Giselle, madness & death.

In this paper the Romantic ballet Giselle (1841) is used as a case study through which to examine the themes of madness and death. Giselle is a heartrending story of the intertwining of love and death. It is argued that Giselle is an evocative example of narratives of hysteria and suicide, and literature in the field of medical history is drawn upon to demonstrate the relations between the cultural fields of ballet, medicine, and the wider social world at the time of Giselle. Finally, it is suggested that the notion of the embodiment of vulnerability provides a fruitful way to meld our understandings of the interconnections between the arts, society, and medicine.

Reflections on embodiment and vulnerability.

Bodies matter as our experience of them is the basis both for social life and also for much medical and social research. There has been a spectacular increase in academic research on the body in the last twenty years or so. This paper-although a review of three ethnographic studies on the seemingly disparate and narrow fields of the embodiment of working class experience, boxing, and ballet-illuminates the broader relationships between the body, self, and society. Our paper works on three levels: firstly, as an account of the "lived experience" of embodied vulnerability; secondly, as an application of Bourdieu's theoretical schema, and thirdly, as a philosophically grounded critique of radical social constructionist views of the body.

On the methodological, theoretical and philosophical context of health inequalities research: a critique.

The integration of survey data with psycho-social theories is an important and emerging theme within the field of health inequalities research. This paper critically examines this approach arguing that the respective models of health inequality which these approaches promote, the related concepts of 'social cohesion' and 'social capital' suffer from serious methodological, theoretical and philosophical flaws. The critique draws particular attention to the limitations of survey-derived data and the dangers of using such data to develop complex social explanations for health inequalities. The paper discusses wider epistemological issues which emerge from the critique addressing the fundamental but neglected question of 'what is inequality'? The paper concludes by introducing a structure for questions regarding health inequalities emphasising the need for those question to be attached to real communities.

An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units.

Endotracheal suctioning is a frequently performed procedure that has many associated risks and complications. It is imperative that nurses are aware of these risks and are able to practise according to current research recommendations. This study was designed to examine to what extent intensive care nurses' knowledge and practice of endotracheal suctioning is based on research evidence, to investigate the relationships between knowledge and practice, and to evaluate the effectiveness of a research-based teaching programme. This quasi-experimental study was a randomized, controlled, single-blinded comparison of two research-based teaching programmes, with 16 intensive care nurses, using non-participant observation and a self-report questionnaire. Initial baseline data revealed a low level of knowledge for many participants, which was also reflected in practice, as suctioning was performed against many of the research recommendations. Following teaching, significant improvements were seen in both knowledge and practice. Four weeks later these differences were generally sustained, and provide evidence of the effectiveness of the educational intervention. The study raised concern about all aspects of endotracheal suctioning and highlighted the need for changes in nursing practice, with clinical guidelines and focused practice-based education.

Philosophical problems with social research on health inequalities.

This paper offers a realist critique of social research on health inequalities. A conspectus of the field of health inequalities research identifies two main research approaches: the positivist quantitative survey and the interpretivist qualitative 'case study'. We argue that both approaches suffer from serious philosophical limitations. We suggest that a turn to realism offers a productive 'third way' both for the development of health inequality research in particular and for the social scientific understanding of the complexities of the social world in general.

Psychosocial recovery from adult kidney transplantation: a literature review.

Kidney transplantation is the preferred treatment for patients with end-stage chronic renal disease. There appears to be no recent and extensive review of the literature on psychosocial recovery from adult kidney transplantation. This comprehensive review considers literature on six aspects of patient recovery and rehabilitation: psychiatric sequelae, functional recovery, stress and coping, the psychological impact of failed kidney transplants, quality of life (QOL), and adherence with medications. We conclude that although studies have become both more ambitious and rigorous, there is a pressing need to move away from descriptive research toward carefully designed multidisciplinary psychological intervention studies with kidney transplant patients.

Non-adherence with medications in organ transplant patients: a literature review.

The problems of non-adherence with treatment in health care in general, and with medication adherence in particular, is an area with a voluminous and burgeoning literature. However, there appears to be no review of the literature on non-adherence with medications in organ transplant patients. This comprehensive review therefore considers literature on adherence in adult kidney, heart and liver transplantation. The particular problem of adherence in paediatric transplant patients is also addressed. This transplant research literature is then evaluated within the broader context of social science research on medication adherence. From the review it is apparent that there is an urgent need for research which examines the patient's beliefs about their illness and medicines. Such research is a precursor for rigorous nursing intervention studies which aim to promote adherence by being tailored to the patient's perceptions.

Patient self-administration of medication: a review of the literature.

The purpose of this review was to critically examine the literature published in the English language (1983-1995) related to the use of self-medication programmes by hospital patients and to determine whether such a scheme could be implemented and evaluated within the acute medical setting. Searches revealed a wealth of information relating to self-medication and it was evident that such schemes have been welcomed with enthusiasm by clinical nurses. However, only 12 empirical studies evaluating the advantages and disadvantages of self-medication programmes could be located. The remainder were all anecdotal or described the process of implementation in such broad terms that they could not be considered to fulfil the rigorous requirements demanded of research studies. Even the 12 empirical studies contained serious methodological flaws. Thus authors' claims that self-medication increased compliance with the drug regime could not be accepted with confidence. Nevertheless, the authors made a number of sensible recommendations which logically would be expected to increase compliance. These included simplification of the drug regime and careful patient assessment with the programme tailored to meet individual need. It was also possible to highlight areas where future research could be conducted (e.g. more detailed examination of the importance nurse-patient interaction to the success of self-medication, longer-term evaluation) and to identify means of improving research designs so that this important field of patient care may in future be examined with greater rigour.

Stress and quality of life in the renal transplant patient: a preliminary investigation.

End-stage renal disease is a chronic condition which reduces the life-span of its victims. At present there is no cure. Renal transplantation, currently the treatment of choice for many patients, is potentially associated with a number of drawbacks: constant risk of rejection, especially during the first six months, the need to comply with a complex regime of medication capable of producing pronounced side-effects and need for ongoing medical supervision. Despite these problems, little research has been undertake with patients following renal transplantation. The aim of the small-scale, exploratory study reported here was to explore patients' perceptions of stress and quality of life at different stages following a first, functioning renal graft: within six months, between one and five years and over five years later (n = 10 in each group). From the results it became apparent that patients had a number of concerns, of which fear of rejection was the most frequently mentioned, followed by stress generated through altered body image (a product of immunosuppressive therapy). Nevertheless, all reported a significant increase in quality of life after transplantation, although improvement was least marked in patients in the intermediate group (1-5 years after surgery) who also experienced most stress. A larger scale study is recommended to increase the validity of findings which clinicians could then use to design patient interventions to enhance quality of care and quality of life.

Transcending chronic liver disease: a qualitative study.

This study explores and describes experiences of chronic liver disease from the patient's perspective. No qualitative research studies appear to have examined the experiences of these patients. In-depth focused interviews and grounded theory data collection and data analysis methods were used. A two-stage theoretical framework (becoming ill, and not living) of the experience of transcending chronic liver disease is presented. Sociological and psychological literature on common sense models of health and illness are briefly reviewed. Several suggestions for further research are made. The way in which this qualitative research study is leading to a quantitative and qualitative appraisal of the psychological adjustment in end-stage chronic liver disease patients is outlined.

A new paradigm for nursing: the potential of realism.

Realism has been the dominant approach in the philosophy of science for the last 20 years. Realist philosophy has also been widely employed across a range of social sciences. Unfortunately, these powerful intellectual currents have not reached the shores of nursing which appears trapped in a time-warped debate about 'qualitative' (constructivist) and 'quantitative' (positivist) approaches. This paper argues that both positivism and constructionism are seriously flawed as philosophies of social and natural science. This is in marked contrast with realism which is a philosophy of both the natural and social sciences. I therefore propose that realism should be adopted as a radically different new paradigm for a unified biopsychosocial nursing.

Endotracheal suctioning: an example of the problems of relevance and rigour in clinical research.

Endotracheal suctioning is a routine but potentially dangerous procedure. The literature documenting approaches to minimizing the cardiopulmonary complications of endotracheal suctioning is reviewed. Hyperoxygenation, hyperventilation, hyperinflation and the use of adaptors are all evaluated. The effects of endotracheal suctioning on haemodynamics and oxygen transport are also examined. The traditional dualist approach to the respiratory and cardiovascular systems is contrasted with the recent emphasis on oxygen transport by the cardiopulmonary system. The trade-off between the rigour of laboratory studies (which can be well controlled but are difficult to generalize) and the relevance of clinical research (which is more easily generalized but which often lacks internal validity) is discussed. Although research studies have become both more methodologically and conceptually sophisticated, definitive recommendations for a safe and effective suctioning procedure still remain elusive.

Endotracheal suctioning in adults with severe head injury: literature review.

Endotracheal suctioning is a routine but potentially dangerous nursing procedure. The research literature documenting approaches to minimising the complications of endotracheal suctioning in adults with severe head injuries is reviewed. Hyperoxygenation, hyperventilation, hyperinflation, normal saline instillation and the effects of endotracheal suctioning on intracranial pressure and cerebral perfusion pressure are examined. Recommendations for an evidence-based endotracheal suctioning protocol are made.

The transformational experience of liver transplantation.

Liver transplantation is now the treatment of choice for patients with end-stage chronic liver disease. However, few studies have examined the recovery of liver transplant patients and no qualitative research studies have examined the experiences of these patients. Therefore the purpose of this study was to explore and describe the experiences of liver transplantation from the patient's perspective. In-depth focused interviews with 10 liver transplant patients were carried out. Grounded theory data collection and data analysis methods were used. A theoretical framework of the transformational experience of liver transplantation is presented. The process of transformation involves moving through a five-stage trajectory of: receiving the transplant, improving in hospital, improving at home, feeling well again, and reciprocating.

Recovery from liver transplantation: a literature review.

Liver transplantation is now the treatment of choice for patients with end stage chronic liver disease. However, there appears to be no review of the literature on patient recovery from liver transplantation. This comprehensive review presents a picture of the state of the art in liver transplantation, and considers literature on psychiatric, functional status, and quality of life aspects of patient recovery. Numerous suggestions for further research are made.