La perspectiva de ama de casa brasileña sobre la vida con diabetes mellitus tipo 2

The purpose of this study is to present an understanding of the experience of Brazilian homemakers with type 2 diabetes mellitus (DM2). A descriptive exploratory design was used and semi-structured interviews were conducted with 25 Brazilian homemakers concerning their experience. The interviews were recorded, transcribed, and the resulting text was analyzed using the sequential step method. Data converged to one dominant category, "constructing one's identity in the family context", which is comprised of three categories: gender differences; day-to-day concerns; and incongruity between knowledge and behavior related to DM2. These findings suggest that participants construct their identities within the family context and that their experience of living with DM2 is integral to their self-identification as wives and mothers. This, in turn, has implications for the design and implementation of programs to assist women in managing DM2 effectively.El propósito de este estudio es comprender la experiencia de las amas de casa brasileñas con la diabetes mellitus tipo 2 (DM2). Se empleo un abordaje exploratorio descriptivo, donde participaron de las entrevistas 25 amas de casa de Brasil acerca de su experiencia con el DM. Las entrevistas fueron grabadas, transcritas y el texto resultante se analizó mediante el método secuencial de cuatro etapas: aprensión, síntesis, teorización y transferencia. Los datos se reunieron en un tema dominante: "construyendo su identidad en el contexto familiar", que se compone de tres sub-temas: las diferencias de género, las preocupaciones del cotidiano y la incongruencia entre el conocimiento y el comportamiento relacionado con DM2. Estos hallazgos sugieren que los participantes construyen su propia identidad dentro del contexto familiar y que su experiencia de vivir con DM2 es parte integral de su identificación como esposas y madres. Esto, a su vez, tiene implicaciones para el planeamiento e implementación de programas para ayudar a las mujeres para administrar con eficacia la DM2.O objetivo deste estudo foi compreender a experiência de donas de casa brasileiras com diabetes mellitus tipo 2 (DM2). Foi utilizada abordagem descritiva exploratória, e entrevistas semiestruturadas foram realizadas com 25 donas de casa, abordando sua experiência com o DM2. As entrevistas foram gravadas, transcritas e o texto resultante foi analisado usando-se o método de etapas sequenciais. Os dados convergiram para um tema dominante construindo sua identidade no contexto da família, composto por três subtemas: diferenças de gênero, preocupações do dia a dia e incongruência, entre conhecimento e comportamento, relacionada ao DM2. Esses achados sugerem que as participantes constroem sua identidade no contexto da família e que a experiência de viver com DM2 é parte integrante de sua identificação como esposa e mãe. Esses resultados têm implicações para o planejamento e a implementação de programas que contribuam para que as mulheres gerenciem seu DM2 de forma eficaz

Writing Assignments: A Relatively Emotional Experience of Learning to Write in one Baccalaureate Nursing Program

This article specifically reports findings from an interdisciplinary case study that explored classroom experiences of learning to write across one baccalaureate nursing degree program in Canada. A combination of rhetorical genre and situated learning theories and institutional ethnography methods were used to help document student and instructor experiences of learning to write two recurring writing assignments called the scholarly paper and journal of reflective practice, which students composed in each semester of their program. Data included 38 classroom/student observations, 22 assignment instruction documents, and 39 voluntary, semi-structured interviews with 34 students and 5 instructors from 4 courses. Interviews focused primarily on perceived enablers and constraints during the process of learning to compose these two recurring genres. Findings revealed that learning to write was a dynamic relational and emotional experience for students as well as instructors. Enablers and challenges were directly influenced by the student/instructor relationship and the degree of competitive/cooperative relationships in the learning environment. Factors that enabled students’ learning to write included peer mentoring programs, where lower-year students learn to write from upper-year students, and instructional rapport with nurse educators and professional nurses, where students learn to write content from a nurse with experience in the content area. Challenges to students’ writing included developmentally inappropriate assignment design and writing supports, inconsistent instructor preferences and expectations, students’ inability to identify and articulate their own writing needs, and students’ tendency to apply the same writing style or strategies to different, evolving genres across the years. An unexpected finding was that students across all years self-reported reading deficiencies that impeded their ability to read assignment descriptions and to differentiate genres. The importance of this surprise finding is that it appeared to have an adverse affect on self-directed learning and students’ desire to communicate with instructors about learning to write the scholarly paper or journal of reflective practice. The article concludes with a discussion of ways that relational cultural theory and narrative pedagogy have better potential than rhetorical genre theory to explain the emotional dynamics that constellate around writing assignments and why the student-instructor relationship is a critical component to writing-to-learn/learning-to-write approaches, especially in writing intensive curricula like this one. Participants’ suggestions for improving writing assignments and instruction are in the appendix. Résumé Cet article présente les résultats d\u27une étude de cas interdisciplinaire qui a examiné les expériences d’apprentissage de la rédaction dans les cours d’un programme de baccalauréat en sciences infirmières, au Canada. Une combinaison de théories sur le genre rhétorique et l’apprentissage contextualisé, et de méthodes ethnographiques en établissement a été utilisée afin de documenter les expériences d’apprentissage des étudiantes et des formatrices en ce qui concerne la rédaction de deux types récurrents de travaux, le texte scientifique et le journal de pratique réflexive, que les étudiantes composaient chaque semestre au cours du programme. Les données comportaient 32 observations en classe, 22 documents de consignes pour les travaux et 39 entrevues semi-structurées avec 34 étudiantes et 5 enseignants volontaires de 4 cours. Les entrevues portaient principalement sur les facteurs facilitants et les défis perçus lors du processus d’apprentissage pour composer selon ces deux types récurrents d’écrits. Les résultats ont révélé que l’apprentissage de rédaction à travers les quatre années était une expérience relationnelle et émotionnelle pour les étudiantes et les formatrices. Les facteurs facilitants et les défis ont été influencés directement par la relation étudiante/formatrice et le degré de relations compétitives/coopératives dans le milieu d’apprentissage. Les facteurs qui ont facilité l’apprentissage de la rédaction incluaient les programmes de mentorat par les pairs, où les étudiantes des premières années apprennent à rédiger avec des étudiantes des dernières années, et les rétroactions des infirmières formatrices et des infirmières professionnelles, où les étudiantes apprennent à rédiger du contenu avec le soutien d’une infirmière qui a de l’expérience dans le domaine. Les défis à la rédaction étaient notamment les préférences et attentes différentes de la part des enseignantes, l’incapacité de l’étudiante à identifier et articuler ses propres besoins en matière de rédaction, et la conception des exigences et des consignes à la rédaction inappropriée pour le stade de développement. Un résultat inattendu a révélé que des difficultés de lecture auto déclarées par des étudiantes nuisaient à leur capacité de lire les descriptions des travaux et de différencier les types de travaux. Ce résultat étonnant est important puisqu’il semble avoir eu un effet défavorable sur l’apprentissage autonome et sur le désir des étudiantes de communiquer avec les enseignantes pour apprendre à rédiger un texte scientifique ou un journal de pratique réflexive. L’article conclut avec des suggestions pour améliorer la rédaction des consignes et une discussion sur l’apport de la théorie relationnelle culturelle pour aborder la question des dynamiques émotionnelles et relationnelles changeantes dans l’apprentissage de la rédaction de travaux au baccalauréat en sciences infirmières

Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse

This handbook is the culmination of a multiphase, multidisciplinary research project that used grounded theory and participatory action research to illuminate ways that healthcare providers can work sensitively (in a trauma-informed way) with adult survivors of childhood sexual abuse. The research identified nine Principles of Sensitive Practice: respect, rapport, taking time, sharing information and control, respecting boundaries, fostering mutual learning, understanding non-linear healing and demonstrating an understanding of trauma to patients. Specific guidelines were developed for a wide variety of issues pertinent to clinical practice such as, removal of clothing, touch, responding to disclosures of abuse, managing triggers among others. The methodology included interviews with women and men adult survivors of childhood sexual abuse from across Canada about how healthcare practitioners can be sensitive to their needs as survivors. It also included learnings from group meetings where survivors and healthcare practitioners discussed together ways healthcare practice could better respond to the needs of survivors. Written feedback received from physicians, nurses, dentists and dental hygienists, physical and occupational therapists, massage therapists, chiropractors, kinesiologists, professional regulators, mental health professionals and survivors from across Canada ensured that suggestions for clinical practice reflected both survivor needs and the realities of clinical practice. We concluded that because healthcare providers are not always aware that they are working with individuals who have experienced childhood trauma, clinicians should apply these principles and guidelines universally in order to work in a trauma-informed manner with all patients

An exploration of addiction in adults experiencing early-life stress: a metasynthesis

Objetivo: revisar e sintetizar pesquisas qualitativas sobre os vínculos entre o estresse no início da vida e os comportamentos de dependência na idade adulta. Método: metassíntese para revisar resultados de pesquisa qualitativa com base em procedimentos que descrevem como identificar temas ou construtos através de estudos em uma área específica. Foram realizadas pesquisas abrangentes em múltiplas bases de dados eletrônicas. A pesquisa inicial produziu 1.050 artigos, cujos títulos e resumos foram selecionados para inclusão com base em critérios predeterminados. Trinta e oito textos completos de artigos revisados por pares foram recuperados e avaliados por três revisores independentes. Doze artigos foram elegíveis para revisão completa e avaliados usando as ferramentas do Programa de Competências de Avaliação Crítica (Critical Appraisal Skills Programme, CASP). Resultados: os achados revelaram que existem associações claras entre o estresse no início da vida e comportamentos aditivos na idade adulta, como entre trauma na infância, violência e comportamentos aditivos. Um tema comum nas descobertas indica que os participantes se voltam para substâncias aditivas como uma maneira de lidar estrategicamente com experiências estressantes da infância, independentemente dos efeitos colaterais deletérios ou resultados sociais prejudiciais. Conclusão: pode-se inferir que o vício pode ser visto como uma forma de lidar com a adversidade na infância e que existe uma inter-relação entre vício, violência doméstica e crime.Objetivo: revisar y sintetizar la investigación cualitativa referida a la relación entre el estrés durante la infancia y las conductas adictivas en la adultez. Método: metasíntesis que examina los resultados de investigaciones cualitativas basadas en procedimientos orientados a identificar temas o constructos en diferentes estudios en un área específica. Se realizaron búsquedas exhaustivas en múltiples bases de datos electrónicas. La búsqueda inicial arrojó 1.050 artículos. Sus títulos y resúmenes fueron analizados para determinar si debían incluirse en este estudio en base a criterios predeterminados. Se obtuvieron treinta y ocho artículos completos revisados por expertos que fueron evaluados por tres revisores independientes. Entre ellos, doce fueron seleccionados para una revisión detallada y evaluados mediante las herramientas del Programa de Habilidades de Evaluación Crítica (CASP por sus siglas en inglés). Resultados: los resultados revelaron que existe una asociación clara entre el estrés de la infancia y las conductas adictivas en la edad adulta, al igual que entre los traumas infantiles, la violencia y las conductas adictivas. Un aspecto común encontrado en los resultados es que los participantes recurren a las sustancias adictivas como una estrategia para lidiar con experiencias estresantes de su niñez, independientemente de sus efectos secundarios dañinos o de sus resultados sociales perjudiciales. Conclusión: se concluye que la adicción puede ser vista como una forma de lidiar con la adversidad en la niñez y que existe una interrelación entre la adicción, la violencia doméstica y la delincuencia.Objective: to review and synthesize qualitative research on the links between early-life stress and addiction behaviours in adulthood. Method: metasynthesis to review qualitative research findings based on procedures that outline how to identify themes or constructs across studies in a specific area. Comprehensive searches of multiple electronic databases were performed. The initial search yielded 1050 articles and the titles and abstracts were screened for inclusion based on predetermined criteria. Thirty-eight full text, peer-reviewed articles were retrieved and assessed by three independent reviewers. Twelve articles were eligible for full review and appraised using the Critical Appraisal Skills Programme (CASP) tools. Results: the findings revealed that clear associations exist between early-life stress and addictive behaviours in adulthood, such as between trauma in childhood, violence, and addictive behaviours. A common theme in the findings indicates that participants turn to addictive substances as a way of strategically coping with stressful childhood experiences, regardless of the harmful side effects or detrimental social outcomes. Conclusion: it can be inferred that addiction may be viewed as a way to deal with adversity in childhood and that there is an interrelationship between addiction, domestic violence and crime

Handbook on Sensitive Practice for Health Care Practitioners: Lessons from Adult Survivors of Childhood Sexual Abuse

This handbook is the culmination of a multiphase, multidisciplinary research project that used grounded theory and participatory action research to illuminate ways that healthcare providers can work sensitively (in a trauma-informed way) with adult survivors of childhood sexual abuse. The research identified nine Principles of Sensitive Practice: respect, rapport, taking time, sharing information and control, respecting boundaries, fostering mutual learning, understanding non-linear healing and demonstrating an understanding of trauma to patients. Specific guidelines were developed for a wide variety of issues pertinent to clinical practice such as, removal of clothing, touch, responding to disclosures of abuse, managing triggers among others. The methodology included interviews with women and men adult survivors of childhood sexual abuse from across Canada about how healthcare practitioners can be sensitive to their needs as survivors. It also included learnings from group meetings where survivors and healthcare practitioners discussed together ways healthcare practice could better respond to the needs of survivors. Written feedback received from physicians, nurses, dentists and dental hygienists, physical and occupational therapists, massage therapists, chiropractors, kinesiologists, professional regulators, mental health professionals and survivors from across Canada ensured that suggestions for clinical practice reflected both survivor needs and the realities of clinical practice. We concluded that because healthcare providers are not always aware that they are working with individuals who have experienced childhood trauma, clinicians should apply these principles and guidelines universally in order to work in a trauma-informed manner with all patients

Domestic Violence and Immigrant Women: A Glimpse Behind a Veiled Door

Domestic violence (DV) experienced by immigrant women is a public health concern. In collaboration with a community agency, researchers undertook a retrospective review of 1,763 client files from 2006–2014. The three aims were to document the incidence of DV, service needs associated with DV, and identification of risk factors associated with DV in the extracted file data. About 41% reported DV and required multiple services. Separated and divorced women, and women on visitor/temporary visas showed the highest risk. The results underscore the value of research partnerships with community-based service agencies in increasing our understanding of DV among immigrant women

Social support intervention to promote resilience and quality of life in women living in Karachi, Pakistan: a randomized controlled trial

Objectives: This study tested the efficacy of a 6-week social support intervention for enhancing resilience and quality of life among women living in low socioeconomic areas of Karachi, Pakistan.Methods: One hundred and twenty women were randomly allocated to the intervention (n = 60) or control group (n = 60). Women in the intervention group attended a 6-week social support program, while those in the control group attended a single mental health awareness session. Outcome variables were measured via the resilience scale-14 item (RS-14), the resilience scale for adults (RSA), and World Health Organization quality of life brief scale (WHOQOL-BREF).Results: Compared to participants in the control group, women in the intervention group reported improvements in resilience measured by RS-14 (p = 0.022) and the structured style subscale of the RSA (p = 0.043). A medium effect size was also measured on the structured style subscale (d = 0.6, 95% CI = 0.62874, 2.57126). No significant findings were noted on QOL scores.Conclusions: Community-based social support interventions are a gender-sensitive-, culturally appropriate-, and resource-sparing approach to promote women\u27s resilience and improve their mental health