Qualitative health research
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When parents are unwilling or unable to care for their children, more often than not, grandparents step up to assume this task. Although insights into the multifaceted and unique needs of custodial grandparents are emerging, there is little research on how these changes in living circumstances impact the lives of custodial grandparents and the grandchildren in their care. In this exploratory study, the authors examined the circumstances under which grandparents in a border community assumed custodial care of their grandchildren and the factors that contributed to their decision. Through semi-structured interviews with six grandparents and five grandchildren, they also explored how grandparents and grandchildren coped with transition, how grandparents understood and found meaning in their role as caregivers of their grandchildren, how grandchildren viewed their grandparents in their new role, and how their lives and relationships had changed.
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Although self-determination is a key issue in empowerment, the perspective of patients on their experience of empowerment has been poorly investigated. The authors have attempted to understand better what the process of empowerment means to patients by investigating the situations and feelings of powerlessness from which a process of empowerment might evolve. ⋯ Their findings show that powerlessness extends well beyond strictly medical and treatment-related issues, as the study participants all expressed or demonstrated to have at some point or another experienced a distressing feeling of insecurity and a threat to their social and personal identities. The authors therefore suggest that an empowering provider-patient interaction should address these issues by providing for reassurance and opportunities for self-exploration as a prerequisite to participation and self-determination in treatment-related decisions.
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The purpose of this study is to describe the process of parenting a child with life-threatening heart disease. Despite advances in pediatric cardiac sciences, hypoplastic left heart syndrome remains difficult and controversial to treat. ⋯ Extraordinary parenting in a context of uncertainty was evident as parents simultaneously safeguarded their child's precarious survival as well as their own survival. As technologically advanced treatment contributes to the survival of children with complex health conditions, health care professionals must consider how to promote and support parenting strategies that benefit the new survivors of technology as well as their families.
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This hermeneutic phenomenological inquiry reveals the meaning in critical care nurses' lived experiences of making a difference in practice with a view to deepening our understanding of nursing in pursuing nursing excellence. It serves to show how critical care nurses make a difference and what difference they make to critically ill patients in a manner that more fully captures nursing practice as enacted in the critical care setting. ⋯ Guided by the lifeworld existentials, these themes became the threads around which an interpretive-descriptive text was written. The authors wove other relevant sources of lived-experience material into the evolving text to assist with the explication of meaning.
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Current medical emphasis on autonomy requires that patients be primary in authorizing do-not-resuscitate (DNR) orders, countermanding provision of cardiopulmonary resuscitation (CPR) on terminally ill patients. The assumptions that patients make regarding CPR and DNR orders will influence their choices about them. ⋯ However, a minority drew on dominant construals of DNR orders and CPR to locate themselves outside the category of suitable candidates for DNR orders, thus justifying a preference for CPR--even though some had current DNR orders. Doctors' and patients' assessments of eligibility for DNR orders might not coincide, and when patient autonomy is presumed by patients to be determinant, discrepancies between patient expectations and instituted medical practice are inevitable.