COPD stories of complex causal 'truths' 'Sure I've smoked all my life/but I also put in 37 years at the mine'.

AIMS AND OBJECTIVES: Secondary analysis was conducted to interpret the causes of illness stories told by patients living with chronic obstructive pulmonary disease. BACKGROUND: Despite the abundance of quantitative evidence regarding the causal relationship between smoking and chronic obstructive pulmonary disease, there is limited research that provides a contextual emic understanding of chronic obstructive pulmonary disease aetiology. DESIGN: Interview data from two earlier focused ethnography studies were examined by retrospective interpretation, a type of secondary qualitative research. Chronic obstructive pulmonary disease causation stories were identified in both primary study data bases, but were not previously systematically examined. METHODS: The analysis was completed using an eclectic, explicit narrative approach that involved the examination of causation story elements. RESULTS: Participants told 104 causal stories about the development of their lung disease. They situated the aetiology of their chronic illness within a psychosocial reality. CONCLUSIONS: The causal stories told by participants demonstrate that those living with chronic obstructive pulmonary disease present a broader causal explanation for their illness, an orientation not commonly presented in the literature. They demonstrate the need for further examination of the important lay accounts of causes of illness in relation to chronic obstructive pulmonary disease. RELEVANCE TO CLINICAL PRACTICE: Clinicians' ability to hear an alternative understanding may be impeded when they only listen for what they already know, 'facts' concerning the relationship between smoking and chronic obstructive pulmonary disease. Addressing vulnerable persons in such a manner may impede patients' efforts to be responsible for the development of their chronic illness and individualised care.

Representations of disability in nursing and healthcare literature: an integrative review.

AIM: This paper is a report of an integrative review to explore the way in which disability has been considered in the multidisciplinary health and nursing literature. BACKGROUND: In the multidisciplinary health and nursing literature, two ways are presented in which disability can be understood: the traditional, functional perspective and a more contemporary, social perspective. DATA SOURCES: Computerized databases of the CINAHL, Proquest Nursing and Allied Health Sources, EBSCO and Evidence Based Medicine Reviews Multifile and Cochrane databases were conducted for papers published in English in the period 1963-2007 using the keywords 'models of disability', 'disability and nursing research' and 'theories of disability'. METHODS: An integrative review was performed and, of the 11,578 papers identified, 65 were included. RESULTS: The concept of functional disability refers to an individual who is physically 'disabled' and unable to perform expected roles. The concepts of social stigmatization and normalcy are associated with functional disability. In contrast, social disability concerns functional limitations within an individual's experience of living with disability, examining how socially constructed barriers actually 'disable' people. Conventionally, disability research has been conducted from an etic perspective. Researchers contend that a shift towards an understanding from the emic perspective is needed for disability research to be emancipatory. CONCLUSION: Adoption of a social perspective is necessary to inform an understanding of disability that addresses stigmatization and oppression. Research-informed nursing practice, complemented by supportive health and social policies, could transform the experience of living with disability.