COPD in primary care settings in Ireland: stories from usual care.

The aim of the PRINCE study was to determine the effectiveness of a structured education pulmonary rehabilitation programme for those living with COPD in primary care in Ireland. This qualitative element of the larger PRINCE trial aims to describe the constituents of 'usual care' for patients allocated to the control arm of the study. A descriptive qualitative study was used to explore the constituents of usual care. A convenience sample of participants (n=20) allocated to the usual care group were interviewed. Three main themes arose from the study: experiences of having and managing COPD, lifestyle advice, and factors that helped or hindered self-management. Usual care left many people grappling in the dark trying to manage their COPD. It was found that usual care was not at its optimum for people with COPD in the control arm of the PRINCE study.

Life with chronic obstructive pulmonary disease: striving for 'controlled co-existence'.

AIMS AND OBJECTIVES: To understand the meaning of chronic obstructive pulmonary disease (COPD) for people and their response to this disease. BACKGROUND: COPD is a major cause of disability and death. The symptoms of COPD have the potential to impact on every aspect of a person's day-to-day life. To date most published qualitative studies have focused on the 'experience' of breathlessness and its impact on the person. Few studies have sought to 'understand' the meaning of COPD to people and their response to this disease. This study aimed to address this gap. DESIGN: Straussian grounded theory guided study design. Grounded theory was considered appropriate for this study because of its focus on how people respond to and act on the problems they encounter. METHODS: Data were collected through semi-structured interviews with 26 people with COPD. Study participants were recruited from general practices on the western seaboard of Ireland. RESULTS: Two interrelated categories were identified as contributing to 'co-existing with COPD': 'hiding' and 'battling'. 'Co-existing with COPD' was conceptualised as the core category. The potential to 'co-exist' with COPD was influenced by mediating factors. CONCLUSION: The Theory of Co-existing with COPD was generated from the data. This theory explains the delicate balance people with COPD maintain to 'co-exist with COPD'. 'Controlled co-existence' enables the person to feel in control and live life to the optimum. This is a fragile balance however and the unpredictability of COPD can tip the person into 'strained co-existence' or 'uncontrolled co-existence'. RELEVANCE TO CLINICAL PRACTICE: Understanding the experience of living with COPD and the balances involved in 'co-existing with COPD' can help health professionals provide more focused and empowered client care. Enabling people to achieve 'controlled co-existence' with COPD challenges health professionals to educate people with COPD on how to effectively manage their disease.

Nursing students' attitudes to health promotion to: implications for teaching practice.

For several decades now the World Health Organization has indicated the need for a reorientation of the health services away from focusing solely on illness and disease to one that considers both disease prevention and health promotion. Successive publications that guide public health policy both nationally and internationally reiterate the need for health promotion and the principles of health for all to become integral to the fabric of health care delivery. The role of the nurse as health promoters is well recognized. However despite acknowledgement by professional nursing bodies and nurse educators that health promotion forms a central tenet of undergraduate nurse education curricula, there are varied approaches to teaching and learning and little formal evaluation of the consequences of approaches taken. The aims of this study are to identify current health promotion curricular content within the Irish undergraduate nursing programme context; to measure nursing students' attitudes towards health promotion and to examine nursing students' reported lifestyle behaviours.

Spirituality as a universal concept: student experience of learning about spirituality through the medium of art.

Precise definitions of spirituality can be elusive (McSherry, 2000). This factor together with the increasing class sizes for undergraduate nursing students render the teaching and learning of spirituality in nursing a challenge for both lecturers and students alike (McSherry, 2000). This paper reports on the design, delivery and evaluation of an innovative spirituality program for second year nursing students attending a Bachelor of Science degree at a university in the Republic of Ireland. This teaching program was introduced in 2005 to enhance nursing students' engagement with the concept of spirituality. The program consisted of a series of lectures on the topic, followed by a visit to the National Gallery of Ireland. The latter involved a structured visit, whereby the students (n=100) were divided into ten small groups and asked to wander through a section of the gallery and choose a piece of art work that they perceived to be spiritual in nature. Students were then asked to write their subjective impressions and reasons for their choice of painting. A list of themes related to spirituality was provided to the students as a prompt. Students later visited the paintings with both a lecturer and an art gallery guide and their chosen paintings were discussed within the group. Later that day, purposive sampling was used, whereby a selection of nursing students participating in the Gallery visit (n=21) partook in four recorded focus group interviews following the Gallery visit. Themes emerging from the interviews pertained to the universal and individual nature of spirituality. In keeping with Mc Sherry's (2000:27) definition of spirituality as a "universal concept relevant to all individuals", students in the study revealed their surprise at the uniqueness of their colleague's interpretations. The teaching methodology offered them an opportunity to reflect upon their own understandings and develop a deeper awareness of the meaning of spirituality. It also allowed many of them to understand how spirituality transcends traditional religions and permitted many of them to verbalize their feelings on spirituality for the first time.