Chinese female nurses’ perceptions of male genitalia‐related care – Part 1

Aims. To explore Chinese female nurses’ experiences of male genitalia‐related care. Background. Male patients who require male genitalia‐related care may have psychosocial and sexual concerns and needs. Nurses’ attitudes and conduct in the provision of male genitalia‐related care, if negative, may obviate meeting these needs. Previous research indicates that limited studies have been conducted focusing on nurses’ perceptions, responses and attitudes towards male genitalia‐related care. There is a dearth of knowledge about the practice of Chinese female nurses delivering male genitalia‐related care, particularly given that physical contact between Chinese adults of different genders outside marriage is traditionally prohibited. Design. This study is an exploratory qualitative study. Methods. Through purposive sampling, eight subjects were approached and semi‐structured interviews were conducted. Digitally recorded interviews were transcribed verbatim and thematic analysis was conducted. The strategies of long engagement, member checking, peer debriefing and journal writing were used to establish trustworthiness. Results. Two themes emerged from interviews: ‘association with sexuality’ and ‘consequences’. The theme ‘association with sexuality’ comprised the sub‐themes of ‘being sexual’, ‘impact on intimate relationship’ and ‘emotional responses’. The theme ‘consequences’ was constituted by the sub‐themes of ‘care with preconditions’, ‘unavoidable responsibilities’ and ‘limited involvement with implicit approval’. Conclusions. This study suggests that Chinese female nurses’ perceptions, responses and attitudes towards male genitalia‐related care may be negative, with the consequence that the quality of male genitalia‐related care might be compromised. The Chinese culture of sexual conservativeness may play a critical role. Relevance to clinical practice. Risks may be embedded in the practice of male genitalia‐related care by Chinese female nurses. Particular attention, therefore, should be drawn to the possibility of adverse effects of Chinese female nurses delivering male genitalia‐related care on them and their patients.     

‘It was me answering my own questions’: Experiences of method of levels therapy amongst people with first‐episode psychosis

In this study, we aimed to understand how people with first‐episode psychosis experienced a transdiagnostic cognitive therapy called method of levels (MOL). Semistructured interviews were conducted with 12 individuals who were participants of a feasibility randomized controlled trial of MOL for first‐episode psychosis. Interviews were analysed using thematic analysis. Four superordinate themes were identified: ‘The therapist's approach’; ‘I was in control’; ‘Thinking and talking’; and ‘Looking at problems from a different perspective’. Our findings suggest that therapy was experienced as most helpful when participants perceived themselves to have control over the process of therapy, could explore and express a wide range of difficulties, and were able to generate new perspectives on their problems. MOL and its associated system of client‐led appointment scheduling were predominantly perceived to be helpful and appear suitable for further testing in a larger clinical trial.     

Gendered attitudes towards sexual relationships among adolescents attending nurse led sexual health clinics in England: a qualitative study

Aims. This study aimed to explore gender differences in attitudes towards sexual relationships of adolescent attending nurse led sexual health clinics. Background. Nurse led sexual health clinics are at the forefront of promoting adolescent sexual health. To provide sensitive, effective and non‐judgemental care, nurses need to understand the complexities of adolescent sexual behaviour and the social factors that influence sexual relationships. Design. A qualitative, exploratory research design was used. Methods. Ten focus groups (five male and five female) involving sexual health clinic attendees aged between 14–16 years were conducted. Focus groups were asked to comment on four sexual relationship ‘case studies’. Group discussions were recorded and transcribed. Data were subject to thematic analysis. Results. Three themes emerged from the data analysis. ‘Empathy’ reflected how young women were more likely to try to see their partner’s point of view. ‘Complexity’ also reflected that young women were more aware of the complex nature of relationships than were the male participants. ‘Language’ related to how young males used aggressive language in the context of relationships – a feature absent from female participants’ discourse. Conclusions. Male and female attitudes clearly differ. Female responses are more complex and empathic because of the more complex nature of the social pressures that sexualise young women. Young males are not as subject to these social forces. Young men are socialised into behaviour that can place females under pressure to have sex – this pressure can include the use of alcohol. Relevance to clinical practise. Nurses working in sexual health should attempt to encourage empathic thinking in male clients. Females should be educated to deal with the social pressures they may face from their partners. Practitioners should also recognise the problematic role alcohol can play within sexual relationships.     

Disappearing in a Female World: Men’s Experiences of Having an Eating Disorder (ED) and How It Impacts Their Lives

The number of men diagnosed with anorexia has increased, men now representing 25% of those with eating disorders (EDs). Research has mainly been quantitative and female focused, with only two qualitative studies exploring the experiences of men. This study focused on the lived experiences of men diagnosed with an ED, and its impact on ‘everyday’ aspects of their lives. Qualitative research adopting narrative interviews was conducted with seven men aged 23–34 years old. Narrative analysis was used to interpret each individual story, with thematic analysis used to explore commonalities across all seven narratives. Four themes were identified, 1) The Final John Doe; 2) Help! I need somebody - Bedlam revisited; 3) Masculinity; 4) Not Working 9 to 5. Narratives highlight the need for further research if men are to receive appropriate mental health care and better understanding and acceptance on the part of society, service providers, employers and men themselves.     

Parents’ Experiences of the Provision of Community‐Based Family Support and Therapy Services Utilizing the Strengths Approach and Natural Learning Environments

Background In recent years, community based therapy service providers have explored different service delivery models to optimize child and family outcomes. This qualitative study aimed to explore parents’ experiences of one particular service team that adopted a strengths approach, utilizing natural learning environments. Materials and methods Nine parents undertook in‐depth, semi‐structured interviews that were taped, transcribed, and examined using thematic content analysis. Rigour was ensured through peer and member checking, field journals and an audit trail. Results Several key themes emerged including; families’ initial experiences of the service, their views of their child with a disability, their hopes for the future, and their experiences of receiving intervention from the team. Conclusions Parents were generally positive about the adoption of a strengths approach. ‘Working together’, ‘being positive’ and ‘information exchange’ were the main themes that parents’ attributed to their positive experiences with the service.     

Family care in chronic obstructive pulmonary disease: what happens when the carer is a man?

Chronic obstructive pulmonary disease (COPD) is a major cause of disability, morbidity and mortality in old age, representing a significant burden for family carers. However, knowledge regarding the specific issues faced by men in the COPD caregiving role is nonexistent. This study explored the experience of husbands and sons providing care to a family member with moderate‐to‐severe COPD. A cross‐sectional qualitative study using in‐depth, semi‐structured individual interviews was conducted with twelve men carers: seven husbands with a mean age of 70.9 ± 8.8 years and five sons with a mean age of 43.4 ± 10.5 years. The interviews were analysed for recurrent themes using thematic analysis. Main findings suggest that men are committed and dedicated carers; however, differences between husbands and sons related to ‘meaning’, ‘challenges and constraints’, ‘fears and concerns about the future’, ‘needs’ and ‘positive aspects’ have emerged. These differences reflect relationship and generational differences and are of relevance when planning adequate community support interventions.     

‘It's just a peripheral issue’: A qualitative analysis of mental health clinicians’ accounts of (not) addressing sexuality in their work

Sexuality, relationships, and intimacy are integral parts of many peoples’ lives, not negated by mental distress and illness. Yet typically, these needs are not addressed adequately in mental health settings. In‐depth interviews were conducted with mental health clinicians with an aim of exploring their perceptions and understandings of sexuality and sexual concerns within mental health settings. Participants were 22 mental health nurses, psychologists, and psychiatrists working with people across a range of settings in four Australian cities. Sexuality or aspects of this were often not addressed in clinical practice, and this was common across participants’ accounts. A critical thematic analysis was conducted to explore how participants made sense of or explained this silence in relation to sexuality. Two key themes were ‘Sexuality is hard to talk about’ and ‘Sexuality is a “peripheral issue”’. In positioning sexuality as a peripheral issue, participants drew on three key explanations (sub‐themes): that sexuality rarely ‘comes up’, that it is not pragmatic to address sexuality, and that addressing sexuality is not part of participants’ roles or skill sets. A third theme captured the contrasting perception that ‘Sexuality could be better addressed’ in mental health settings. This analysis indicates that, beyond anticipated embarrassment, mental health clinicians from three disciplines account for omissions of sexuality from clinical practice in similar ways. Moreover, these accounts serve to peripheralize sexuality in mental health settings. We consider these results within the context of espoused holistic and recovery‐oriented principles in mental health settings.     

Iranian nursing students’ comprehension and experiences regarding evaluation process: a thematic analysis study

Scand J Caring Sci; 2011; 25; 151–159
Iranian nursing students’ comprehension and experiences regarding evaluation process: a thematic analysis study In this study, a qualitative design based on a thematic analysis approach was employed to explore the comprehension and experiences of Iranian nursing students regarding evaluation process in both classroom and clinical setting. After utilising purposeful sampling to choose 13 bachelor’s degree nursing students, semi‐structured interviews were held for data gathering. During the data analysis, three main themes emerged: ‘definition of evaluation process’, ‘unfair evaluation’ and ‘ideal evaluation’. The second theme consisted of two sub‐themes: ‘problematic process’ and ‘unexpected outcome’. Our study findings showed a gap between what Iranian nursing students depicted as a fair and equitable evaluation and what they experienced during their academic career. There is a need to bring a change to process of evaluation to increase the feeling of fairness and justice regarding evaluation among nursing students. The findings can be helpful for international nurse instructors to be exposed to the unheard perspectives of nursing students and reconsider the weaknesses of evaluation process conducted by them.     

Mortality and sexuality after diagnosis of penile cancer: a participative study

Survival for penile cancer is high but treatment can have a long‐term detrimental effect on urological function and quality of life. Owing to its rarity, it is difficult to include men with penile cancer in research about their condition. The aim of this study was to identify aspects of their diagnosis and treatment that they would want explored in penile cancer research. The study employed a participative, mixed qualitative methods design; it utilized focus groups and patient‐conducted interviews, combined into a 1 day ‘pilot workshop’. The data were analysed using framework analysis. ‘Early signs and seeking help’, ‘disclosure of a ‘personal’ cancer’ and ‘urological (dys)function’ emerged as three key themes. Men with penile cancer want research about their condition to explore early signs and helping seeking, disclosure of a ‘personal’ cancer and urological (dys)function. Research could use methodologies that include consideration of the chronological narrative of the experiences of men with penile cancer, which could be applied in clinical practice by integrating opportunities to explore specific aspects of their experiences at appropriate times along the care pathway.     

Forensic psychiatric patients’ perceptions of situations associated with mechanical restraint: A qualitative interview study

To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence‐based patient care, we need more knowledge about patients’ subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients’ perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Twenty participants were interviewed. Four themes were identified through a thematic analysis: ‘overt protest reactions’, ‘silent protest reactions’, ‘illness‐related behaviour’, and ‘genuinely calm’, which together characterize patients’ perceptions of their ways of acting and reacting during mechanical restraint episodes. These themes are linked together in two patterns in the process of mechanical restraint: ‘pattern of protest’ and ‘pattern of illness’. Further research is needed to illuminate the associations between patients’ perceptions of being subjected to mechanical restraint and ways of acting and reacting through the process of mechanical restraint.     

Critical Care nurses' understanding of the NHS Knowledge and Skills Framework. An Interpretative Phenomenological Analysis

Aims: This small‐scale research study aimed to explore Critical Care nurses' understanding of the National Health Service (NHS) Knowledge and Skills Framework (KSF) in relationship to its challenges and their nursing role. Background: The NHS KSF is central to the professional development of nurses in Critical Care and supports the effective delivery of health care in the UK. KSF was implemented in 2004 yet engagement seems lacking with challenges often identified. Design: This qualitative study adopted an Interpretative Phenomenological Analysis framework. Method: Data were collected from five Critical Care nurses using semi‐structured interviews that were transcribed for analysis. Results: Two super‐ordinate themes of ‘engagement’ and ‘theory‐practice gap’ were identified. Six subthemes of ‘fluency’, ‘transparency’, ‘self‐assessment', ‘achieving for whom’, ‘reflection’ and ‘the nursing role’ further explained the super‐ordinate themes. Critical Care nurses demonstrated layers of understanding about KSF. Challenges identified were primarily concerned with complex language, an unclear process and the use of reflective and self‐assessment skills. Conclusions: Two theory‐practice gaps were found. Critical Care nurses understood the principles of KSF but they either did not apply or did not realize they applied these principles. They struggled to relate KSF to Critical Care practice and felt it did not capture the ‘essence’ of their nursing role in Critical Care. Relevance to clinical practice: Recommendations were made for embedding KSF into Critical Care practice, using education and taking a flexible approach to KSF to support the development and care delivery of Critical Care nurses.     

After discharge home: a qualitative analysis of older ICU patients' experiences and care needs

Most patients in intensive care units suffer from critical diseases/injuries and are in need of life‐saving medical treatment. Recovery after such diseases/injuries may be lengthy and may vary. Little is known about older patients' own assessment of recovery following intensive care. The aim of this study was to explore and describe older patients' experiences of recovery and need of care within 2 months following discharge from hospital after being cared for in an intensive care unit. Fifteen patients 65 years or older, who had received care in an intensive care unit, were telephone‐interviewed 2 months following discharge. The interview texts were analysed using qualitative content analysis. Six themes were identified: ‘Discharge – a matter of physicians' and nurses' decisions', ‘Wanted to go home’, ‘Feeling well and feeling better, but…’, ‘Recovered or not, that is the question’, ‘In need of help from others’ and ‘In need of care’. Patients trusted in the medical experts’ assessment of their condition as regarded hospital discharge, but they also stated that they wanted to go home, as soon as possible, to their own familiar and private environment. Patients did not see the hospital as a place for recovery. Patients claimed that they were used to taking care of themselves within the limits of their strength and energy. If they need help, they first of all turn to family members or relatives. Patients who reported comorbidity did not assess themselves as recovered, while others stated that they had recovered but also suffered from a variety of discomforting symptoms.     

Study of intra‐racial exclusion within Australian Indigenous communities using eco‐maps

In Australia, ‘indigeneity’ is not determined by skin colour, but rather by a person's heritage, acceptance by an indigenous community, and active participation in the affairs of that indigenous community. Some people who identify as indigenous, however, have experienced ‘colourism’ – that is, experiences of social exclusion because of the colour of their skin – from non‐Indigenous and also Indigenous Australians. This paper describes research that explored the effect of intra‐racial exclusion on the mental health and wellbeing of Indigenous Australians, with a particular focus on skin colour or ‘manifest indigeneity’. Framed within a qualitative design, an eco‐map was used to guide in‐depth interviews with 32 participants that gave rise to personal stories that described the distress of experiencing intra‐racial colourism. Findings were derived from a thematic analysis that identified four major themes: ‘Growing up black’, ‘Living on black country’, ‘Looking black’, and ‘Fitting in black’. These findings are important because they suggest a way forward for mental health nurses to better understand and support the mental health and wellbeing of Indigenous Australians who have experienced social exclusion as a result of colourism.     

The sexual health consultation as a moral occasion

Sexually transmitted infections (STIs) are socially constructed as more ‘dirty’ than other gynaecological conditions. This article analyses women’s accounts of interactions with clinicians, subsequent to a diagnosis of genital herpes simplex virus or human papilloma virus. Women conceptualised consultations as a ‘moral event,’ different from other consultations. This moral component is highlighted drawing on Foucault’s notion of ‘the confessional.’ Additionally, Douglas’ anthropological construction of ‘dirt’ is used to consider why these consultations are ‘confessional’ experiences. Email interviews were conducted with 26 women diagnosed with a viral STI and 12 sexual health clinicians. Data were analysed thematically using a feminist, poststructuralist approach. Findings indicated that discourses of morality shape sexual health consultations. Five themes were identified in relation to the moral ‘work’ in clinical consultations about a viral STI diagnosis: the particular ‘dirtiness’ of viral STIs, clinicians as moral agents, the ‘non‐judgmental’ clinician, women juggling truth‐telling and risk and clinicians prescribing moral work. Clinicians support and educate women more effectively if they recognise subjective, moral aspects of sexual health consultations rather than assuming that effective clinical teaching is rational, scientific and non‐judgmental.     

Information-seeking behaviour of men newly diagnosed with cancer: a qualitative study

Aim. This paper reports the findings of a study, which explored the information‐seeking behaviour of men newly diagnosed with cancer. Background. There is worldwide recognition that there are significant differences in the way men and women react to and cope with illness, yet there seems to be a lack of research into men's information‐seeking behaviours and how they get their information needs met. The needs of men with cancer has so far received less research attention than women. Methods. A qualitative approach, consisting of in‐depth interviews, was used. A convenient sample of 13 men newly diagnosed with cancer and five healthcare professionals and four lay sources were recruited for this study. Results. Five themes emerged from the data. These were: ‘experiencing discomfort in the healthcare setting’, ‘reliance on partners as information gatherers’, ‘reluctance to explore a range of information sources and support’, ‘unmet information needs’ and ‘getting back to normal’. Together, they provide a perspective on men's information needs and information‐seeking behaviour. Conclusions. Healthcare professionals should be aware that there may be gender differences in how patients cope with their cancer, how they seek information and what information needs they have. Further training and preparation in ‘men's health’ is recommended for all those working with men in cancer care. Relevance to clinical practice. Understanding how, when and in what circumstances men express their information needs will help healthcare professionals to develop strategies to meet these needs and other support needs of men with cancer.     

Coming out to talk about suicide: Gay men and suicidality

International studies report increased rates of mental health problems and subsequent suicidality among homosexual populations. While international health‐care policy is concerned with reducing suicide among young people, important research findings relating to gay people and suicidality remain unacknowledged in the Suicide Prevention Strategy for England. This qualitative study, utilizing single case studies, was used to gain an in‐depth understanding of the life experiences contributing to the suicidality of four gay men. The methodology was psychoanalytically informed, using free association narrative interviewing. The initial data analysis involved interpretation of each of the case studies and a subsequent analysis exploring the shared experiences found in each of the individual narratives. Thematically, these are described as ‘knowing and not knowing’, ‘the centrality of the father–son relationship’, ‘the loneliness of outsiderness’, ‘leading a double life’, and ‘crime and punishment’. The significance of the life experiences these themes illustrate reveal why some gay men might not only experience long‐term mental health problems, but also engage in suicidality. Individually and collectively, the analyses provide important insights for mental health nurses becoming more attuned to provide sensitive mental health care to those who have a gay sexual orientation.     

Consumer sexual relationships in a Forensic mental health hospital: Perceptions of nurses and consumers

The management of consumer‐related risk is paramount in a secure forensic mental health facility. However, the consequent risk aversion presents a major barrier to consumers forming sexual relationships in a manner that is open and accepted. Investigation of the views of nurses working in forensic mental health settings on this topic is limited, and even more so for consumers of services. This qualitative exploratory study was undertaken to elicit the views of consumers and nurses about forming sexual relationships within this long‐term and secure setting. Individual in‐depth interviews were conducted with 12 nurses and 10 consumers. The benefits of, and barriers to, sexual relationships was identified as a major theme, and these findings are the focus of this paper. Nurse responses included the subthemes ‘supportive factors’ and ‘potential dangers’, reflecting their qualified support. Consumer responses included the subthemes ‘therapeutic’, ‘feeling normal’, ‘restrictions and barriers’, and ‘lack of support and secrecy’. The importance of sexual relationships was clearly articulated, as was the difficulties in forming and maintaining them within the forensic setting. More open discussion about this commonly‐avoided issue and the education of nurses and other health professionals is required.