End-of-life care in the intensive care setting : a descriptive exploratory qualitative study of nurses' beliefs and practices

Background: End-of-life care is a significant component of work in intensive care. Limited research has been undertaken on the provision of end-of-life care by nurses in the intensive care setting. The purpose of this study was to explore the end-of-life care beliefs and practices of intensive care nurses. Methods: A descriptive exploratory qualitative research approach was used to invite a convenience sample of five intensive care nurses from one hospital to participate in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach. Findings: Three major categories emerged from analysis of the interviews: beliefs about end-of-life care, end-of-life care in the intensive care context and facilitating end-of-life care. The first two categories incorporated factors contributing to the end-of-life care experiences and practices of intensive care nurses. The third category captured the nurses’ end-of-life care practices. Conclusions: Despite the uncertainty and ambiguity surrounding end-of-life care in this practice context, the intensive care setting presents unique opportunities for nurses to facilitate positive end-of-life experiences and nurses valued their participation in the provision of end-of-life care. Care of the family was at the core of nurses’ end-of-life care work and nurses play a pivotal role in supporting the patient and their family to have positive and meaningful experiences at the end-of-life.Variation in personal beliefs and organisational support may influence nurses’ experiences and the care provided to patients and their families. Strategies to promote an organisational culture supportive of quality end-of-life care practices, and to mentor and support nurses in the provision of this care are needed.

Cancer-related psychosocial research : what are the perspectives of cancer care centre users on participation?

Purpose To explore the perspectives of cancer care centre users on participation in psychosocial research to inform research design and ethics. Methods The study is based on a qualitative research design. Fourteen semistructured interviews were carried in people diagnosed with cancer and carers. The interview included four main questions about practical barriers to participation, types of research design, motivating factors and the conduct of research in a cancer care support setting. The data were analysed using qualitative content analysis. Results Interviewees demonstrated a willingness to participate in psychosocial research within certain circumstances. There were no practical barriers identified, although they considered payment for research-related travel important. The most acceptable research design was the face-to-face interview and the least preferred was the randomised control trial. The factors that motivated participation were altruism, valuing research, and making a contribution to the centre. Interviewees supported the conduct of research in cancer care support centres conditional upon delaying recruitment during the initial months of users’ visits and its need to be discreet to avoid deterring visitors from accessing the centre. Conclusions The study concludes that the personal interaction between participants and researchers is the most important feature of decision-making by patients/carers to join studies. Taking into account the perspectives of people affected by cancer during the early stages of research design may enhance recruitment and retention and can contribute to the development of research protocols and ethics.

A qualitative analysis of stress, uplifts and coping in the personal and professional lives of Singaporean nurses.

Aim. This paper is a report of a descriptive study of nurses’ experiences of daily stress and coping. Background. Much of the research on stress in nursing is quantitative and has focused on only work stressors. Moreover, few studies have examined the uplifting side of living and the role it may play in moderating stress. A theoretical framework on stress and coping, ‘hassles’ and ‘uplifts’ was used to examine nurses’ experiences across their personal and professional lives from a qualitative perspective. Methods. A purposive sample of Singaporean hospital nurses (n = 23) identified using a snowball sampling technique, participated in two sets of email interviews in 2009. The qualitative data were analysed using thematic analysis. Results. Three themes were identified as constituting daily hassles: (i) time pressures, (ii) nature of nursing work and (iii) multiple roles. Uplifts were expressed in relation to one main theme of feeling good extending across nurses’ personal and professional lives. Three themes were identified as ways of coping: (i) taking time out, (ii) seeking emotional support and (iii) belief systems. Conclusion. The interaction between personal and professional life plays a major role in Singaporean nurses’ experiences of stress and coping. However, stress may be ameliorated through effective management and strong familial support. Nurses and employers are recommended to use uplifts and identify ways of coping to minimize attrition and contribute to the development of a healthy workforce.

Comparing and complementing methods : traditional market research vs. deep customer insights

Quantitative market data has traditionally been used throughout marketing and business as a tool to inform and direct design decisions. However, in our changing economic climate, businesses need to innovate and create products their customers will love. Deep customer insight methods move beyond just questioning customers and aims to provoke true emotional responses in order to reveal new opportunities that go beyond functional product requirements. This paper explores traditional market research methods and compares them to methods used to gain deep customer insights. This study reports on a collaborative research project with seven small to medium enterprises and four multi-national organisations. Firms were introduced to a design led innovation approach, and were taught the different methods to gain deep customer insights. Interviews were conducted to understand the experience and outcomes of pre-existing research methods and deep customer insight approaches. Findings concluded that deep customer insights were unlikely to be revealed through traditional market research techniques. The theoretical outcome of this study is a complementary methods matrix, providing guidance on appropriate research methods in accordance to a project’s timeline.

Qualitative criminology : Stories from the field

Qualitative researchers in the discipline of criminology perform a wide range of challenging tasks. They interview prisoners, police officers, magistrates and judges. They speak with survivors of domestic violence, and drink tea with the mothers of murdered children. They observe courts and communities, investigate the decision-making processes of juries and immerse themselves in the data they collect. They ask ‘big’ questions – ‘how do we criminalise the producers of toxic toys?’ – as well as ‘little’ questions – ‘what should I wear to conduct this interview?’ Qualitative Criminology: Stories from the Field brings to life the stories behind the research of both emerging and established scholars in Australian criminology. The book’s contributors provided honest, reflective, and decidedly unsanitised accounts of their qualitative research journeys - the lively tales of what really happens when conducting research of this nature, the stories that often make for parenthetical asides in conference papers but tend to be excised from journal articles. This book considers the gap between research methods and the realities of qualitative research. As such, it aims to help researchers and students who conduct qualitative criminological research reflect upon their role as researchers, and the practical, ideological and ethical issues which may arise in the course of their research. It is also a call to criminologists to make public the ‘failures’ and missteps of their research endeavours so that we can learn from one another and become better informed and more reflexive qualitative criminologists.

Work-based assessment : qualitative perspectives of novice nutrition and dietetics educators

Background The assessment of competence for health professionals including nutrition and dietetics professionals in work-based settings is challenging. The present study aimed to explore the experiences of educators involved in the assessment of nutrition and dietetics students in the practice setting and to identify barriers and enablers to effective assessment. Methods A qualitative research approach using in-depth interviews was employed with a convenience sample of inexperienced dietitian assessors. Interviews explored assessment practices and challenges. Data were analysed using a thematic approach within a phenomenological framework. Twelve relatively inexperienced practice educators were purposefully sampled to take part in the present study. Results Three themes emerged from these data. (i) Student learning and thus assessment is hindered by a number of barriers, including workload demands and case-mix. Some workplaces are challenged to provide appropriate learning opportunities and environment. Adequate support for placement educators from the university, managers and their peers and planning are enablers to effective assessment. (ii) The role of the assessor and their relationship with students impacts on competence assessment. (iii) There is a lack of clarity in the tasks and responsibilities of competency-based assessment. Conclusions The present study provides perspectives on barriers and enablers to effective assessment. It highlights the importance of reflective practice and feedback in assessment practices that are synonymous with evidence from other disciplines, which can be used to better support a work-based competency assessment of student performance.

A qualitative investigation of drug use among Pakistani road users

Background Statistics on drug use by Pakistani drivers are not available, yet considerable numbers of drivers are believed to be drug addicted. The National Drug Abuse Assessment 2006/07, conducted by the United Nation Office on Drugs and Crime and the Ministry of Narcotics Control Pakistan reported that opiate users numbered 628,000, of which 77%were chronic heroin abusers. Injecting drug users have reportedly doubled in the decade to 2006 and drug use has been linked with many major crashes involving professional drivers. Aims This study explored a broad range of risk taking behaviours of road users, including drug use. It also investigated associations between risky road use and fatalism and other cultural beliefs. Methods This paper reports findings relating to drug driving in the cities of Lahore, Rawalpindi and Islamabad. Thirty semi-structured interviews were conducted with bus, truck, and taxi drivers, policy makers and field police officers. Results Interviews suggested widespread use of illicit drugs, particularly among bus, truck and taxi drivers. Reasons for drug use included recreational purposes, stimulants during long driving episodes, and substance addiction. Furthermore, the use of drugs and any association with road crashes was generally viewed as linked to fatalism rather than to any fault of an individual. In other words, people did not believe there was an association between drug use and road crashes, even if they had personally experienced such. Police knowledge of drug use among drivers was evident, although there is no formal drug driving testing regime in Pakistan. Discussion and conclusions The substantial increase in drug use among the population in recent years highlights a significant public health challenge in Pakistan. This qualitative research, although recognized as not representative of the broader population, suggests that there is significant cause for concern about drug driving, especially among professional drivers, and a need for further investigation and intervention.

Evaluation of assessment in the context of work-based learning: Qualitative perspectives of new graduates

Aim Evaluation or assessment of competence is an important step to ensure the safety and efficacy of health professionals, including dietitians. Most competency-based assessment studies are focussed on valid and reliable methods of assessment for the preparation of entry-level dietitians, few papers have explored student dietitians’ perceptions of these evaluations. This study aimed to explore the perceptions of recent graduates from accredited nutrition and dietetics training programs in Australia. It also aimed to establish the relevance of competency-based assessment to adequately prepare them for entry-level work roles. Methods A purposive sample of newly-graduated dietitians with a range of assessment experiences and varied employment areas was recruited. A qualitative approach, using in-depth interviews with 13 graduates, with differing assessment experiences was undertaken. Graduates were asked to reflect upon their competency-based assessment experiences whilst a student. Data was thematically analysed by multiple authors. Results Four themes emerged from the data analysis: (i) Transparency and consistency are critical elements of work-based competency assessment. (ii) Students are willing to take greater responsibility in their assessment process. (iii) Work-based competency assessment prepares students for employment. (iv) The relationship between students and their assessors can impact on the student experience and their assessment performance. Conclusions Understanding this unique perspective of students can improve evaluation of future health professionals and assist in designing valid competency-based assessment approaches.

An analysis of digital storytelling as a documentation tool for research in the creative and performing arts

This paper examines the capacity of digital storytelling to document research activity in the creative and performing arts. In particular, it seeks to identify the thought processes and methods that underpin this research and to capture them using the digital storytelling medium. Interest in this issue was prompted by the author’s work with the creative and performing artists from the Queensland Conservatorium and the Queensland College of Art as part of the Federal government’s Research Quality Framework (RQF) in 2007. The RQF compelled artists to address what it means to undertake research in their disciplines, to describe this, measure it and quantify it; for many practitioners this represents a significant challenge. These issues continue to be pertinent in the context of the Excellence in Research for Australia (ERA) initiative. This research is significant because it seeks to identify, in layman’s terms, the research methods and thought processes used by artists in their research practice. It seeks to do so free of the encumbrances of the professional doctorate policies, the higher education research quality frameworks, and the dense philosophical debates that have to-date dominated discussions of this issue. The research involves qualitative data collection methods including a detailed literature review, interviews with key practitioners and academics involved in the creative and performing arts, and three case studies. The literature review focuses on publications that explore issues of research practice and method in the creative and performing arts. The case studies involve three Queensland-based artists. Digital stories will be developed (and presented) with Marcus and Mafe using their visual materials and drawing on the issues identified in the literature review and interviews. Emmerson’s DVD provided a point of comparison with the digital stories. (Brief bios are attached)

Developing and evaluating interventions that are applicable and relevant to inpatients and those who care for them; a multiphase, pragmatic action research approach

Background Randomised controlled trials may be of limited use to evaluate the multidisciplinary and multimodal interventions required to effectively treat complex patients in routine clinical practice; pragmatic action research approaches may provide a suitable alternative. Methods A multiphase, pragmatic, action research based approach was developed to identify and overcome barriers to nutritional care in patients admitted to a metropolitan hospital hip-fracture unit. Results Four sequential action research cycles built upon baseline data including 614 acute hip-fracture inpatients and 30 purposefully sampled clinicians. Reports from Phase I identified barriers to nutrition screening and assessment. Phase II reported post-fracture protein-energy intakes and intake barriers. Phase III built on earlier results; an explanatory mixed-methods study expanded and explored additional barriers and facilitators to nutritional care. Subsequent changes to routine clinical practice were developed and implemented by the treating team between Phase III and IV. These were implemented as a new multidisciplinary, multimodal nutritional model of care. A quasi-experimental controlled, ‘before-and-after’ study was then used to compare the new model of care with an individualised nutritional care model. Engagement of the multidisciplinary team in a multiphase, pragmatic action research intervention doubled energy and protein intakes, tripled return home discharge rates, and effected a 75% reduction in nutritional deterioration during admission in a reflective cohort of hip-fracture inpatients. Conclusions This approach allowed research to be conducted as part of routine clinical practice, captured a more representative patient cohort than previously reported studies, and facilitated exploration of barriers and engagement of the multidisciplinary healthcare workers to identify and implement practical solutions. This study demonstrates substantially different findings to those previously reported, and is the first to demonstrate that multidisciplinary, multimodal nutrition care reduces intake barriers, delivers a higher proportional increase in protein and energy intake compared with baseline than other published intervention studies, and improves patient outcomes when compared with individualised nutrition care. The findings are considered highly relevant to clinical practice and have high translation validity. The authors strongly encourage the development of similar study designs to investigate complex health problems in elderly, multi-morbid patient populations as a way to evaluate and change clinical practice.

Not just what they want, but why they want it: Traditional market research to deep customer insights

Purpose This paper explores advantages and disadvantages of both traditional market research and deep customer insight methods in order to lay the platform for revealing how a relationship between these two domains could be optimised during firm-based innovation. Design/methodology/approach The paper reports on an empirical research study conducted with thirteen Australian based firms engaged in a design-led approach to innovation. Firms were facilitated through a design-led approach where the process of gathering deep customer insights was isolated and investigated further in comparison to traditional market research methods. Findings Results show that deep customer insight methods are able to provide fresh, non-obvious ways of understanding customer needs, problems and behaviours that can become the foundation of new business opportunities. Findings concluded that deep customer insights methods provide the critical layer to understand why customers do and don’t engage with businesses. Revealing why was not accessible in traditional market research methods. Research limitations/implications The theoretical outcome of this study is a complementary methods matrix, providing guidance on appropriate implementation of research methods in accordance with a project’s timeline to optimise the complementation of traditional market research methods with design-led customer engagement methods. Practical implications Deep customer insight methods provide fresh, non-obvious ways of understanding customer needs, problems and behaviours that can become the foundation of new business opportunities. It is hoped that those in a position of data collection are encouraged to experiment and use deep customer insight methods to connect with their customers on a meaningful level and translate these insights into value. Originality/value This paper provides original value to a new understanding how design techniques can be applied to compliment and strengthen existing market research strategies. This is crucial in an era where business competition hinges on a subtle and often intimate understanding of customer needs and behaviours.

Focusing on what counts: Using exploratory focus groups to enhance the development of an electronic survey in a mixed-methods research design

This paper describes the use of exploratory focus groups to inform the development of a survey instrument in a sequential phase mixed methods study investigating differences in secondary students’ career choice capability. Five focus groups were conducted with 23 year 10 students in the state of New South Wales (NSW), Australia. Analysis of the focus group data informed the design of the instrument for the second phase of the research project: a large-scale cross-sectional survey. In this paper, we discuss the benefits of using sequential phase mixed method approaches when inquiring into complex phenomena such as human capability.

A methodological survey of future mobility literature: Opportunities for design research

This research establishes that the study of mobility and transportation is multi-disciplinary and highly complex, involving the diverse interplay between infrastructural and psychological factors. Coincidently, a new paradigm in personal mobility is developing. A new generation of mobility solutions is becoming widely available in the form of car and ride sharing services. These services build on the assumption that customers no longer need ownership of a product in order to benefit from it. With the emergence of this new paradigm, this paper presents a methodological review of current practises used by the wider research community. Therefore, this research piece aims to explore methodological approaches involved in the study the effect of community on an individual’s attitudes, perceptions and behaviours of future mobility solutions. The results of this review indicate that the majority of published literature uses quantitative methods as opposed to qualitative and even fewer studies have sought to understand the human factors in these new mobility solutions. This gap in knowledge is a valuable opportunity for design. Inherently qualitative and human focused, design research can fill this gap in knowledge by applying distinctly user-centred methods such as persona design, narrative storytelling, and in-depth observations to discover deeper human insights.

Intergenerational collaborative drawing: A research method for researching with/about young children

This paper focuses on the methodological effectiveness of intergenerational collaborative drawing (ICD). A group of eight researchers trialled this particular approach to drawing, most of them for the first time. Each researcher drew with young children, peers and tertiary students, with drawings created over a period of six months. The eight researchers came together in a 'community of scholars' approach to this project because of two shared interests: (i) issues of social justice, access and equity; and (ii) arts-based education research methods. The researchers were curious how ICD might methodologically support their respective research processes. As knowledge and theory about young children becomes more complex, researchers need responsive methodological tools to ask new questions and conduct rigorous, ethical research. This partial account describes how drawing together might perform methodologically. The data reported here draws from the detailed field notes, drawings and reflections of the researchers. Conclusions arise from the analysis of these reflections, with the authors suggesting ways in which ICD might benefit research with young children.