationships. Nevertheless, the users believe it is necessary to organize and plan HVs accordingly. It may thus be inferred that HVs elicit the interaction between humanized healthcare and its users. Planning and reinforcement of health actions must be continuously improved when planning and conducting home visits.     

Smoking and workers' autonomy: a qualitative study on smoking practices in manual work

A massive amount of research has brought out the association of daily smoking with social class. Smoking remains very common in the most disadvantaged groups, but it has also maintained its popularity among manual workers. The starting point of the article is that what needs to be taken into account in explaining the social differentiation of smoking is the social context in which smoking takes place. The study is based on interviews of daily smokers, ex-smokers and occasional smokers from different occupational backgrounds. In this article, the focus is on manual workers (N = 19), and the main interest is in the meaning of smoking in working-class contexts and how it is attached to daily routines and social settings in manual work. Theoretically, the study draws on the pragmatist idea of habits and how they are formed in accordance with the context. As a shared ritual, smoking was a self-evident part of daily routines at the workplaces under scrutiny. The study shows how smoking was a legitimate way to challenge the official rules and to make the work more bearable by increasing social contacts and a sense of belonging. Paradoxically, smoking was to a great extent an unquestioned routine, but at the same time it increased the autonomy of the workers in terms of their daily tasks.     

The interpersonal management of environmental tobacco smoke in the home–a qualitative study

The home is a significant source of environmental tobacco smoke (ETS) exposure for many children and, therefore, increasingly a focus of intervention, although evidence of effectiveness remains equivocal. However, little is known about the nature, genesis, and micro-social context of self-imposed restrictions on smoking in the home. In this exploratory study, interviews were conducted in 15 diverse households that had resident children in Toronto, Canada. The results suggest that households cluster into three distinctive groups, from a high degree of restrictions to a lack of consistent measures. Attempts to control ETS exposures in homes often emerge as a result of protracted negotiations and must be understood in the context of situated relationships within the family. Implications for policy and practice, as well as recommendations for future research, are addressed.     

Sputum bacteriology in nursing home pneumonia: a retrospective study

INTRODUCTION: Pneumonia is the most lethal infection in nursing homes. The Infectious Disease Society of America recommends that attempts be made to obtain quality sputum to focus antibiotic therapy. This is especially important within the enclosed space of a nursing home, where constant pressure from broad spectrum, empiric antibiotics sets the stage for the emergence of resistant organisms. METHODS: We reviewed all cases of radiographic pneumonia diagnosed on-site at the Wisconsin Veterans Home, a 721-bed facility, for the recording of sputum bacteriology and 30-day mortality. RESULTS: Ninety-nine cases of radiographic pneumonia diagnosed on-site were identified over 1 year. Mortality was 10% within 30 days. Fourteen quality sputum specimens were obtained and processed microbiologically. None of the individuals who had a sputum specimen died within 30 days, probably because the ability to obtain a sputum specimen is a marker of higher functional status. DISCUSSION: Even if empiric therapy continues in the majority of cases, cultures in individual cases may alert clinicians to noncovered, resistant pathogens, and allow focused antibiotic therapy with agents like amoxicillin that might extend the usefulness of empiric, broad spectrum antibiotics. Institutions may also sum the results of sputum bacteriology to assist in the choice of empiric antibiotic therapy. Sputum bacteriology may benefit both the individual resident and the entire population of the institution.     

The management of a multigenerational nursing team with differing qualifications: a qualitative study

Retiring age is no longer fixed at 39 years of working service by Italian law, so nurses with more than 40 years of service continue to work in the wards, creating a distinct older generation. Moreover, with the closure of nursing colleges and the introduction of university degree courses for nurses, nursing education has changed significantly. This article reports on a study which explored the experiences of chief nurses in the daily management of nursing teams composed of multigenerational nurses who differed in age and qualifications. Husserls' phenomenologic approach was used, interviewing at length a purposeful sample of 10 chief nurses. Five main areas of concern emerged: (a) The generation gaps between peers and team leaders; (b) nomadism versus being settled; (c) conflicting methods of working which result in nothing being accomplished: managing the "flat paradox"; (d) different nursing values, ideals, and visions; and (e) existing generation gaps with the younger staff. The number of younger nurses will increase with time and, as a consequence, the relevance of intergenerational differences must be seriously debated, not only difficulties with age differences but also those relating to nursing education.     

Suicide among nursing home residents: a population-based study

OBJECTIVE: The rate of suicide is highest among the oldest old and is associated with chronic medical illness and functional impairment. These risk factors are prevalent among nursing home (NH) residents, yet little has been published on suicide in this population. METHODS: We performed a population-based, retrospective cohort study to identify clinical features of NH residents attempting or completing suicide. A computerized data-base search was conducted to identify cases of completed suicide in Olmsted County and surrounding communities (846 NH beds) between 1981 and 1997. Subjects' medical records were reviewed to identify clinical details. RESULTS: Five cases of completed suicide and three suicide attempts were identified, including six men and two women. Deaths were the result of drowning, hanging, or medication overdose (the latter following a period of intentional hoarding). Those who died ranged in age from 69 to 87 years. Most had been NH residents for less than 6 months. No deaths occurred in patients with severe cognitive impairment. CONCLUSIONS: Suicide and suicide attempts in the NH seem to be uncommon but are likely underrecognized and underreported. Suicide risk among NH residents seems to be highest among men and those recently admitted to facilities. In addition, suicide methods differ among NH residents compared with community-dwelling older people, likely reflecting environmental restrictions and physical limitations. Suicide and suicide attempts are important resident health issues and risk management concerns for staff in long-term-care facilities.     

There's no place like home: a qualitative study of the working conditions of home health care providers

OBJECTIVE: Home health care (HHC) is one of the fastest growing US industries. Its working conditions have been challenging to evaluate, because the work environments are highly variable and geographically dispersed. This study aims to characterize qualitatively the work experience and hazards of HHC clinicians, with a focus on risk factors for bloodborne pathogen exposures. METHODS: The researchers conducted five focus group discussions with HHC clinicians and ten in-depth interviews with HHC agency managers and trade union representatives in Massachusetts. RESULTS: HHC clinicians face serious occupational hazards, including violence in neighborhoods and homes, lack of workstations, heavy patient lifting, improper disposal of dressings or sharp medical devices, and high productivity demands. CONCLUSIONS: The social context of the home-work environment challenges the implementation of preventive interventions to reduce occupational hazards in HHC.     

Management preparedness criteria: a study of nursing home administrators

The observations from this study seem to suggest that there are some correlations between education, experience, age, and sex on the level of preparedness in the practice domains identified. Specifically, this study finds that years of experience have a significant negative correlation with the practice domains of physical plant/building management, fiscal reimbursement, financial management, and overall preparedness in both Oklahoma and Connecticut respondents. Experience level further correlates negatively with all other practice domains (except licensing standards) in Oklahoma respondents. Education level, on the other hand, did not correlate with any practice domain (except licensing standards among Oklahoma respondents). Age correlated positively with financial management activities but only with Oklahoma respondents, while sex correlated positively with physical plant/building management (Oklahoma and Connecticut) and with financial management in Connecticut only. Sex, however, had a negative correlation with basic nursing activities among Connecticut respondents. This study suggests that the nursing home administrators from Connecticut in our study felt that they were more prepared in the practice domains identified as compared to those responding from Oklahoma. This can be attributed to the fact that Connecticut respondents had almost a 13 percent higher average of experience years. This was also demonstrated in the correlation table. Other factors such as sex, age at onset of administrator career, and educational level had no or very limited effect on the practice domains identified in the study (p greater than 0.05). This holds true for both Oklahoma and Connecticut respondents. Therefore, the hypothesis stating that education has a direct effect on job performance and preparedness of nursing home administrators does not hold true with this study. It is the years of experience that has a direct effect on performance and preparedness of nursing home administrators.     

Acceptability and use of clean home delivery kits in Nepal: a qualitative study

This research was carried out in rural Nepal to explore how different categories of birth attendants at home deliveries accepted and used clean home delivery kit (CHDK) and its contents, including hand-washing practices, during delivery and preparations for birth. In-depth interviews were conducted to collect information from 51 women-both users and non-users of the kit. The respondents were interviewed within one month of their most recent delivery. Results of the interviews showed that the attendants who used the kit perceived it as hygienic and convenient, affordable, and culturally acceptable. The razor blade and thread were the most useful items, and the purpose of the plastic coin was understood. Despite its perceived usefulness, awareness and use of the kit were low, and common reasons for non-use included not knowing about the kit or difficulty in procuring a kit locally. In addition, the kit had limited influence on general hygiene practices. The authors explore the importance of evaluating promotional efforts re-targeted to individuals who hold decision-making power regarding the use of the kit. They recommend that kit promoters emphasize hand-washing and single use of the kit.     

The public image of nursing: a profession to learn about

Nursing is a profession that has suffered from public stereotyping for a long time. It has been viewed historically as a female profession, under the orders of doctors and without its own field of competence. Major changes have occurred in the discipline over the last decade that directly affect the profession. As a result, this review of the literature has tried to identify the image of nursing held by the population, the prevailing stereotypes related to it, and what the public considers that nurses do. Eight categories emerged from the thematic analysis that can help in explaining the view that society has of nursing and the evolution it has undergone. It seems that the public is predominantly ignorant of the essence and focus of the discipline, which is none other than care of the person, family or community. It is also a little known profession as society does not fully acknowledge that nurses have their own field of competence, autonomy and independence. There is still a tendency to consider nursing as a profession inferior to medicine, closely related to "tasks", and there is trust in its carrying out those activities that have been traditionally associated with it. However, it is coming to be perceived as a profession that is less related to femininity and that involves greater preparation than in the past.