Qualitative health research
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The referral letter is a key instrument in moving patients from primary to secondary care services. Consequently, the circumstances in which a referral should be made and its contents have been the subject of clinical guidelines. This article is based on a project that demonstrated that physicians do not adhere to clinical guidelines when referring patients to secondary mental health services. ⋯ They also present a content analysis of referral letters to demonstrate the important ways in which they differ from guideline criteria. However, their central argument is that the role of the referral letter in relation to the GP's repertoire of treatments has not been understood fully. Such understanding implies the need for a reexamination of the support available for GPs.
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Comparative Study
Palliative care, care for life: a study of the specificity of residential palliative care.
In this study, the authors describe the concept of palliative care as applied in a palliative care unit. They conducted in-depth interviews with 8 patients, 9 relatives, and 24 caregivers from two residential palliative care units. Observation of the care and of team meetings and analysis of patient records provided additional data. ⋯ The first is to create space to live by diverting attention from the sick body, moving the illness into the background. The second is to fill the space as meaningfully as possible, so that patients can enjoy life even in the face of death. The quality of the caregiving process in palliative care is determined by a range of conditions and processes that reflect its complexity.
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Dyspnea, the major symptom associated with acute exacerbation events of chronic obstructive pulmonary disease (COPD), is a subjective experience. Extensive research has been done on the pathophysiology and affective components of dyspnea; however, the precise physical mechanism of breathlessness remains elusive. One purpose of this narrative research was to explore the affective component of dyspnea/anxiety as described by patients living with COPD characterized by acute illness events. ⋯ They described their understanding of acute dyspnea as an experience inextricably related to anxiety and emotional functioning. Their stories suggest that given the absence of clear objective measures of illness severity, patient-reported anxiety might provide an important marker during acute exacerbation events. Health care providers need to recognize anxiety as an important and potentially measurable sign of invisible dyspnea for end-stage patients with COPD in acute respiratory distress.
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The author examined the experience of fathers who have a child with juvenile rheumatoid arthritis (JRA). He used grounded theory methodology, in which 22 fathers participated in semistructured interviews, and developed a substantive theory of fathers' experience that addresses the impact of their child's JRA, their adaptational responses, and the meanings they associated with their experiences. ⋯ Fathers' efforts to be strong for others resulted in an overreliance on self-support strategies, particularly during periods of high stress. Given the nature of fathers' experience and the extent of their involvement, greater attention by health care practitioners to fathers' adaptation is indicated.
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Family surrogate decision makers are pivotal in end-of-life decision-making processes. The author investigated decision-making experiences of 20 surrogates who assisted terminally ill family members for this grounded theory study. Findings describe a basic social process of Seeing Them Through With Care and Respect, during which surrogates continuously synthesized the core values of caring for their family member and respecting their family member's autonomy. ⋯ The major categories of surrogate decision makers' activities during the process were Standing With and Acting For the ill family member. Events reported in two gating categories, Brokering Information and Working With Family, facilitated or impeded decision making. A final category, Outcomes, reports consequences for the surrogate of having been a decision maker.