Spirituality or psychosis?--An exploration of the criteria that nurses use to evaluate spiritual-type experiences reported by patients

Spiritual experiences and psychotic symptoms have many aspects of form and content in common. Despite this, clinicians make judgements about the pathology of these experiences and base care-plans on these judgements. Semi-structured interviews incorporating vignettes of spiritual-type experiences were given to 14 UK mental health nurses. This revealed that the nurses employed a complex and inter-relating set of criteria when evaluating spiritual-type experiences. The nature of the experience was considered, but the outcome of the experience (positive or negative) was an important evaluative factor, together with the personal and cultural context in which the experience occurred. The nurses demonstrated a tolerance of ambiguity and the need for awareness of their own subjectivity. They emphasised the importance of close-engagement with patients to achieve a rounded and holistic view of the patient's experience. They also emphasised the importance of team working in reducing idiosyncratic decision making.     

Development and review of vignettes representing older people with cognitive impairment

This paper describes a process undertaken to develop and review five clinical vignettes to be used in geriatric nursing educational research. The purpose of this process was to provide valid depictions of delirium and its subtypes and distinguish delirium from dementia. Five vignettes depicting hospital bedside interactions between nursing staff, family, and an older patient who displayed signs of one of the following conditions: delirium (hyper and hypoactive types respectively), dementia, or delirium (both types) superimposed on dementia were constructed. Vignette accuracy and reliability were established using a multistage process that culminated in formal review by a group of ten international nursing and medical delirium experts. The final five vignettes accurately depicted the given scenario as agreed by the experts and were at an appropriate level of simplicity and clarity. Given the increased interest in vignettes for both nursing research and educational purposes, the described method of vignette development and review has the ability to assist other vignette developers in creating reliable representations of their desired clinical scenarios.     

The development of research tools used in the STORK Study (the Scottish Trial of Refer or Keep) to explore midwives' intrapartum decision making

Objectives

to develop appropriate tools to assess midwives' attitudes and behaviour in relation to decision making involving risk.

Design

a questionnaire and series of vignettes were developed and testes to explore midwives' intrapartum decision making in relation to their attitudes towards risk. An innovative online computer package was developed specifically for use in the STORK Study which enabled the programme to be very tightly controlled with limited functions accessible to participants.

Testing

a pilot study was conducted with over 50 midwives and nurses to ensure face and content validity of the vignettes and questionnaire. Initially designed to be a paper‐based study, rigorous piloting highlighted the many difficulties in presenting it in that particular format. The solution to this problem was to develop the study as a secure online package.

Findings

online data collection provided the researchers with a greater degree of control of the data collection process, not achievable using traditional paper survey methods. Another example of this control is the immediate entry of data from participants’ responses to a background database which automatically stores and backs up data this means that no additional time is required for data entry. The cost of employing an information technology professional was easily offset by the financial savings made through the limited use of stationery and postage.

Key conclusions

although the development and testing of the research tools for the STORK Study was labour and time intensive, ultimately a questionnaire and vignette package was produced that had been rigorously tested by over 50 midwives and nurses. The researchers are confident in the reliability of the questionnaire and vignettes, as well as the validity of the data collected. The use of an online survey is clearly indicated when the population has readily available internet access, and where controlling the process of data collection is required, as such control cannot be achieved in traditional survey and questionnaire implementation.     

患者医疗服务满意度研究与应用综述

目的:探讨患者满意度测量与评价的科学方法。方法:通过系统文献检索的方法,回顾国内外患者满意度调查的现状,分析实践中存在的诸多问题,并提出加以改进的建议。结果:目前患者满意度调查中存在的缺陷包括调查所得的资料本身具有高度主观色彩,难以控制患者期望和个性情绪,调查指标体系主观臆断,调查对象缺乏代表性,调查结果缺乏可比性。结论:完善患者满意度测评体系的建议:通过场景锚定法来控制患者期望,通过德尔菲专家咨询法来构建患者满意度调查指标体系,开展预调查提高量表的信度和效度,合理抽样,建立统一的标准评价体系。     

Vignette Methodology and Culture-Relevance: Lessons Learned through a Project on Successful Aging with Iranian Immigrants to Sweden

It is a well-known fact that cultural values play an important role in the construction of aging and old-age related understandings. This is why ethnogerontologists have tried to expand the gerontological imagination by arguing that research needs to become more culturally-relevant. Tapping into the values that people uphold and the understandings of aging that are shaped by them is a challenging endeavor. This is especially the case if one does not share the cultural background of the people whose values one is studying. The same holds true when one wants to shed light on understandings that mainstream social gerontology regards as deviations from the norm. It is after all relatively easy to “impose the Western template” under such circumstances. Vignette methodology has been found to be particularly useful when studying value-laden understandings. This is why it is an appropriate method to consider when designing research that aims to avoid the imposition of the Western template. This article focuses on the pros and cons of this methodology while discussing some of the lessons learned from a project that explored how the construct of successful aging is understood by a group of Iranian immigrants to Sweden. It will be argued that vignettes are particularly useful when trying to shed culturally-relevant light on aging and old age-related understandings.

Pain judgements of patients’ relatives: examining the use of social contract theory as theoretical framework

Observer underestimation of others' pain was studied using a concept from evolutionary psychology: a cheater detection mechanism from social contract theory, applied to relatives and friends of chronic pain patients. 127 participants estimated characters' pain intensity and fairness of behaviour after reading four vignettes describing characters suffering from pain. Four cues were systematically varied: the character continuing or stopping liked tasks; continuing or stopping disliked tasks; availability of medical evidence; and pain intensity as rated by characters. Results revealed that pain intensity and the two behavioural variables had an effect on pain estimates: high pain self-reports and stopping all tasks led to high pain estimates; pain was estimated to be lowest when characters stopped disliked but continued with liked tasks. This combination was also rated least fair. Results support the use of social contract theory as a theoretical framework to explore pain judgements.     

Parents who catastrophize about their child's pain prioritize attempts to control pain

How parents respond to their child in pain is critically important to how both parent and child attempt to cope with pain. We examined the influence of parental catastrophic thinking about child pain on their prioritization for pain control. Using a vignette methodology, parents reported, in response to different pain scenarios, on their imagined motivation for 2 competing goals: to control their child's pain (ie, pain control) or to encourage their child's participation in daily activities (ie, activity engagement). The effects of parent gender, pain intensity, and duration on parental goal priority were also explored. Findings indicated that higher levels of parental catastrophic thoughts were associated with the parents prioritizing child pain control over activity engagement. This effect was significantly moderated by pain duration. Specifically, pain control was more of a priority for those high in catastrophic thinking when the pain was more acute. In contrast, parental catastrophic thoughts had no effect on the pain control strategy favored by parents in situations with longer-lasting pain. Furthermore, independently of parental catastrophic thoughts, heightened priority for pain control was observed in highly intense and chronic pain situations. Moreover, in highly intense pain, priority for pain control was stronger for mothers compared with fathers. Theoretical and clinical implications and directions for future research are discussed.