Supportive care needs of people with brain tumours and their carers

Goals of work: The diagnosis and treatment of a brain tumour may result in long-term changes in a patient's functional and social abilities and/or in a greatly reduced life span. A qualitative investigation was conducted to examine the supportive care needs of patients with brain tumour and their carers. Materials and methods: Overall, 18 patients and 18 carers participated in focus groups or telephone interviews, following a structured interview guide to elicit supportive care services of importance to these patients and carers. Main results: Six major themes were identified using the framework analysis method, including needs for information and coping with uncertainty, practical support, support to return to pretreatment responsibilities or prepare for long-term care, support to deal with social isolation and organize respite care, support to overcome stigma/discrimination and support to discuss potentially reduced life expectancy. Conclusions: Five recommendations to improve service delivery include: assignment of a dedicated member of the care team or case manager; proactive dissemination of information, education and psychosocial support; access to objective assessment of neuropsychological functioning; facilitating easier access to welfare payments; and services facilitating communication about difficult illness-related topics. Provision of services along these recommendations could improve supportive care of brain tumour patients and their carers.

ESTRUTURA E DINÂMICA DO FUNCIONAMENTO PSÍQUICO DE MULHERES ENVOLVIDAS EM VIOLÊNCIA CONJUGAL REITERADA

Apesar das campanhas de combate à violência de gênero e a legislação elaborada para promover o aumento da segurança de mulheres envolvidas pelo fenômeno, trabalhos realizados demonstram que muitas mulheres agredidas por seus companheiros, mesmo após tentativa de separação, retornam a conviver com os agressores. Com base nessas informações, o objetivo desta pesquisa foi estudar a estrutura e a dinâmica do funcionamento psíquico de cinco mulheres envolvidas em violência conjugal reiterada. Trata-se de um estudo clínico-qualitativo, cujas participantes foram selecionadas por conveniência e fazem parte de um grupo de mulheres vítimas de violência conjugal, atendidas por uma organização não governamental, com processos em trâmite numa Vara Criminal da Grande São Paulo. Utilizou-se como instrumentos de investigação um Roteiro de Entrevista semiestruturado; a Escala da Associação Brasileira de Institutos de Pesquisa de Mercado (ABIPEME); e o Teste de Relações Objetais de Phillipson (TRO). Os resultados apontam que as participantes apresentam ego fragilizado, pouco integrado e superego rígido, pouco indistinguível de seus impulsos destrutivos e de seus perseguidores internos, resultado de introjeções e deflexões para o exterior carentes. Essa dinâmica mental se desenvolveu a partir de processos primários de cisão muito violentos, com predominância de impulsos destrutivos e da pulsão de morte sobre a pulsão de vida. Ademais, percebeu-se que as participantes se mantém predominantemente na fase esquizo-paranóide do desenvolvimento, sem conseguir alcançar de forma adequada a posição depressiva de reparação, assim, elas utilizam de mecanismos primitivos de defesa para manterem o equilíbrio psíquico como: a identificação projetiva, a negação, a idealização e a paralização. Espera-se que os resultados desta pesquisa possam auxiliam na elaboração de propostas de atendimento a mulheres em situação de violência conjugal reiterada.

ASSISTÊNCIA DE SAÚDE ÀS MULHERES MUÇULMANAS NO BRASIL: UMA ANÁLISE DA RELAÇÃO ENTRE O SISTEMA RELIGIOSO ISLÂMICO E A POLÍTICA NACIONAL DE ATENÇÃO INTEGRAL À SAÚDE DA MULHER.

A presente dissertação tem por objetivo analisar os aspectos religiosos islâmicos e as implicações das relações de gênero no islam sobre a assistência de saúde às mulheres muçulmanas, e através disto, discutir a importância do conhecimento prévio do islamismo pelos profissionais de saúde para propor uma assistência de saúde congruente a estas mulheres, tendo por referência a Política Nacional de Atenção Integral à Saúde da Mulher. Esta pesquisa tem abordagem qualitativa, com o desenvolvimento de pesquisa de campo e aplicação de um roteiro de perguntas semi-estruturado, com questões relacionadas ao islamismo e à saúde das mulheres. Ao todo, foram entrevistadas dez pessoas, sendo estas: quatro mulheres revertidas ao islam, três mulheres de família muçulmana, dois sheiks e uma assistente social. As entrevistas foram realizadas no Centro de Divulgação do Islam para a América Latina e o Caribe (CDIAL) e na Assembléia Mundial da Juventude Islâmica na América Latina (WAMY).

A qualitative analysis of the lived experience of nursing staff developers in the process of changing to a new educational model

The purpose of this study was to document and critically analyze the lived experience of selected nursing staff developers in the process of moving toward a new model for hospital nursing education. Eleven respondents were drawn from a nation-wide population of about two hundred individuals involved in nursing staff development. These subjects were responsible for the implementation of the Performance Based Development System (PBDS) in their institutions.^ A purposive, criterion-based sampling technique was used with respondents being selected according to size of hospital, primary responsibility for orchestration of the change, influence over budgetary factors and managerial responsibility for PBDS. Data were gathered by the researcher through both in-person and telephone interviews. A semi-structured interview guide, designed by the researcher was used, and respondents were encouraged to amplify on their recollections as desired. Audiotapes were transcribed and resulting computer files were analyzed using the program "Martin". Answers to interview questions were compiled and reported across cases. The data was then reviewed a second time and interpreted for emerging themes and patterns.^ Two types of verification were used in the study. Internal verification was done through interview transcript review and feedback by respondents. External verification was done through review and feedback on data analysis by readers who were experienced in management of staff development departments.^ All respondents were female, so Gilligan's concept of the "ethic of care" was examined as a decision making strategy. Three levels of caring which influenced decision making were found. They were caring: (a) for the organization, (b) for the employee, and (c) for the patient. The four existentials of the lived experience, relationality, corporeality, temporality and spatiality were also examined to reveal the everydayness of making change. ^

Theological reflection at work: A phenomenological study of learning processes

Using the learning descriptions of graduates of a graduate ministry program, the mechanisms of interactions between the knowledge facets in learning processes were explored and described. The intent of the study was to explore how explicit, implicit, and emancipatory knowledge facets interacted in the learning processes at or about work. The study provided empirical research on Yang's (2003) holistic learning theory. ^ A phenomenological research design was used to explore the essence of knowledge facet interactions. I achieved epoche through the disclosure of assumptions and a written self-experience to bracket biases. A criterion based, stratified sampling strategy was used to identify participants. The sample was stratified by graduation date. The sample consisted of 11 participants and was composed primarily of married (n = 9), white, non-Hispanic (n = 10), females (n = 9), who were Roman Catholic (n = 9). Professionally, the majority of the group were teachers or professors (n = 5). ^ A semi-structured interview guide with scheduled and unscheduled probes was used. Each approximately 1-hour long interview was digitally recorded and transcribed. The transcripts were coded using a priori codes from holistic learning theory and one emergent code. The coded data were analyzed by identifying patterns, similarities, and differences under each code and then between codes. Steps to increase the trustworthiness of the study included member checks, coding checks, and thick descriptions of the data. ^ Five themes were discovered including (a) the difficulty in describing interactions between knowledge facets; (b) actual mechanisms of interactions between knowledge facets; (c) knowledge facets initiating learning and dominating learning processes; (d) the dangers of one-dimensional learning or using only one knowledge facet to learn; and (e) the role of community in learning. The interpretation confirmed, extended, and challenged holistic learning theory. Mechanisms of interaction included knowledge facets expressing, informing, changing, and guiding one another. Implications included the need for a more complex model of learning and the value of seeing spirituality in the learning process. The study raised questions for future research including exploring learning processes with people from non-Christian faith traditions or other academic disciplines and the role of spiritual identity in learning. ^

How employees with different national identities experience a geocentric organizational culture of a global corporation: A phenomenological study

A global corporation values both profitability and social acceptance; its units mutually negotiate governance and represent a highly interdependent network where centers of excellence and high-potential employees are identified regardless of geographic locations. These companies try to build geocentric, or “world oriented” (Marquardt, 1999, p. 20), organizational cultures. Such culture “transcends cultural differences and establishes ‘beacons’ – values and attitudes – that are comprehensive and compelling” (Kets de Vries & Florent-Treacy, 2002, p. 299) for all employees, regardless of their national origins. Creating a geocentric organizational culture involves transforming each employee’s mindset, beliefs, and behaviors so that he/she can become “a world citizen in spite of having a national identity” (Marquardt, 1999, p. 47). The purpose of this phenomenological study was to explore how employees with different national identities experience a geocentric organizational culture of a global corporation. Phenomenological research aims to understand “how people experience some phenomenon—how they perceive it, describe it, feel about it, judge it, remember it, make sense of it, and talk about it with others” (Patton, 2002, p. 104). Twelve participants were selected using criteria, convenience, and snow-ball sampling strategies. A semi-structured interview guide was used to collect data. Data were analyzed inductively, using Moustakas’s (1994) Modification of the Stevick-Colaizzi-Keen Method of Analysis of Phenomenological Data. The participants in this study experienced a geocentric organizational culture of a global corporation as on in which they felt connected, valued, and growing personally and professionally. The participants felt connected to the companies via business goals and social responsibility. The participants felt valued by the company because their creativity was welcomed and they could contribute to the corporation certain unique knowledge of the culture and language of their native countries. The participants felt growing personally and professionally due to the professional development opportunities, cross-cultural awareness, and perspective consciousness. Based on the findings from this study, a model of a geocentric organizational culture of a global corporation: An employee perspective is proposed. Implications for research and practice conclude this study.

Factors that differentiate persistence beyond the first session at a for-profit university

An increasing number of students are selecting for-profit universities to pursue their education (Snyder, Tan & Hoffman, 2006). Despite this trend, little empirical research attention has focused on these institutions, and the literature that exists has been classified as rudimentary in nature (Tierney & Hentschke, 2007). The purpose of this study was to investigate the factors that differentiated students who persisted beyond the first session at a for-profit university. A mixed methods research design consisting of three strands was utilized. Utilizing the College Student Inventory, student’s self-reported perceptions of what their college experience would be like was collected during strand 1. The second strand of the study utilized a survey design focusing on the beliefs that guided participants’ decisions to attend college. Discriminant analysis was utilized to determine what factors differentiated students who persisted from those who did not. A purposeful sample and semi-structured interview guide was used during the third strand. Data from this strand were analyzed thematically. Students’ self-reported dropout proneness, predicted academic difficulty, attitudes toward educators, sense of financial security, verbal confidence, gender and number of hours worked while enrolled in school differentiated students who persisted in their studies from those who dropped out. Several themes emerged from the interview data collected. Participants noted that financial concerns, how they would balance the demands of college with the demands of their lives, and a lack of knowledge about how colleges operate were barriers to persistence faced by students. College staff and faculty support were reported to be the most significant supports reported by those interviewed. Implications for future research studies and practice are included in this study.

Island diasporas: Perceptions of Indo-Caribbean protégés regarding the effects of their cross-cultural mentoring experiences in the United States

Mentoring is defined as an "intense caring relationship in which persons with more experience work with less experienced persons to promote both professional and personal development" (Caffarella, 1992, p. 38). It is "a powerful emotional, and passionate interaction whereby the mentor and protégé experience...intellectual growth and development" (Galbraith & Zelenak, 1991, p. 126). In cross-cultural mentoring, mentors and protégés from different cultures confront social and cultural identities, goals, expectations, values, and beliefs (Cross & Lincoln, 2005) to "achieve a higher level of potency in education and society" (Mullen, 2005, p. 6). Cross-cultural mentoring research explores attitudes, behaviors, linguistics and motivators of the more visible racial and ethnic groups in the U.S. (Elmer, 1986, Ulmer, 2008). The cross-cultural mentoring experiences of Indo-Caribbeans in the U.S. are obscured from the research despite their rich socio-historic culture. The purpose of this phenomenological study was to explore the perceptions of Indo-Caribbean protégés regarding the effects of their cross-cultural mentoring experiences in the United States. Phenomenology is "the systematic attempt to uncover and describe...the internal meaning structures, of lived experience [by studying the] particulars or instances as they are encountered" (Van Manen, 1990, p. 10). Criterion and snowball sampling were used to recruit 15 participants. A semi-structured interview guide was used to gather data and Creswell's (2007) simplified version of Moustakas's (1994) Modification of the Stevick-Colaizzi-Keen Method of Analysis of Phenomenological Data was used to analyze the data. Three themes emerged: (a) "Sitting at the feet of gurus" taught protégés how to accept guidance, (b) Guru-Shishya: Learning and Discipleship, ways that protégés perceived mentors' guidance related to work, skill acquisition, and social or emotional support, and (c) Samavartan sanskar: Building Coherence, helped protégés understand, manage and find meaning. Protégés' goals and professional expectations determined what they wanted from cross-cultural mentoring relationships and what they were willing to endure within those relationships. Since participants valued achievement and continuous improvement, mentor support was integral to making meaning and developing a sense of coherence in their lives. Implications regarding cross-cultural mentoring relationships together with recommendations for future research conclude the study.

Living on both sides of the fence: A phenomenological study of human resource development professionals as downsizing survivors and strategic human resource development facilitators

This phenomenological study explored how HR professionals who identified themselves as facilitators of strategic HRD (SHRD) perceived the experience of being an organizational agent-downsizing survivor. Criterion and snowball sampling were used to recruit 15 participants for this study. A semi-structured interview guide was used to interview participants. Creswell's (2007) simplified version of Moustakas's (1994) Modification of the Stevick-Colaizzi-Keen Method of Analysis of Phenomenological Data was used to analyze the data. Four main themes and corresponding sub-themes emerged from an inductive data analysis. The four main themes were a) the emotionality of downsizing, b) feeling responsible, c) choice and control, and d) possibilities for growth. Participants perceived downsizing as an emotional organizational change event that required them to manage their own emotions while helping others do the same. They performed their roles within an organizational atmosphere that was perceived as chaotic and filled with apprehension, shock, and a sense of ongoing loss, sadness and grieving. They sometimes experienced guilt and doubt and felt deceptive for having to keep secrets from others when planning for downsizing. Participants felt a strong sense of responsibility to protect employees emotionally, balance employee and organizational interests, and try to ensure the best outcomes for both. Often being there for others meant that they put on their games faces and took care of themselves last. Participants spoke of the importance of choosing one's attitude, being proactive rather than reactive, and finding ways to regain control in the midst of organizational crisis. They also perceived that although downsizing was emotionally difficult to go through that it provided possibilities for self, employee, and organizational growth.

Estrutura e desempenho organizacional: uma análise na Universidade Federal do Rio Grande do Norte

This research analyses the components of the organizational structure of the UFRN (Rio Grande do Norte Federal University) and to what extent they affect organizational performance. The study, classified as exploratory and descriptive, was conducted in two phases. The first phase consists of a pilot test to refine the research instrument and to identify the latent components of the organizational structure, and the second to characterize these components and thereby establish relationships with organizational performance. In the first phase, the research was conducted in 20 UFRN organizational units with the participation of 84 employees between technical-administrative and teachers, after considering missing values and outliers, while the second phase occurred in two stages: one conducted with 279 valid cases, consisting of technical-administrative and teachers of 37 UFRN units, and another with 112 managers of the institution in the 49 units identified in this research. The instrument adopted in the first phase was composed of 36 indicators of organizational structure, with six extracted and adapted from the instrument developed by Medeiros (2003) and 30 prepared based on the literature review, from Mintzberg (2012), Hall (1984), Vasconcellos and Hemsley (1997) and Seiffert and Costa (2007) and 7 performance indicators adapted from Fleury and Mills (2006), Vieira and Vieira (2003) and Kaplan and Norton (1997) from the self-assessment instrument in use by the university. In this stage the data were analyzed using the techniques of factor analysis and reliability analysis by means of Cronbach’s alpha, aiming to extract the factors representing the components of the organizational structure. In step 1 of the second phase, the instrument, refined and reduced in the previous phase, with 24 variables of organizational structure and 6 for performance was used, while in step 2, a semi-structured interview guide with questions, organized into nine organizational structure elements, was adopted aiming to gather information to understand the relationship of structure to performance of the UFRN. The techniques used in the second phase, as a whole, were factor analysis and reliability analysis to characterize the components extracted in the previous phase and to validate the performance variables and correlation analysis, regression and content analysis to establish and understand the relationship between structure and performance. The results showed, in the two stages, six latent components of organizational structure in the context under study: training and internalization, communication, hierarchy, decentralization, formalization and departmentalization - with high levels of Cronbach's alpha indexes - which can thereby be characterized as components of UFRN structure. Six performance indicators were validated in this study, showing them as efficient and highly reliable. Finally, it was found that the formalization, communication, decentralization, training and internalization components positively affect UFRN performance, while departmentalization has an adverse affect and hierarchy did not show a significant relationship. The results achieved in this work are important in future studies to support the development of a model structure that represents the specifics of the university

Intern kontroll: En fallstudie på Trafikverket

Internal control is something that’s grown more important for enterprises to keep in mind. The community is increasingly affected by the IT-development which demands a bigger degree of security. Enterprises needs to make sure that their systems are up to date and secure enough to keep it safe from unauthorized to take part of sensitive information. Internal control can exist in a major part of the work. If an enterprise have a goal for no harm or serious injury at work, internal control is necessary to reach that goal. The purpose for this essay is to examine how five different departments of Trafikverket practices internal control. How internal control is described. How the guidance from the managements is described and how it reaches the rest of the enterprise. This will lead to a proposal of improvement of the internal control at Trafikverket. We focus our frame of reference on the COSO-model and its five components. The components included in the COSO-model are control environment, risk valuation, control activities, information and communication and monitoring. The essay is a case-study of Trafikverket. We have chosen a qualitative method and interviewed five respondents from the different departments on Trafikverket. The respondents we interviewed works with internal control in their everyday work or have a god insight in the subject. We used a semi structured interview guide with questions based on the COSO framework. The results from our study shows that it exist big variations between how the departments work with internal control. It emerged that there are new guidelines for how the work should be done. This makes it necessary with education to implement the new ways to work. How the departments use the COSO-model varies. Some of them have incorporated the model in their new ways to work others have never heard of it. The conclusion of our study shows that the COSO-model and it´s components contribute to a functioning internal control. Implementing the components is important and the most important feature to good internal control is the corporate management. Education within the enterprise is the most effective way to inform the staff about the model and to implement it.

A qualitative study of the emotional coping and support needs of children living with a parent with a brain injury

Primary objective: To examine emotional coping and support needs in children of persons with acquired brain injury, with a view to understanding what interventions would be helpful for these children. Design: The study was qualitative, using a thematic analysis approach. Methods and procedure: Six children between 9 and 18 years of age, six parents (three with ABI), and three support workers were interviewed either at home or at a support centre, using a semi-structured interview guide. Results: Children reported using a variety of adaptive and maladaptive emotional coping strategies, but were consistent in expressing a need for credible validation, i.e. sharing experiences with peers. The results are presented under four overarching themes: difficulties faced; emotions experienced; coping strategies; and reported support needs. Conclusions: The results reveal an interaction between the child’s experiences of complex loss that is difficult to acknowledge, emotional distancing between parent and child, and the children’s need for credible validation. All children expressed a desire for talking to peers in a similar situation to themselves, but had not had this opportunity. Interventions should set up such peer interaction to create credible validation for the specific distress suffered by this population.

The +Contigo Project in the Voice of Eight-Grade Students

The +Contigo Project is a longitudinal research project based on a multilevel network intervention aimed at promoting mental health and well-being and preventing suicidal behaviors. Students participate in social skills training sessions on the stigma of mental disorders, adolescence, self-esteem, problem-solving skills, and wellbeing. Problem statement: To identify the qualitative impact of the +Contigo Project. Objectives: To identify the importance of the project for students, the problem situations which it helped to solve, and its impact on an individual level. Research methods: Content analysis (Bardin, 2009) with a posteriori categorical identification. Semi-structured interview guide with 5 questions. A convenience sample of 16 students, from three schools of one school cluster in the Center Region of Portugal, was used. The ethical aspects of parental consent, voluntary participation and data confidentiality were addressed. Findings: Fourteen categories emerged from the data analysis. The answers to Question 4 'How was this project important to you?' were particularly relevant. Students mentioned that it improved their self-esteem by increasing self-confidence and interpersonal skills, and that it increased their reflection and awareness on problems with which they learned how to cope during the sessions. Conclusions: All interviewees considered that the +Contigo project helped them to solve problems, improve their interpersonal skills and cope with the adolescence period. Students improved their self-esteem and self-knowledge, and were able to apply what they had learned in the sessions in their daily lives. We concluded that the project had a positive impact on the students' mental health.

La transition vers la vie adulte : les besoins des jeunes adultes présentant une déficience intellectuelle profonde et de leur famille, les facteurs qui l'influencent et les pistes de solutions pour la faciliter

Résumé : Introduction : Au Québec, jusqu’à l’âge de 21 ans, les enfants et adolescents ayant une déficience intellectuelle (DI) profonde ont des services de pédiatrie adaptés et l’opportunité de fréquenter des écoles spécialisées publiques. Toutefois, au-delà de cet âge, l’accès à ces services spécialisés est plus limité : le financement pour la fréquentation scolaire cesse et les jeunes adultes transfèrent des services de santé pédiatriques vers le secteur adulte. Malgré la mise en place de solutions visant à faciliter cette transition, des difficultés tendent à persister, une situation pouvant avoir des effets négatifs considérables au niveau de la personne ayant un handicap et de sa famille. Cependant, peu d’études se sont intéressées aux facteurs qui influencent le vécu de la transition vers la vie adulte des familles de jeunes personnes présentant une DI profonde, rendant difficile l’adaptation des programmes déjà existants de planification de la transition à la réalité de ces familles. Objectif : Ce projet vise à décrire les besoins des personnes présentant une DI profonde et de leur famille lors de la transition vers la vie adulte, en décrivant le vécu des parents lors de cette période et les facteurs qui l’influencent, ainsi qu’en explorant les pistes de solution à mettre en place. Méthodologie : Afin de réaliser cette étude qualitative, un devis descriptif interprétatif a été choisi. Deux entrevues semi-dirigées individuelles ont été réalisées auprès de quatorze parents, la deuxième entrevue permettant de valider et d’approfondir les résultats à l’aide d’un résumé de la première rencontre. Résultats : Plusieurs facteurs multisystémiques de l’ordre du soutien matériel, informatif, cognitif et affectif semblent influencer la transition vers la vie adulte. Ces différents facteurs contribuent au vécu particulièrement difficile des familles, qui vivent beaucoup d’anxiété et de frustration face au peu de soutien qui leur est offert. Plusieurs idées intéressantes ont été proposées par les parents pour répondre à ce manque de soutien, autant au plan du partage des connaissances, de l’amélioration de la collaboration inter-établissement que du soutien psychologique. Conclusion : Cette étude souligne l’importance d’impliquer l’ensemble des acteurs œuvrant auprès du jeune adulte et de sa famille dans la planification de la transition. La compréhension de la réalité des personnes avec une DI profonde et de leur famille devrait permettre de développer des interventions concrètes leur étant destinées dans de futurs projets.

Orthodox versus unorthodox care: A qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria

Introduction Utilization of orthodox health facilities for maternal health services is determined by factors operating at the individual, household, community and state level. The prevalence of small family norm is one of the identified variables operating within the community which influences the decision of where to access care (orthodox/traditional). The objective of the study was to determine the use of orthodox versus unorthodox maternity healthcare and determinants among rural women in southwest Nigeria. Methods A qualitative study was done and involved three focus group discussions. A semi-structured interview guide was used to collect information from women of reproductive age group within a rural Local Government Area in Lagos state. Results Most of the women access some form of healthcare during pregnancy, orthodox, unorthodox or both. Those who patronize both services concurrently do so to benefit from the two as each has some unique features such as herbal concoctions for traditional, ultrasound and immunization of babies for orthodox. Traditional belief exerts a strong influence on decision of where to access maternal healthcare services. Actual place of delivery is determined by individual and household factors including financial resources. Conclusion Rural women utilize one or both orthodox and unorthodox maternal health services for different reasons. Ward Development Committees should be strengthened so as to reach the communities, educate and convince women to dispel myths which limit their use of orthodox care. Training and monitoring of Traditional Birth Attendants (TBAs) are vital to eliminate harmful practices. We also recommend improved financial access to orthodox healthcare.