Qualitative research in palliative care 1990-1999: a descriptive review

A collaborative, evaluative review of qualitative research in palliative care published between 1990 and 1999 has been conducted. Nearly 30,000 articles in 48 journals from specialist palliative care, oncology, death studies, medicine, nursing, gerontology, health and the social sciences were examined. From these journals, 138 articles (0.5%) reporting qualitative research with a focus on palliative care in the context of death, dying or bereavement were identified. These articles were reviewed using a proforma designed by the group. This article describes the review process, and the following findings: the distribution of different forms of qualitative research in palliative care; the location of such papers; the focus of the research; and the research methodology and methods adopted.     

428篇危重病护理论文分析

目的:分析近年我国危重病护理领域护理研究的现况,存在的问题。方法:手工查阅2000～2005年发表于国内4种护理核心期刊的428篇危重病护理论文,就论文研究内容、研究方法等进行分析。结果:目前国内危重病护理研究论文数量呈逐年增长趋势,以经验性论文为主,占60%;机械通气与气道管理为研究的热点问题;实验性研究论文增长较快;需要在科学性和有效性方面进一步提高。结论:危重病护理研究水平有待进一步提高,应发挥学科优势,促进危重病护理研究的发展。     

Using satisfaction to measure the quality of palliative care: a review of the literature

BACKGROUND: The advent of clinical governance in British health policy has placed increased demands on health care providers and practitioners to ascertain the quality of their services. Traditional indicators of quality of health care, such as death or recovery rates, are not appropriate in palliative care. Thus, it is important to establish alternative approaches to measuring the quality of palliative care services and interventions. AIMS: Satisfaction levels have been used widely in palliative care to assess quality. A literature review was conducted which aimed to explore the strengths and weaknesses of using satisfaction as an indicator of the quality of palliative care services. It also aimed to provide a solid basis upon which further work could be built. METHODS: Five electronic databases were searched using key words and phrases and key authors. Hand searches were conducted of four journals that contributed significantly to the concept of satisfaction, and reference lists of reviewed papers were scrutinized. Relevant papers were reviewed, data were extracted and these data were thematically analysed. FINDINGS: There are a number of important unresolved issues in the literature with regard to using satisfaction as an indicator of the quality of palliative care services. First, few alternatives to satisfaction are available. Secondly, satisfaction is under-theorized and no widely accepted definition exists. Thirdly, there are methodological inconsistencies across studies. It is important to take into account these findings when planning and implementing change following service evaluation using satisfaction as a measure. CONCLUSIONS: Relying on findings of satisfaction surveys to determine clinical and policy amendments in palliative care may not result in improvements in overall quality of care. Using satisfaction as a method of assessing the quality of health care services is particularly problematic and requires further investigation in both practical and conceptual terms.     

Qualitative research in health care: II. A structured review and evaluation of studies

A hand search of the original papers in seven medical journals over 5 years was conducted in order to identify those reporting qualitative research. A total of 210 papers were initially identified, of which 70 used qualitative methods of both data collection and analysis. These papers were evaluated by the researchers using a checklist which specified the criteria of good practice. Overall, 2% of the original papers published in the journals reported qualitative studies. Papers were more frequently positively assessed in terms of having clear aims, reporting research for which a qualitative approach was appropriate and describing their methods of data collection. Papers were less frequently positively assessed in relation to issues of data analysis such as validity, reliability and providing representative supporting evidence. It is concluded that the full potential of qualitative research has yet to be realized in the field of health care.     

基于Web of Science数据库有关胶质瘤护理研究的文献计量分析

目的 分析胶质瘤护理研究的分布情况,为胶质瘤护理研究提供参考。方法 以Web of Science（WOS）数据库收录1985－2020年相关文献为对象,借助Web of Science数据库提供的文献分析功能和BICOMB软件,对胶质瘤护理相关研究的发表年度、国家和机构分布、来源出版物、作者、被引情况、研究方向及高频关键词进行文献计量分析。结果 共纳入84篇胶质瘤护理相关研究文献,分别发表在53种期刊上,其中护理专业刊物10种。整体发文量呈上升趋势。美国发文量最多。胶质瘤护理研究领域初步形成核心团队。高频关键词显示研究热点集中在姑息治疗、支持性护理干预、流行病学、生活质量、康复等方面。结论 胶质瘤护理研究正在不断发展,现有研究数量仍有待提升。护理人员应紧跟研究热点,针对胶质瘤患者的临床需求,积极开展支持性护理干预和姑息治疗,以指导临床实践。     

Measuring the outputs of Australian nursing research published 1995-2000

AIMS: To analyse the research published in refereed nursing journals by Australian authors from 1995 to 2000. BACKGROUND: Analysis of the research topics and types of methodologies used by Australian nurse researchers has not been recently undertaken. The study was similar to an analysis of United Kingdom (UK) nursing research between 1988 and 1995 to allow comparison between the two countries. DESIGN: A quantitative approach analysed the research abstracts for the topic researched, source of data, location of data collection, paradigm and methodology used and funding source. RESULTS: A total of 509 articles from 11 generalist Australian and UK nursing journals were analysed. The highest numbers of articles were published in Australian Journal of Advanced Nursing and Journal of Advanced Nursing. The most popular topics were education of nurses (18.7%, n=95) and practice issues relating to patient care (15.3%, n=78). However, scant attention was paid to major Australian health issues. Most research was undertaken in the hospital setting (55.8%, n=247). Data were most often drawn from nurses themselves (40.7%, n=206), followed by patients (25.5%, n=129). Both quantitative (41%, n=203) and qualitative approaches (47%, n=230) were employed. A minority of studies acknowledged any funding (14.9%, n=76). CONCLUSIONS: Research findings need to be applied in practice to improve patient care. Nurse researchers need to publish their findings and align their research interests to meet national health priorities. They need to be involved in setting these health priorities to ensure that nursing has a place in health research.     

Paving the way: Stepping stones to evidence-based nursing

Wallace MC, Shorten A, Russell KG. International Journal of Nursing Practice 1997; 3: 147–152
Paving the way: Stepping stones to evidence-based nursing
Evidence-based practice is an emerging paradigm in health care. This paper outlines the main features of this paradigm and its potential value to nursing. Evidence-based practice is based on a conceptual framework that examines the extent of evidence available in support of particular clinical practices. The Quality of Evidence Ratings adapted by the National Health and Medical Research Council (NHMRC) from the United States Preventive Services Task Force are discussed, and the strengths and weaknesses of different categories of evidence are highlighted. Potential barriers to implementation of research into practice are identified. The authors suggest that legal, ethical, economic and humane imperatives oblige nursing to develop evidence-based practice as one of several viable contributions to nursing knowledge. Suggestions for analysing current research and for the planning of the direction of future nursing research are made.     

Nursing research in Spain: bibliometrics of references of research papers in the decade 1985-1994

BACKGROUND: Spain is one of the few European countries to have recently totally incorporated the study of nursing into the university sector. Bibliometric studies may be of a great help for the consolidation of nursing research. AIM OF THE STUDY: The aim of this paper is to describe bibliographic references in Spanish nursing research papers and their evolution over a decade. METHOD: The method consists of a retrospective bibliometric study of a sample (cluster sampling) of 622 research papers (original papers and review papers), which were contained in the Spanish nursing journals Enfermería Científica, Revista ROL de Enfermería, Enfermería Clínica and Enfermería Integral, and published from 1985 to 1994. The journal Nursing Research was selected for qualitative comparative purposes. A series of classic bibliometric indexes were used. RESULTS: The mean of references per paper is 10.64 +/- 10.42; this increased over time (P < 0.001). Review papers have more references (P < 0.001). Price index (percentage of references published during the last 5 years) is 44% and the Insularity (percentage of references published in same country as the article) is 55%. References to journals predominate (58.6%), with a growing tendency for references to Spanish nursing journals, although they are still scarce (18.1% of the references to journals). Spanish is the language of most of the references (60.3%), the second language being English (36.1%). CONCLUSIONS: Bibliographic references in Spanish nursing research papers are scarce and not very specific: this happens both in regard to Nursing Research and to publications in other national and international science areas. However, there is an increasing tendency of references (including references to nursing journals) in the period analysed. The age of the references places Spanish nursing in an intermediate position between the 'hard' sciences and the humanities; and, according to the type of documentation used, we find it halfway between experimental and natural sciences, and technologies and social sciences. There has been a slight increase in references in English in recent years.     

Towards a conceptual evaluation of transience in relation to palliative care

AIM: This paper is a report of a concept evaluation of transience and its relevance to palliative care. BACKGROUND: A qualitative study into palliative care patients' experiences of transition revealed a gap between current definitions of transition and their expression of the palliative care experience. Transience appears to offer a better definition but remains conceptually weak, with limited definition in a healthcare context. METHODS: A qualitative conceptual evaluation of transience was undertaken using two case examples, interview data and the literature. Multiple sources were used to identify the literature (1966-2006), including a search on Cumulative Index to Nursing and Allied Health Literature Medline, and Ovid and Arts and Humanities Index using the keywords 'transience' and 'palliative care'. Thirty-one papers related to transience were retrieved. Analysis and synthesis formulated a theoretical definition of transience relative to palliative care. FINDINGS: Transience is a nascent concept. Preconditions and outcomes of transience appear contextually dependent, which may inhibit its conceptual development. Transience depicts a fragile emotional state related to sudden change and uncertainty at end-of-life, exhibited as a feeling of stasis. Defining attributes would seem to include fragility, suddenness, powerlessness, impermanence, time, space, uncertainty, separation and homelessness. CONCLUSIONS: Transience is potentially more meaningful for palliative care in understanding the impact of end-of-life experiences for patients than current conceptualizations of transition as a process towards resolution. As a nascent concept, it remains strongly encapsulated within a framework of transition and further conceptual development is needed to enhance its maturity and refinement.     

Use of Physiologic Variables in Nursing Research

In this study, the use of physiologic variables is described in research reports published 1989-1993 in four broad-based research journals. The National Institute for Nursing Research (NINR) emphasizes the need for more physiologically based nursing research. This analysis documents the current number and proportion of such research reported in four journals during a 5-year period. Each report was evaluated for the population sampled, type of physiologic variable, type of study, definitions, and reporting of reliability and validity measures. Among the 763 reports, 114 (15%) examined physiologic variables. The most frequently studied physiologic variables were blood pressure, heart rate, and body temperature. The majority of studies posed and answered a clinical nursing question, and the study populations sampled were adults. Theoretical and operational definitions were included in most reports. Evidence of reliability and validity analysis were in 36% and 60% of the reports respectively. Although most nursing research focuses primarily on psychosocial aspects of care, several conceptual and psychometric issues were also addressed in studies that examined physiologic variables     

Examining the care of patients with peripheral venous cannulas

The purpose of this study was to examine nursing issues in the care of patients with peripheral venous cannulas (PVCs) with particular focus on duration of cannulation in order to minimize risk of infection. A tentative practice model evolved from this study. The research approach used involved qualitative methods utilizing grounded theory. Data analysis produced one tentative core category, 'effectiveness'. This allowed for the development of a 12-dimensional model explaining the nursing function against four interrelated models: development; practice; organizational support; effectiveness. Related to these four models were key professional aspects of 'autonomy-control' and 'knowledge-practice'. Interpretative findings from the study were plotted against this model, giving a graphic representation and highlighting strengths and weaknesses of nursing practice. Aspects requiring improvement included: PVC care as a syllabus subject; nursing practice; autonomy and control issues; shared responsibility problems; documentation systems; goal setting; outcomes. The policy, nurses' knowledge of PVC care and identification of critical issues were considered satisfactory. The model incorporates 12 important dimensions associated with effective practice that can be applied to nursing at different levels - clinical practice, education, management - and to other disciplines, providing a framework for narrowing the theory-practice gap and improving patient care.     

The future of palliative care nursing research in Australia

Nursing research in palliative care is becoming more important as cost effectiveness and evidence-based practice are becoming mandatory. Fifty-nine published and unpublished projects relating to nursing research on palliative care in Australia between 1990 and 1996 were reviewed. Findings indicated that nurses working in palliative care in Australia are interested in researching a range of topics using varied methods. The nurses' primary interests appear to be their own professional issues and management of the patient's pain. Little research on families/carers of palliative care patients was evident. There is a need for future research to focus on projects that justify the nurse's role in the palliative care team, show that nursing interventions for symptom control affect patient outcomes and prove nurses are integral to the psychosocial and spiritual wellbeing of the patient and family during the palliative care journey.     

Narrative research: a viable methodology for clinical nursing

TOPIC: Narrative research provides a reasonable methodology for gathering rich, multidimensional data in the clinical setting. PURPOSE: To familiarize nurses with the concept of narrative research, review pertinent narrative research literature, and identify some ways this methodology can be integrated into clinical nursing. SOURCES: A review of published literature from psychology, sociology, anthropology, and nursing, with citations from women with breast cancer. CONCLUSIONS: Narrative research can make a valid contribution to nursing science in language familiar to nurses and other healthcare professionals.     

Priority areas for clinical research in palliative care nursing

This report highlights a number of current research issues and concerns in palliative care nursing. The aim of the study was to identify high clinical nursing research priorities in palliative care, drawing on the expertise of nine (n = 9) clinical nurse consultants currently working in this specialty. The Delphi method was used to collect and process data in the study. Thirteen high research priorities emerged which have relevance for nursing practice, patient and family care in the hospice and community care setting. In the context of this study, the concept of high priority relates to research participant consensus on the most pressing nursing research problems which require investigation to improve clinical practice. Study findings provide direction for clinical research and continuing education in palliative care which may benefit expert nurses and their patients.     

Clinical intervention research in nursing

As a healthcare profession nursing has a duty to develop practices that contribute to the health and well being of patients. The aim of this paper is to discuss current issues in clinical research within nursing. The paper defines clinical interventions research as a theoretically based, integrated and sequential approach to clinical knowledge generation. The paper provides specific criteria for defining a clinical intervention together with an overview of the stages involved in clinical research from problem identification to implementing knowledge in practice. The paper also explored the extent to which nursing research was focussed on clinical issues, through a snapshot review of all the original research papers in Europe’s three leading nursing research journals. In total of 517 different papers were included and classified in the review. Of these 88% (n = 455) were classified as non-clinical intervention and 12% (n = 62) as clinical intervention studies. The paper examined the intervention studies in detail examining: the underpinning theory; linkage to previous (pre-clinical) work; evidence of granularity; protocol clarity (generalisable and parsimonious); the phase of knowledge development; and evidence of safety (adverse event reporting). The paper discusses some of the shortcomings of interventions research in nursing and suggests a number of ideas to help address these problems, including: a consensus statement on interventions research in nursing; a register of nursing intervention studies; the need for nursing to develop clinical research areas in which to develop potential interventions (nursing laboratories); and a call for nursing researchers to publish more research in nursing specific journals.     

中国非实验性护理研究论文引文分析

目的 描述我国非实验性护理研究论文的引文情况,反映非实验性护理研究论文的学术水平及研究者对文献信息吸收利用能力.方法 采用文献计量法通过手工检索对<中华护理杂志>及<实用护理杂志>(于2003年更名为<中国实用护理杂志>)1990～2006年共466期期刊中刊载的2547篇非实验性护理研究论文全文逐篇分析其引文量、普莱斯指数、引文类型、引文来源、引文语种等.结果 非实验性护理研究论文平均引文量为4.4条,随时间推进逐渐增加;普莱斯指数为55.6%;引文类型以期刊文献为主(73.4%),且随时间推进其比例逐渐增加;来源于护理专业以外的其他医学专业的引文所占比例最高(59.1%),来自护理专业的引文所占比例有逐渐增高的趋势;中文语种的引文所占比例最高(73.6%),英文语种引文的比例在整体上呈现逐渐升高的趋势.结论 随着护理专业的发展,护理研究者吸收文献信息的能力逐渐增强,对外文信息的获取能力亟待提高.     

The strengths and weaknesses of quantitative and qualitative research: what method for nursing?

The overall purpose of research for any profession is to discover the truth of the discipline This paper examines the controversy over the methods by which truth is obtained, by examining the differences and similarities between quantitative and qualitative research The historically negative bias against qualitative research is discussed, as well as the strengths and weaknesses of both approaches, with issues highlighted by reference to nursing research Consideration is given to issues of sampling, the relationship between the researcher and subject, methodologies and collated data, validity, reliability, and ethical dilemmas The author identifies that neither approach is superior to the other, qualitative research appears invaluable for the exploration of subjective experiences of patients and nurses, and quantitative methods facilitate the discovery of quantifiable information Combining the strengths of both approaches in triangulation, if time and money permit, is also proposed as a valuable means of discovering the truth about nursing It is argued that if nursing scholars limit themselves to one method of enquiry, restrictions will be placed on the development of nursing knowledge     

Making a difference with dying people: positive nurse-patient interactions

This paper presents some of the qualitative findings from a recent research study, which explored the nature and effects of palliative nursing care for patients. By using story telling as the research methodology, the participants related their positive experiences about palliative care nursing. The results of the research indicated that there was a strong link between positive experiences and effective nurse-patient interactions. The characteristics and the results of these interactions are presented in this article. The article concludes with a discussion of the potential ethical problems of assessing palliative care patients suitability for research.