Application of Caring Theory to Nursing Care of Women Experiencing Stillbirth.

Purpose: The purpose of this study was to determine the extent to which labor and delivery nurses used the tenets of Swanson's middle-range theory to care for women whose babies were stillborn.

Study Design And Methods: A secondary analysis of qualitative in-depth interview data from 20 labor and delivery nurses obtained during a recent grounded theory study was conducted using the directed content analysis method. The five caring processes as described in Swanson's theory were used as a priori codes to conduct the analysis.

Adaptation of Coping Together - a self-directed coping skills intervention for patients and caregivers in an outpatient hematopoietic stem cell transplantation setting: a study protocol.

Background: Despite numerous reports of significant distress and burden for hematopoietic stem cell transplantation (HSCT) patients and caregivers (CGs), HSCT-specific coping interventions remain rare. The few in use lack specificity and are often not easily accessible or cost-effective. Whereas the development of new interventions is resource-intensive, theory-informed adaptation of existing evidence-based interventions is promising.

The benefits of respectful interactions: fluid alliancing and inter-occupational information sharing in primary care.

Though inter-occupational interactions in health care have been the focus of increasing attention, we still know little about how such interactions shape information sharing in clinical settings. This is particularly true in primary care where research on teams and collaboration has been based on individual perceptions of work (using surveys and interviews) rather than observing the interactions that directly mediate the inter-occupational flow of information. To explore how interactions shape information sharing, we conducted a secondary analysis of ethnographic data from 27 primary care practices.

Complex patients and interprofessional relationships: Perceptions of primary care nurse practitioners and primary care physicians.

Purpose: The literature describing primary care nurse practitioners (PCNPs) and primary care physicians (PCPs) suggests that PCNPs provide care to patients with less complicated diagnoses than their PCP colleagues. However, other literature suggests the contrary. Therefore, the purpose of this qualitative study was to understand how patients are assigned and cared for by primary care clinicians and how these clinicians relate to one another.

The experience of information sharing among primary care clinicians with cancer survivors and their oncologists.

Purpose Of Study: Knowledge about information sharing among primary care clinicians, oncologists, and their cancer patients is critical given its importance in facilitating the delivery of quality care to the increasing number of cancer survivors. The purpose of our study was to provide a better understanding of the nature of interactions among primary care clinicians, patients, and oncologists throughout the cancer care continuum to better understand the transition to survivorship.

Method: Twenty-one qualitative in-depth interviews were conducted with 11 primary care physicians and 10 nurse practitioners.

Strategies used and challenges faced by a breast cancer patient navigator in an urban underserved community.

Patient navigation has been widely implemented by cancer care programs across the United States. While activities of navigators have been described elsewhere, little has been documented regarding specific strategies used or challenges experienced by navigators from their own perspectives. We describe the experience of an African American patient navigator who promoted breast cancer screening and facilitated diagnosis and treatment among inner-city mostly African American women in Newark, New Jersey.

Organizational culture influences health care workers' influenza immunization behavior.

Background And Objectives: Low rates of influenza immunization among health care workers (HCWs) pose a potential health risk to patients in primary care practices. Despite previous educational efforts and programs to reduce financial barriers, HCW influenza immunization rates remain low. Variation in practice-level organizational culture may affect immunization rates.

Understanding healing relationships in primary care.

Purpose: Clinicians often have an intuitive understanding of how their relationships with patients foster healing. Yet we know little empirically about the experience of healing and how it occurs between clinicians and patients. Our purpose was to create a model that identifies how healing relationships are developed and maintained.

Complementary and alternative medicine in US family medicine practices: a pilot qualitative study.

Context: The growth of complementary and alternative medicine (CAM) has led some family medicine practices to include CAM. Acupuncture or herbal medicine, for example, may be offered at such practices. When a practice incorporates both CAM and conventional treatments, its goals and values may differ from those found in traditional primary care.

Variation in electronic prescribing implementation among twelve ambulatory practices.

Background: Electronic prescribing has been advocated as an important tool for improving the safety and quality of medication use in ambulatory settings. However, widespread adoption of e-prescribing in ambulatory settings has yet to be realized. The determinants of successful implementation and use in these settings are not well understood.

Developing a model of social capital: relationships in primary care.

We have developed a model of social capital to enhance relationships within primary care practices that promote organizational success and improve patient care outcomes. The model extends the meaning and the value of social capital by providing dimensions, attributes, and operational definitions that can be used to measure outcomes and guidelines to develop future interventions. Our model brings new insight and logic to understanding relationships to create resources to improve primary care practices.

Electronic medical records and diabetes quality of care: results from a sample of family medicine practices.

Purpose: Care of patients with diabetes requires management of complex clinical information, which may be improved by the use of an electronic medical record (EMR); however, the actual relationship between EMR usage and diabetes care quality in primary care settings is not well understood. We assessed the relationship between EMR usage and diabetes care quality in a sample of family medicine practices.

Methods: We conducted cross-sectional analyses of baseline data from 50 practices participating in a practice improvement study.

The qualitative research interview.

Background: Interviews are among the most familiar strategies for collecting qualitative data. The different qualitative interviewing strategies in common use emerged from diverse disciplinary perspectives resulting in a wide variation among interviewing approaches. Unlike the highly structured survey interviews and questionnaires used in epidemiology and most health services research, we examine less structured interview strategies in which the person interviewed is more a participant in meaning making than a conduit from which information is retrieved.

Social network analysis as an analytic tool for interaction patterns in primary care practices.

Purpose: Social network analysis (SNA) provides a way of quantitatively analyzing relationships among people or other information-processing agents. Using 2 practices as illustrations, we describe how SNA can be used to characterize and compare communication patterns in primary care practices.

Methods: Based on data from ethnographic field notes, we constructed matrices identifying how practice members interact when practice-level decisions are made.

Delivery of clinical preventive services in family medicine offices.

Background: This study aimed to elucidate how clinical preventive services are delivered in family practices and how this information might inform improvement efforts.

Methods: We used a comparative case study design to observe clinical preventive service delivery in 18 purposefully selected Midwestern family medicine offices from 1997 to 1999. Medical records, observation of outpatient encounters, and patient exit cards were used to calculate practice-level rates of delivery of clinical preventive services.

Speaking of weight: how patients and primary care clinicians initiate weight loss counseling.

Background: Obesity is epidemic in the US and other industrialized countries and contributes significantly to population morbidity and mortality. Primary care physicians see a substantial portion of the obese population, yet rarely counsel patients to lose weight.

Methods: Descriptive field notes of outpatient visits collected as part of a multimethod comparative case study were used to study patterns of physician-patient communication around weight control in 633 encounters in family practices in a Midwestern state.

Opportunistic approaches for delivering preventive care in illness visits.

Objective: To describe how clinicians create opportunities to deliver preventive care in illness visits and assess the impact this has on preventive service delivery.

Method: Detailed and descriptive fieldnotes were collected from 18 purposefully selected family practices, including direct observations of 53 primary care clinicians and 1620 patient encounters. Conversation analysis was used to examine the conversational techniques employed to deliver four preventive services (smoking counseling, immunization delivery, mammography, and cervical cancer screening) in illness visits.

The racial and gendered experiences of immigrant nurses from Kerala, India.

The purpose of this article is to describe the experience of a group of immigrant women nurses regarding their life and work in a culture other than their own. Semistructured, in-depth interviews were conducted with nurses who were born in Kerala, India, educated in India, and are actively employed as nurses in the United States. The participants told stories that were about (a) the challenges of living between two cultures and countries, (b) the racism they experience, and (c) their marginalization as female nurses of color.

Assessing diversity and quality in primary care through the multimethod assessment process (MAP).

The U.S. health care system serves a diverse population, often resulting in significant disparities in delivery and quality of care.

Home care nurses: a study of the occurrence of culturally competent care.

The purpose of this study is to describe how home care nurses orient to and manage cultural issues during patient visits. Fourteen home care nurse-patient dyads were observed. Interviews were then conducted with nurses.

Antibiotic use in acute respiratory infections and the ways patients pressure physicians for a prescription.

Objective: We identified those aspects of physician-patient communication that influence physicians to prescribe antibiotics for respiratory infections.

Study Design: A multimethod comparative case study was performed including descriptive field notes of outpatient visits.

Population: We included patients (children and adults) and clinicians in 18 purposefully selected family practices in a midwestern state.