Hearing what older consumers say about participation in their care

A study exploring older people's participation in their care in acute hospital settings reveals both consumers' and nurses' views of participation. Using a critical ethnographic design, data were collected through participant observation and interviews from consumers in acute care settings who were over 70 years old and nurses who were caring from them. Thematic analysis identified that older people equated participation with being independent. Importantly, consumers highlighted the complexity of the notion of participation when describing situations where they were unable to participate in their own care. The difficulties in communicating with health professionals and an inability to administer their own medications in inpatient settings were identified as barriers to participation. Understanding what consumers believe participation means provides a starting point for developing meaningful partnerships between health professionals and people receiving care.     

Relationships of older women: exploring the implications for health professionals

Five older women were interviewed about their relationships, particularly those with health professionals. The taped interviews were analyzed according to Colaizzi's method and four themes emerged. They were: older women do not matter any more; older women have no legitimate complaints; professionals who care about their work, care about me; and older women are worthy of being treated with honesty and respect. Findings indicated that there may be more negative stereotyping of older women by health professionals than by members of the public. Implications of this study include the need to: promote the concept of health co-existing with illness in health education; recognize the connection between personal feelings and professional responses to older women; and devise strategies to enhance positive attitudes and respect for all people, regardless of age.     

Being Healthy: Voices of Adolescent Women Who Are Parenting

PURPOSE: The purpose of this ethnography was to explore how adolescent women who are parenting describe what "being healthy" means to them and how they define their health needs. METHODS: In addition to traditional ethnographic methods of interviewing and participant observation, photovoice was utilized. RESULTS: Women's definitions of "being healthy" were grouped into three categories: (1) "taking care of my body," (2) "not being stressed out," and (3) "having what you need." PRACTICE IMPLICATIONS: The findings of this research study suggest that healthcare professionals should consider adolescent mothers knowledgeable actors of their own lives and move beyond current strategies to concentrate on issues, such as socioeconomic contexts, that hinder the health and nutrition of these young women.     

Health care seeking among Mexican American men.

This focused ethnography explored health care seeking beliefs and behaviors of Mexican American men living in south central Washington State. Data collection included interviews with 36 research participants living in the community, participant observation in the research setting, and examination of ethnographic documents and cultural artifacts. Four major themes were identified: the identity of manhood dictates health care seeking, health means being able to be a man by fulfilling cultural obligations, illness means not being able to be a man, and men seek health care when their manhood is threatened or impaired. Machismo, the cultural concept of manliness, persisted among men despite the level of acculturation and other factors. Women influenced men's health care seeking behaviors. To fulfill their obligations, men must stay healthy and seek care when needed. Knowing when and why men do not seek health care enables nurses to better understand and serve the Mexican American community.     

Living with lymphedema: a qualitative study of women's perspectives on prevention and management following breast cancer-related treatment.

A phenomenological research method was used to investigate the experience of lymphedema in 13 women following breast cancer-related treatment. The women, ranging in age from 45 to 82, living on the east coast of Canada, had lymphedema of the upper extremity for at least one year, and had no evidence of active cancer disease. Semi-structured interviews were used to examine the physical and psychosocial suffering that women with lymphedema experienced. The lack of appropriate pre-intervention education and post-intervention support by health care professionals as well as the lack of effective protocols to prevent lymphedema combined to intensify the suffering. Data analysis incorporated van Manen's (1990) six research activities which give human science its vigor. These non-sequential steps assisted in identifying five major themes: 1) Constancy; 2) Yearning for Normalcy; 3) Continually Searching; 4) Emotional Impact; and 5) Abandonment. The prevailing thread or essence salient to all five themes in this study is denoted as Existential Aloneness as each participant expressed a sense of isolation, of being on their own, of being set adrift to discover what they could about lymphedema, in the best way that they could. Nursing implications and recommendations for change are highlighted.     

Older African American women's beliefs, attitudes, and behaviors about breast cancer

Breast cancer poses a greater risk for African American than Caucasian women due to persistent health disparities. To reduce mortality risk, culturally specific knowledge is needed to support and encourage regular breast cancer screening and risk-reduction behaviors in older African American women. The specific aims of this study were to identify social, cultural, and behavioral factors associated with regular participation in breast cancer screening and risk-reduction behaviors; examine health beliefs that may influence regular participation in breast cancer screening and risk-reduction behaviors; and identify perceived facilitators and barriers to regular breast cancer screening and risk-reduction behaviors. African American women older than 65 (N = 57) participated in six focus groups. Analysis of focus group data revealed six major themes: Being Blessed, Cancer as a Death Sentence, Fear/Fear of Disfigurement, Avoiding Finding Out, Beliefs About Breast Cancer, and Tending to One's Family. These themes could be used by health care providers to develop culturally relevant educational initiatives to promote breast health practices and risk-reduction behaviors in this vulnerable population, thus helping reduce breast cancer disparities.     

The unique health needs of young women: application for occupational health professionals.

This article presents some alternate views on how young women maintain health and how occupational health nurses can intervene with illness. These interventions are based on relational theories that address the importance of healthy connections for health and growth, and propose disconnections as what (Miller & Stiver, 1977): underlies many of the problems common to women in particular, including depression, various forms of anxiety, eating problems, and so-called personality disorders." (p. 81) Interventions outlined include teaching young women and families how to deconstruct damaging media images and creating groups for young women or parents as a venue to learn (e.g., signs of healthy and unhealthy relationships and knowing how interaction in the group can be an intervention in itself). Offering parents and other adults support and resources to help them discuss health issues with young women will provide a way for young women to examine healthy choices more accurately. The occupational health nurse can teach the importance of keeping connected during an illness and refer clients to an EAP for additional support. Knowing that some young women do not have homes where they receive adequate safe and healthy messages reinforces the value of a nurse and managers to create a caring and respectful climate in the workplace. The effectiveness of applying relational theories to health care is evidenced when professionals offer young women a resonant relationship, with mutuality and respect which fosters a safe environment for voicing health concerns (Slater, Guthrie, & Boyd, 2001). Occupational health nurses can also make a difference for young women within their own communities. Whether taking social action in a town meeting, addressing media influences, writing a letter when offended, or supporting local and national girls' organizations, nurses' input is valuable. Interactions with girls outside the workplace are also important. Young women often consider relationships with the older women in their lives (e.g., mothers, aunts, parents for whom they babysit) to be among the most valuable. With cultural messages normalizing unhealthy behaviors and health consequences, young women can benefit greatly from their relationships with adult relatives and friends who care enough to stay connected.     

‘You do know he’s had a stroke,don’t you?’ Preparation for family care‐giving – the neglected dimension

? Countries throughout the developed world have introduced a policy of community care for older people to reduce costs to the state and maintain quality of life. ? In reality community care is largely family care and recognition of the need to support family carers is being promoted through the notion of partnership with professional carers. ? Such a partnership calls for a more complete understanding of how carers’ needs change over time and how professional support can be most effective. ? Support is particularly important at the start of care‐giving in order that carers can exercise free choice and be adequately prepared for their role. ? This paper provides an overview an ongoing longitudinal study and reports specifically on the findings of data from a preliminary study in which a convenience sample of seven experienced carers of stroke survivors who attended a stroke and carers club were interviewed in their own homes. ? Based on initial data from a longitudinal study of stroke victims, this paper outlines four themes: ‘What’s it all about’, ‘Going it alone’, ‘Up to the job’ and ‘What about me?’ These themes highlight the difficulties carers experience in the immediate aftermath of stroke.     

Fear of humiliation inhibits women's care-seeking behaviour for long-term urinary incontinence

Most women with urinary incontinence (UI) do not seek professional help. Women's experiences of their behaviour when seeking care for incontinence are important to improve understanding by nurses and encourage as well as enable women to seek help. The aim of this study was to illuminate the meaning of women's lived experiences of their behaviour when seeking care for long-term UI. Thirteen women were interviewed (range 37-52 years) who had not sought professional help for incontinence. A phenomenological hermeneutic method was used to analyse and interpret the interview texts. Three themes evolved from data: being in an affected situation, having personal beliefs about seeking care and having desired expectations about care. Being in an affected situation, means that the women were negatively affected by their long-term incontinence. Living with shame, altered sexual relationships and a need for distancing have negatively influenced their care-seeking behaviour (CSB). Having personal beliefs about seeking care means that the women had their own beliefs regarding morally acceptable behaviour for seeking care because of incontinence. This led to a toning down of their problem and a minimization of the problem associated with incontinence as it was considered to be a normal consequence of pregnancy and childbirth. Having desired expectations about care means that the women had opinions relevant to the care and felt being asked about incontinence and an understanding atmosphere should be included. The conclusion is that fear of humiliation inhibited women from seeking care for long-term UI. The findings suggest that nurses should be precise when asking about women's experiences of UI because otherwise they do not bring it up. Additionally, CSB can help nurses to explain the experience and enable women to seek help for this manageable condition.     

Blood pressure monitoring. Older adults' perceptions

The purpose of this article is to report the qualitative findings on older adults' perceptions of blood pressure measurement and its meaning to their health. The convenience sample consisted of 51 community-dwelling older adults who were recruited from either wellness clinics or a senior citizens' club. Data were collected through in-depth audiotaped interviews. Participants' responses were analyzed by identifying topics, patterns, and themes. The following three themes emerged: provision of reassurance, decision-making leading to self-care activities, and reliance on health care professionals. These findings can be used by community health nurses, especially those in gerontology to gain insight into how a sample of older adults perceived blood pressure monitoring. In addition, the findings can serve as guidelines for nurses in the provision of effective hypertension management with older adults.     

Perspectives from family caregivers receiving home nursing support: findings from a qualitative study of home care patients with heart failure

Many heart failure (HF) patients depend on a family caregiver and many families need additional home care nursing support. This qualitative study identified perspectives of being a HF caregiver for families receiving home care nursing. Eleven caregivers of homebound HF patients were interviewed on what helps them the most, their own health, obstacles in caregiving, and greatest needs overall. Eight themes emerged and will be discussed in this article. The findings articulate the positive influence nurses can have on HF families to guide future practice and research.     

Career choices: a comparison of two occupational therapy practice groups

The increasing number of elderly people in the population and their greater use of the health care system require an increasing number of health care providers to work with older adults. A shortage of health care professionals to provide this care, as well as a reluctance to provide such care have been reported in the literature. The purpose of this qualitative study was to investigate how occupational therapists decide to work with older adults. Using a comparative approach, 40 occupational therapists were interviewed, 20 working in gerontology and 20 working in paediatrics. The findings indicate that social characteristics and experiences of the individual, as well as the context of work are important influences for practice choice decisions. Mapping of career paths led to the development of a typology to further describe the different influences involved in the career choices of these occupational therapists. Recommendations related to education and practice provide practical means by which to implement change.     

Integrity in the care of elderly people,as narrated by female physicians

Three female physicians were interviewed as part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experience of being in ethically difficult care situations in the care of elderly people. The interviewees expressed great concern for the low status of care for elderly people, and the need fight for the specialty and for the care and rights of their patients. All the interviewees' narratives concerned problems relating to perspectives of both action ethics and relational ethics. The main focus was on problems concerning the latter perspective, expressed profound concern and respect for the individual patient. Secondary emphasis was placed on relationships with relatives and other professionals. The most common themes in action ethics perspective were too little treatment and the lack of health services for older patients, together with overtreatment and death with dignity. These results were discussed in the light of L?gstrup's ethics, which emphasize that human life means expressing oneself, in the expectation of being met by others. Both Ricoeur's concept of an ethics of memory and Aristotle's virtue ethics are presented in the discussion of too little and too much treatment.