bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilizing Insider-Outsider Research Teams in Qualitative Research
Authors: Thomas Mary Durand , Blacksmith Joann , Reno Jackie
Published: May 2004

Teams including members from both inside and outside the organization being studied make valuable contributions. A team configuration including both insiders and outsiders is highly effective because variations in the experience history of researchers on the team broaden the available perspectives and maximize the potential interpretations of observed behaviors. An insider-outsider research team consisting of university faculty and nurses at two psychiatric hospitals conducted a study, Meanings of State Hospital Nursing. This article summarizes the study, discusses issues to be resolved when using an insider-outsider research team, and presents the ways in which this approach enhanced the trustworthiness of our findings.
Dilemmas of Self in the Method
Authors: Chesney Margaret
Published: May 2004

In this article, the author focuses on the researcher in research. Challenged by the theory and criticism of self-indulgence, the author has, as the researcher, come out through reflection and self-scrutiny to address some of the dilemmas the research process has held for her. Dilemmas concerning interviewing women from Pakistan using interpreters have been covered previously. The dilemmas discussed in this article concern the position of the researcher and honesty, the criticism of Western dominance, and how the research process has changed the author.
The Rhetorical Construction of the Predatorial Virus: A Burkian Analysis of Nonfiction Accounts of the Ebola Virus
Authors: Weldon Rebecca A.
Published: May 2004

Over the past 5 years, a new subgenre of horror films, referred to as plague films, has turned our focus to the threat of a hemorrhagic viral pandemic, comparable to the Spanish Flu epidemic of 1916. Based on the Ebola viral outbreaks of 1976, various writers have presented their accounts under the guise of increasing interest and prevention strategies. Disregarding inappropriate health care practices as the cause of these epidemics, accountability is refocused onto the rhetorically constructed, predatory nature of the virus. By employing Burke’s theory of dramatism and pentadic analysis, the author examines this rhetorical construction of Ebola as a predatorial virus and its implications for public perceptions of public health endeavors.
Joint Actions of Parents and Adolescents in Health Conversations
Authors: Young Richard A. , Lynam M. Judith , Valach Ladislav , Novak Helen , Brierton Iona , Christopher Ada
Published: May 2004

Based on an action theory approach, of 32 videotaped parent-adolescent conversations about health in two Canadian ethno-cultural groups were analyzed to identify and describe the joint action of parents and adolescents in the health domain. The data include manifest behavior (the conversation), internal processes (recalled thoughts and feelings on viewing the videotape of the conversation), and social meaning. These data were analyzed using the goals, functions, and elements of the conversations. Five categories of joint actions emerged from these data: sharing and exploring information, values, and beliefs about health; negotiating and struggling about aspects of the adolescent’s independence; providing and receiving guidance; adjusting to family and home issues; and fostering joint understanding by giving voice to the adolescent.
We are the Canaries: Self-Care in Multiple Chemical Sensitivity Sufferers
Authors: Lipson Juliene G.
Published: May 2004

This ethnographic study investigates the experiences of living with multiple chemical sensitivity (MCS), a condition increasing in prevalence but medically contested, on which very little qualitative research has been done. Participant observation included two treatment centers, a support organization, an Internet chat room, and conversations with MCS sufferers, activists, and educators. Semistructured interviews were conducted with 33 people with MCS, recruited to reflect a broad demographic range and severity of illness variation. This article describes several methodological issues associated with doing “peer research” and then describes self-care for symptom management. With no known cure, MCS sufferers manage their symptoms through three main avenues: prevention/avoidance, detoxification, and emotional self-care. Implications include education of health care providers and a warning from those who have MCS: “We are the canaries in the coal mine; what has happened to us will happen to many others unless we clean up our environment.”
Developing Qualitative Databases for Multiple Users
Authors: Manderson Lenore , Kelaher Margaret , Woelz-Stirling Nicole
Published: May 2004

Conventionally, anthropological data are collected and analyzed by individuals, and although researchers may use data managers to organize their information, there is little need to classify and code systems to be accessible to others. Recently, however, qualitative and quantitative data have been collected in projects with multiple researchers. Difficulties with the establishment, verification, and management of databases for multiple users, particularly in longitudinal studies, are considerable if the rules underlying coding schemes are difficult to identify or if the documentation is cumbersome. Drawing on the authors’ experiences in Australia, the use of computer packages for data management is discussed, and the importance of preserving the integrity of data and maintaining context while facilitating its continued and varied use is emphasized.
When the Visit to the Emergency Department is Medically Nonurgent: Provider Ideologies and Patient Advice
Authors: Guttman Nurit , Nelson Myra Shoub , Zimmerman Deena R.
Published: May 2004

It is estimated that more than half of pediatric hospital emergency department (ED) visits are medically nonurgent. Anecdotal impressions suggest that ED providers castigate medically nonurgent visits, yet studies on such visits are scarce. This study explored the perspectives of 26 providers working in the EDs of two urban hospitals regarding medically nonurgent pediatric ED visits and advising parents or guardians on appropriate ED use. Three provider ideologies regarding the appropriateness of medically nonurgent ED use were identified and found to be linked to particular communication strategies that providers employed with ED users: restrictive, pragmatic, and all-inclusive. The analysis resulted in the development of a typology of provider ideological orientations toward ED use, distinguished according to different orientations toward professional dominance.
Empowerment and Australian Community Health Nurses’ Work with Aboriginal Clients: The Sociopolitical Context
Authors: Ritchie Linda
Published: May 2004

A portion of a study designed to explore community health nurses’ (CHNs) perceptions of the concept of empowerment in their work with Australian Aboriginal clients is discussed in this article. The 12 study participants were identified through purposive convenience sampling. During this exploration, contentions regarding the concept of empowerment emerged, revealing the sociopolitical context of CHNs’ work with Aboriginal people that shaped their practice in crucial ways. These issues emerged from the participants’ discussions regarding the meaning of empowerment in their work with Aboriginal clients and the strategies for and challenges to working in empowering ways within the context of Aboriginal health. Selected components of Habermas’s works provided a useful framework to facilitate an understanding of the forces that underpin community health nursing practice.
Team Collaboration: A Case Study of an Early Intervention Team
Authors: Hinojosa Jim , Bedell Gary , Buchholz Ester S. , Charles Jeanne , Shigaki Irene S. , Bicchieri Stephen M.
Published: May 2004

The study described in this article sought to examine the workings of an interdisciplinary team as a research entity and as a service provider. There were two levels of analysis in the study: the process of collaborating on the research and the results of the research observation of an interdisciplinary team in a clinical setting. An interdisciplinary research team studied the interaction of a single clinical team over a 6-month period working with one child in a hospital-based early intervention program. The data were collected through intensive interviews, direct observations of the family and team members, and selected videotaping of team meetings. Qualitative data analysis methods were used, and five themes emerged: who takes the lead, the classroom as a way station, we like our freedom but..., who is giving and who is taking advice, and communication comes in few forms.
Gaining and Maintaining Consent: Ethical Concerns Raised in a Study of Dying Patients
Authors: Lawton Julia
Published: May 2004

This article provides a frank discussion of the practical and ethical issues that emerged during the process of setting up and conducting a participant observation study within an inpatient hospice. A general overview of the participant observation approach is used to prefigure a discussion of its strengths and weaknesses when employed as a research and evaluation tool among palliative care populations. Although participant observation provided a flexible and viable means of collecting data in the hospice, it also created a number of dilemmas that in many cases could not be satisfactorily resolved. Difficulties arose, in particular, with obtaining informed consent from patients and assuming that consent remained valid after patients had deteriorated physically and mentally. Further complications stemmed from the role conflict and ambiguity inherent within an approach that requires a researcher to work simultaneously as a participant and as an observer.
Unsolicited Narratives from the Internet: A Rich Source of Qualitative Data
Authors: Robinson Katherine Morton
Published: May 2004

Recently, the Internet has become a forum for informal communication. Many—whose voices may have been unheard—can now express themselves through this medium. Rich narratives are available to the qualitative researcher from bulletin boards, guestbooks, Web pages, and listservs on the Internet. In this article, these data sources are defined and described. Strategies for using these data are discussed. One concern with using unsolicited data from the Internet is the protection of human subjects and the requirement for consent. A proposed model describing the process for deciding when such data are publicly available, as defined by the Office for the Protection of Rights of Research Subjects, and when the use of the data requires consent is presented.
Women’s Lived Experiences of Pregnancy: A Tapestry of Joy and Suffering
Authors: Bondas Terese , Eriksson Katie
Published: May 2004

The phenomenological study of the lived experiences of pregnancy described in this article is part of a Finnish caring science research program. Eighty interviews with 40 women combined with nonparticipant observation were analyzed according to Colaizzi. Pregnant women wishing for a perfect child want to promote the health of their unborn baby, no longer take health for granted, and try to change their health behavior. Their altered mode of being involves body changes, variations in mood, and worries. The striving to achieve family communion is seen in the evolving significance of the baby; in dreams, hopes, and plans; and in changing relationships. In relation to Eriksson’s ontological health model, the joy and suffering in pregnancy are based on being there for another. Taking seriously the women’s experiences and the hidden questions that reveal suffering in both lay and professional caring might prevent the serious postpartum misery of motherhood.
Conceptualizing Sports Medicine as Occupational Health Care: Illustrations from Professional Rodeo and Wrestling
Authors: Kotarba Joseph A.
Published: May 2004

The purpose of this article is to propose a sociological model of sports medicine that conceptualizes it as occupational health care. All occupational health care systems can be summarized according to three types: elite, managed, and primitive. These types reflect the quality of health care provided, the social class membership of workers, and workers’ value to employers. The author presents ethnographic data to illustrate the social dynamics of primitive occupational health care delivered to rodeo cowboys and local professional wrestlers. This care is primitive because these athletes have relatively low economic value as workers, and the rugged individualism of their sports’ subcultures supports a system of health care that is inexpensive, nonmedical in its philosophy, personalistic in the structure of its practitioner-patient relationship, and incidental in its delivery.
Components of Quality of Life for Persons with a Quadriplegic and Paraplegic Spinal Cord Injury
Authors: Manns Patricia J. , Chad Karen E.
Published: May 2004

This investigation determined the themes that represented quality of life for persons with a spinal cord injury. Fifteen people (6 females, 9 males; 7 persons with quadriplegia, 8 with paraplegia) participated in this study, which used naturalistic inquiry methodologies. Results showed that quality of life for this population, regardless of severity of impairment, consisted of nine themes: (a) physical function and independence, (b) accessibility, (c) emotional well-being, (d) stigma, (e) spontaneity, (f) relationships and social function, (g) occupation, (h) finances, and (i) physical well-being. The themes of life quality were similar for quadriplegics and paraplegics; however, physical function and independence and physical well-being affected the quality of life of persons with a quadriplegic injury to a greater extent. These findings may provide health professionals with information necessary to assist in the development of programs to enhance quality of life.
Care-as-Worry, or “Don’t Worry, be Happy”
Authors: Van Manen Max
Published: May 2004

Care, or caring, is one of the central concepts in North American health science and nursing theories. Yet, experiential accounts of caring show dimensions of meaning that have received little attention in the literature. The author compares the meanings of the terms care and caring with their counterparts in other languages. He explores the significance of care-as worry embedded in lived relations of caring and relates these concepts to ethical considerations surrounding health care. It is because of this felt “care-as-worry” that the life of care may be experienced as a complex moral-emotional relation of responsibility.
Struggling for a Tolerable Existence: The Meaning of Men’s Lived Experiences of Living with Pain of Fibromyalgia Type
Authors: Paulson Margareta , Danielson Ella , Söderberg Siv
Published: May 2004

Chronic pain is a major health problem in Sweden because of its consequences in daily life. Fourteen men with fibromyalgia-type pain were interviewed regarding their experiences. A phenomenological hermeneutic method was used to interpret the transcribed interviews. Three major themes emerged: experiencing the body as an obstruction, being a different man, and striving to endure. Overall, the meaning of men’s lived experience of chronic pain was experienced as change in the body, self, and relationships. Striving to live life required achieving balance during both calm and difficult phases of the illness—struggling for a tolerable existence. Information from this study could provide guidelines for health care staff members to give empathic and supportive care to men living with a long-term illness.
Making Meaning: The Creative Component in Qualitative Research
Authors: Hunter Anita , Lusardi Paula , Zucker Donna , Jacelon Cynthia , Chandler Genevieve
Published: May 2004

Findings in qualitative research are often wondrous and exciting, expounding new knowledge and perceptions previously unknown. Qualitative research requires the researcher to ponder and reflect on the data collected so as to find the meaning within. Helping researchers learn how to perform this step is not well discussed in the qualitative literature, yet this is one of the more crucial components of this type of research. In this article, the incubation, the meaning-making phase of qualitative research, is discussed in relation to the experiences of five researchers who have used traditional processes, models, metaphors, plays, pastiche, poetry, and quilt making and design to help them make meaning.
Critical Issues in Interviewing People with Traumatic Brain Injury
Authors: Paterson Barbara , Scott-Findlay Shannon
Published: May 2004

People with cognitive impairments often cannot effectively recall and articulate experiences, feelings, and perceptions. Therefore, interviewing them can be fraught with pragmatic and methodological difficulties. Given this situation, the authors’ experience in a study on the allocation of rehabilitative services to survivors of traumatic brain injury is discussed. Participants had physiological impairments affecting their ability to focus on interview questions. The authors discuss the unique challenges, including participants’ recall of events, intolerance to stimuli, and image management and offer strategies for mitigating these concerns. The traditional view that reality is captured only in the subjective accounts of articulate people who can remember events in a precise and reflective manner is challenged.
Chronic Illness Experience: Insights from a Metastudy
Authors: Thorne Sally , Paterson Barbara , Acorn Sonia , Canam Connie , Joachim Gloria , Jillings Carol
Published: May 2004

Concurrent with the recent enthusiasm for qualitative research in the health fields, an energetic call for methods by which to synthesize the knowledge has been generated on various substantive topics. Although there is an emerging literature on meta-analysis and meta-synthesis, many authors overestimate the simplicity of such approaches and erroneously assume that useful knowledge can be synthesized from limited collections of study reports without a thorough analysis of their theoretical, methodological, and contextual foundations and features. In this article, the authors report some of the insights obtained from an extensive and exhaustive metastudy of qualitative studies of chronic illness experience. Their findings reveal the complexities inherent not only in any phenomenon of interest to health researchers but also in the study of how we have come to know what we think we know about it.
A Metasynthesis: Mothering Other-than-Normal Children
Authors: Nelson Antonia M.
Published: May 2004

The author used Noblit and Hare’s 1988 comparative method of synthesizing qualitative studies to address the need for collective knowledge development related to mothering other than-normal children. Twelve studies were included in a metasynthesis for a total sample of 79. The nature of the child’s disability, demographics, and methodology used varied widely. Initially, 13 common themes were extracted using reciprocal translation. Further analysis revealed 4 steps common to the mothering experience under which themes were categorized. Suggestions for application to practice include keeping in mind qualities of a supportive health professional from the mothers’perspective, encouraging mothers to challenge societal definitions of normalcy, and recognizing the significance of hope in fueling maternal caregiving.
Language and Power: Ascribing Legitimacy to Interpretive Research
Authors: Ceci Christine , Limacher Lori Houger , McLeod Deborah L.
Published: May 2004

More than merely describing what constitutes a good or truthful interpretation, all judgments about the legitimacy of knowledge claims can be understood as enacting relations of power. That is, our understanding of what it means to make a reasonable claim to knowledge is already caught up in relations of power that privilege some perspectives and marginalize others. Language, understood as productive rather than reflective of meaning, both enables and constrains the kinds of statements we are entitled to make. Competing discourses do not exist equally in the world but rather differ in terms of what they are held to explain and what effect they have. The authors explore these issues and suggest that evaluating interpretive research involves not only epistemological issues but also questions of value and power.
Understanding and Practice: A 7-Year Follow-Up Study on Implementation of a Cardiac Rehabilitation Program
Authors: Henriksen Eva , Rosenqvist Urban
Published: May 2004

The authors explore the perspectives of managers, health care professionals, and patients on a comprehensive cardiac rehabilitation program. Using qualitative methodology, they compare and analyze results from individual interviews and two conceptual modeling seminars held 7 years apart. Professionals and managers understood their own tasks in a professional-centered way that did not include the client’s perspective. Patients believed they were not seen in their whole context. Initially, health care organization was fragmented, lacking clear leadership, coordination, and communication between levels of care. However, lack of common understandings of structure, process, and outcome in cardiac rehabilitation services hampered the implementation of program changes.
Reconstructing Intimate Violence: The Structure and Content of Recollections of Violent Events
Authors: Eisikovits Zvi , Winstok Zeev
Published: May 2004

The purpose of this article is to explore the structure and content of recollections of violent events among cohabiting partners. The authors used qualitative methodology to examine 48 in-depth interviews. Content analysis of the interviews yielded two parallel and interrelated continua: One represented the life circumstances (staying in spite of violence) impinging on the recollections; the other dealt with the content of the memories of violent events. These two interacted according to a series of structural features. Both men and women living in violent relationships described a contextual variation ranging from choosing to stay to being prevented from leaving. The memory of violence was constructed in a manner meant to achieve coherence with the appropriate context.
Leveling the Playing Field? Exploring the Merits of the Ethics-as-Process Approach for Judging Qualitative Research Proposals
Authors: Cutcliffe John R. , Ramcharan Paul
Published: May 2004

There has been a recent growth in claims that qualitative research proposals are not treated equitably by ethics committees. In response, recent arguments centered on establishing the ethics of qualitative research, in the eyes of ethics committees, have indicated the need for an “ethics-as-process” approach. Accordingly, in this article, the authors illustrate the merits of this approach and provide three examples from the field: the outcomes of participating in qualitative interviews, sensitive handling of ending in qualitative research relationships, and the ongoing establishment of informed consent. The authors hope to increase awareness of the potential benefits of this approach and contribute to the ensuing debate.
Informal Networks among Women with HIV/AIDS: Present Support and Future Prospects
Authors: Ciambrone Desirée
Published: May 2004

Given the importance of informal support in the lives of chronically ill people, it is imperative to gain a deeper understanding of the nature and impact of HIV-positive women’s informal networks. Through interviews with 37 women with HIV infection, the author explores women’s social network composition and the extent to which these networks appear to facilitate or mediate the disruption caused by HIV/AIDS. Women reported having at least one person, usually a family member, on whom they could depend for emotional support. Although women report adequate levels of current support, the author questions the likelihood that their informal networks will provide support further along in women’s illness trajectories.
Changes in Self-Concept While Using SSRI Antidepressants
Authors: Knudsen Pia , Hansen Ebba Holme , Traulsen Janine Morgall , Eskildsen Kristin
Published: May 2004

In this study, the authors analyze how younger women see themselves within the context of using the antidepressants selective seroton in re-uptake inhibitors (SSRIs). Twelve in-depth interviews and 6 reinterviews were conducted with a community-based sample of women who had been taking SSRIs between 1 and 4 years. The empirical analysis revealed that SSRI users passed through stages in their careers as medicine users, these stages corresponding to how the users thought and felt about themselves. Four major changes in self-concept emerged: distressed and needing help, conflicts about taking the medicine, improvements in condition, and problems discontinuing the medicine. Users evaluated themselves from what they believed was the perspective of society, and the way they saw themselves was closely related to how they felt they functioned in everyday life.
Studying Health Care “Quality” Qualitatively: The Dilemmas and Tensions between Different Forms of Evaluation Research within the U.K. National Health Service
Authors: Bate Paul , Robert Glenn
Published: May 2004

The authors tell the story of an attempt to depart from a tradition of evaluation research (ER) and to address the research-practice interface in a different way through a more hands-on, action research (AR) approach, which combines qualitative and quantitative methods. In doing so, they raise issues about the role and nature of evaluation for development and, especially, about the place of qualitative research in such evaluations; the identity of future ER; “paradigm wars” between the positivists and the phenomenologists; and the politics of conducting policy-based evaluations in health care settings and of what happens when qualitative researchers try to help an improvement process.
Naturalistic Inquiry and Reliabilism: A Compatible Epistemological Grounding
Authors: Miller Steven I. , Fredericks Marcel
Published: May 2004

In this brief analysis, the authors suggest that naturalistic inquiry as a field must return to a more rigorous interpretation of epistemological issues. The need is highlighted by the fact that ideological and methodological claims are increasingly becoming conflated. This produces a distancing of what is truly at stake: a need to defend a genuine epistemological theory consistent with the aims of naturalistic perspectives and establish some ontological commitments as a result. The authors argue that the epistemological theory of process reliabilism is worth examining critically. They also suggest its consistency with the ontological claims of minimal realism.
The Role of Qualitative Methods for Investigating Barriers to Adult Immunization
Authors: Silverman Myrna , Terry Martha Ann , Zimmerman Richard Kent , Nutini Jean F. , Ricci Edmund M.
Published: May 2004

In 1999, the Agency for Healthcare Research and Quality funded a study of barriers to immunization, which included a short-term qualitative data collection to assess the organizational and cultural features of selected primary care practices and to explore their impact on adult immunization rates. The authors describe the short-term qualitative data collection system and the contributions made by the qualitative study to the parent project. They address previously held concerns about qualitative research and provide a system that can be replicated or modified for use for projects designed to assess complex attitudes and behaviors that affect health outcomes.
Multiple Realities in a Study of Medical Consultations
Authors: Barry Christine A.
Published: May 2004

A study of doctor-patient communication offers convincing arguments for using multiple methods of data collection incorporating both meanings and practices. Multiple realities emerged clearly that would have remained invisible had only one data source been used. Two case studies illustrate how four factors interact to produce different versions of reality: setting, participants, time, and forms of data recording. The author discusses the apparent markedly different realities of doctors and patients, and the researcher’s role in synthesizing these multiple accounts. Only by using multiple methods can attention be paid to the central tensions, the gaps and white spaces, and the discrepancies and misunderstandings that are so important in understanding human interaction. However, this approach is labor- and time-intensive, and requires skilled, experienced researchers.
Advancing What? Qualitative Research, Scholarship, and the Research Imperative
Authors: Cheek Julianne
Published: May 2004

In this keynote address, the author explores the role that scholarship plays in shaping and advancing qualitative research. The focus is on the dynamic relationship that exists between scholarship, qualitative research, qualitative researchers, and the research imperatives that form part of the context in which they operate. Neither scholarship nor qualitative research exists in a contextual vacuum. Changing thoughts and emphases in educational institutions and society at large influence, and are in turn influenced by, understandings of scholarship and research. Boyer’s (1990) work on scholarship provides a vehicle for much of the discussion.
Embracing Uncertainty: An Exploration of the Experiences of Childhood Cancer	Survivors
Authors: Parry Carla
Published: May 2004

Uncertainty is a central theme in the cancer survivorship and coping literature. Existing research on cancer-related uncertainty has primarily documented the adverse effects of existential uncertainty on survivors' well-being and located uncertainty within the stress and coping paradigm. Using in-depth qualitative interviews, the author explores the paradoxical meanings and impact of uncertainty in the lives of long-term survivors of childhood cancer. The findings suggest that although uncertainty can be a source of distress, it can also be a catalyst for growth, a deepened appreciation for life, greater awareness of life purpose, development of confidence and resilience, and optimism. The results suggest that uncertainty is a dialectic phenomenon located within larger contexts of both stress and coping, and psychospiritual growth.
Using Metaphor as a Qualitative Analytic Approach to Understand Complexity in Primary Care Research
Authors: Aita Virginia , McIlvain Helen , Susman Jeffrey , Crabtree Benjamin
Published: May 2004

Metaphors offer exciting opportunities to identify and explore tacit knowledge and behavior that are embedded in complex organizations and shape health care practices. In this article, the authors explore the theoretical rationale, background, and advantages of using metaphor as an analytic strategy in qualitative health research. They used an analysis of 18practices in a comparative case study designed to explore office practice strategies for delivering cancer prevention services for illustrations. During the individual and comparative stages of the analysis process, researchers heeded the metaphors that they used in their descriptive language of practices. The authors explore examples showing how metaphors clarify unwritten assumptions, values, and motivators that shape variations in practice behavior.
Developing a Provisional Standard for Clinical Supervision in Nursing and Health Visiting: The Methodological Trail
Authors: Rafferty Mic , Jenkins Emrys , Parke Sian
Published: May 2004

The authors outline the process that led to the development of a provisional professional standard for clinical supervision, focusing on design, data collection, and analysis methods. The work was undertaken in an ethos of new paradigm/fifth-generation approaches and used the “manifold of subjective knowing” to gain a holistic understanding of supervisors’ experience as represented by experiential, presentational, propositional, and practical knowing. They show how they arrived at the indicators of the standard: Professional Support, Learning, and Accountability. Each of these indicators consists of further elements related to Time, Environment, Relationship (Professional Support), Focus, Knowledge, Interventions (Learning), Organizational Support, Recording, and Competency (Accountability).Findings confirm that clinical supervision practice is complex, and the authors describe proportionally complex methods of analysis.
Ethnography and Measurement in Mental Health: Qualitative Validation of a Measure of Continuity of Care (CONNECT)
Authors: Ware Norma C. , Tugenberg Toni , Dickey Barbara
Published: May 2004

Ethnography contributes to measure development by enhancing validity and providing a basis for qualitative validation. Validating research measures means making cases for their “trustworthiness.” The authors argue for the trustworthiness of CONNECT, a measure of continuity of care, by presenting the interpretive logic through which they elaborated continuity for measure construction purposes. They used category construction methods to identify mechanisms of continuity in ethnographic data. Mechanisms suggested five measurement domains: (a) knowledge, (b) flexibility, (c) availability, (d) coordination, and (e) transitions. Validation rationales summarize the ethnographic evidence and explain how the domain relates to continuity. In making explicit the data and the reasoning used, the authors argue for the trustworthiness of their interpretation. The arguments for trustworthiness demonstrate a qualitative validation process.
Balancing: A Basic Process in End-of-Life Cancer Care
Authors: Thulesius Hans , Håkansson Anders , Petersson Kerstin
Published: May 2004

In this grounded theory study, the authors interviewed caregivers andpatients in end-of-life cancer care and found Balancing to be a fundamentalprocess explaining the problem-solving strategies of most participants and offering a comprehensive perspective on both health care in general and end-of-life cancer care in particular. Balancing stages wereWeighing— sensing needs and wishes signaled by patients, gauging them against caregiverresources in diagnosing and care planning; Shifting—breaking bad news, changing care places, and treatments; and Compensating—controlling symptoms, educating and team-working, prioritizing and “stretching” time, innovating care methods, improvising, and maintaining the homeostasis of hope. The Balancing outcome is characterized by Compromising, or “Walking a fine line,” at best an optimized situation, at worst a deceit.
Surfacing the Life Phases of a Mental Health Support Group
Authors: Mohr Wanda K.
Published: May 2004

Support groups have increased rapidly in number and become a viable alternative to formal treatment in the United States. However, little is known regarding how mental health advocacy or support groups start and develop, or about challenges that can threaten their survival. In this 21/2-year ethnography, the author studied the culture of a developing family support program associated with a system of care. Several phases emerged, reflecting an organizational dynamic. The group dynamics and response to challenges have implications for organizers and parent organizations about the need for technical assistance necessary for survival of the group. Participant observation and immersion in the culture of such groups can provide a deeper understanding of the ideologies and values around which they organize and the kinds of tensions that members can experience during the group’s cycle.
Facilitators and Challenges to Organizational Capacity Building in Heart Health Promotion
Authors: Joffres Christine , Heath Stephanie , Farquharson Jane , Barkhouse Kari , Latter Celeste , MacLean David R.
Published: May 2004

The authors describe the facilitators and challenges to a multisectoral initiative aiming at building organizational capacity for heart health promotion in Nova Scotia, Canada. The research process was guided by participatory action research. The study included 21 organizations from diverse sectors. Participant selection for the data collection was purposive. The authors collected data through organizational reflection logs and one-to-one semistructured interviews and used grounded theory techniques for the data analyses. Factors influencing organizational capacity for heart health promotion varied, depending on the project stage. Nonetheless, leadership, organizational readiness, congruence, research activities, technical supports, and partnerships were essential to capacity-building efforts. Approaches to organizational capacity building should be multileveled, because organizations are influenced by multiple social systems that are not all equally supportive of capacity.
Know When to Hold ’Em, Know When to Fold ’Em: Qualitative Thinking Outside the University
Authors: Agar Michael H.
Published: May 2004

Qualitative researchers often face a dilemma. They are asked to apply their knowledge to problems without adequate time or support to conduct projects that meet traditional academic standards of research design and methodology. Should qualitative researchers pitch in and get involved or keep their distance? What can they hope to accomplish, if anything? How do they know whether a particular job can be done? Traditional research training provides few guidelines to answer such questions. In this article, the author explores one way to think about what such guidelines might look like.
Understanding Illness: Using Drawings as a Research Method
Authors: Guillemin Marilys
Published: May 2004

Visual methodologies are becoming more evident in social research. These methodologies encompass media such as film, video, still photography, electronic visual media, and material artifacts. In this article, the author examines the use of drawings as a research tool used as an adjunct to other social research methods. Using examples from two studies, she illustrates how drawings can be used to explore the ways in which people understand illness conditions. She argues that the act of drawing necessitates knowledge production, with a visual product as its outcome. Although the examples presented in this article are limited to illness conditions, she argues that drawings offer a rich and insightful research method to explore how people make sense of their world.
Stories in the Flesh and Voices in the Head: Reflections on the Context and Impact of Research With Disadvantaged Populations
Authors: Warr Deborah J.
Published: May 2004

In this article, the author reflects on her involvement in qualitative health among disadvantaged and disenfranchised groups whose life experiences are, for the most part, very different from her own. Despite the differences, she is persuaded that it is possible to have an empathetic understanding of other people’s experiences through research. Recalling experiences from her own research encounters, she shows the ways in which these encounters as embodied and situated interactions generate a powerful methodological potential for gaining insight into other people’s lives. She suggests strategies for preserving the layers of context and meaning that can otherwise be lost when research encounters are transformed into research data. Furthermore, the methodological power of qualitative research can mean that research encounters are intense and emotional experiences for researchers. Therefore, she offers some strategies for managing the emotional potency of some of the more distressing life stories that social researchers might come to know.
Communicating Professional Identity in Medical Socialization: Considering the Ideological Discourse of Morning Report
Authors: Apker Julie , Eggly Susan
Published: May 2004

In this study, the authors investigate how medical ideology and physician professional identity are socially constructed during morning report, a formal teaching conference considered to be a cornerstone of medical education. Analysis of transcripts from 20 meetings reveals physician identity is developed through ideological discourse that produces and reproduces systems of domination that privilege scientific medicine and marginalize humanistic approaches. Findings indicate how, in a socialization context uniquely focused on discourse, communication functions to construct a professional identity grounded in the principles of the biomedical model. Although medical residents deviate from traditional ideology by articulating the voice of the lifeworld, faculty physicians counter these moves by asserting the voice of medicine. The authors draw conclusions regarding identity formation and the socialization practices of medical education.
Counting Apples as Oranges: Epidemiology and Ethnography in Adolescent Substance Abuse Treatment
Authors: Reisinger Heather Schacht
Published: May 2004

In spite of a history of collaboration between epidemiology and qualitative research, the mix of these two perspectives is not well developed in the substance use field. Part of the reason for the difficult match is that qualitative research often adds issues of context and meaning that complicate the epidemiological data of interest. In the substance use field, epidemiological indicators tend to focus on a single drug, but the context typically involves persons who use multiple illicit and licit substances in a variety of ways that change over time. In this article, the author describes four adolescents in an outpatient substance abuse treatment center to provide context and insight into the lives behind the epidemiological indicators. Studying a site of epidemiological data collection ethnographically is yet another way to build collaboration between epidemiology and qualitative research.
Expressions of Loss of Adulthood in the Narratives of People with Colorectal Cancer
Authors: Rozmovits Linda , Ziebland Sue
Published: May 2004

The diagnosis and treatment of colorectal cancer entail detailed discussions of bodily functions, invasive procedures, and a reorientation of life around bowel habit. Furthermore, people with stomas undergo a second experience of toilet training in adulthood. For these reasons, colorectal cancer is sometimes considered an embarrassing disease. Narrative interviews with colorectal cancer patients indicate the inadequacy of the concept of embarrassment in describing the loss of dignity, privacy, independence, and sexual confidence as well as a compromised ability to work, travel, and socialize. The link between bowel control and the constitution of adult identity must be acknowledged if health professionals and carers are to offer the most appropriate forms of information and support to people affected by colorectal cancer.
Perception of Tuberculosis in the Democratic Republic of Congo: Wali Ya Nkumu in the Mai Ndombe District
Authors: Bennstam Agneta Lillqvist , Strandmark Margaretha , Diwan Vinod K.
Published: May 2004

To implement effective tuberculosis (TB) control programs, we must first understand the health culture in a given region. The authors organized eight focus group sessions in the Mai Ndombe district in the Democratic Republic of Congo to study the underlying attitudes toward TB and to describe the TB context with special reference to gender differences. They then analyzed the focus group data using a grounded theory design. TB is called “the disease of distance” and is described as a person invading people. Isolation and stigmatization are the methods being used to protect society from the TB threat. The authors observed no gender differences in the collected data.
Benefits and Drawbacks of Employment: Perspectives of People with Mental Illness
Authors: Honey Anne
Published: May 2004

In this article, the author presents the perspectives of people with mental illness about the benefits and drawbacks of employment, what factors influence these, and how they affect consumers’ decisions and actions. Forty-one consumers of mental health services participated in 76 in-depth interviews and two focus groups. The author coded data inductively and analyzed them using grounded theory method. The results demonstrate that the benefits and drawbacks of employment are experienced in six domains. Individuals’ perceptions of benefits and drawbacks are influenced by individual and contextual factors, are dynamic over time, and are instrumental in determining their employment-related actions. The findings suggest several areas for future exploration with a view to improving policy and practice in employment for people with mental illness.
Recruiting Participants from a Community of Bangladeshi Immigrants for a Study of Spousal Abuse: An Appropriate Cultural Approach
Authors: Shelton Andrea J. , Rianon Nahid J.
Published: May 2004

In this article, the authors describe a recruitment strategy used to enroll female Bangladeshi immigrants into a study of spousal abuse, crucial in the process of identifying abuse in this community. The researchers used a qualitative method involving a three-staged process designed for sampling and recruiting for focus groups and in-depth interviews. The Bangladeshi women declined participation in either of these qualitative genres, but the modified and adapted strategies proved effective in recruiting participants from the tightly knit immigrant community. Key to the success of the effort was the involvement of a Bangladeshi investigator, unspecified time to establish rapport with key informants and representatives of the larger community, and maintaining contact with the target population after completion of the project.
Medical Profiling: Narratives of Privilege, Prejudice, and HIV Stigma
Authors: Poindexter Cynthia Cannon
Published: May 2004

In this article, the author uses selected narrative analysis methods to deconstruct stories presented in separate interviews by a married couple who believe that their HIV-infected adult daughter has been victimized by medical profiling. In their accounts, they construct their belief that their daughter’s gender, race, education, appearance, and socioeconomic status contributed to her not receiving an accurate diagnosis despite repeated medical examinations. Their similar accounts paint a picture of parents frantically seeking a diagnosis as symptoms worsen without explanation. They perceive that their daughter, not fitting the profiling ideas about who is at risk for HIV, missed her chance for early intervention. The author examines in detail how these parents separately tell similar stories, probably representing the explanation they have jointly constructed to explain what they see as a failure of medicine.
Descriptive Versus Interpretive Phenomenology: Their Contributions to Nursing Knowledge
Authors: Lopez Kay A. , Willis Danny G.
Published: May 2004

Anumber of articles in the nursing literature discuss the differences between descriptive and interpretive approaches to doing phenomenology. A review of studies demonstrates, however, that many researchers do not articulate which approach guides the study, nor do they identify the philosophical assumptions on which the study is based. Such lack of clarity makes it difficult for the reader to obtain a sense of how the knowledge produced by the study is to be evaluated and used. In this article, the authors compare the philosophical components of descriptive and interpretive approaches to doing phenomenology and illustrate types of knowledge produced by each through reviewing specific studies. They focus on the various uses of phenomenology in generating useful knowledge for health care practice. Keywords:qualitative; hermeneutic; critical theory; Husserl; Heidegger; existentialism; phenomenology
Stories, Moral Judgment, and Medical Care in an Intensive Care Unit
Authors: Cassell Joan
Published: May 2004

A division of labor exists between nurses and doctors in a surgical intensive care unit. Nurses perform a culturally identified feminine expressive role, caring about patients as well as for them. Doctors perform a culturally identified masculine instrumental role, concerned with curing patients’ bodies. The nurses are interested in the patients’ stories; the doctors attempt to ignore the stories to concentrate on returning patients to function. Based on the patient’s story, however, the nurses make severe judgments as to moral worth. Such judgments can impair medical care. Must doctors, then, disregard patients’ stories? In other words, must they limit themselves to caring for patients’ bodies, attempting to ignore the individuals, situated in a web of social relationships, who inhabit those bodies?