Functional status from the patient's perspective: the challenge of preserving personal integrity.

The purpose of this naturalistic, qualitative study was to describe the meaning of functional performance from the perspective of patients themselves. Twelve men and women with moderate to severe chronic obstructive pulmonary disease (COPD) participated in unstructured, tape-recorded interviews. The essential structure of the experience of finding purpose and meaning through activity was derived through an adaptation of Colaizzi's phenomenological method and the consensus dialogue approach to concept clarification. Results suggest people who are ill face an ongoing challenge of preserving their personal integrity, defined as a satisfying sense of wholeness, as they encounter a variety of physical changes that can interfere with day-to-day activity. Qualities most salient to integrity are a sense of effectiveness, or "being able," and of connectedness, or "being with." Identifying personal integrity as a motivating and explanatory factor in day-to-day activity performance may be an important consideration in designing effective intervention programs to improve capacity, strengthen performance, and enhance quality of life.

Research triangulation to derive meaning-based quality-of-life theory: adolescent resilience model and instrument development.

We describe the triangulation of qualitative and quantitative research methods used to develop and test the Adolescent Resilience Model (ARM). The differences in meaning-based and function-based health-related quality of life (HRQL) are discussed, and method triangulation is presented as a means of developing models of HRQL that represent the perspectives of the adolescent and family. Qualitative methods of phenomenology, simultaneous concept analysis, focus groups and thematic analysis were used to generate the ARM. Quantitative instrumentation and structural equation model development and testing were used to evaluate the ARM. A decision-making process for combining qualitative and quantitative research, so that both approaches are equally valued and used, is also presented. Int. J. Cancer Suppl. 12:125-131, 1999.

Functional performance in people with chronic obstructive pulmonary disease: a qualitative analysis.

The variation of functional performance seen in people with chronic obstructive pulmonary disease (COPD) is perplexing. Some patients appear to do well in their day-to-day activities, while others, with the same apparent disease severity, have difficulty. This naturalistic inquiry sought to describe functional performance from the perspective of 12 people with COPD. Thematic analysis was used to identify activities in which these men and women were engaged and the way they perceived activities, symptoms, and treatments within the context of their daily lives. Decisions to perform activities were influenced by a sense of deriving satisfaction, weighed against the discomfort that might occur. Intruders and enablers influenced activity performance. The results of this study provide a useful framework for assessing functional performance and developing interventions that are sensitive to patient values and expectations and that have a greater likelihood of improving life quality.

Experiences of completing cancer therapy: children's perspectives.

PURPOSE/OBJECTIVES: To explore the child's perspective of experiencing completion of cancer treatment. DESIGN: Descriptive, phenomenologic. SETTING: A pediatric hematology/oncology clinic in the southwestern United States. SAMPLE: Seven children ages 5 to 18 who have completed cancer therapy within the past year and who were in remission. METHODS: Open-ended, audiotaped interviews were conducted in a quiet setting away from the hospital. Interview data were transcribed and analyzed using Colaizzi's eight-step procedure. MAIN RESEARCH VARIABLES: Child's description of the experience of completing treatment for cancer. FINDINGS: Six theme categories were identified from the data: a gradual realization of normal; hierarchical and cyclical recurrence fears; completion embedded in the cancer experience; seeking a new normal; modifying relationships; and resolution and moving on. The themes were developed into an essential structure that indicated that the experience of completing cancer treatment has two faces--one of celebration and hope and one of uncertainty and fear. CONCLUSIONS: Children completing cancer treatment experience numerous changes. With the assistance of healthcare providers, family, and friends, they can begin to move beyond the immediate cancer experience. Yet, fears and concerns remain for an extended time and must be addressed actively. IMPLICATIONS FOR NURSING PRACTICE: Study findings provide an awareness of current practices administered around the time of completion and are meant to precipitate dialog with children and families to improve follow-up care for childhood survivors.

Simultaneous concept analysis of spiritual perspective, hope, acceptance and self-transcendence.

This paper seeks to clarify four previously elusive concepts of concern to nurses: spiritual perspective, hope, acceptance and self-transcendence. Simultaneous concept analysis (SCA), a method developed by the authors, was used to generate a process model of antecedents, critical attributes and outcomes of all four concepts. This resulted in refined theoretical definitions for each concept. Interrelationships that became apparent among the concepts are discussed and implications of these interrelationships for theory and measurement are presented.

At the time of death: help for the child's parents.

A qualitative study was done to determine actions by health care personnel perceived as helpful and unhelpful to parents at the time of their child's death. A semistructured interview with 14 parents was conducted and data were classified according to existing or emerging themes: informing of the death, viewing the body, consent for autopsy, siblings, effects of health care personnel on the grieving process, supportive persons, chaplains, parents' states of mind at the time of death, attitudes of health care personnel, and closure. Implications for providing parental care at the time of the child's death are discussed.

Components of courage in chronically ill adolescents: a phenomenological study.

Although courage is an important variable when clients successfully deal with hospitalization and illness, the concept is contradictory and ill-defined in nursing and other literature. The phenomenological approach and research method has been suggested as one means of concept clarification and theory development. Using the phenomenological approach, this study asked: What is the essential structure of the lived experience of courage in chronically ill adolescents? Nine chronically ill adolescents participated in an open-ended, audiotape-recorded interview, describing their subjective experiences of courage. The descriptions were analyzed phenomenologically. Significant statements were extracted, meanings formulated, and themes identified. Thirty-one theme clusters in nine categories emerged from which an essential structure of courage in chronically ill adolescents was derived.