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Posts from the ‘Research’ Category

Research practices to address health equity

The authors of our current featured article provide exemplars from a study exploring African American participation in research to demonstrate the use of a combined framework for analysis that examines the interactions of environment, culture, biology and history to understand the complex problems of health inequity.  The article, titled “Uniting Postcolonial, Discourse, and Linguistic Theory to Explore Participation of African Americans in Cancer Research as an Effect of Social and Historical Race Relationships” is authored by Darryl Somayaji, PhD, RN, CNS, CCRC and Kristin Gates Cloyes, PhD, RN.  They present a compelling discussion of the need to better understand the experience of African Americans as research participants, and to use this understanding to change the social and political realities of the research environment, research practices, and the teaching of research methods. Dr Somayaji shared the following account of how this work evolved:

Kristin and I are honored that our article was selected to be featured for the current issue of ANS. I was fortunate to be a doctoral student of Dr. Kristin Gates Cloyes at the University of Utah, School of Nursing. Although our clinical backgrounds and expertise are different (Kristin’s in mental health; mine in cancer and cancer research), we share a

Dr. Somayaji (left) and Dr. Cloyes

Dr. Somayaji (left) and Dr. Cloyes

common history of interest in social justice and health equity. Kristin’s knowledge and expertise in critical research was instrumental in opening my eyes to new ways of thinking about research theory and how different approaches to research can translate to practice. The article “Uniting Postcolonial, Discourse, and Linguistic Theory to Explore Participation of African Americans in Cancer Research as an Effect of Social and Historical Race Relations” is from my dissertation work on exploring African American participation in research. Our hope is that this article will illuminate the complexity of participation in cancer research, and the importance of understanding how history, relationships, and language are closely tied to research subject identity.

The article will be available at no charge while it is featured on the ANS web site!  I invite you to read this important and thought-provoking article while it is featured, and contribute your responses and thoughts on this topic by commenting here.  This is a topic that calls for ongoing and lively discussion, and we welcome the opportunity to engage using this blog!

Strength Amid Struggle

The current “editor’s pick” article is a notable example of a nursing perspective that is based on people’s strengths as they face health challenges, not solely on the challenges themselves.  The article, titled “Intimate Partner Violence in Mexican-American Women With Disabilities: A Secondary Data Analysis of Cross-Language Research” is authored by Chris Divin, MSN, RN, FNP; Deborah L. Volker, PhD, RN, AOCN, FAAN; and Tracie Harrison, PhD, RN.  Ms. Divin shared this background on the work that she completed for this article with her advisors, Drs. Volker and Harrison:

I have had the privilege of being a nurse for over thirty years. Almost half of those years were spent working in Latin America. It was in Venezuela when I worked with a group of health promoters that I first learned of the complexities of intimate partner violence (IPV). Our health group started a support group for women who were living in situations of IPV. We strengthened one another as we sat on hand made cushions in a safe and hidden open air patio behind the clinic. For the “Dia Internacional de la Mujer, International Day of Women,” men, women, and children joined together to paint murals throughout the barrio addressing the reality of IPV.

Until I worked in geriatrics as a nurse practitioner, I, like many people, held the mistaken assumption that IPV is only a phenomenon affecting younger women. I was both surprised and saddened that some of the women I

Chris Divin, MSN, RN, FNP

Chris Divin, MSN, RN, FNP

cared for in their 80s continued to struggle with IPV in their relationships. I presently work as an FNP providing primary care at a domestic violence shelter one day a week where I see the acute effects of abuse. I am passionate about the work I do, not only to raise awareness about IPV but to hope, dream, and continuously wonder what more can be done about this serious but preventable public health issue.

I was reminded at the Nurses Network for Violence against Women Conference in Vancouver earlier this year that nurses are called to be natural advocates for women affected by the multi-faceted health issues of IPV, and belonging to a predominantly female profession, there is tremendous power in numbers. I am delighted to be among nurse researchers who are actively engaged in pursuing a deeper understanding of this phenomenon, especially in the area of long term effects of abuse in an aging population. Not only is it important to recognize the scars of abuse but the amazing strength, perseverance, and peace that women manifest in the midst of their adversities.

Lastly, I, a novice researcher, had the opportunity to work on this study for over a year guided by two most amazing qualitative researchers. I have expressed gratitude to Dr. Harrison repeatedly for the “goldmine” that was handed to me when I was given the opportunity to analyze some of the data that had been collected for an entirely different study; an ethnographic investigation of health disparities and disablement among Mexican-American and non-Hispanic white women aged 55-75 years. I gained deep appreciation for the complex and intricate details that go into a secondary data analysis. I also could not help but wonder how many different research questions could be answered with data obtained for an entirely different objective and study. What richness in the human story and how serendipitous that ANS was soliciting articles for their “Peace and Health” issue as we were actively analyzing these stories for glimpses of peace and health amidst multiple adversities including IPV. We are very grateful for the timing and opportunity to publish in ANS and we appreciate any questions or comments in regards to our article.

Visit the ANS web site to day to download your copy of this article at no charge!  And do make comments here … the authors of ANS articles are eager to hear from you!

Critical Cultural Competence

In the current, very timely “Editor’s Pick” article titled “Critical Cultural Competence for Culturally Diverse Workforces: Toward Equitable and Peaceful Health Care, Dr. Adel F. Almutairi and Dr. Patricia Rodney describe the concept of “critical cultural competence” as essential to peace and health.  In their analysis, they view peace as not only a political responsibility of the state, but also a sociocultural concept that is relevant to all human encounters, animated by the ideal of human dignity.  The basis for this perspective is described in the article as follows:

The theoretical underpinnings of the approach to critical  cultural competence that we articulate in this article is an extension of the findings from Almutairi’s doctoral research project, which was a qualitative exploration of the cultural competence of a multicultural nursing workforce in a tertiary hospital in Saudi Arabia.  The nursing workforce in that Saudi tertiary hospital includes nurses from more than 25 nationalities from different parts of the world who provide care to the indigenous people of Saudi Arabia. The findings in Almutairi’s doctoral research project explicated the complex nature of cultural and linguistic diversity during clinical encounters. He found that this diversity poses threats to the physical, psychological, emotional, spiritual, and cultural safety of nurses, patients, families, and their communities. Such threats are caused by the increased potential for cultural clashes, negative attitude, and misunderstandings related to both communication and behavior. (p. 203)

Using evidence from Dr. Almutairi’s research, they present an analysis of the challenges of working in a multicultural environment, as well globe300as insights that can lead to peace in health care delivery.  They conclude:

 In this article, we have argued that because of its foundations in postcolonial theory and cultural safety—as well as its operationalization through critical awareness, critical knowledge, critical skills, and empowerment—critical cultural competence offers an action orientation from which to enact our shared responsibility and address structural injustices. It is our conviction that as a nursing profession we are well positioned to look toward the future and share responsibility locally, nationally, and globally to foster equitable and peaceful heath care. (p. 209)

I hope that ANS readers will find this message relevant, will share this work broadly, and will join the challenge to foster equitable and peaceful health care.  To download your copy of the article at no cost, visit the ANS web site now!


Translating Research to Reach for Peace

I am delighted to feature this article to introduce the current ANS issue focusing on “Health and Peace.”  The article, authored by Patricia Liehr, PhD, RN; Kate Morris, BA, MA; Mary Ann Leavitt, RN, BSN, CCRN and Ryutaro Takahashi, MD, PhD is titled “Translating Research Findings to Promote Peace: Moving From ‘Field to Forum’ With Verbatim Theatre.”  The background on this research, and the development of the theater play, is a fascinating story that Dr. Liehr has generously shared with us here:

Our manuscript, entitled “Translating research finding to promote peace: Moving from “field to forum” with verbatim theatre” began years ago when I began working with Japanese researchers. The research side of this story has merged with the creative arts side of the story to present With Their Voices Raised, which was first performed in November 2012. The Playwright/Dramaturg note and the Researcher note were in the program for the inaugural performances in 2012. They are included here to provide a context for understanding the origins of the manuscript.

Researcher Note

            The performance that we will watch tonight has its roots in research that began nearly two decades ago when Japanese and American researchers were studying blood pressure changes while talking to Japanese elders who had suffered a stroke. Our study purpose was to understand how the pathophysiology of stroke affected blood pressure recorded during talking. We asked our research participants to talk for four minute about their health; how they were managing the limitations imposed by their stroke…while we recorded blood pressure every two minutes.

Our participants took us down an unexpected path. The stories they shared while speaking wove in how they survived World War II, with the implicit and sometimes explicit suggestion that surviving a stroke was “nothing” compared to their World War II experience. As the research team considered what we were hearing, we decided that we needed to know more about surviving WWII for both Japanese and American elders. The bombings of Pearl Harbor and Hiroshima were selected as points of comparison, where each participant would be called upon to recollect aggressive actions taken by the opposing country.

About the same time the research was launched, we knew that we wanted to share these findings in ways other than traditional scholarly venues, like scientific journals. We wanted to touch people who may never read a scientific journal; wanted to reach youth who may be experiencing aggression in their own lives. We have published our research findings in a scholarly journal. Now….tonight, you are joining our journey as With Their Voices Raised shares the wisdom of our participants through documentary theatre. With your guidance, we will move on to share this wisdom with young people. We thank you for being here.

The Research Team: Patricia Liehr, Chie Nishimura, Mio Ito, LisaMarie Wands, Ryutaro Takahashi

Playwright/Dramaturg Note

When I was first approached in the spring of 2010 by American and Japanese nursing researchers to develop a theatre presentation based on approximately fifty Pearl Harbor and Hiroshima survivor testimonies, I had only a general

Invitation to performance, Miami Dade College, November 13, 2013

Invitation to performance, Miami Dade College, November 13, 2013

understanding of the events leading to United States involvement in World War II. My knowledge of the Pacific theater was based upon a recollection of a grainy photograph in my American History high-school text book of the U.S. Arizona engulfed in smoke and flames at Pearl Harbor on Dec 7, 1941. I had also read Hiroshima by John Hersey, but had no connection with the term hibakusha. I had a lot to learn.

In the winter of 2011 I traveled to Hiroshima, Japan and had my picture taken underneath the Memorial Monument for Hiroshima. Inside the Peace Museum I noticed a pocket watch, forever stopped at 8:15, tattered swatches of blackened clothing, and tiny pieces of concrete that were once buildings and homes. I watched video footage of the atomic bomb, its mushroom cloud of ash and debris rising high into the morning sky. I saw archaic clips of bald hibakusha, their faces covered with red dots, their teeth black and decaying. Finally, I signed the visitor’s book, along with countless others, in a pledge and plea for peace throughout the world.

In the spring of 2012 I visited Oahu, Hawaii. I climbed the steps of the control tower at the Pacific Aviation Museum on Ford Island and listened to the silence of the salt air. I rode a ferry over to the USS Arizona and saw the oil-slick ‘tears’ on top of the water while the ship’s turrets remained below. I took the “Home of the Brave” bus tour and drove past the countless headstones at Punchbowl National Cemetery, all decorated with an American flag. Finally, I signed the visitor’s book, along with countless others, thanking our brave servicemen and women for their sacrifice and service to our country.

Needless to say, working with the Pearl Harbor and Hiroshima survivors’ stories opened up a whole new path to my studies and the way I viewed the world. It also introduced me to documentary or verbatim theatre as a way to disseminate history and perpetuate research outside the textbook and classroom. By presenting With Their Voices Raised it is my hope that together we may learn by listening, by sharing, and by thoughtfully exploring our cultural differences and similarities in the hopes of a more peaceful future for us all. With that thought in mind, I welcome any comments or questions you may have in the talk-back following the performance and written in the survey.

Thank you, Kate Morris

Where do we go from here?

With Their Voices Raised will be performed in Miami on November 13, 2013.  The announcement for the performance has been included above in this blog message, as has a photo from the Florida Atlantic University performance (11-11-2012), capturing a

Voices of Nurses

Voices of Nurses

segment where the script focused on the stories of nurses. (Download a PDF copy of the performance invitation). Also included below is a video clip from the end of the performance at the Morikami Museum and Japanese Gardens on December 6, 2012. Some important terms that are used in the script and will occur in the video clip are:

Genbaku – short for Genshi-bakudan, the Atomic bomb

Hibaku – A-bomb exposed. Being subjected/exposed to the bomb/radiation

Hibakusha – A-bomb survivor. One who was subjected/exposed to the bomb/radiation.

Our next efforts will be directed to taking the script to high school students who will assume the roles of the 8 actors, perform the play, and engage with classmates in a discussion of the meaning of living through aggression. With this research-based creative experience, young people will have a history lesson as well as a lesson about the human spirit that calls for peace.

Patricia Liehr, Katy Morris, Mary Ann Leavitt, Ryutaro Takahashi

To download your copy of this article while it is featured, visit our ANS web site now!  Watch the video clip here!

Liehr: Promoting Peace with Verbatim Theater from Peggy L Chinn on Vimeo.

Recognizability: Assessing External Validity

This week’s “Editor’s Pick” article is titled “Recognizability: A Strategy for Assessing External Validity and for Facilitating Knowledge Transfer in Qualitative Research” by Hanne Konradsen, PhD; Marit Kirkevold, DrEd; and Karin Olson, PhD.  Dr. Konradsen sent this message for our blog:

Dear ANS and readers


Hanne Konradsen

When you sit and type on your computer, you often wonder “will anyone ever read this?”, “will anyone else think this is interesting?” and “will this in any way help improve lives or situations for patients?”

In debates external validity has been an issue that has divided qualitative researchers in many different groups. We argue in this article, that recognisability could serve as a strategy for quality assessment in relation to grounded theory. And for facilitating knowledge transfer. This implies that the researcher must be active in the scientific as well as public debate. Hopefully some will read the conclusions from the research. But it is equally important that the researcher must present the results in different forums. This gives the possibility for a wide variety of people to give their opinion regarding the results, and assess the recognizability of the findings. From these responses the researcher can then collect and paint a picture of whether others find the results important and whether the results of the research can contribute to future patient care.

You can download your copy of this article while it is featured!  Visit the ANS web site now!


Conversational Interviewing

This week’s Editor’s Pick article is titled “Making Meaning in Qualitative Research With Conversational Partnerships: A Methodological Discussion” by Susan M. Hunter Revell, PhD, RN.  In this article, Dr. Revell describes the interviewing method she uses in her research.  This is a 3-part approach to interviewing that facilitates a deep understanding of a person’s experiences.  I highly recommend this article for anyone interested in qualitative methods, because Dr. Revell provides a rich description of the method, and discusses some of the challenges she encountered in using the method.  She uses an example of her own approach to this type of interview with a person who has experienced a traumatic spinal cord injury.  By using a 3-part interview, she was able to reflect on the person’s words, the messages that Revell-wheelchair_smwere conveyed in both verbal and non-verbal elements of the interview, and plan subsequent interviews to explore meanings of the person’s experience in greater depth.  Dr. Revell starts her discussion of the example as follows:

 When using the responsive interviewing method, it is the conversational partnership that becomes the instrument in the study. The following discussion reflects on this perspective including the importance of establishing trust and rapport in the conversational partnership, challenges faced regarding the researcher role, and some unexpected findings from using the method.

To read more of her insights in this discussion, visit the ANS web site now!  Her article is available for download at no cost while it is being featured!

Grounded Theory and the Literature Review

The current Editor’s Pick article addresses a methodological issue that remains controversial – the timing of the literature review in the grounded theory method.  This article, titled  “The Timing of the Literature Review in Grounded Theory Research: An Open

Tracey Giles

Tracey Giles

Mind Versus an Empty Head” is authored by Tracey Giles, MNg, MACN, RN; Lindy King PhD, BN, DippAppSc, RN; and Sheryl de Lacey, PhD, MA, BAppSc, RN.  Ms. Giles describes their work, and invites you to respond with your perspectives on this issue:

What an absolute pleasure it is to have our article published in Advances in Nursing Science and featured as the editor’s article of the week on the ANS blog. I am a nursing lecturer and PhD candidate at Flinders University School

of Nursing and Midwifery. The aim of my PhD research is to explore decision making by health care professional and family members around family presence during cardiopulmonary resuscitation in an acute care setting using a constructivist grounded theory method (GTM).

I wrote this article with the support and guidance of my PhD supervisors in response to the often confusing advice I

Lindy King

Lindy King

encountered around the timing of the literature review in GTM research. My initial reading of methodological texts and articles revealed inconsistent and conflicting recommendations, many of which were to delay the literature review until analysis begins, or even until codes begin to emerge. However this advice was not compatible with my constructivist approach to GTM research. A constructivist approach actively repositions the researcher as a co-constructor of experience and meaning and takes into account their past and present perspectives, experiences and knowledge. This often includes an extensive knowledge of the existing literature.

A critical examination of the methodological literature was therefore undertaken in order to clarify and justify my use of the literature, and to offer recommendations to other researchers who are considering GTM as a potential research approach. We found that previous recommendations to delay the literature review are out-dated and that preconceptions are not only unavoidable but can enhance creativity,

Sheryl deLacey

Sheryl deLacey

theoretical sensitivity and rigour. We concluded that any bias that could potentially distort data analysis can be addressed by using correct, GTM transparent techniques and by ensuring the researcher openly acknowledge the influence of previous work in their perspective of what is emerging from their own data. We believe that if used reflexively, a preliminary literature review can enhance GTM research.

Thank you for the opportunity to share our ideas about GTM research. We look forward to your feedback about our recommendations.

Visit the ANS web site now to download your copy  of the article, and contribute your comments and feedback here!

Creativity and Quality: Qualitative research with people with aphasia


Berit Arnesveen Bronken

The authors of the current Editor’s Pick article in ANS provide an inspirational example of overcoming a research challenge that may seem impossible!  The challenge: to understand the experience of people with aphasia, despite their limitations in being able to convey their experience in spoken or written language.  The authors, Berit Arnesveen Bronken, MNS and Marit Kirkevold, EdD, provide thought-provoking explanations to address this challenge.  In addition, their approaches and their conclusions provide creative and rigorous approaches for conducting qualitative studies with all populations.  This article, titled “Between the Lines: Generating Good Qualitative Data in Studies Involving Persons With Aphasia” is a “must read” for anyone who is planning and conducting qualitative research.  Here is a description of their work:


Marit Kirkevold

Studying experiences of persons with aphasia following stroke challenge traditional norms of generating data of good quality because the research methods are based on abilities to produce and understand oral and written language, read and write. A longitudinal design, using a combination of research methods contributed to generate relevant and important data from a dialogue-based nursing intervention which included persons with moderate to severe aphasia.

To get your copy of this article, visit the ANS web site while it is being featured, and you can download it at no cost!

Developing Compentency Assessment Tools

The featured article by Shoa-Jen Perng, PhD and Roger Watson, PhD titled “Psychometric Testing of an Instrument Measuring Core Competencies of Nursing Students: An Application of Mokken Scaling” provides a report of a study  developing a tool to measure 8 core competencies of nursing students in Taiwan.  The authors propose that one way to bridge the gap between nursing education and practice is to competency-based approaches that prepare nursing students for practice.  Dr. Perng describes their work here:


Drs. Perng and Watson

It is an honor to have our manuscript published in Advances in Nursing Science. As a nurse educator I have strived to find an instrument that is useful to measure students’ learning outcomes. Previous literature has offered a lot of significant works, but some of the content or items in the existing instruments were not suitable for my needs. I needed an instrument that is not only valid for varied types of students, but also one that shows the strength and weakness of the students. The use of Mokken scaling analysis seemed suitable to expand the possibilities of assessment outcomes. In my role as a Director, Department of Nursing I hope that the results of assessing nursing students using this approach can provide information for further educational improvement. My co-author, Dr. Watson is a respected scholar and also a wonderful mentor for my research career. We are grateful for this opportunity to share our work in ANS and in this blog post. I hope you find our work is helpful to develop a new measure, and I look forward to your comments.

To examine their work further, visit the ANS web site now, and you can download a copy at no cost while the article is featured!

Practical Guidelines for Feminist Research

The current “Editor’s Pick” article is by Eun-Ok Im, PhD, MPH, RN, CNS, FAAN, who has published a number of articles that focus on feminism and nursing.  As a feminist scholar in nursing, she is well qualified to offer to the discipline her article titled “Practical Guidelines for Feminist Research in Nursing.”  Dr. Im provided this message, and an invitation for readers to engage in discussion of this article with her on this blog!

First of all, thanks a million to you, Dr. Chinn, editor of  ANS!!!  Thanks for choosing my article as the “Editor’s Picks” so that I could have scholarly discussion with all my respectable colleagues throughout the world.

To explain the background of the article…  The article was motivated by questions from my own doctoral students.  In my doctoral classes, I have frequently been asked about “how to conduct” a feminist study.  As all of us would agree, there is no one way to conduct a feminist study, but the students were eager to hearN753-April-2013 about my previous experience in feminist studies and some advice for their future feminist studies. That was the start point when I re-collected all my previous research notes from three feminist studies that I had conducted and re-analyzed to identify what would be essential components in feminist research.

Through the process, I have extracted a total of 10 idea categories, and I have proposed guidelines for these idea categories. Yet, these guidelines would not be new to feminist scholars/researchers who have been conducting feminist research. Rather, these are the ones that feminist scholars/researchers have taken for granted. However, for our novice feminist scholars/researchers, these kinds of explicit guidelines would be helpful (my hope!!!).

As noted in the article, there are several major limitations of the article.  I simply took a pragmatic approach to provide tangible guidance for feminist research. Also, the guidelines are from only three Internet-based studies with limitations in generalizability.

Anyway, I think we could further develop the guidelines for our future generation through our future collective efforts.  So, please feel free to add absent components that you found in your studies.  Thanks for all your attention to this article and thanks again to Dr. Chinn for this opportunity to dialogue with other scholars!

I invite you to download your copy of this article now at no cost, and engage in this dialogue!

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