On the phenomenology of empathy in nursing: empathy or sympathy?

In her recent phenomenological study Baillie attempted to describe the essential structure of empathy in surgical nursing. The study is important in that it utilizes a qualitative research method to investigate the phenomena of empathy, in contrast to previous quantitative studies. Although the phenomenological approach is clearly identified and ascribed to Husserl as the founder of the phenomenological movement, as well as utilizing the peculiarly Husserlian notion of bracketing, or epoché, in an attempt to describe the essence (another Husserlian objective) of the phenomenon under investigation (empathy), the research method does not reflect Husserl's philosophy. The results reflect nurses' subjective views on empathy, an exercise consistent with the nurse-phenomenologists quoted, who without exception, all believe Husserlian phenomenology concerns itself with subjective experience. However, in seeking the essence of phenomena unclouded by subjective opinion, Husserl stands in contrast to nursing interpretations of phenomenology's famous catch phrase, 'back to the things themselves' (zu den Sachen selbst). Nurse-phenomenologists have misunderstood the intention of Husserlian phenomenology, and despite their opposition to traditional scientific methods, are still mired in the Kantian notion of science as a reality independent of mind. A theme consistent with the 'things-in-themselves', not the things themselves. As such, nursing's use of the phenomenological method is questionable, and therefore the research findings on the phenomenon of empathy need to be reformulated. Interestingly, the phenomenon of empathy challenges us to question such underlying assumptions on how we view the world.     

Support for the effectiveness of culturally competent drug and alcohol treatment,policy planning and programme development

With a rapidly diversifying US population, alcohol and other drug treatment providers are finding increasing need to focus on culturally competent interventions. While the research on such interventions is somewhat limited, existing empirical findings suggest the efficacy of cultural competence in treatment, policy planning and programme development. Research on culturally competent mental health and drug and alcohol treatment is reviewed, suggestions are made for future research efforts, and areas of particular effectiveness are highlighted. The use of existing research emphasizes the urgency of the move towards more culturally competenttreatment models.     

Combining data mining tools with health care models for improved understanding of health processes and resource utilisation

Variability and uncertainty are inherent characteristics of most health care processes. Patient pathways and dwelling times even within the same process typically vary from patient to patient, such as the flow of patients through a particular health care provider or patient progression through the natural history of a given disease. The challenge for the OR modeller is to adequately handle and capture the stochastic features within developed models. This paper will discuss the benefits of combining patient classification tools (data mining techniques) with developed OR models, such as simulation tools, to more accurately capture patient outcomes, risks and resource needs. Illustrative applications will demonstrate the approach.     

Adequate health research funding: a justifiable imperative

The position paper that follows was developed by an ad hoc committee comprised of representatives of national organizations interested in biomedical and behavioral research including the Association of American Medical Colleges, the Association of American Universities, the Delegation for Basic Biomedical Research, and the National Committee for Medical Research and Education. The development of this document represented a unique attempt to reach a consensus among the diverse segments of the research community on the level of funding necessary to preserve the integrity of the health research enterprise. This paper was subsequently endorsed by 58 major organizations with a commitment to maintaining a strong national research program. The AFCR Public Policy Committee endorsed this position paper on July 10, 1982. It is worthy of note that although recent trends in health research funding are cause for concern, this situation will worsen in the future because of the recent passage of the Small Business Innovation Development Act. This bill will require all federal agencies, including the NIH, to "set-aside" 1.25% of their R&D budgets for allocation to small businesses. The FY 1983 projections in this position paper do not include estimates of the impact of this recent legislation.     

Information provided to surgical patients versus information needed

The importance of providing preoperative information to patients has been reiterated in many research studies; however, the delivery is based on health care providers' view of what information should be included. An analysis of studies on the type of preoperative information given to patients confirms the lack of patient focus when delivering such information. In this study, a multifaceted approach was used to determine patients' and health care providers' perceptions about preoperative information. Importance was placed on information about the details of anesthesia by all three cohorts (ie, patients, nurses, physicians). A gap in information provided about the details of anesthesia and the OR environment was found. Further analysis seems to attribute the inadequate information received by patients to health care providers' misunderstanding regarding the information patients want. AORN J 77 (March 2003) 546-561.     

A public health nursing research agenda

Public health nurses (PHNs) use many interventions to prevent illness and promote the health of populations. Unfortunately, generating evidence regarding PHN practice is not explicitly identified as a research priority area of the major national funding agencies. Nor has PHN, as a profession, had a strong enough research agenda to drive practice improvement on a population-level and to drive funding to support such areas of research. To further advance the science needed to guide PHN practice, a national conference to set the research agenda was held in October 2010 with grant support from the Agency for Healthcare Research and Quality. The conference was part of a multimethod, participatory, multistage approach taken to generate the final research priority themes and corresponding priority research questions. The process yielded four high priority PHN research themes: PHN intervention models, Quality of population-focused PHN practice, Metrics of/for PHN, and comparative effectiveness and PHN outcomes. As the agenda is adopted by funding agencies, researchers, and practice-based partners, a more focused program of research will produce evidence that can guide population-focused PHN practice.     

W(h)ither complexity? The emperor's new toolkit? Or elucidating the evolution of health systems knowledge?

Rationale The outputs from vastly expanding health research and knowledge industry with a broadening range of approaches to the synthesis of knowledge provide an impetus to develop complex science and theory‐informed knowledge management in health care. Aims To stimulate debate in order to assist health care decision makers to move beyond framing certainty and evidence in purely reductionist terms. Objectives To locate health, health care and health knowledge systems research using a complex adaptive systems theory framework. Methods An conceptual analysis of pervading methodologies and ways of knowing in health systems research to elucidate a framework in order to inform health care decision making. Findings A living Tree of (Research) Knowledge is proposed, with theoretic and operational frameworks. Branches of the tree are linked to differing evolutionary and developmental processes in order to assist researchers in the ongoing self‐organizing of taxonomies, multiple methods and types of knowledge, recognizing the ‘lived’, developing and adaptive nature of our understandings. Conclusions It is challenging to determine whither the directions ‘knowledge’ creation and management should take in complex health systems, beyond a total reliance on reductionism. Yet quality will wither, if knowledge does not pertain to real world contexts.     

Nurses' ethical decision-making role in artificial nutritional support

This study provides an insight into the process of ethical decision-making regarding the initiation or withdrawal of artificial nutritional support of seriously ill patients and explores the nursing involvement in it. Fifteen health carers were recruited from a clinical nutrition unit in the UK and qualitative research methods were used to gather data. The findings of the study indicate that nursing contribution to decision-making appeared to be in the 'back room' as the nurses feel that the decisions about difficult ethical dilemmas are 'out of their hands' because of lack of knowledge, experience and confidence. The medical staff and the clinical nurse specialist appear to be primarily responsible for making important decisions. It is clear from the study that to become more effective in the process, nurses need to enhance their knowledge in nutritional support and to develop their practical skills in ethical decision-making through experience and research.     

Measuring disease frequency in the Marshfield Epidemiologic Study Area (MESA)

The Marshfield Epidemiologic Study Area (MESA) is a rare resource for population-based health and medical research developed at Marshfield Clinic Research Foundation. Because of high population coverage and health event capture, MESA is particularly useful for determining the frequency of disease in the general population. A substantial proportion of MESA-based publications appearing in the peer reviewed literature have reported incidence or prevalence rates of disease or disease-related factors. This paper reviews the first 10 years of MESA's support of meaningful inquiry into the frequency of disease occurrence, and briefly reports on the data and methods used for such calculations using selected chronic diseases as examples. Limitations of MESA estimates are discussed as are alternate methods. Compared to limited data published for the selected conditions, occurrence rates in MESA based on diagnostic codes and general validation rules only appear somewhat high, although the observed temporal trends and relationships with demographics are consistent. Rich clinical data sources are available to be linked with MESA to improve the specificity of case ascertainment, as is typically done for disease-specific publications from MESA.     

The Omaha system and meaningful use: applications for practice, education, and research

Meaningful use has become ubiquitous in the vocabulary of health information technology. It suggests that better healthcare does not result from the adoption of technology and electronic health records, but by increasing interoperability and informing clinical decisions at the point of care. Although the initial application of meaningful use was limited to eligible professionals and hospitals, it incorporates complex processes and workflow that involve all nurses, other healthcare practitioners, and settings. The healthcare community will become more integrated, and interdisciplinary practitioners will provide enhanced patient-centered care if electronic health records adopt the priorities of meaningful use. Standardized terminologies are a necessary component of such electronic health records. The Omaha System is an exemplar of a standardized terminology that enables meaningful use of clinical data to support and improve patient-centered clinical practice, education, and research. It is user-friendly, generates data that can be shared with patients and their families, and enables healthcare providers to analyze and exchange patient-centered coded data. Use of the Omaha System is increasing steadily in diverse practice, education, and research settings nationally and internationally.     

Using a historical genealogical approach to examine Ireland's health care system

The health of a nation tells much about the nature of a social contract between citizen and state. The way that health care is organised, and the degree to which it is equitably accessible, constitutes a manifestation of the effects of moments and events in that country's history. Research around health inequalities often focuses on demonstrating current conditions, with little attention paid to how the conditions of inequality have been achieved and sustained. This article presents a novel approach to inequalities research that focuses on examining powerful historical discourses as legitimising processes that serve to sustain unequal conditions. The use of this Foucauldian historical genealogical approach in a study of the Irish health care system is explored and proposed as a novel approach to the research of health inequities.     

The Impact of Psoriasis on Psychosocial Life Domains

Living with a chronic disease, such as psoriasis, is likely to have psychological as well as social implications. Hence, knowledge about the impact of psoriasis on patients' life situation is important for designing and selecting suitable health care programmes for this group of patients. A review of studies published between 1983 and 1995 shows that there are some common factors as regards the psychological distress and social and functional limitations this group of patients has to deal with. However, it is difficult to compare the findings on the psychosocial impact of psoriasis owing to the differences in methods, study design and patient samples. This suggests that further research is needed. A holistic perspective that includes patients' quality of life may represent a fruitful approach.     

Spiritual care in nursing: an overview of the research to date

Aims. The paper gives an overview of nursing research papers published on spiritual care between 1983 and October 2005. It also provides pointers for the future direction of research in this emerging field. Background. Spiritual care of patients/clients is expected of nurses and is reflected in nursing codes of ethics, nurse education guidelines, policy documents and nursing guidance. Recent years have seen a proliferation in nursing research in this area, particularly in the UK and North America, and now in other European countries. It seemed timely, therefore, to review this published research. Method. Included in the review were 47 original published nursing research papers identified from a CINAHL search and from a collection held by the author since 1983. Papers were sorted into five categories, a template to aid reviewing was produced and a short summary and critique of each paper was written. Conclusions. Research on spirituality and health needs to move forward in a systematic and co‐ordinated way. Relevance to clinical practice. Hopefully, the research summarized in this paper will be useful to clinicians and nurse educators as they strive to incorporate spiritual care within their practice. In turn patients/clients and their families should benefit from care which is more holistic and addresses their deepest concerns and needs.     

循证卫生决策研究方法介绍

循证决策是卫生决策者最常用的、客观的、也是最重要的一种卫生政策研究方法。其目的是改变传统的主观臆断卫生决策,促进卫生政策和系统研究知识的应用与传播,以改进国家和地区卫生系统的绩效。影响循证卫生决策效果的三个要素是：研究证据,可利用的卫生资源以及政策的价值取向。本文介绍了一些实用的循证决策方法,特别是系统评价、优先重点的选择和CAM矩阵分析方法。     

Validating the nursing diagnosis of impaired physical mobility

The lack of research-based literature and of research models for validating nursing diagnoses results in some ambiguity in research efforts. Research must, however, move forward if there is to be progress in differentiating nursing and medical diagnostic models and use of nursing diagnoses to improve communication among nurses. Operational definitions of nursing diagnosis terminology are essential to continue work in validating nursing diagnoses, particularly in the clinical setting. The diagnosis impaired physical mobility was found to be an appropriate diagnosis for rehabilitation patients. Continued study and refinement of etiologies and defining characteristics is needed.     

How to determine if PPS will provide adequate resources for your population: one agency's experience

Extensive research was conducted to develop the proposed Prospective Payment System (PPS) and to ensure that it will adequately cover the costs of care for Medicare beneficiaries receiving the home health benefit. However, there is tremendous variation among the patients served by agencies, meaning that the system will impact each agency somewhat differently. Using the methods outlined in this article, agencies can determine potential problem areas under PPS, enabling them to develop and implement solutions before October 1, 2000.     

Yaitya tirka madlanna warratinna: exploring what sexual health nurses need to know and do in order to meet the sexual health needs of young Aboriginal women in Adelaide

Young Aboriginal women are consistently identified as having poorer health outcomes and access to sexual health services than non-Indigenous Australians. Yet the literature is particularly silent on what sexual health nurses need to know and do in order to work well with young urban Aboriginal women. This paper reports on a qualitative pilot study undertaken by a non-Indigenous nurse in Adelaide. The participatory action research methods used in this study were sensitive to the history of problems associated with research in Aboriginal communities. A reference group of Elder Aboriginal women and Aboriginal health workers guided all aspects of the study. A partnership approach between the researcher and the Reference Group ensured that the methods, analysis, and final report were culturally safe. Three groups participated in this study: Elders and Aboriginal health workers; young Aboriginal women, and sexual health nurses. All participants acknowledged the importance of nurses being clinically competent. However, the overarching finding was a lack of a clear model of cultural care to guide health service delivery. Three interrelated themes emerged from the data to support this contention. These were: the structural and personal importance of establishing and maintaining trustworthy relationships between nurses, Aboriginal health workers and Elders; the recognition that Aboriginal culture does exist, and is important in urban areas; and the importance of gender considerations to understanding urban women's health business. A partnership approach was recommended as a way to use these findings to develop a transparent cultural model of care. Further research is currently being undertaken to progress this agenda.     

From paradigm to method in interpretive action research

It is generally accepted in many areas of research, including nursing research, that decisions about research methods should be informed by the nature of the research question, that the research question will indicate what approach and methods should be used However, it is arguable that this over-simplifies the process of decision-making It is suggested that the axiom that question determines approach and method overlooks the influence of the researcher's personal worldview in such decisions This paper seeks to examine some of the elements of the process of moving from underlying philosophy to research design and strategies, by exploring the concept of paradigm, features of this researcher's worldview, and the principles and processes which influence decisions about the research The process is illustrated by reference to features of a study into the work of community psychiatric nurses in relation to the quality of life and social networks of their clients with enduring mental health problems     

Introduction: papers from the National Institutes of Health State-of-the-Science Conference on Improving End-of-Life Care

A 1997 Institute of Medicine report cited growing public concern about the quality of care in the U.S. health care system for persons at the end of life. The National Institute of Nursing Research (NINR), the lead Institute at the National Institutes of Health for end-of-life research, has conducted a number of public forums to gather information and to assist in identifying research priorities. The complexity of biomedical research requires new methods of discovery, and scientists must use a broad approach and explore new models of team science. In December 2004, NINR and the NIH Office of Medical Applications of Research, along with many co-sponsors, held an interdisciplinary State-of-the-Science Conference on Improving End-of-Life Care. The conference panel identified many gaps in our current state of knowledge and provided suggestions for future research directions. This supplement presents papers from a distinguished group of scientists with a wide range of backgrounds who participated in this state-of-the-science conference.     

Translating research into practice: Protocol for a community-engaged,stepped wedge randomized trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative

BackgroundRacial and socioeconomic disparities in breast cancer mortality persist. In Boston, MA, Black, Non-Hispanic women and Medicaid-insured individuals are 2–3 times more likely to have delays in treatment compared to White or privately insured women. While evidence-based care coordination strategies for reducing delays exist, they are not systematically implemented across healthcare settings.MethodsTranslating Research Into Practice (TRIP) utilizes community engaged research methods to address breast cancer care delivery disparities. Four Massachusetts Clinical and Translational Science Institute (CTSI) hubs collaborated with the Boston Breast Cancer Equity Coalition (The Coalition) to implement an evidence-based care coordination intervention for Boston residents at risk for delays in breast cancer care. The Coalition used a community-driven process to define the problem of care delivery disparities, identify the target population, and develop a rigorous pragmatic approach. We chose a cluster-randomized, stepped-wedge hybrid type I effectiveness-implementation study design. The intervention implements three evidence-based strategies: patient navigation services, a shared patient registry for use across academic medical centers, and a web-based social determinants of health platform to identify and address barriers to care. Primary clinical outcomes include time to first treatment and receipt of guideline-concordant treatment, which are captured through electronic health records abstraction. We will use mixed methods to collect the secondary implementation outcomes of acceptability, adoption/penetration, fidelity, sustainability and cost.ConclusionTRIP utilizes an innovative community-driven research strategy, focused on interdisciplinary collaborations, to design and implement a translational science study that aims to more efficiently integrate proven health services interventions into clinical practice.