Interpretive Description Method Research Articles

Maintaining ordinariness around food: partners’ experiences of everyday life with a dying person

To explore partners' experiences of everyday life in caring for a dying person with eating deficiencies at home. When a dying person receives care at home, eating deficiencies can influence everyday life for family members, who often take responsibility for the provision of food and meals. The literature reveals this to be emotionally stressful. Partners of dying persons are challenged both as caregivers and as partners who will soon lose their life companion. There is a need for studies that provide enhanced understanding about the influence of dying persons' eating deficiencies on their partners, from the perspective of everyday life. A qualitative design was chosen to obtain experience-based knowledge of relevance for the clinical context of palliative home care. Nine people were purposefully selected and interviewed three-six months after the death of their partner. Data collection and analysis were guided by an interpretive descriptive method. The partners described experiences of how eating deficiencies brought about changes in the participants' everyday lives. Two patterns of experiences were identified: the challenge of doing the best for their dying partner around matters involving food and mealtimes, and experiences of striving to maintain ordinariness, including holding on to social values around food, despite experiences of unfamiliarity when the dying partners' habits were changed. Living close to a person who has eating deficiencies at the end of life is challenging, both from a caring perspective and for personal well-being. The findings can assist palliative home care teams and other healthcare professionals to give support that goes beyond giving practical advice about food. Initiating talk about the current situation around food and meals at home, by posing questions and opening the way for conversations, is suggested.

Cultural Identity in Everyday Interactions at Work: Highly Skilled Female Russian Professionals in Finland

The dominant research strands into social interaction in culturally diverse workplaces have focused on issues of organizational efficiency and discrimination, and they have treated cultural identity as static, monolithic, and universally shared. This study aims to problematize this view. It is argued that our understanding of cultural workplace diversity could be extended through the integration of interpretive and critical interpersonal communication theorizing on cultural identity as dynamic and processual, constructed between and among people in everyday workplace interactions and in relation to larger social, political, and historical forces. This argument is illustrated by an analysis of in-depth interviews with 10 female Russian immigrants in Finland who performed interactionintense knowledge work. The women talked about their everyday workplace interactions and how they thought Russian identity mattered in them. These data were analyzed with the inductive method of interpretive description designed to provide a systematic description of the phenomenon delineating its characteristic themes and accounting for individual variations within it. The analysis led to the identification of four communication sites for distinct formations of Russian identity: expressing professionalism, managing initial encounters, facing stigma, and facilitating intercultural learning. The findings offer novel insights into social interaction in culturally diverse workplaces with implications for both employee well-being and organizational processes.

Protocol for a qualitative study on promoting dietary change and positive food choices for poor people with low income who experience cardiovascular disease in Pakistan

IntroductionThere is a misconception that cardiovascular disease (CVD) is the burden of wealthy nations, but, in fact, it is the leading cause of death and disability-adjusted life worldwide. Healthy diets...

Students’ experience of prison health education during medical school

Background: Social responsibility and accountability can be important core values in medical education. At the University of British Columbia, undergraduate medical students engage in prison health community service-learning opportunities in regional correctional facilities.Methods: To describe the impact of prison health exposure on pre-clinical medical students, in-depth individual interviews were conducted with individuals who had participated in a prison health medical education program. All interviews were transcribed verbatim, and interpretive descriptive methods were used to inductively derive thematic findings to describe students’ experiences.Results: Major themes emerged as students reported how (1) exposure to incarcerated populations increases students’ insight into issues that diverse marginalized sub-populations encounter; (2) positive interactions with the incarcerated individuals enhances relationship building; (3) collaboration reinforces teamwork skills and (4) community placements garner important learning opportunities within the medical school curriculum.Conclusions: Our findings demonstrated that pre-clinical exposure to incarcerated individuals and prison health education provided a unique setting for medical students to develop an increased sense of social responsibility and accountability.

Abstract A46: Exploration of women's experiences with triple-negative breast cancer.

Abstract Background/Significance: Triple negative breast cancer (TNBC) is a breast cancer sub-type that disproportionally affects African American and premenopausal women. TNBC lacks receptors for estrogen, progesterone, and human epidermal growth factor, thus limiting treatment options. Despite the lack of standard guidelines, women diagnosed with TNBC typically receive surgery, chemotherapy, and/or radiation. There is a high recurrence rate and poor prognosis associated with a TNBC diagnosis. There are no known studies which describe the psychosocial concerns of women with TNBC and how they cope with the diagnosis and treatment. Purpose: The aim of the study is to understand the experiences of women diagnosed with TNBC to establish a foundation for interventions to improve health outcomes. Methods: A qualitative research approach using an interpretive descriptive method was selected to describe the experience of women with TNBC. A purposive sampling strategy will be used to identify the target population. Participants are being recruited through local breast cancer support groups, a metropolitan hospital cancer center, and community oncology practices. Qualitative data will be collected using semi-structured interviews. Data will be analyzed through an iterative process of repeated immersion and a constant comparative method. Verbatim transcriptions of tape recorded interviews will be reviewed with the use of a data management program, ATLAS.ti. Common themes and individual meaning will be extracted. Data collection will continue until theoretical saturation, which is generally achieved with 20-30 participants. Additional data sources include field notes, memos, and observations which will contribute to the interpretation of the data. To date, eight participants have been recruited and interviewed. There are one Asian, two African American, and five Non-Hispanic white women between the ages of 44 and 68 years old with three women holding high school diplomas and five graduate degrees as the highest level of education achieved. Findings: The average interview was 75 minutes. Preliminary findings indicate that women have different levels of understanding of TNBC and its treatment. Some appear well informed of the prognostic implications and limitations of therapeutic options, while others are less knowledgeable. The amount of understanding affects adherence to follow up recommendations. Some women reported coping by distracting themselves, some dwelt on their fears, others integrated their experiences into their lives. How women cope with fears, feelings of uncertainty and their needs in managing as TNBC survivors will continue to be explored with additional participants. Conclusions: This study will offer insight into women with TNBC and identify if their needs and coping are unique compared to women with other types of breast cancer. The findings will provide guidance for clinicians and direct future research. Citation Format: Yasemin Turkman, M. Tish Knobf, Holly Powell Kennedy, Lyndsay N. Harris. Exploration of women's experiences with triple-negative breast cancer. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A46.

Issues contributing to non-attendance for chronic illness care for hepatitis C

Purpose: To identify and describe the personal and systems factors related to not seeking, delaying or deferring chronic illness care for hepatitis C. Theory: A multi-level ecological theory guided the analysis, organization and interpretation of findings. Methods: This qualitative study, nested within a larger exploration and intervention study, used an interpretive descriptive method. Data were collected through a demographic questionnaire and open-ended individual and focus group interviews which were transcribed, coded and subjected to thematic analysis. Results and conclusions: Data were obtained from 4 focus groups, attended by 29 health and social service providers, and 55 interviews with affected individuals (55% male) from five Canadian provinces. Issues contributing to non-attendance were identified at multiple levels: personal, interpersonal, provider-system and structural. Key themes contributing to non-attendance were previous negative experience, provider and/or client disease knowledge and communication, stigma, restrictive policies, treatment eligibility criteria, personal priorities, poverty and unstable lifestyles.

Tanzanian Nurses Understanding and Practice of Spiritual Care

Spirituality, as a basic characteristic of humans and a contributor to human health, is regarded as part of nursing practice. The purpose of this study was to examine how Tanzanian nurses understand spirituality and spiritual care. Using the qualitative method of interpretive description, fifteen registered nurses engaged in clinical practice in a Tanzanian hospital were recruited to participate in this study. In-depth interviews using open-ended questions were carried out, tape-recorded, and transcribed verbatim. Data collection and inductive analysis occurred concurrently. In this paper, key findings are grouped under the following headings: meaning of spiritual care, recognition of spiritual needs, and interventions to respond to spiritual needs. Although there were some differences, overall participants' understanding of spirituality and spiritual care was similar to what is found in the literature about nurses in other countries. The provision of spiritual care also included some unique elements that may reflect the African context.

Self-Management and Transitions in Women With Advanced Breast Cancer

Context Self-management involves behaviors that individuals perform to handle health conditions. Self-management may be particularly challenging during transitions—shifts from one life phase or status to another, for example, from cure- to noncure-oriented care—because they can be disruptive and stressful. Little is known about individuals' experiences with self-management, especially during transitions. Objectives Our purpose was to describe experiences of self-management in the context of transitions among women with advanced breast cancer. Methods We interviewed a purposive sample of 15 women with metastatic breast cancer about their self-management preferences, practices, and experiences, including how they managed transitions. Interviews were recorded and transcribed. The qualitative method of interpretive description was used to code and analyze the data. Results Participants' mean age was 52 years (range 37–91 years); most were White (80%), married (80%), and college educated (60%). Self-management practices related to womens' health and to communication with loved ones and providers. Participants expressed a range of preferences for participation in self-management. Self-management included developing skills, becoming empowered, and creating supportive networks. Barriers to self-management included symptom distress, difficulty obtaining information, and lack of knowledge about the cancer trajectory. Women identified transitions as shifts in physical, emotional, and social well-being, as when their cancer progressed and there was a need to change therapy. Transitions often prompted changes in how actively women self-managed and were experienced as positive, negative, and neutral. Conclusion Self-management preferences can vary. Providers should explore and revisit patients' preferences and ability to self-manage over time, particularly during transitions.

The Experience of Planned Home Birth: Views of the First 500 Women

Home birth remains a contentious issue in North America. Professional regulatory bodies are in conflict about the safety of home birth as an option for healthy women. The voices of women have largely been ignored in this debate. The purpose of this study is to report on the experiences of 559 women who had a planned home birth over a 2-year period in British Columbia, Canada. We asked all women in the Province of British Columbia who had planned for their birth to be at home with a regulated midwife in attendance to answer an open-ended question about positive and negative aspects of their birth. The qualitative method of interpretive description was used to understand what women believed to be the essence of their experience. Women felt strongly positive about their trust in their midwife's skill and knowledge, a sense of emotional support and empowerment attained through their relationship with the midwife, perceptions of relaxation in their own home, being informed and included in the planning of their care, and the amount of time the midwife spent with their family. They believed that the confidence arising from their intense preparation and partnership with their midwives permitted them to choreograph their birth experience to a degree that would not be possible in a formal setting. Women who planned a home birth with a registered midwife in British Columbia were overwhelmingly positive about their experience. Our qualitative report underscores the value women place on having the choice to give birth at home.

Iraqi Expatriates’ Experience of North American Media Coverage of the Iraq War

The extensive North American (NA) media coverage of the recent conflict in Iraq invites the question of how adult Iraqi immigrants have experienced such coverage. This qualitative investigation, involving Iraqi immigrants in Vancouver, Canada, used an interpretive description method (Thorne et al., Int J Qual Methods 3(1):1–21, 2004) to analyze ten participant interviews using Miles and Huberman’s (1994) analytic framework. Eleven themes emerged that identified the participants’ perceptions of the NA media war coverage, and the initial and ongoing impact of being exposed to it. Implications for counseling are considered.

Situated/being situated: Client and co-worker roles of family caregivers in hospice palliative care

Since the inception of the modern hospice movement, the patient and family caregiver (FCG) have been considered the unit of care; family members are identified as ‘clients’ within palliative care philosophy. Little research has focused on how FCGs define their roles within the hospice palliative care (HPC) system. The aim of this study was to describe how FCGs of dying cancer patients view their roles in relation to the HPC system. Secondary analysis of interviews with 36 bereaved FCGs in Western Canada, guided by interpretive descriptive methods, found that FCGs perceived themselves as having two roles: client and co-worker. FCGs situated themselves as clients, where they actively sought help from the health care system. FCGs at times also perceived they had been situated as clients by health care providers, and were more resistant to accepting help. In other comments FCGs situated themselves as co-workers, seeking out an active role within the HPC team, whereas in other instances, felt they were situated as co-workers by a health care system with limited financial and human resources. Findings suggest that greater emphasis be placed on helping family members identify suitable interventions depending on how they view their roles within the HPC system. How we define family members in relation to the HPC system may also require reconsideration to reflect a more current conceptualization of realities in end-of-life care.

The Strength of Rural Nursing: Implications for Undergraduate Nursing Education

Nursing in rural communities offers opportunities for independent nursing practice and community participation. However, recruitment of nurses to rural settings can be difficult. In response to this challenge and the rising demand within nursing education for community clinical placements, intensive, short-term, rural community clinical placements are being developed by urban universities. As yet, little research has examined the use of these placements for undergraduate nursing education. The purpose of this qualitative research study was to examine the experiences of students, registered nurse mentors, and clinical instructors in rural health clinical placements, as part of a larger study examining alternative clinical placements. Through use of the interpretive descriptive method, the perspectives of participants were elicited from focus groups and interviews. The paradox of nursing student placements in rural health is that limitations of the rural site became the impetus for nursing student learning and partnership. An implication is that service learning partnerships be pursued for mutual benefit of students, communities, and rural nurses.

Non-residential fathers and their support needs

This study, undertaken for the qualification of BSW(Hons), explored the nature of supports used by non-residential fathers after separating from their children. It was designed to address the perspectives of men who were separated from their children and to explore the supports they used to cope with this separation experience. It acknowledges the complexity and changing nature of the fathering role in Australia today.Data was obtained from semi-structured interviews with men who were encouraged to share experiences in relation to their roles as non-residential fathers. An interpretive perspective and descriptive method used in the design allowed for a deeper understanding of what men experience when separated from their children.The findings demonstrated that the nature and use of supports employed by fathers related to how they experienced separation and managed relationships and contacts with their children. Men used a range of informal and formal supports to manage the often difficult post-separation period and maintain relationships with their children. These findings have implications for social work practice, particularly for understanding the support needs of men when separating from their children. It points also to the need for an increased emphasis on the importance of supports for non-residential fathers.

The Experience of Waiting for Diagnosis After an Abnormal Mammogram.

In order to better understand the experience of women following abnormal screening mammogram and before definitive diagnosis, we undertook a series of focus group interviews in six geographic areas in the province of British Columbia, Canada. While all 33 participants had experienced abnormal mammograms within the previous year, each group included women with a range of ages and diagnostic outcomes. Verbatim transcripts of all focus groups were subjected to qualitative secondary analysis using interpretive descriptive methods. Through a process of grounded inductive analysis, conceptual themes within the data were identified and tested. The findings of this study provide an experiential account of common patterns within the structure and process of waiting for diagnosis. The accounts depict the way the women experienced time, their individual and common responses to waiting, and the impact of health system factors, including provider communication. These findings confirm that, regardless of its outcome, waiting for definitive diagnosis after an abnormal screening mammogram is an intense and often agonizing experience for the women involved and for their families. Furthermore, our results highlight the relevance of such issues as information systems, support, coordination of services, and health care communication, and underscore the important role that service delivery factors can play in making such experiences bearable.

Primary osteoarthritis of the elbow.

Sixteen patients (14 male, two female; mean age 61, range 49-75 years) with elbow osteoarthritis (OA) unassociated with nodal or crystal related OA were studied. None had received obvious trauma. The dominant elbow was affected in 14, the other in 12 (mean symptom onset in these 26 elbows 53 years (range 31-63), mean symptom duration 7 year (range 1-20]. Joint fluids (six patients) were non-inflammatory: biopsy (two) showed non-specific synovitis. Radiographic changes occurred in humeroulnar (25/26, 96%), humeroradial (100%), and radioulnar (22/26, 85%) compartments: uniform narrowing with hypertrophic change predominated and osseous bodies were common (18/26, 69%). Thirteen had OA elsewhere, notably 2nd/3rd metacarpophalangeal joints (10/16, 62%), knees (6/16, 38%), and hips (5/16, 31%). A good clinical outcome was observed in 22/26 elbows. In our experience symptomatic 'primary' OA of the elbow particularly affects middle aged men, commonly associate with metacarpophalangeal OA ('Missouri metacarpal syndrome'), and has a favourable outcome. Contrary to previous reports a major role for trauma is difficult to substantiate.