Health according to the experiences of Iranian women with diabetes: A phenomenological study

This study explores the meaning of health among Iranian women with diabetes using hermeneutic phenomenology based on Van Manen's approach. A total of 19 women with diabetes who were referred to the Diabetes Center of Imam Khomeini hospital in Ardabil, Iran were recruited using a purposive sampling method. Data were gathered through semi‐structured interviews. Each interview was transcribed verbatim and analyzed simultaneously. Data analysis led to the emergence of five main themes: a God‐centered life, health as a precious possession, health as wellbeing, independence, and acceptance. Patients often described coping with their illnesses and pursuing lifestyle changes by applying their spiritual and religious beliefs. The findings of this study can be used by healthcare teams to revise their opinions about patients with diabetes according to the culture of their patients.     

Adaptation and coping following a first stroke: a qualitative analysis of a phenomenological orientation

Stroke can have consequences in all areas of a person's life. If not coped with optimally, this life event will have a deleterious effect on the quality of life. The aim of this study was to improve understanding of appraisal and coping, post-stroke. Ten individuals were purposely recruited upon admission for a first stroke to participate in this qualitative study. Participants were asked to share their personal experiences with regard to their efforts to deal with the consequences of the stroke. In-depth interviews were transcribed verbatim and the content was analyzed using a rigorous method, inspired by a phenomenological orientation. Seven themes related to appraisal (unpredictability, overwhelming, feeling out of control, threat, turning point, acceptance/resignation and future prospects) and five themes related to coping (active and passive compensation, escape, change how the situation is perceived and utilization of resources) emerged from the content analysis of the in-depth interviews. In conclusion, since returning to the previous life style and activities is rather improbable, changing how the situation is perceived appears to be the most effective way of coping, in order to reach a state of acceptance/resignation favourable to an optimal quality of life.     

Coping or acceptance: what to do about chronic pain?

Research and treatment of chronic pain over the past 20 or more years have tended to focus on patient coping as the primary behavioral contribution to adjustment. The purpose of the present study was to compare a coping approach to chronic pain with a different behavioral approach referred to as acceptance of chronic pain. These approaches were compared in terms of their ability to predict distress and disability in a sample of patients seeking treatment for chronic pain. Subjects were 230 adults assessed at a university pain management center. All patients completed the coping strategies questionnaire and the chronic pain acceptance questionnaire among other standard measures. Results showed that coping variables were relatively weakly related to acceptance of pain and relatively unreliably related to pain adjustment variables. On the other hand, acceptance of chronic pain was associated with less pain, disability, depression and pain-related anxiety, higher daily uptime, and better work status. Regression analyses examined the independent contributions of coping and acceptance to key adjustment indicators in relation to chronic pain. Results from these analyses demonstrated that acceptance of pain repeatedly accounted for more variance than coping variables.     

Elders' perceptions of formal and informal care: aspects of getting and receiving help for their activities of daily living

A purposive and convenience sample of 16 women and four men receiving informal and formal care for their activities of daily living either at home or institutions in Southeast Washington, USA was interviewed. Qualitative findings related to asking for help, getting and receiving help, interpersonal aspects of receiving help, and met and unmet needs are reported. Some seniors found it more difficult to ask for and accept help and there were gender differences, with men tending to adopt a more logical and pragmatic approach while women viewed receiving help as a loss of independence and an invasion of privacy. Intimacy and nudity were also threats for women. Three styles of adjustment and acceptance were identified within the data and related to positive acceptance, resigned acceptance and passive acceptance. There appeared to be a relationship between independence and control, with elders losing some independence but retaining control through choice, payment and involvement in decision making. Reciprocity was found to bring added value to relationships between care providers and elders, with a rhythm and symmetry developing in relationships where needs were known, anticipated and met. Seniors should be encouraged to plan for their future and to find out about local help and services available to them in advance of their requiring any assistance.     

Acceptance of Chronic Neuropathic Pain in Spinal Cord Injured Persons: A Qualitative Approach

Chronic neuropathic pain (CNP) in spinal cord injury (SCI) is a significant problem that has physical, functional, and psychosocial repercussions beyond the consequences of SCI. The notion that acceptance may be a viable alternative to suffering when resolution of pain is unattainable was explored. Studies indicate that acceptance of pain is associated with lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily active time, and improved work status in patients who have other types of chronic pain. This exploratory qualitative study examined acceptance of pain in SCI individuals who have CNP. Grounded theory was used to develop a conceptual framework to describe acceptance in people with CNP and SCI. Data were obtained from in-depth interviews with seven SCI individuals. Six phases were identified, including: “comprehending the perplexity of CNP,” “seeking pain resolution,” “acknowledging pain permanence,” “redefining core values,” “learning to live with the pain,” and “integrating pain.” Two driving forces, “increasing independence” and “evolving pain view,” were noted to move the process of acceptance forward. The findings in this study suggest that acceptance of pain appeared to be beneficial in terms of reducing suffering and facilitating a more satisfying and fulfilling life in these SCI individuals. A decreased emphasis on continued searching for a cure for CNP and movement toward a self-management approach was associated with increased pain coping for these SCI individuals. Clinical implications suggest that early intervention to facilitate effective coping and an exploration of the notion of acceptance could be beneficial.     

Coping with pediatric cancer: strategies employed by children and their parents to manage cancer-related stressors during treatment

Pediatric cancer patients and their families face significant physical, emotional, and psychosocial challenges. Few studies have investigated how children manage these challenges and how parents may help in the process. This qualitative study aimed to explore common cancer-related stressors for children and to examine child coping and parental assistance in coping with these stressors during treatment. Fifteen children undergoing cancer treatment and their parents participated in semistructured interviews. Four themes emerged capturing cancer-related stressors: cancer treatment/side effects, distressing emotions, disruption in daily routines, and social challenges. Six themes emerged regarding child coping strategies that were classified within an approach/avoidance coping framework. Approach coping strategies included the following: cognitive restructuring, relaxation, practical strategies, seeking social support, and emotional expression. Distraction was the only avoidant coping strategy. Parents tended to encourage approach coping strategies (eg, cognitive restructuring, social support). Within families, few coping strategies were reported (child: M = 1.47, SD = 0.99; parent: M = 3.33, SD = 1.18), suggesting that early family-based interventions teaching coping techniques for cancer-related stressors may be beneficial.     

Women's work environment and health: Clerical workers in Brazil

Although women are participating more in the formal workforce, the majority are employed primarily in low-income and low-status occupations. While work roles may provide women with some rewards, employment may also create many stressful demands on their daily lives. As part of an international study, 60 female Brazilian clerical workers responded to a self-administered questionnaire describing what they liked, disliked, and found stressful about the structural, physical, and social aspects of their work environment. Participants also identified strategies they used to cope with stress in the work environment. Dimensions of healthy environments identified in the data included utility, challenge, participation, safety, pleasing workplace, valuation, clarity of roles, and empowerment. Unhealthy environments were characterized by hazards, bureaucracy, devaluation, and economic constraints. Participants described their concerns about the effect of the environment on their physical and mental health, but tended to adopt a passive, resigned coping style rather than a proactive approach to co-creating a healthier work environment. The results and their relationship to healthy work environments are discussed within the context of the larger sociopolitical environment of Brazil. © 1996 John Wiley & Sons, Inc.     

Adapting to life after burn injury-reflections on care

A burn injury is an unforeseen event that means physical and psychological trauma for the person afflicted. The trauma experienced by different individuals varies greatly, as do perceived problems during care, rehabilitation, and throughout the remainder of life. The purpose of this study was to explore burn patients' experiences of adapting to life after burn injury to acquire a deeper understanding of the most important issues for patients when providing care during and after a burn injury. A qualitative approach was applied, and interviews were conducted with 12 adult burn patients (8 men and 4 women) 6 to 12 months postburn. The interviews were analyzed using Kvales' method for structuring analysis and comprised a close reading and interpretation of the texts. Analysis focused on the personal experiences of burn patients living after burn injury and treatment. Struggling with the consequences of burn injury and how patients perceived life today after treatment are important issues for adapting to life after burn injury. New experiences of a fragile body, coping with daily life, and reflections of burn care were also prominent themes. Patients with burn injuries need adequate repeated information about the plan for their care, about the physiological changes, and more support to handle the trauma event. The patients would also like to be more involved in their care. A program of support and preparatory work to help the patient to cope with the new bodily sensations and new body image is necessary and should begin during hospital care. A multidisciplinary team approach for pain treatment needs to be prioritized. In addition, multidisciplinary follow-up after burns need to include patients with minor burns.     

Accepting pain management or seeking pain cure: an exploration of patients' attitudes to chronic pain.

This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital's nurse-led pain clinic. The sample was subdivided by an expert panel rating procedure into two groups: those accepting pain management and those seeking a pain cure. The study used a multimethod approach comprising extended, highly focused interviews coupled with patients' diaries and drawing on a phenomenologic theoretical framework. Initial hermeneutic data analysis provided emerging themes: "rules for living," "pain = life," and "acceptance" for the pain management group, and "pillar to post," "self-fulfilling prophecy," and "mood" for those seeking a cure. Thematic content common to both groups were "family" and "coping strategies." These themes illustrate some differences and similarities between those who manage pain compared with those who seek a pain cure. Phenomenologically based research findings can rarely be generalized, but they enlighten and highlight the need for further research to generate detailed understanding of why some patients with chronic pain can accept pain management and others relentlessly seek a cure that is frequently not possible.     

Coping with breast cancer in newly diagnosed Iranian women

AIM: This paper reports a study exploring how Iranian women coped with newly diagnosed breast cancer and provides a foundation for cultural-based care. BACKGROUND: Although research has indicated that coping strategies are associated with adaptation to breast cancer, and despite the number of women with newly diagnosed breast cancer increasing each year, there is no information on how Iranian women cope with breast cancer when compared with women of other cultures. METHOD: In this qualitative study, 19 women with newly diagnosed breast cancer were interviewed during the period May-September 2004 about coping with their disease. Interviews were analysed using a content analysis method. FINDINGS: The main themes emerging from this qualitative study included coping using a religious approach (acceptance of disease as God's will; spiritual fighting), thinking about the disease (positive thinking: positive suggestion, hope, intentional forgetfulness; negative thinking: hopelessness, fear, impaired body image), accepting the fact of the disease (active acceptance; passive acceptance), social and cultural factors and finally finding support from significant others. CONCLUSION: Understanding how Iranian women cope with diagnosis of breast cancer is important to nurses involved in the process of healing. The majority of strategies used by Iranian women were positive, and religious faith played a major role in this. The findings of the study can be used to design a nursing approach to improve successful coping in Iranian women suffering from breast cancer, and can provide nurses and other healthcare professionals with deeper understanding of these women as they face this diagnosis.     

The nursing management of elderly patients with pain in the community: study and recommendations

This study is designed to identify factors which influence quality of life for elderly people suffering from painful conditions. It is based upon a theoretical model of control in which mood state is used as the indicator of coping. One hundred and ninety elderly patients took part in semi-structured interviews about their pain and coping experiences, and data were also collected from their nurses in the community. Multivariate statistical analysis revealed that the key determinants of mood were having regrets about the past, being occupied, perceived level of pain control, additional personal problems (notably bereavement) and feeling informed about the painful condition. Active personal coping strategies were identified as more therapeutic than passive strategies. Nurses' data revealed that pain complaints were associated with perceived exaggeration. Few nurses used formal pain assessment. Recommendations for the management of persistent pain in the community are given.     

Coping with stroke: psychological and social dimensions in U.S. patients

Stroke is the third-leading cause of death in the world, affecting 3 million women and 2.5 million men annually. The success of rehabilitation efforts for stroke patients is often measured in terms of physical functioning. However, the literature suggests that the effects of stroke and subsequent adaptation include psychological and social dimensions as well. The purpose of this study was to investigate how patients in the United States perceived their stroke experiences by examining their coping strategies and hopes for recovery. In addition, factors that inspired hope during recovery were identified. Sixty participants with a diagnosis of embolic or ischemic stroke were interviewed during their initial hospitalization. Tape-recorded interviews were coded and categories of data identified. Findings suggested that stroke patients experience a range of physical symptoms and emotions surrounding their stroke experience, and that stroke often interfered with daily functioning. Coping strategies included maintaining a positive attitude and asserting independence, as much as possible, during the acute stroke experience. Many patients expressed general hopes for recovery while some admitted fear of getting worse. Hopefulness was often inspired by interaction with family and spiritual beliefs and practices. The findings will hopefully enhance nurses' understanding of patients' perceptions of the stroke experience and increase their ability to provide interventions that will aid in promoting effective coping strategies.     

Elderly persons' experiences of striving to receive care on their own terms in nursing homes

Anderberg P, Berglund A-L. International Journal of Nursing Practice 2010; 16 : 64–68
Elderly persons' experiences of striving to receive care on their own terms in nursing homes
Elderly persons' participation in and decisions about their own care need more attention. The aim of this study was to gain a deeper understanding of elderly persons' experiences of care and help, and how their lives change in nursing homes. Fifteen elderly persons living in four nursing homes were interviewed about their experiences of needing care and help in their daily life. The interviews were analysed using van Manen's phenomenological approach. Elderly persons' experiences of care and help were described as: a balance between sorrow and relief, a struggle to maintain control and connectedness, managing to live in the present and yet worrying about the future, and an attempt to hide one's vulnerability in order to be accepted and create an inner calm in an exposed situation. In conclusion, important issues were raised concerning elderly persons' perspectives on care and help in daily life in nursing homes.     

Value-based design for the elderly: An application in the field of mobility aids

In the aging society, the need for the elderly to remain mobile and independent is higher than ever. However, many aids supporting mobility often fail to target real needs and lack acceptance. The aim of this study is to demonstrate how value-based design can contribute to the design of mobility aids that address real needs and thus, lead to high acceptance. We elicited values, facilitators, and barriers of mobility of older adults via ten in-depth interviews. Next, we held co-creation sessions, resulting in several designs of innovative mobility aids, which were evaluated for acceptance via nine in-depth interviews. The interviews resulted in a myriad of key values, such as “independence from family” and “doing their own groceries.” Design sessions resulted in three designs for a wheeled walker. Their acceptance was rather low. Current mobility device users were more eager to accept the designs than non-users. The value-based approach offers designers a close look into the lives of the elderly, thereby opening up a wide range of innovation possibilities that better fit their actual needs. Product service systems seem to be a promising focus for targeting human needs in mobility device design.     

Self-rating and external rating of how women cope with breast cancer in the perioperative phase

Little is known both about how women suffering from breast cancer cope with their illness in the perioperative phase and about the ability of nurses to assess this. By means of the self-rating and external rating versions respectively of the Bernese Coping Modes (BEFO), it was determined how breast cancer patients cope with their illness during primary surgical therapy. External rating was carried out by the nurses and two researchers. The nurses' rating based on their daily care experiences, and the researcher's rating based on a half-standardized interview. Participants were given the BEFO self-rating questionnaire. As with the patients themselves, the nurses and team members rated attention and care (H(A) 90,5-100%), tackling (H(A) 66,7-100%), passive co-operation (H(A) 59,5-100%) and acceptance/stoicism (H(A) 64,3-97,6%) as the strongest forms of coping. In ranking order of coping modes the researchers rated dissimulation and isolation/suppression and the nurses rated altruism much higher than the patients themselves. Several forms of coping revealed a clear dependence on age. The discrepancy between the ranking order of the nurses' rating versions and the patients' self-ratings were discussed on the basis of empirical findings on communication events between nurses and patients.     

Themes of effective coping in physical disability: an interview study of 26 persons who have learnt to live with their disability

The aim of this study was to gain a deeper understanding of effective coping in physical disability and/or chronic illness. Twenty-six well-adjusted adults with various disabilities were interviewed. The interviews focused on how they perceived they had managed to master problems encountered by their disability and their personal views about how one should act and think to manage a life with a disability. The protocols were content analysed according to grounded theory. Five categories were extracted--self-trust, problem-reducing actions, change of values, social trust and minimization. These categories clustered around two broader bipolar constructs--acknowledgement of reality vs. creation of hope and trust in oneself vs. trust in others. The different themes of coping complemented each other and tended to be used in different contexts in a flexible manner. Both the extracted categories and the core concepts have been extensively described in the coping literature, supporting their validity. The importance of understanding coping processes from the disabled's point of view is discussed.     

Social and existential alienation experienced by people with long-term mental illness

The aim of this study was to explore how people suffering from long-term mental illness and who live in the community experience their daily lives. The study was based on an ethnographic framework involving participant observations with 23 individuals from two rehabilitation centres and interviews with six women and two men. The observational notes and interviews were recorded, transcribed into the data and analysed based on the phases of hermeneutic interpretation. The process consisted of identifying tentative interpretations that highlighted various impediments that prevent people with long-term mental illness from having an active life. The impediments can also be interpreted as a form of alienation, an interpersonal phenomenon and a consequence due to of the lack of social acceptance towards mental illness. The participants expressed concern about the future and lack of hope. Viewing themselves as being 'odd' is not a symptom of mental illness, but rather evidence of experiencing existential and social alienation not only as a consequence of other people's reactions but also their own negative attitudes towards mental illness and effects of their cognitive dysfunction.     

Chronic pain coping experiences of institutionalized elderly

While pain is a common problem among the elderly, a group that has grown significantly as a percentage of population in recent decades, few studies have been done to describe their chronic pain coping experiences. The aim of this qualitative study was to enhance understanding of chronic pain coping strategies adopted by elderly residents of long-term care facilities. Eighteen elderly residents were interviewed, with Lincoln and Guba's trustworthiness criteria utilized to evaluate methodological rigor. Colaizzi's phenomenological approach was used to analyze chronic pain coping data. Three themes that emerged in findings included: use of multiple pain relief strategies, use of passive pain endurance and learning to live with chronic pain. The author hopes that results of this study will provide better insight on approaches taken by the elderly to personal pain management and help guide the development of nursing guidelines for chronic pain management. Recommendations highlighted in this study include increasing chronic pain education and continued research in support of developing a Chinese version chronic pain assessment tool for the elderly.     

中青年与老年冠心病患者应对方式及社会支持的比较研究

目的探讨中青年与老年冠心病患者应对方式及社会支持的差异。方法采用一般情况调查表、简易应对方式问卷及社会支持评定量表对158例首发冠心病患者进行问卷调查。结果老年组冠心病患者消极应对为（11．5205±3．4525）分,社会支持为（38．1096±6．8426）分,与中青年组比较有统计学意义（均P〈0．01）;冠心病患者的客观支持、主观支持及社会支持与积极应对呈正相关,与消极应对呈负相关。结论中青年与老年冠心病患者的应对方式及社会支持存在差异,应针对性地对不同人群进行健康教育,面对生活事件应激时要采用正确的、积极的应对方式,有效利用社会网络以获得更多的社会支持,尤其重视老年人的社会支持。     

Problem-solving experiences among elders living alone in eastern Taiwan

Aim. To explore problem‐solving experiences among older people living alone in eastern Taiwan. Background. Elders living alone in Taiwan have a low participation rate in government social support programmes. Providing sufficient care for this population of elders requires knowing not only their problems, but also how and when they seek help solve their problems. Design. Qualitative research was used to gain a deeper understanding of the problem‐solving experiences of older people living alone. Methods. Elders living alone (n = 9) were recruited from a remote area of Taiwan. Data were gathered in audiotaped, semi‐structured interviews and analysed by content analysis. Results. Participants used both internal and external resources to solve problems through an appraisal process. Their internal resources included self‐perception of health status, preventive coping strategies, flexible coping ability and being resigned to one's situation. Their external resources included both human and environmental resources. Based on their lived experience, participants appraised the usefulness of both internal and external resources before deciding whether to seek help from external resources. Conclusion. In Chinese society, maintaining a balance between internal and external resources is an important mechanism for elders in solving problems. Relevance to clinical practice. Our findings may enhance policy makers’ and healthcare providers’ understanding of the problem‐solving experiences of elders who live alone in Taiwan. In practical terms, these findings can be used to improve the elderly people's use of support systems in their community.