Enduring love: a grounded formal theory of women's experience of domestic violence.

Using a grounded formal theory approach, 13 qualitative research reports were analyzed with the goal of synthesizing a middle-range theory of women's responses to violent relationships. The combined sample numbered 282 ethnically and geographically diverse women ages 16-67. Within cultural contexts that normalized relationship violence while promoting idealized romance, these women dealt with the incongruity of violence in their relationships as a basic process of enduring love. In response to shifting definitions of their relationship situations, many women moved through four phases, which began with discounting early violence for the sake of their romantic commitment ("This is what I wanted"), progressed to immobilization and demoralization in the face of increasingly unpredictable violence that was endured by the careful monitoring of partner behavior and the stifling of self ("The more I do, the worse I am"), shifted to a perspective that redefined the situation as unacceptable ("I had enough"), and finally moved out of the relationship and toward a new life ("I was finding me"). Variations in the manifestation and duration of these phases were found to be linked to personal, sociopolitical, and cultural contexts.

Parenting self-efficacy and perception of insufficient breast milk.

OBJECTIVE: Insufficient breast milk is a major reason why mothers give up breastfeeding and may be related to low levels of maternal confidence. This study explored the relationship between parenting self-efficacy (PES) and perception of insufficient breast milk. DESIGN: Cross-sectional descriptive correlational study. SETTING: Four private primary care pediatric practices in the northern United States. PARTICIPANTS: Sixty breastfeeding mothers of infants ages 1 to 11 weeks. PROCEDURES: Mothers were recruited during well-baby pediatric visits. They returned completed questionnaires by mail. Data were analyzed using descriptive statistics, t tests, and multiple regression analysis. MAIN OUTCOME MEASURE: The Perception of Insufficient Milk (PIM) questionnaire, an investigator-developed instrument. RESULTS: There was a significant correlation (r = .487, p < .01) between the self-efficacy and perceived insufficient milk scores. Regression analysis revealed that 23% of the variance in PIM was explained by PES, after maternal age, education, and parity had been taken into account. CONCLUSIONS: Although further research is needed to refine the measurement of perceived insufficient milk and differentiate breastfeeding self-efficacy from general parenting self-efficacy, nursing interventions to enhance self-efficacy may improve mothers' confidence in the adequacy of their milk supply.

Pregnant women's perceptions of abuse.

OBJECTIVE: To determine whether pregnant women's perceptions of abuse severity and danger, and their ability to control the abuse, are significantly correlated with the acts of abuse they experience, and to find out whether relationships exist among women's appraisals of abuse severity, danger, and their perceived ability to stop the abuse. DESIGN: A correlational design was used to compare the abusive acts experienced by the women and their perceptions of that abuse. SETTING: Nine prenatal clinics in urban areas of the northeastern United States. PARTICIPANTS: Sixty-one ethnically diverse, pregnant abused women were interviewed. MAIN OUTCOME MEASURE: Pearson's product-moment correlations were used to examine relationships between abusive experiences and women's perceptions of abuse. RESULTS: Women's perceptions of abuse severity were modestly correlated with threatened (r = .25) and actual violence (r = .36). Perceptions of abuse severity and danger were correlated (r = .41). CONCLUSIONS: Women's beliefs about abuse severity, danger, and their ability to control abuse cannot be fully comprehended by exploring the discrete acts they experience. Further research is needed to identify additional factors that influence those beliefs.

Levels and applications of qualitative research evidence.

Evaluation of qualitative findings for application to nursing practice can go beyond the rigor with which the evidence was developed to the characteristics of the findings themselves. Five categories of qualitative findings are described that vary in their levels of complexity and discovery: those restricted by a priori frameworks, descriptive categories, shared pathway or meaning, depiction of experiential variation, and dense explanatory description. Four modes of clinical application of qualitative evidence are proposed-insight or empathy, assessment of status or progress, anticipatory guidance, and coaching-that vary in their degree of visibility and patient involvement. The greater the complexity and discovery within qualitative findings, the stronger may be the potential for clinical application.

Effects of home visits to vulnerable young families.

PURPOSE: Nurses' home visits to new parents have been replaced in many high-need communities by nonprofessional visits without clear evidence of effectiveness. Previous reviews of home visiting research have combined nurse and non-nurse interventions and have pooled studies from the US, where home visiting is mainly limited to low-income families, with those from nations where home visiting is a universal service. This integrative review was focused on nurse-delivered interventions in the US and Canada to identify the nursing-specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim. DESIGN: The sample consisted of 20 experimental and quasi-experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity. METHODS: Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described. FINDINGS: Maternal outcomes, maternal-infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well-child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well-educated nurses, and were focused on building a trusting relationship and coaching maternal-infant interaction. Social ecology theory was partially supported. CONCLUSIONS: Future nurse home-visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse-delivered interventions for vulnerable families.

Ready-to-wear: discovering grounded formal theory.

As qualitative methods have become popular and qualitative reports abundant, researchers have begun to discuss techniques for synthesizing findings about related phenomena from diverse samples. Grounded formal theory analysis is one such approach that can yield higher level, broadly applicable theory from analysis of situation-specific substantive theories. Although grounded formal theories may lack the cultural detail and contextual tailoring of smaller, more focused "designer" analyses, they have the potential to serve as "ready-to-wear" models that fit experiences of individuals in a variety of settings.

Truthful self-nurturing: a grounded formal theory of women's addiction recovery.

This grounded formal theory study was designed to develop a midrange theory of women's addiction recovery from multiple substantive reports. Ten research reports from diverse contexts were analyzed using theoretical sampling and constant comparison. The basic problem of addiction was found to be self-destructive self-nurturing. The basic process of recovery was truthful self-nurturing, which required a painful awareness shift in which addiction gained meaning as a problem. Subsequent recovery involved three areas of social-psychological change: abstinence work, self-work, and connection work. Consequences were enjoying simple pleasures, growing self-understanding, self-acceptance, and sense of belonging, and empowered connectedness. The theory was supported by findings of other qualitative studies of the same phenomenon.

Drug treatment for women: traditional models and new directions.

Drug treatment is a diverse field in which a variety of treatment frameworks and formats exist, few of which have been tailored to women's circumstances and needs. Most drug treatment is based on insight-oriented and behavioral approaches, often accompanied by pharmacologic treatments. Complementary approaches such as acupuncture and biofeedback also are available. Feminist criticisms of traditional therapy have prompted development of woman-centered treatment, which provides a safe environment for empowerment and building relationship skills. Nurses can provide supportive interventions using mutuality and avoiding confrontation, and can advocate for access to woman-centered drug treatment and harm reduction measures to minimize the damage caused by alcohol and drugs.

Reclaiming normal life: mother's stages of recovery from drug use.

OBJECTIVE: Pilot study to describe the process and stages of pregnant and postpartum women's recovery from drug addiction. DESIGN: Naturalistic inquiry directed by the grounded theory approach of constant comparison and theoretical sampling, including individual interviews and a focus group. SETTING: A hospital-affiliated, nurse-directed comprehensive drug treatment program for pregnant and postpartum women. PARTICIPANTS: Fourteen pregnant and postpartum women enrolled in substance abuse treatment completed individual interviews, and 3 substance abuse counselors completed a focus group. MAIN OUTCOME MEASURES: Grounded theory analysis of the process and stages of addiction and recovery. RESULTS: Abstinence was short-lived unless supported by the long, intensive process of reconstructing an identity as a member of society. The basic process of recovery, "reclaiming normal life," consisted of four stages: "rescue or refuge," "no fun any more," "leaving drugs but not the life," and "building a life." An important transition point, "clearing up," was identified between the third and fourth stages. Nine dimensions of attitude changed across the stages. CONCLUSIONS: Nurses can assess women's stage of drug use or recovery, considering attitudes typical of each stage in nurse-patient interactions. Future research may enable tailoring of interventions to women's stages of addiction and recovery.

Salvaging self: a grounded theory of pregnancy on crack cocaine.

A grounded theory was developed to describe how pregnant crack cocaine users perceived their problems and responded to them. A basic social psychological process, salvaging self, was identified from constant comparative analysis of in-depth interviews with 60 pregnant or postpartum women who used crack cocaine an average of at least once per week in pregnancy. Salvaging self included two phases, facing the situation and evading harm. Participants evaluated the value, hope, and risk of various responses to pregnancy. Actions included strategies of harm reduction and stigma management aimed at reducing damage to the fetus, their identities as individuals and mothers, and the maternal-child relationship. Personal histories and social contexts influenced the salvaging process.

Mothering on crack cocaine: a grounded theory analysis.

Mothers who use crack cocaine are commonly believed to be selfish, uncaring, and neglectful of their children. For this paper, the grounded theory method was used to analyze 68 semi-structured depth interviews with cocaine-using mothers. These women's views of motherhood, the strategies they used to manage mothering on cocaine, and the contextual influences on mothering outcomes were explored. Contrary to popular assumptions, the women highly valued motherhood and held firm standards for childrearing. Mothers were concerned about the possible risks to their children and used a process of defensive compensation to protect both their children and their maternal identities from the negative influences of crack cocaine. When unable to fulfil their maternal responsibilities by other means, some mothers placed their children with family members, and others lost custody involuntarily. When children were forcibly removed, mothers often increased their drug use to cope with the loss. Social and economic conditions influenced the outcomes of mothering on crack.

Breastfeeding and employment.

Breastfeeding problems, outcomes, and satisfaction of married, well-educated first-time mothers who returned to work within six months postpartum were compared to those of mothers with the same characteristics who stayed at home. Mothers who planned to work after giving birth anticipated and experienced shorter durations of breastfeeding than did those who planned to remain at home. Breastfeeding experiences and satisfaction among working mothers differed little from the experiences and satisfaction of their nonworking counterparts; however, employment prior to two months postpartum exerted some negative effects on breastfeeding outcomes.

Cesarean delivery and breastfeeding outcomes.

Breastfeeding outcomes of 121 primiparas enrolled in a larger study were examined to determine the impact of cesarean delivery on time of first breastfeeding. Mothers giving birth by cesarean had a later first breastfeeding and expressed less satisfaction with the birth experience than did those who delivered vaginally. No relationships were found between delivery type and duration of breastfeeding or pain or fatigue related to breastfeeding. Time of first breastfeeding was not related to breastfeeding duration. Although some investigators have reported that mothers who have cesarean deliveries or delayed first feeding are less successful at breastfeeding, the high level of commitment to breastfeeding in this sample may have overcome the effect of perinatal events.

Breast-feeding problems in the first week postpartum.

Pre- and perinatal variables commonly found to predict breast-feeding duration were examined to see whether they also predicted breast-feeding problems in the first week postpartum. One hundred and twenty-eight families who prenatally committed to breast-feeding for at least 6 weeks comprised the sample. The families were randomly assigned to one of two groups: a group in which bottle feedings would be avoided in Weeks 2-6 postpartum and a group in which approximately one bottle per day would be given during the same period. Breast-feeding events most commonly experienced as problems in previous studies were also reported by mothers in this sample. Multiple regression analyses revealed that bottle use in the hospital, lower satisfaction with first breast-feeding, and group assignment were weakly predictive of the Breast-feeding Problem Score at 1 week, R2 = .154, p = .0004. The negative effect of hospital bottle use was greater for women in the bottle-restricted group than for women in the planned-bottle group.

Identifying psychosocial obstacles to breastfeeding success.

Breastfeeding is an intimate process that requires psychosocial adjustment as well as technical skill. This article reviews research on the relationships of personality, family and social environments, attitudes, and emotional states to breastfeeding outcomes. Risk factors for breastfeeding difficulties are discussed, alternative feeding plans are outlined, and interventions to address psychosocial needs are described.