Transient ischaemic attack: a qualitative study of the long term consequences for patients.

BACKGROUND: Transient ischaemic attack (TIA) is characterised by its transient nature with symptoms of neurological dysfunction resolving within 24 hours. The occurrence of TIA is a major risk factor for stroke with 10-15% of TIA patients going on to have ischaemic stroke. Internationally, recommendations for the management of TIA focus on the need for early diagnosis and medical management of the acute increased risk of ischaemic stroke. However there is a limited amount of evidence that some patients suffer enduring consequences as a result of this 'transient' event. This paper focusses on patients' long term lived experience following a TIA. METHODS: Semi structured interviews were carried out with patients who had a TIA between two and 24 months previously. Participants were asked about their TIA, the advice and management received and any changes made as a result of the TIA. Interviews were recorded and transcribed verbatim. Thematic content analysis involved scrutinising transcripts to look for links and associations within and between accounts in a process similar to the grounded theory approach of open coding. The category of transience emerged and was explored in more detail to examine the enduring consequences of TIA. RESULTS: Thirty nine patients aged between 31 and 89 years were interviewed. Accounts detailed the long term impact of the TIA and the subsequent 'at risk' status, on the physical and psychosocial wellbeing of participants. Some participants sought to proactively manage the consequences of their TIA but found it difficult to obtain the information and support they needed, whereas others felt that no further action was needed to prevent future stroke. CONCLUSION: Current definitions conceptualise TIA as a transient event however our study suggests that some patients experienced long term consequences as a result of their TIA. These included anxiety and uncertainty in the light of their increased stroke risk. TIA patients need access to detailed, evidence based stroke prevention information from a credible source, and support to help them understand and apply the information over time, if they are to effectively self-manage the long term consequences of TIA and reduce their risk of future stroke.

The care needs of Pakistani families caring for disabled children: how relevant is cultural competence?

OBJECTIVE: To identify factors that Pakistani parents living in the UK and caring for children with learning disabilities felt were important components of their care and to discuss the relevance of the concept of cultural competence in the light of these findings. DESIGN: A qualitative study taking a constructivist approach to gain insight into participants' experiences of health care provision. In depth interviews were used to explore the ways in which personal understandings and life experiences shaped the characteristics of the therapeutic encounter that participants identified as important. Data were analysed thematically. SETTING: A Northern city in England. Interviews took place in participant's homes or work places. PARTICIPANTS: Eleven Pakistani parents and one grandparent from nine different families, all caring for children with learning disabilities. FINDINGS: The study identified features of the therapeutic encounter that were important to Pakistani parents and highlighted that there is nothing to suggest that these are different to those of the majority population. CONCLUSIONS: The utility of the concept of cultural competence may be limited where it depends on concepts of ethnic groups as relatively fixed cultural groups with distinct and clearly defined sets of health beliefs and behaviours. Physiotherapists cannot prejudge health status and behaviours from an individual's ethnic status. Instead there is a need to actively seek the understandings that are relevant to practice. In addition health service providers must develop and operate systems that ensure access, use and quality of care are the same at the point of delivery regardless of patient ethnicity.

Evaluating standards in cross-language research: a critique of Squires' criteria.

Innovative methods to conduct cross-language research continue to evolve. There is a need to evaluate the processes involved in cross-language research to assess the extent to which they are fit for purpose from an epistemological point of view, and the subsequent impact on quality of resultant findings. Debate continues about the application of evaluative criteria to qualitative research, not least because of the multiplicity of worldviews and perspectives associated with different qualitative research paradigms. In this article we use two of the authors' studies to discuss how we assess whether methodologies underpinning cross-language research and the choice of methods used are 'fit for purpose'. We use Squires' (2009) 14 criteria to evaluate cross-language nursing and health sciences research based around conceptual equivalence, translator credentials, translator role/competence and study methods, and consider their value as an heuristic or a guide to encourage reflexivity and fuller accounting of the justifications for the approaches taken.