Is it really theoretical? A review of sampling in grounded theory studies in nursing journals

Background Grounded theory is a distinct method of qualitative research, where core features are theoretical sampling and constant comparative analysis. However, inconsistent application of these activities has been observed in published studies. Aim This review assessed the use of theoretical sampling in grounded theory studies in nursing journals. Design An adapted systematic review was conducted. Method Three leading nursing journals (2010–2014) were searched for studies stating grounded theory as the method. Sampling was assessed using a concise rating tool. Results A high proportion (86%) of the 134 articles described an iterative process of data collection and analysis. However, half of the studies did not demonstrate theoretical sampling, with many studies declaring or indicating a purposive sampling approach throughout. Conclusion Specific reporting guidelines for grounded theory studies should be developed to ensure that study reports describe an iterative process of fieldwork and theoretical development

Older People, Sense of Coherence and Community

Population ageing is a global trend and even though years added to life often are lived in good health; it will have an impact on healthcare, housing and facilities, and social security costs. Healthy ageing in place, especially in one’s own home and community, increasingly receives attention from health professionals, researchers, and policymakers. In this chapter, we first discuss the meaning of the concept of healthy ageing, and how Sense of Coherence contributes to this process. Next, we discuss the characteristics of the community in which older people live their lives and how the community can provide resources (GRR and SRR) to strengthen Sense of Coherence and hence perceived well-being and quality of life

Should the provision of home help services be contained?: Validation of the new preventive care policy in Japan

<p>Abstract</p> <p>Background</p> <p>To maintain the sustainability of public long-term care insurance (LTCI) in Japan, a preventive care policy was introduced in 2006 that seeks to promote active improvement in functional status of elderly people who need only light care. This policy promotes the use of day care services to facilitate functional improvement, and contains the use of home help services that provide instrumental activity of daily living (IADL) support. However, the validity of this approach remains to be demonstrated.</p> <p>Methods</p> <p>Subjects comprised 241 people aged 65 years and over who had recently been certified as being eligible for the lightest eligibility level and had began using either home help or day care services between April 2007 and October 2008 in a suburban city of Tokyo. A retrospective cohort study was conducted ending October 2009 to assess changes in the LTCI eligibility level of these subjects. Cox's proportional hazards model was used to calculate the relative risk of declining in function to eligibility Level 4 among users of the respective services.</p> <p>Results</p> <p>Multivariate analysis adjusted for factors related to service use demonstrated that the risk of decline in functional status was lower for users of home help services than for users of day care services (HR = 0.55, 95% CI: 0.31-0.98). The same result was obtained when stratified by whether the subject lived with family or not. Furthermore, those who used two or more hours of home help services did not show an increase in risk of decline when compared with those who used less than two hours.</p> <p>Conclusions</p> <p>No evidence was obtained to support the effectiveness of the policy of promoting day care services and containing home help services for those requiring light care.</p

Do-not-attempt-cardiopulmonary-resuscitation decisions : an evidence synthesis

Background: Cardiac arrest is the final common step in the dying process. In the right context, resuscitation can reverse the dying process, yet success rates are low. However, cardiopulmonary resuscitation (CPR) is a highly invasive medical treatment, which, if applied in the wrong setting, can deprive the patient of dignified death. Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) decisions provide a mechanism to withhold CPR. Recent scientific and lay press reports suggest that the implementation of DNACPR decisions in NHS practice is problematic. Aims and objectives: This project sought to identify reasons why conflict and complaints arise, identify inconsistencies in NHS trusts’ implementation of national guidelines, understand health professionals’ experience in relation to DNACPR, its process and ethical challenges, and explore the literature for evidence to improve DNACPR policy and practice. Methods: A systematic review synthesised evidence of processes, barriers and facilitators related to DNACPR decision-making and implementation. Reports from NHS trusts, the National Reporting and Learning System, the Parliamentary and Health Service Ombudsman, the Office of the Chief Coroner, trust resuscitation policies and telephone calls to a patient information line were reviewed. Multiple focus groups explored service-provider perspectives on DNACPR decisions. A stakeholder group discussed the research findings and identified priorities for future research. Results: The literature review found evidence that structured discussions at admission to hospital or following deterioration improved patient involvement and decision-making. Linking DNACPR to overall treatment plans improved clarity about goals of care, aided communication and reduced harms. Standardised documentation improved the frequency and quality of recording decisions. Approximately 1500 DNACPR incidents are reported annually. One-third of these report harms, including some instances of death. Problems with communication and variation in trusts’ implementation of national guidelines were common. Members of the public were concerned that their wishes with regard to resuscitation would not be respected. Clinicians felt that DNACPR decisions should be considered within the overall care of individual patients. Some clinicians avoid raising discussions about CPR for fear of conflict or complaint. A key theme across all focus groups, and reinforced by the literature review, was the negative impact on overall patient care of having a DNACPR decision and the conflation of ‘do not resuscitate’ with ‘do not provide active treatment’. Limitations: The variable quality of some data sources allows potential overstatement or understatement of findings. However, data source triangulation identified common issues. Conclusion: There is evidence of variation and suboptimal practice in relation to DNACPR decisions across health-care settings. There were deficiencies in considering, discussing and implementing the decision, as well as unintended consequences of DNACPR decisions being made on other aspects of patient care. Future work: Recommendations supported by the stakeholder group are standardising NHS policies and forms, ensuring cross-boundary recognition of DNACPR decisions, integrating decisions with overall treatment plans and developing tools and training strategies to support clinician and patient decision-making, including improving communication. Study registration: This study is registered as PROSPERO CRD42012002669. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Variation in local trust Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policies: a review of 48 English healthcare trusts.

OBJECTIVES To explore Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policies from English acute, community and ambulance service Trusts for evidence of consistency and variation in implementation of national guidelines between healthcare organisations. SETTING Acute, community or ambulance National Health Service (NHS) Trusts in England. PARTICIPANTS 48 NHS Trusts. INTERVENTIONS Freedom of information requests for adult DNACPR policies were sent to a random sample of Trusts. OUTCOMES DNACPR policies were assessed on aspects identified from national guidelines including documentation, ethical and legal issues, decision-makers and involvement of others in DNACPR decisions as well as practical considerations such as validity, review and portability of decisions. RESULTS Policies from 26 acute, 12 community and 10 ambulance service Trusts were reviewed. There was variation in terminology used (85% described documents as policies, 6% procedures and 8% guidelines). Only one quarter of Trusts used the recommended Resuscitation Council (UK) record form (or a modification of the form). There was variation in the terminology used which included DNAR, DNACPR, Not for CPR and AND (allow natural death). Accountability for DNACPR decisions rested with consultants at all acute Trusts and the most senior clinician at community Trusts. Most Trusts (74%) recommended discussion of decisions with a multidisciplinary team. Compliance with guidance requiring clinical staff to assess the patient for capacity and when to consult a lasting power of attorney or independent mental capacity advocate occurred less commonly. There was wide variation in the duration of time over which a DNACPR decision was considered valid as well as in the Trusts' approach to reviewing DNACPR decisions. The level of portability of DNACPR decisions between healthcare organisations was one of the greatest sources of variation. CONCLUSIONS There is significant variation in the translation of the national DNACPR guidelines into English healthcare Trusts' DNACPR policies

Impact of high water carbon dioxide levels on Atlantic salmon smolts (<i>Salmo salar</i> L.): Effects on fish performance, vertebrae composition and structure

The role of high carbon dioxide (CO2) levels on fish performance, bone structure/composition and as a potential cause of spinal deformities was studied. Two groups of fish were exposed to a low (control) and a high level of CO, for 135 days during the freshwater period. After smoltification, the fish were transferred to seawater and followed up for 517 days until they reached harvest weight (3.1 kg BW). Differences in body weight between the control and high CO2 groups were observed. At the end of the freshwater period, average weight in the group exposed to high CO2 levels was 20.9% lower than in the control group. Specific growth rates (SGR) from the start of the experiment (10 g BW) to smolt stage were 1.63 +/- 0.04 and 1.36 +/- 0.01 for the control group and the high CO2 group, respectively. Differences in body weight were maintained during the initial stages of the seawater period, but were not observed at harvest weight. Nephrocalcinosis was not observed in any of the experimental groups at the end of the freshwater period and no external signs of spinal deformities were observed either at smolt stage or at harvest weight. X-rays revealed mild abnormalities in some vertebrae bodies, which could not be related to any experimental group. Despite the lack of signs of pathological bone alterations, the histological examination suggested that the exposure to high CO2 levels resulted in an increase in trabeculae volume and a higher rate of bone remodeling at the end of the freshwater period. Furthermore, fish exposed to a high CO2 level presented a higher bone ash content at the end of the freshwater period. These differences could not be observed at the end of the grow-out period