How do people with COPD or diabetes type 2 experience autonomy? An exploratory study

Purpose. To develop an empirically grounded conceptualization of personal autonomy in the context of chronic physical illness and to investigate the impact of two chronic illnesses on autonomy.

Method. Grounded theory study consisting of 13 in-depth interviews with older adults with Chronic Obstructive Pulmonary Disease (COPD) or diabetes mellitus type 2 (diabetes).

Results. The results indicate that autonomy involves taking account of current circumstances as the frame of reference in which people can arrange their lives. Chronic illness disturbed autonomy by limiting opportunities and by prompting a reappraisal of the value that people placed on different activities or aspects of life. The participants responded to this disturbance differently, in ways that did not always restore autonomy. Limited opportunities occurred more often with COPD, while reappraisal occurred more often with diabetes.

Conclusions. Personal autonomy in the context of chronic physical illness might be conceptualized as correspondence between the way people's lives are actually arranged and the way people want their lives to be arranged, considering the circumstances. Health professionals could stimulate their clients to prevent and overcome impasses in the realisation of autonomy, while broad self-management interventions might improve people's skills for coping with the impact of chronic illness on autonomy.     

How do people with COPD or diabetes type 2 experience autonomy? An exploratory study

Purpose. To develop an empirically grounded conceptualization of personal autonomy in the context of chronic physical illness and to investigate the impact of two chronic illnesses on autonomy.

Method. Grounded theory study consisting of 13 in-depth interviews with older adults with Chronic Obstructive Pulmonary Disease (COPD) or diabetes mellitus type 2 (diabetes).

Results. The results indicate that autonomy involves taking account of current circumstances as the frame of reference in which people can arrange their lives. Chronic illness disturbed autonomy by limiting opportunities and by prompting a reappraisal of the value that people placed on different activities or aspects of life. The participants responded to this disturbance differently, in ways that did not always restore autonomy. Limited opportunities occurred more often with COPD, while reappraisal occurred more often with diabetes.

Conclusions. Personal autonomy in the context of chronic physical illness might be conceptualized as correspondence between the way people's lives are actually arranged and the way people want their lives to be arranged, considering the circumstances. Health professionals could stimulate their clients to prevent and overcome impasses in the realisation of autonomy, while broad self-management interventions might improve people's skills for coping with the impact of chronic illness on autonomy.     

Why do people still die from brown‐snake bites?

Brown snakes are the leading cause of snakebites and snakebite fatalities in Australia and the incidence may be rising. Most fatalities are the result of early events after the bite, often a general or cardiac collapse. Lack of appropriate first aid is a common finding. It is probable that an early thrombotic effect of venom procoagulants, prior to defibrination, is responsible for the cardiac collapse in most of these cases. CSL brown‐snake antivenom, while not perfect, is usually effective if given in sufficient quantity, but cannot reverse established vital‐organ damage. Increased public education about the danger of snakebite and correct first aid may reduce the death toll, and improved professional continuing education on snakebite is advisable but, ultimately, some brown‐snake bite deaths are probably inevitable, despite optimum medical care.     

Why do student nurses leave? Suggestions from a Delphi study

The high dropout rate of nursing students is a major concern. However, there is little research available about the reasons why students leave. Universities collect some information from 'exit' interviews but, due to ethical sensitivities, it is not made available for research analysis. The purpose of this study was to establish a consensus view of the reasons why student nurses leave their pre-registration education programme. The study was undertaken in two phases. Initially, an exploratory phase using focus groups and one-to-one interviews was used to gather multi-professional views about the reasons why students leave. In the second phase a questionnaire was developed from the themes arising from the data analysis in phase one. The questionnaire was administered to an expert panel of student nurses in the form of a three-round Delphi Study. The consensus level was set at 75%. It is important to clarify that, for reasons stated above, the views expressed in this paper are those of current students about others who had left the programme. From this study, it is apparent that, with the exception of academic failure, there was no single contributing factor that was thought to make students leave. However, there were a number of important issues identified as factors that may result in student nurses leaving. These include communication and operational factors between the university and clinical areas, feelings of not being valued, unmet expectations, and stress. These issues were of concern to students and appeared to have a cumulative effect that led them to question whether they should continue their education programme. On the basis of these findings, several recommendations are made to improve the student nurse experience.     

Is nurse education sexist? An exploratory study

A cross-sectional population survey of students enrolled at an Australian university was undertaken using a web-based survey, to examine the perceived prevalence of sexism and gender discrimination in each of their programs, with the aim of determining how nursing student perceptions compare to those of non-nursing students. A total of 221 students participated in the study. Results indicated that there was a perception of sexism involved in a range of programs, as well as perceived gender discrimination. Male students in general felt significantly more affected by this perceived discrimination than did female students. Moreover, students in the nursing program felt significantly more affected by both sexism and discrimination than non-nursing students, and this was particularly the case for male nursing students. These findings may have implications for the recruitment and retention of males in nursing, in a context where shortages of nurses is a problem internationally.     

Why don’t young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors

BACKGROUND: In the past decade, the number of blood donors has steadily declined in the Netherlands, and young adults are underrepresented among registered donors. An understanding of the correlates of donation intentions among nondonors could facilitate targeting psychological prerequisites of donation decisions in recruitment campaigns. STUDY DESIGN AND METHODS. A cross-sectional study with self-administered questionnaires based on an extension of the Theory of Planned Behavior (TPB; a social cognition model to study the determinants of volitional behavior) was conducted to assess potential cognitive determinants of willingness to donate blood in a student sample. A response rate of 50.5 percent yielded a sample of 311. RESULTS: Just over 7 percent of participants were registered blood donors but most (61.7%) had never seriously considered becoming donors. Self-efficacy (confidence in performing the behavior), attitude (the overall evaluation of the behavior), and personal moral norm (the perceived personal responsibility to perform the behavior) regarding blood donation were the most important correlates of the intention to become a blood donor. In total, 43 percent of the variance in the intentions toward blood donation could be explained by a TPB-based model. CONCLUSION: Among students, determinants of the intention to become a blood donor include self-efficacy, attitude, personal moral norm regarding blood donation, and subjective norm (perceived social support). Future research could establish whether campaigns targeting these psychological prerequisites would be more effective than current strategies.     

Do nurses and social workers have different values? An exploratory study of the care for older people

This study explored the different values of staff from two care homes for older people in which the managers had different qualifications (social worker vs. nursing). Their views were examined to explore whether the values of the staff might reflect any value difference originating in the professional backgrounds of the managers. There was little evidence of awareness in either home of the ethical principles underlying day-to-day decisions. However, a distinction based on care qualification did appear with "care-qualified" staff (defined in terms of qualification requirements for this care work) demonstrating a more reflective response and fewer ageist assumptions than their non-care-qualified colleagues. The study found no difference in values between the nursing and social worker-led homes. All respondents, regardless of the profession of their manager, were keenly aware that they have a "duty of care" and overwhelmingly they defined that as their duty to keep the resident safe, as opposed to allowing her to exercise autonomy. The study results suggest that value base constitutes a commonality between professions involved in the care of older people rather than a barrier to collaboration, as is sometimes posited.     

How do homeopaths make decisions? An exploratory study of inter-rater reliability and intuition in the decision making process

The validity of clinical decision making in homeopathy is largely unexplored and little is understood about the process or its reliability. This exploratory study investigated, in the context of a questionnaire based re-proving of Belladonna 30c, the extent to which decisions are based on clinical facts or intuition and how reliable decisions are. Three experienced, independent homeopathic clinicians/proving researchers rated the symptom diaries of the 206 subjects taking part. They reported their proving decision (ie positive proving response, no proving response or undecided) based on the total symptom profiles and rated (on a scale of 0-10) their use of clinical facts or intuition. Keynote symptoms and overall confidence scores were also reported. The level of agreement between raters was generally poor (weighted kappa 0.349-0.064). All raters used both facts and intuition. The rater's reliance on the facts was significantly associated with classifying those subjects who had no proving response [rater 1, P<0.001; rater 2, P<0.001]. Raters used significantly higher intuition scores when classifying a prover [rater 2, P= 0.001; rater 3, P= 0.012]. Issues regarding the education and practice of homeopathy are discussed.     

Cumulative abuse: do things add up? An evaluation of the conceptualization, operationalization, and methodological approaches in the study of the phenomenon of cumulative abuse

For women, any one type of abuse rarely occurs in isolation of other types, and a single abusive experience is often the exception rather than the norm. The importance of this concept of the cumulative nature of abuse and its negative impact on health has been well recognized within the empirical literature, however there has been little consensus on what to call this phenomenon or how to study it. For the most part researchers have operated on the premise that it is the sheer number of different types of cumulating abuse experiences that is primarily responsible for worse health outcomes among women. And although this simplistic 'more is worse' approach to conceptualizing and operationalizing cumulative abuse has proven to be a powerful predictor of poorer health, it contradicts growing empirical evidence that suggests not all victimizations are created equal and that some victimizations may have a more deleterious effect on health than others. Embedded in abuse histories are individual and abuse characteristics as well as other life adversities that need to be considered in order to fully understand the spectrum and magnitude of cumulative abuse and its impact on women's health. Furthermore, given the long-term and persistent effects of abuse on health it becomes imperative to not only evaluate recent abusive experiences, but rather all abuse experiences occurring across the lifespan. This review highlights and evaluates the conceptual, operational, and methodological challenges posed by our current methods of studying and understanding the phenomenon of cumulative abuse and suggests that this phenomenon and its relationship to health is much more complex than research is currently portraying. This paper calls for the urgent need for interdisciplinary collaboration in order to more effectively and innovatively study the phenomenon of cumulative abuse.     

Why do we sleep? Contributions from animal research

Despite the almost ubiquitous presence of sleep and the sleep stages nonREM and REM sleep in mammals and birds, the functions of sleep still remain elusive. Several promising approaches may shed light on this problem. Thus investigation of sleep-like states such as hibernation and torpor have shown that these states are more similar to sleep deprivation than to sleep. Furthermore, sleep-like states, which are homeostatically compensated for after rest deprivation have been found in Drosophila. These results allow to search for genes and gene products which change as a function of the vigilance states in these more simpler organisms. Thereafter, homologous genes can be investigated in mice.     

What do people know about and expect from nurses?

The purpose of the present study was to learn about people's opinions on nurses' performance and on what do they expect from it. Authors interviewed patients and their families in Health Institutions and people walking in malls at the cities of Ribeir?o Preto (125) and Bauru (125). The interviews were recorded, transcribed and analyzed. Results showed that the nurse is recognized as the one who is responsible for the care but there is still a representation of nurses as the doctor's helper. They refer to the nurse as someone courageous, important and on whom they depend on. They look for human care, dedication, respect, responsibility, understanding, affection and efficiency. They enable nurses' work and recognize the lack of better work conditions and fair wages.     

Why do people report better health by phone than by mail?

CONTEXT: Past research shows that fewer health symptoms are reported by phone than by mail. OBJECTIVES: We sought to examine whether interview mode-dependent differences in health symptom reporting are the result of socially desirable responding or to expending less cognitive effort when formulating responses, a behavior known as satisficing. DESIGN: Participants were randomly assigned to telephone interview only or to mail interview followed 2 weeks later by telephone interview. SETTING & PARTICIPANTS: Participants were American veterans from the Gulf War Registry (n=719). MAIN OUTCOME MEASURES: Our main outcome measure was the number of mild, moderate, or severe symptoms reported (of 48 possible). RESULTS: Veterans reported an average of 5 more symptoms via mail than via telephone, F (1, 709) = 32.50, P < 0.001. The difference was mainly the result of symptoms reported by mail as mild but not reported at all by phone. Veterans with higher social desirability scores reported fewer symptoms by phone and mail, F (1, 709) = 10.11, P = 0.001, but social desirability scores did not interact with interview mode. Furthermore, embarrassing symptoms such as genital complaints were no less likely to be reported by phone. CONCLUSIONS: Reporting of better health in phone surveys is the result of fewer mild symptoms reports but not of socially desirable responding. The findings are consistent with phone interviews encouraging satisficing by limiting the recall of less severe health states. Researchers should handle mild symptom reports with some skepticism.     

An exploratory study of IV metoclopramide + diphenhydramine for acute post-traumatic headache

Background

Headache is a frequent complaint among the 1.4 million patients who present to US emergency departments (ED) annually following trauma to the head. There are no evidence-based treatments of acute post-traumatic headache.