A conceptual foundation for human suffering in nursing care and research.

Suffering is a significant, yet elusive, phenomenon in nursing and health care. Despite the importance and prevalence of suffering, there is only a small body of substantive literature on this topic. Some of the difficulty in expanding this knowledge base undoubtedly is related to the lack of a solid conceptual foundation for exploration of this phenomenon. Although there have been attempts to provide needed conceptual clarity, these efforts typically have not been based on systematic inquiry. In this study, the method of concept analysis was used to inductively generate a definition of the concept of suffering and to clarify various contextual aspects of the concept. Suffering is defined as an individualized, subjective, and complex experience that involves the assignment of an intensely negative meaning to an event or a perceived threat. Implications of these findings and additional contextual aspects of the concept for nursing practice and inquiry are presented. These results help to provide the conceptual foundation needed to enhance recognition and understanding of the human experience of suffering.

Sexual assault victims' compliance with follow-up care at one sexual assault treatment center.

OBJECTIVE: To determine whether patients who receive emergency care at a sexual assault treatment center (SATC) follow suggested guidelines for prevention and/or treatment of associated sexually transmitted diseases (STDs). DESIGN: The research was a descriptive study of 26 adult victims of sexual assault who had been treated initially at a SATC. METHODS: A nine-item questionnaire was designed to query participants by telephone 6 to 8 weeks after their initial care for sexual assault. Participants were questioned about their compliance with the suggested medication regimen and follow-up medical attention. In addition, health insurance coverage information was retrieved from participants' records to ascertain possible patterns of compliance by availability of health insurance. Participant perceptions of the nursing care received in the SATC also were elicited. Data were analyzed with frequencies and percentages, as well as qualitative categorization procedures. RESULTS: Twenty-six women, aged 19 to 43 years (mean = 27), participated in the study. Seventy-three percent reported taking all of the prophylactic medication prescribed or given to them at the SATC, whereas only 50% had made and kept a recommended follow-up appointment with a physician. No association could be determined between compliance with the suggested follow-up protocol and the availability of health insurance. Reasons for not following suggested protocols varied greatly. Of particular importance for those who were noncompliant were the implied misunderstandings related to the need to take medications after a sexual assault. CONCLUSIONS: Although concern has been expressed in the literature regarding sexual assault victims' compliance with follow-up regimens for the prevention and treatment of STD, the findings from this study indicate that compliance, particularly with medication protocols, may be higher than expected. However, continuing work is needed to ensure that all victims receive all recommended information regarding follow-up care during the first encounter with the nurse and that the rationale for follow-up care is fully understood by the patient. Nurses who interact with victims of sexual assault are in the best position to enhance compliance with follow-up regimens by identifying victims who may be at risk of noncompliance.

Cultural perspectives of grief: an expanded concept analysis.

The concept of human grief has been of interest to scholars and practitioners for many years. However, there are many aspects of grief about which little is known. One of these is the role that cultural heritage plays in influencing the individual, intrapersonal experience of grief. Through the use of six focus groups, each consisting of persons from a specific cultural background, the investigator explored the concept of grief. The data were thematically analysed and the findings then compared to the findings from a previous concept analysis of grief drawn from professional literature. The findings indicated that individuals from a variety of cultural backgrounds whose knowledge of grief was derived primarily from their personal experiences defined grief in much the same way as had the authors of the professional literature. Most importantly, the findings also clearly indicated that although cultural differences are perceived to exist in mourning rituals, traditions and behavioural expressions of grief, there are no particular differences in the individual, intrapersonal experience of grief that can be attributed to cultural heritage or ethnicity alone. Implications for future research and considerations for practising nurses as they pertain to the highly individual and pervasive nature of grief are presented.

The qualitative research audit trail: a complex collection of documentation.

A qualitative study typically involves a large volume of researcher-generated data, including notes about the context of the study, methodological decisions, data analysis procedures, and self-awareness of the researcher. Such data are important in many aspects of the study, particularly in the development of an audit trail to substantiate trustworthiness. Unfortunately, there is little information available to assist researchers in generating the needed documentation. In this article, we discuss the types of data that contribute to credible investigations. Strategies for maintaining effective records in qualitative studies are included, along with examples from our own research.

When a loved one has AIDS: care for the significant other.

1. The significant others of persons with AIDS, whether they assume the role of primary caregiver or not, have a number of unique experiences, concerns, and needs specifically related to their situations. 2. During the initial period following the diagnosis of a loved one, the significant others indicated their primary needs as sensitivity to their situations, assistance in securing appropriate information, and psychological support in dealing with uncertainty, and a general sense of dread. 3. Other common concerns and needs expressed by the significant others included support and reassurance, assistance in adjusting to a myriad of personal relationship changes, and help in meeting needs for active involvement in some form of AIDS-related work.

The concept of grief: a foundation for nursing research and practice.

In spite of the significance of grief as a human response, research to expand knowledge of this phenomenon has been impeded by the existence of a conceptual problem. In this study, a comprehensive and systematic review of both current and classic literature concerning grief was conducted within the disciplines of nursing and medicine. Findings contributed to the definition of grief as a pervasive, highly individualized, dynamic process that often is discussed normatively within professional disciplines. This definition provides not only a synthesis of knowledge concerning grief but a reconceptualization that can promote efforts to clarify this important concept for nursing.