ABSTRACT
An estimated 35 to 50 million Americans have no medical insurance; the vast majority are employed persons and their dependents. This phenomenological study was developed to make visible the experience of working Americans living on the edge-forced to walk a fine line between health and illness without the safety net of medical insurance. A purposive sample of 12 individuals was asked, "What is it like to be working and without medical insurance? Based on textual analysis, using an adaptation of Colazzi's method, themes were grouped into four theme clusters: A Marginalized Life, Up Against Rocks and Hard Places, Making Choices-Chancing It, and Getting By-More or Less. These are illustrated through commentary and direct quotation to depict an overall sense of the experience. Implications for nurses charged with addressing the needs of the medically uninsured and for nursing as a whole are discussed.
Subject(s)
Attitude to Health , Health Services Needs and Demand , Medically Uninsured/psychology , Adult , Female , Health Services Accessibility , Humans , Male , Patient Advocacy , United StatesABSTRACT
Under tremendous pressure to contain costs, most U.S. hospitals are radically altering the composition and skill mix of their staff, thinning their skilled registered nurse (RN) ranks, and often substituting them with minimally trained, lower paid, unlicensed assistive personnel (UAP). Twelve staff nurses were interviewed to illuminate the experience of working with UAP, who function largely in untested, expanded roles. Only two nurses viewed this experience positively; the rest were either opposed to or had strong reservations about UAP use. Confusion and emotional turmoil predominated as these nurses struggled to maintain safe, comprehensive care with the assistance of UAP who were often ambivalent and sometimes dangerously inept.
Subject(s)
Attitude of Health Personnel , Nursing Assistants/organization & administration , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/psychology , Acute Disease/nursing , Adult , Clinical Competence , Female , Humans , Job Description , Middle Aged , Nursing Assistants/education , Nursing Methodology Research , Surveys and Questionnaires , United StatesABSTRACT
An estimated 9 million adults in this country may have had a near-death experience (NDE), yet little research has been focused on the early aftermath of this extraordinary phenomenon. The purpose of this interpretive study was to appropriate and make visible how patients who had an NDE during a cardiac or respiratory arrest understood and experienced this early period of survival. Gadamerian hermeneutics (1975/1990) informed and guided the study. This interpretation demonstrates that NDEs and their early aftermath can be the positive, life-enhancing experiences that the common lore and most research tend to depict, yet they can also be unpleasant and distressing experiences fraught with emotional pain and angst.