Earlier Qualitative Study Research Articles

Development and psychometric testing of an instrument to compare career choice influences and perceptions of nursing among healthcare students

BackgroundWith the availability of more healthcare courses and an increased intake of nursing students, education institutions are facing challenges to attract school leavers to enter nursing courses. The comparison of career choice influences and perception of nursing among healthcare students can provide information for recruitment strategies. An instrument to compare the influences of healthcare career choice is lacking. The purpose of this study is to develop and evaluate the psychometric properties of an instrument to compare the influences of healthcare career choice with perceptions of nursing as a career choice.MethodsThe study was conducted in two phases. In phase one, two sets of scales with parallel items that measure the influences of healthcare career choice and perceptions of nursing as a career choice were developed through an earlier qualitative study, literature review, and expert validation. Phase two involved testing the construct validity, concurrent validity and reliability with a convenience sample of 283 first year healthcare students who were recruited at two education institutions in Singapore.ResultsAn exploratory factor analysis revealed 35-parallel items in a six-factor solution (personal interest, prior healthcare exposure, self-efficacy, perceived nature of work, job prospects, and social influences) that explained 59 and 64% of the variance for healthcare career choice and nursing as a career choice respectively. A high correlation (r = 0.76, p < 0.001) was obtained with an existing tool, confirming the concurrent validity. The internal consistency was sufficient with Cronbach’s alpha of 0.93 for healthcare career choice and 0.94 for nursing as a career choice. The test-retest reliability was acceptable with an Intraclass Correlation Coefficient of 0.63 for healthcare career choice and 0.60 for nursing as a career choice.ConclusionsThe instrument provides opportunities for understanding the differences between influences of healthcare career choice and perceptions of nursing as a career choice. This comparative understanding of career choice influences can guide educator and policy-makers on nursing recruitment.

Higher education teachers’ descriptions of their own learning: a quantitative perspective

ABSTRACTIn this large-scale study, higher education teachers’ (n = 1028) descriptions of their own learning are examined with quantitative analyses. The study follows up an earlier qualitative study that, using a phenomenographic approach, identified four different ways in which teachers at Finnish universities of applied sciences described their own learning. The purpose of the present study was to find out how teachers’ descriptions were divided into the categories formed in the previous study and to examine whether teachers’ descriptions of their learning differ according to their position, gender and age. The results show that most teachers described their learning as an individual activity. Differences between teacher, gender and age groups were found. Lecturers were represented more often than senior lecturers in the category of individual learning, and male teachers more often than their female colleagues. Individualistic learning was especially typical of lecturers under 50 years of age.

Protective Nursing Advocacy: Translation and Psychometric Evaluation of an Instrument and a Descriptive Study of Swedish Registered Nurse Anesthetists' Beliefs and Actions

To translate and adapt the Protective Nursing Advocacy Scale (PNAS) into a Swedish version (PNAS-Swe), evaluate its psychometric properties, and describe registered nurse anesthetists' (RNAs) advocacy beliefs and actions from a protective perspective. A cross-sectional design was used. First, the PNAS was translated into Swedish. Next, the content and construct validity of the PNAS four subscales was evaluated. Finally, the PNAS-Swe was used to describe Swedish RNA beliefs and actions regarding protective nursing advocacy. The final PNAS-Swe has 29 items in four subscales. The RNAs reported that they feel that they should provide protective nursing advocacy for their patients. There were no differences in gender, or associations with age, or work experience regarding their advocacy beliefs or actions. The PNAS-Swe is valid for use in a Swedish context. Protective nursing advocacy is important to the RNAs, which is in congruence with earlier qualitative studies.

Janus Nanoparticles for T Cell Activation: Clustering Ligands to Enhance Stimulation.

The in vitro activation of T cells by synthetic particles is a promising technique for adoptive cancer immunotherapy. While it is known that cell-surface receptors form clusters during T cell activation, the use of clustered ligands on synthetic particles to modulate T cell response is a largely unexplored concept. Building upon our previous finding that T cells respond differently to various micro-sized patterns of ligands, we here investigate the effect of nano-sized ligand clusters on T cell activation. Two-faced Janus nanoparticles were fabricated to display ligands of different functions in spatially segregated clusters on single nanoparticles. Going beyond our earlier qualitative study, here we precisely quantified and controlled the surface density and the total amount of ligands on single nanoparticles. We show that nanoparticles with clustered ligands activate T cells to a greater level than ones uniformly coated with the same number of ligands. The enhanced effect is due to increased local surface density of ligands. The results demonstrate that the spatial arrangement of ligands on particles influences activation response of T cells and may be used as a new strategy to increase T cell stimulation in the presence of insufficient amount of stimuli. This fundamental study also represents an initial step in using nanoscale Janus particles for manipulating immune cell responses.

Challenges faced by China compared with the US in developing wind power

In the 21st Conference of the Parties held in Paris in December 2015, China pledged to peak its carbon emissions and increase non-fossil energy to 20% by 2030 or earlier. Expanding renewable capacity, especially wind power, is a central strategy to achieve these climate goals. Despite greater capacity for wind installation in China compared to the US (145.1 versus 75.0 GW), less wind electricity is generated in China (186.3 versus 190.9 TWh). Here, we quantify the relative importance of the key factors accounting for the unsatisfactory performance of Chinese wind farms. Different from the results in earlier qualitative studies, we find that the difference in wind resources explains only a small fraction of the present China−US difference in wind power output (−17.9% in 2012); the curtailment of wind power, differences in turbine quality, and delayed connection to the grid are identified as the three primary factors (respectively −49.3%, −50.2%, and −50.3% in 2012). Improvements in both technology choices and the policy environment are critical in addressing these challenges. Several factors, such as wind power curtailment and quality of turbines, cause a reduced capacity of wind energy production in China compared with the US. The authors quantify the relative weight that these factors have in limiting the wind power output in China, and provide policy recommendations.

Factor Analytical Investigation of Krathom (Mitragyna speciosa Korth.) Withdrawal Syndrome in Thailand

ABSTRACTKrathom (Mitragyna speciosa Korth.) is an addictive and illicit substance used in Thailand and other Southeast Asian countries. It has become the most commonly used substance among villagers. The study aimed to explore the factor structure of the krathom withdrawal syndrome based on the findings of an earlier qualitative study. The current study was divided into two stages. Cross-sectional data collections were employed in both phases. The samples comprised, respectively, 196 and 330 krathom users aged over 25 years. The characteristics of krathom withdrawal symptoms and signs were identified and the factor structure examined using exploratory factor analysis (EFA). Confirmatory Factor Analysis (CFA) was used to examine the construct validity and multivariate linear regression was used to identify factors predicting the intensity of krathom withdrawal symptoms. The final scale comprised 20 items with four factors: craving-fatigue syndrome; musculoskeletal system and insomnia; mood symptoms; and autonomic nervous system/physical sickness. Symptoms and signs of krathom withdrawal similar to those of the withdrawal syndrome of opioid substances appear to be present in regular krathom users. The krathom withdrawal intensity is predicted by duration of krathom use, frequency, and daily amount of krathom use.

Pyrolysis of drugs of abuse: a comprehensive review.

This review summarizes the literature to date relating to pyrolysis and heated vapour ingestion of drugs of abuse. In this context, heating is referred to as smoking or pyrolysis, but these are generic descriptors that encompass numerous methods of vapour generation and inhalation. Depending on the amount of drug used, diluents and contaminants present, heating conditions, and the oxidative/reductive environment, many thermal decomposition products can be formed. In addition to the recognized hazard of rapid onset of pharmacological effects of the parent drug, thermal decomposition products may be pharmacologically active as well as acutely/chronically toxic. For example, several published reports have linked heroin smoking to a form of brain encephalopathy and to the development of movement disorders. Early qualitative studies focusing on the thermal decomposition of drugs have evolved into more complex investigations employing mass spectral identification, confirmation, and elucidation of formation mechanism. In most cases, thermal decomposition begins with cleavage of the weakest bond (often C-N) to generate free radicals that then form the most stable sterically favoured products. Several reports of rearrangements at higher temperatures have been identified and hint at an underlying complexity that arises from the variety of smoking methods and conditions. Given that many designer drugs such as synthetic cannabinoids are ingested primarily through smoking, this issue has taken on new importance.

The development and piloting of a leadership questionnaire for general dental practitioners: preliminary results from the North West of England and Tokyo.

Key reforms in England and Japan have called for greater clinical leadership from general dental practitioners to deliver improvements in the quality of care for patients. In England, the reorganisation of the National Health Service has led to the development of Local Professional Networks to ensure services are clinically led, patient and outcome focused. In Japan, the rapidly changing demographics have led to calls for general dental practitioners to become more active in meeting the emerging population health challenges. Both require engagement at a strategic and a local level. However, little is known about what is meant by clinical leadership in dentistry or what training needs exist. The aim of this study was to develop and pilot a questionnaire to understand what general dental practitioners feel is important about clinical leadership and how they rate themselves. A 61-item questionnaire was developed from the literature, an earlier qualitative study and refined through cognitive interviews. Questionnaires were distributed to general dental practitioners across the North West of England and Tokyo, using random sequence generation. For each item, the participant had to record whether they thought the statement was an important component of clinical leadership and how they rated themselves. Both were rated using a seven-point Likert scale. Data reduction was undertaken using principal component analysis to examine for factor loadings within the questionnaire. Differences in mean scores were also used to highlight substantive differences in how general dental practitioners rated the different components of leadership and how they rated themselves. The response rate for the pilot was low (22.9% and 7.5% for North West and Tokyo respectively). The items that were considered to be important in leadership reduced to two components in the North West (accounting for 62.1% of the total variance): 'How to lead' and 'How not to lead'. In Tokyo, 56.4% of the total variance was explained by three components: 'Demonstrating personal qualities', 'Working with others' and 'How not to lead'. When the self-rated items were reduced, three factors were found to be important in the North West: 'Working with others', 'Setting direction' and 'Managing services' (55.1% of the variance). 'Working with others', 'Demonstrating personal qualities', 'Pragmatism', 'Setting direction' and 'Improving services' were found to be important in Tokyo (52.8% of the variance). The questionnaire items relating to integrity, team-working and having a positive attitude during difficult times were rated highly by both groups. Items relating to providing vision for team, being assertive and having a positive attitude had the greatest mean difference, suggesting possible areas of training need. The nature of the pilot study and the poor response rate makes any conclusion difficult to infer. Among those that participated, leadership was understood to be more important at a practice level rather than at a strategic level. The questionnaire should be refined further based on the results of the pilot and the data reduction.

‘They think it's all up to the girls’: gender, risk and responsibility for contraception

Much research suggests that attitudes towards responsibility for use of contraception amongst young people are strongly gendered. However, decision making, if ‘decisions’ happen at all, is bound up with notions of hegemonic masculine and feminine roles as well as factors concerning relationship status. Data from two earlier qualitative studies were re-analysed with an emphasis on findings related to gender and responsibility for use of contraception. The first study investigated unintended conceptions amongst 16–20-year-old women. Interviews focused on knowledge and views about contraception, sex education and sexual health services. The second study involved focus groups with two groups of 14–18-year-old men to explore their views on sex education, sexual health and contraception. Almost all the young women said that young men viewed contraception as ‘not their job’. In contrast, the young men thought that responsibility should be shared. The key issue, however, related to relationship status, with decision-making being shared in long-term relationships. There are some gender differences in accounting for decisions about use of contraception, however the key issue revolves around relationship status.

Recruitment challenges facing elderly care service providers in Hong Kong

The present survey study was conducted to examine the challenges facing the elderly care service industry in Hong Kong. The survey was designed based on a qualitative study conducted earlier and was aiming to examine the recruitment challenges facing Hong Kong's elderly care service providers and their perceptions of the latest elderly policy, ‘Ageing in Place’. The results resonated with an earlier qualitative study, strengthening the findings that recruitment of frontline care workers remained the major difficulty facing many elderly care service providers, and that maintaining a stable frontline care workforce can be done only with an effective preparation of the workforce through adequate education and training, along with a well-structured career prospect and reasonable competitive remuneration. Nevertheless, many elderly service providers supported the concept of ‘Ageing in Place’ and it can only be facilitated with an aged-friendly environment and by promoting the culture of intergenerational harmony in Hong Kong.

Big Cells Cleave as Fast as Small Ones: the Physics of Cytokinesis

Big Cells Cleave as Fast as Small Ones: the Physics of Cytokinesis

Interpretation in Cross-Language Research: Tongues-Tied in the Health Care Interview?

Medication prescribing and use is a normative aspect of health care for the elderly, rendering medication taking by elderly persons problematic. In an earlier qualitative study, we examined how medicine-use is negotiated (used/refused/resisted, and assessed against expected outcomes) by older persons with limited fluency in English-the main language of health care in the study setting. In the present article, we describe a reflexive methodological review of that study's design, with a particular focus placed on interpreter-mediated data collection. We illustrate that what was heard in open-ended interviews (what became data) was influenced by not only what was asked and how, but also by how the interpreter 'heard' and conveyed dialogue to and from study participants. We illustrate differing accounts of the dialogue between an interviewer and participant provided via real-time interpretation and through a reflexive re-interpretation of talk-to-text transcripts, reflecting the different stakes in the research, and different capital available to study- and review-interpreters. Implications for research design and practice of cross-cultural and cross-language research are highlighted.

Contemporary chiropractic practice in the UK: a field study of a chiropractor and his patients in a suburban chiropractic clinic

BackgroundTwo recent surveys of chiropractors in Great Britain suggest that there are discrepancies between chiropractic practice as defined in regulatory guidelines and day-to-day chiropractic clinical practice and there is in general a paucity of information regarding the characteristics of contemporary chiropractic practice in the United Kingdom. This field study describes the daily practice of a contemporary British UK-trained chiropractor.MethodsThe fieldwork took place during the spring and summer of 2008 when the author spent one day per week observing consultations and interviewing patients in a chiropractic clinic. The chiropractor was subjected to interviews on two occasions. The author also registered as a patient. Field notes were taken by the author, interviews were recorded and the transcripts were corrected and analysed by the author.ResultsA total of 25 patients took part in the study. The interaction that took place between patients and staff in reception could be considered as a prelude to consultation facilitating the transformation from individual to patient and back to individual. Coupled with the continuous physical contact between the chiropractor and each patient there was a substantial amount of verbal and non-verbal communication throughout treatment visits. The patients presented with predominantly musculo-skeletal pain and the majority had consulted the chiropractor as a result of recommendations from others in their close social environment. The majority of the interviewed patients had either an inaccurate or at best rudimentary understanding of the mechanisms of chiropractic treatment. A few of the interviewed patients indicated that they had at first experienced concerns about the nature of chiropractic treatment or getting undressed. The author was able to gain some insight into how the chiropractor's experiences, opinions and beliefs had shaped his approach to chiropractic treatment and how this formed the basis of his clinical modus operandi.ConclusionAlthough no robust conclusions should be drawn from this small scale field study it does show that the clinical chiropractic practice as carried out by this UK trained British chiropractor contains a number of elements described in earlier qualitative studies in the United States, Canada, and Australia.

Empowerment of Senior Citizens via the Learning of Information and Communication Technology

Most East Asian countries have policies to promote digital inclusion, especially among the children of low-income families and persons with disabilities, for the purposes of social development. However, such efforts and their impact among older people have been rather limited. In Hong Kong, only 7 % of those aged 65 or above were Internet users in 2008, compared with 66.7 % of the general public. Providing computer and Internet training programmes to older people is thus crucial in promoting digital inclusion. This paper discusses the experience and results of training older people to use both a computer and the Internet. Based on findings from an earlier qualitative study, we hypothesise that acquiring knowledge of computers and Internet use will have an empowering effect for older people in terms of increasing self-efficacy and enhancing communication with friends and family members. This paper presents two studies of such empowerment among older people in two non-governmental organisations (NGOs). While older people with little computer knowledge showed some effects of empowerment, at the same time, they also became more aware of the marginalisation and exclusion effects of their limited knowledge of computer and Internet usage. However, among users with some prior experience of using a computer, further training failed to show additional positive empowerment results. The results of the two studies call for a re-examination of the training process and experience of older people as well as integration of such training with other strategies to achieve better results in promoting their social inclusion in the information society.

Big boys don't cry: male secondary school students' attitudes to depression.

In an earlier qualitative study we explored the attitudes of young men aged 15-19 (Group A) to mental health and, in particular, to engaging with the various mental health services available. We found that the participants perceived stigma in connection with mental ill health and they displayed particularly strong negative attitudes in relation to both doctors and medication. The investigation was then repeated with students who had been given a short (less than two-hour) programme called 'Beat the Blues' (BTB) about mental health (Group B) in order to assess the effect of that exposure by comparing the attitudes of the two groups of students. This present phase of the analysis is a quantitative examination of the written responses by both Groups A and B to an administered questionnaire. A total of 42 young men took part in eight focus groups held in boys-only Dublin secondary schools, described in Burke et al. A questionnaire, administered to each participant, examined the students' attitudes to depression and mental illness. The results were analysed by computer using SPSS to search for any trends and any contrasts between groups A and B and among the different socio-economic groups (SEGs) within the sample. Almost no statistically significant differences were found between groups A and B. However, some differences were found among the SEGs. In particular, very significant differences (p < 0.01 in each case), were found in attitudes towards depression, with increasing support for statements such as "People with depression just need to snap out of it", "Drinking alcohol can help cure depression" and "Depression is only an excuse for laziness" found among the lower SEGs. A very high percentage of students indicated their desire to talk to someone in times of personal stress; this was almost always their best friend or their mother. However, most students said they would be uncomfortable if a friend raised such a topic. The main conclusion - that a single exposure to a positive programme about depression produces little or no effect - is hardly unexpected. Nonetheless, there are indications of a great willingness among older secondary students to learn about and discuss mental health issues. Furthermore, the highly negative attitudes among students from the lowest socio-economic group in this study would seem to indicate that the greatest need for education about mental health lies with working-class adolescents. Hence, it is recommended that a programme of multiple interventions be introduced into the senior cycle of secondary education.

Understanding Patients' Experiences of Treatment Burden in Chronic Heart Failure Using Normalization Process Theory

Our goal was to assess the burden associated with treatment among patients living with chronic heart failure and to determine whether Normalization Process Theory (NPT) is a useful framework to help describe the components of treatment burden in these patients. We performed a secondary analysis of qualitative interview data, using framework analysis, informed by NPT, to determine the components of patient "work." Participants were 47 patients with chronic heart failure managed in primary care in the United Kingdom who had participated in an earlier qualitative study about living with this condition. We identified and examined data that fell outside of the coding frame to determine if important concepts or ideas were being missed by using the chosen theoretical framework. We were able to identify and describe components of treatment burden as distinct from illness burden using the framework. Treatment burden in chronic heart failure includes the work of developing an understanding of treatments, interacting with others to organize care, attending appointments, taking medications, enacting lifestyle measures, and appraising treatments. Factors that patients reported as increasing treatment burden included too many medications and appointments, barriers to accessing services, fragmented and poorly organized care, lack of continuity, and inadequate communication between health professionals. Patient "work" that fell outside of the coding frame was exclusively emotional or spiritual in nature. We identified core components of treatment burden as reported by patients with chronic heart failure. The findings suggest that NPT is a theoretical framework that facilitates understanding of experiences of health care work at the individual, as well as the organizational, level. Although further exploration and patient endorsement are necessary, our findings lay the foundation for a new target for treatment and quality improvement efforts toward patient-centered care.

Estimating the National Impact of the Financial Crisis in Indonesia by Combining a Rapid Qualitative Study with Nationally Representative Surveys

SummaryThis paper draws on a rapid qualitative assessment of the impact of the financial crisis in Indonesia, to generate hypotheses about the potential national impacts. We test these hypotheses using nationally representative labour force surveys from before and after the onset of the financial crisis. We find that Indonesia weathered the storm rather well: there is no evidence for increased school dropout; labour force participation fell, particularly for young workers, whilst unemployment rose for the young, but fell for workers over 25. The changes for female workers were the same as those for male workers and there do not appear to have been any major sectoral shifts in labour. Surprisingly, we find that real wages for employees rose significantly during the crisis period, although those in the informal sector did not benefit to the same extent. Our results are similar to those from the earlier qualitative study, except that, because it focused on areas harder hit by the crisis, the qualitative study did not observe the significant gains made by employees over the crisis period.

Slowing Down to Stay Out of Trouble in the Operating Room: Remaining Attentive in Automaticity

Automaticity is integral to expert performance, but experts must be able to transition from an automatic mode into a more effortful state when required. In this study, the authors identified and characterized the manifestations of the phenomenon of "slowing down when you should" to stay out of trouble in operative practice. The authors interviewed 28 surgeons (60-minute, semistructured format) from various specialties at four academic medical centers and observed 5 hepatopancreatobiliary surgeons in the operating room (29 cases, 147 hours) during 2007-2009. Using a grounded theory qualitative methodology, they conducted a thematic analysis of transcripts and field notes in an iterative manner. Data collection continued until saturation. They adopted a reflexive approach throughout. Surgeons described and the authors observed four phenomenological manifestations of the transition to a more effortful state. In the most extreme manifestation, "stopping," surgeons actually stopped the procedure, whereas in the most subtle manifestation, "fine-tuning," surgeons were able to continue the procedure and focus on minor events simultaneously. A separate phenomenon of "drifting" represented surgeons' failure to transition out of the automatic mode when appropriate, resulting in surgical errors or near misses. The manifestations of the slowing down phenomenon represent acts of cognitive refocusing during the potentially more-critical moments of operative practice. Further, the authors challenge the conception of automaticity as effortless, arguing that automatic behavior can be attentive (fine-tuning) as well as inattentive (drifting).

A curriculum design and instructional development proposal for an intelligence studies program

This article presents a prescriptive curriculum design for a new Bachelors of Arts program in Intelligence Studies. Commencing from an earlier qualitative and quantitative empirical study that conducted and analyzed an extensive assessment of the discipline subject content, this work offers detailed recommendations for curriculum, instruction, assessment, and program evaluation aspects of this Intelligence Studies program. Likewise, this paper features course descriptions, recommended textbooks and other requirements for this course of study. Reflecting on this effort to establish an Intelligence Studies program, this research asserts a significant program of study and provides a rich proposal for those seeking to inaugurate or refine a similar effort. Key words: Intelligence studies, program development, curriculum and instruction design, international studies, and security studies.

Health professionals, patients and chronic illness policy: a qualitative study.

This study investigates health professionals' reactions to patients' perceptions of health issues - a little-researched topic vital to the reform of the care of chronic illness. Focus groups were undertaken with doctors, nurses, allied health staff and pharmacists (n = 88) in two Australian urban regions. The focus groups explored responses to patient experiences of chronic illness (COPD, Diabetes, CHF) obtained in an earlier qualitative study. Content analysis was undertaken of the transcripts assisted by NVivo7 software. Health professionals and patients agreed on general themes: that competing demands in self-management, financial pressure and co-morbidity were problems for people with chronic illness. However where patients and carers focused on their personal challenges, health professionals often saw the patient experience as a series of failures relating to compliance or service fragmentation. Some saw this as a result of individual shortcomings. Most identified structural and attitudinal issues. All saw the prime solution as additional resources for their own activities. Fee for service providers (mainly doctors) sought increased remuneration; salaried professionals (mainly nurses and allied health professionals) sought to increase capacity within their professional group. Professionals focus on their own resources and the behaviour of other professionals to improve management of chronic illness. They did not factor information from patient experience into their views about systems improvement. This inability to identify solutions beyond their professional sphere highlights the limitations of an over-reliance on the perspectives of health professionals. The views of patients and carers must find a stronger voice in health policy.