Browsing by Author "Hoare K"

Now showing 1 - 11 of 11
  • Thumbnail Image
    Item
    Giving voice to children in research: The power of child-centered constructivist grounded theory methodology
    (Wiley Periodicals LLC, 2022-08) Sudarsan I; Hoare K; Sheridan N; Roberts J
    There has been a growing interest in giving voice to children in response to the introduction of the United Nations Convention on the Rights of the Child and evolving sociological discourses on childhood. Using child-sensitive methodologies such as constructivist grounded theory (CGT) enables children's voices to contribute authentic, meaningful, and eventually more actionable data, capable of informing policies and practices in children's best interests. In this article, we discuss how researchers using CGT can privilege children's voices through effective knowledge coconstruction by creating a child-sensitive research space and using methods that are appropriate to their abilities and interests. We draw on selected data from the first author's (I. S.) PhD project that explores Indian immigrant children's and their family carers' beliefs, practices, and experiences of asthma in New Zealand. We encourage researchers to consider CGT as one of the appropriate methodological choices to explicitly promote the voice of the child.
  • Thumbnail Image
    Item
    Grounded Theory Method and Symbolic Interactionism: Freedom of Conceptualization and the Importance of Context in Research
    (Institut für Qualitative Forschung, Internationale Akademie Berlin gGmbH, 30/09/2022) Hewitt S; Mills J; Hoare K; Sheridan N
    Symbolic interactionism (SI), a perspective used to understand human conduct, is commonly said to underpin grounded theory methodology (GTM). However, the purpose of GTM is to produce substantive explanatory social theory from data without reliance on prior assumptions. Therefore, some argue that SI is an unnecessary theoretical constraint on the principal aim of GTM —the free conceptualization of data. In this article we use examples from an ongoing constructionist grounded theory study into the negotiation of nurses' roles in general practice in New Zealand, to demonstrate how SI can inform GTM regarding conceptual development and context. We argue that by asking three questions from a symbolic interactionist perspective, at each stage of the research process, freedom of conceptualization may be enhanced and awareness of contextual matters promoted to better bridge world views.
  • Thumbnail Image
    Item
    Grounded theory: The FAQs
    (University of Alberta, 21/10/2019) Birks M; Hoare K; Mills J
    Since being developed as a research methodology in the 1960s, grounded theory (GT) has grown in popularity. In spite of its prevalence, considerable confusion surrounds GT, particularly in respect of the essential methods that characterize this approach to research. Misinformation is evident in the literature around issues such as the various approaches to GT, how long the process takes, the role of literature and preconceptions, generating and using data and strategies to produce theory. This article examines the most frequently asked questions about GT in an effort to demystify its purpose and use. Understanding the fundamental concepts of GT is critical to the correct use and application of GT methods and the ultimate production of theory that is grounded in data. More significantly, this understanding can prevent researchers encountering common pitfalls that can impede the process and impact the products of research.
  • Thumbnail Image
    Item
    Navigating asthma-the immigrant child in a tug-of-war: A constructivist grounded theory
    (John Wiley and Sons Ltd, 2023-07) Sudarsan I; Hoare K; Sheridan N; Roberts J
    BACKGROUND: Avoidable hospitalisation rates for Indian immigrant children with asthma is high in New Zealand and other Western countries. Understanding how children and their carers manage asthma may lead to a reduction in hospitalisation rates. The topic of asthma and Indian immigrant children's perspectives has not been investigated. Most studies on the topic focus on the experiences of family carers and health professionals. Practice cannot be advanced in the child's best interests unless the child's asthma experiences are explored. The following research addressed this gap by upholding Article 12 of the United Nations Convention on the Rights of the Child, thereby giving Indian immigrant children a voice in describing their asthma experiences. DESIGN: Constructivist grounded theory. METHODS: Intensive interviews were conducted with ten family carers and nine children (eight to 17 years old). Child-sensitive data collection techniques such as drawing, and photography were used to facilitate interviewing children younger than 14 years. The COREQ guidelines guided the reporting of this study. RESULTS: The theory, navigating asthma: the immigrant child in a tug-of-war, is the resulting grounded theory with the tug-of-war being the basic social process. This theory comprises three main categories: being fearful, seeking support and clashing cultures. The data reflected two types of tug-of-war: one between two cultures, the native Indian and the host New Zealand culture and another between family carers' and children's preferences. CONCLUSION: Acculturation and sociocultural factors may significantly influence the asthma experiences of Indian immigrants. RELEVANCE TO CLINICAL PRACTICE: The theory may assist healthcare practitioners to better comprehend Indian immigrants' asthma experiences within their wider sociocultural context. Our research indicates the need for healthcare practitioners to work in partnership with Indian immigrant families to implement culturally safe asthma management strategies.
  • Thumbnail Image
    Item
    Nurses' work in relation to patient health outcomes: an observational study comparing models of primary care.
    (BioMed Central Ltd, 2024-10-04) Sheridan N; Hoare K; Carryer J; Mills J; Hewitt S; Love T; Kenealy T; Primary Care Models Study Group
    BACKGROUND: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO). We describe nurse work in relation to these models of care, populations with high health need and patient health outcomes. METHODS: We conducted a cross-sectional study (at 30 September 2018) of data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥ 65 years), glucose control testing in adults with diabetes, immunisations (at 6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics. RESULTS: Nurse clinical time, and combined nurse, nurse practitioner and general practitioner clinical time, were substantially higher in Trust/NGO, Māori, and Pacific practices than in other models. Increased patient clinical complexity was associated with more clinical input and higher scores on all outcome measures. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, depression screening, glucose control testing) were in Māori, Trust/NGO and Pacific practices. There was an eightfold difference, across models of care, in percentage of depression screening undertaken by nurses and a fivefold difference in cervical screening and glucose control testing. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree. CONCLUSIONS: Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients.
  • Thumbnail Image
    Item
    Panic or peace - prioritising infant welfare when medicating feverish infants: a grounded theory study of adherence in a paediatric clinical trial
    (BioMed Central Ltd, 2022-04-11) Tan E; Hoare K; Riley J; Fernando K; Haskell L; McKinlay CJD; Dalziel SR; Braithwaite I
    Background Literature on factors influencing medication adherence within paediatric clinical trials is sparse. The Paracetamol and Ibuprofen in the Primary Prevention of Asthma in Tamariki (PIPPA Tamariki) trial is an open-label, randomised controlled trial aiming to determine whether paracetamol treatment, compared with ibuprofen treatment, as required for fever and pain in the first year of life, increases the risk of asthma at age six years. To inform strategies for reducing trial medication crossovers, understanding factors influencing the observed ibuprofen-to-paracetamol crossovers (non-protocol adherence) is vital. The aim of this study was to investigate the factors influencing the decision-making process when administering or prescribing ibuprofen to infants that may contribute to the crossover events in the PIPPA Tamariki trial. Methods Constructivist grounded theory methods were employed. We conducted semi-structured interviews of caregivers of enrolled PIPPA Tamariki infants and healthcare professionals in various healthcare settings. Increasing theoretical sensitivity of the interviewers led to theoretical sampling of participants who could expand on the teams’ early constructed codes. Transcribed interviews were coded and analysed using the constant comparative method of concurrent data collection and analysis. Results Between September and December 2020, 20 participants (12 caregivers; 8 healthcare professionals) were interviewed. We constructed a grounded theory of prioritising infant welfare that represents a basic social process when caregivers and healthcare professionals medicate feverish infants. This process comprises three categories: historical, trusting relationships and being discerning; and is modified by one condition: being conflicted. Participants bring with them historical ideas. Trusting relationships with researchers, treating clinicians and family play a central role in enabling participants to challenge historical ideas and be discerning. Trial medication crossovers occur when participants become conflicted, and they revert to historical practices that feel familiar and safer. Conclusions We identified factors and a basic social process influencing ibuprofen use in infants and trial medication crossover events, which can inform strategies for promoting adherence in the PIPPA Tamariki trial. Future studies should explore the role of trusting relationships between researchers and treating clinicians when conducting research.
  • Thumbnail Image
    Item
    Respiratory support in the emergency department a systematic review and meta-analysis
    (Wiley Periodicals LLC on behalf of Sigma Theta Tau International, 2024-03-22) O'Donnell J; Pirret A; Hoare K; Fenn R; McDonald E
    BACKGROUND: An estimated 20% of emergency department (ED) patients require respiratory support (RS). Evidence suggests that nasal high flow (NHF) reduces RS need. AIMS: This review compared NHF to conventional oxygen therapy (COT) or noninvasive ventilation (NIV) in adult ED patients. METHOD: The systematic review (SR) and meta-analysis (MA) methods reflect the Cochrane Collaboration methodology. Six databases were searched for randomized controlled trials (RCTs) comparing NHF to COT or NIV use in the ED. Three summary estimates were reported: (1) need to escalate care, (2) mortality, and (3) adverse events (AEs). RESULTS: This SR and MA included 18 RCTs (n = 1874 participants). Two of the five MA conclusions were statistically significant. Compared with COT, NHF reduced the risk of escalation by 45% (RR 0.55; 95% CI [0.33, 0.92], p = .02, NNT = 32); however, no statistically significant differences in risk of mortality (RR 1.02; 95% CI [0.68, 1.54]; p = .91) and AE (RR 0.98; 95% CI [0.61, 1.59]; p = .94) outcomes were found. Compared with NIV, NHF increased the risk of escalation by 60% (RR 1.60; 95% CI [1.10, 2.33]; p = .01); mortality risk was not statistically significant (RR 1.23, 95% CI [0.78, 1.95]; p = .37). LINKING EVIDENCE TO ACTION: Evidence-based decision-making regarding RS in the ED is challenging. ED clinicians have at times had to rely on non-ED evidence to support their practice. Compared with COT, NHF was seen to be superior and reduced the risk of escalation. Conversely, for this same outcome, NIV was superior to NHF. However, substantial clinical heterogeneity was seen in the NIV delivered. Research considering NHF versus NIV is needed. COVID-19 has exposed the research gaps and slowed the progress of ED research.
  • Thumbnail Image
    Item
    Respiratory support of adults in the emergency department: A protocol for a prospective, observational, multicenter point prevalence study
    (Health Science Reports published by Wiley Periodicals LLC, 2023-01) O'Donnell J; Pirret A; Hoare K; McDonald E
    Background and Aims Providing respiratory support (RS) to patients may improve their oxygenation and ventilation, reducing the work of breathing. Emergency department (ED) patients often need RS; COVID-19 has heightened this need. Patients receiving RS may need escalation of their treatment; hence, studies considering the prevalence of escalation are warranted. Method This is a protocol for a prospective, observational, multicenter point prevalence study (PPS). Researchers will collect data over 2 days. All participants are adult ED patients needing RS. The setting is four EDs in New Zealand. The primary research question asks, “Which patients receiving RS require escalation of therapy in the ED?” For example, transitioning from conventional oxygen therapy (COT) to intubation is deemed an escalation of therapy. A sample size of 80 participants is required to resolve the primary research question. Secondary research questions: (1) Which patients receive nasal high flow (NHF) in the ED? (2) How is NHF therapy delivered in the ED? (3) What are the effects of NHF therapy on physiological and patient-centered outcomes? Research Electronic Data Capture (REDCap) will be used for data organization. Data will be imported for analysis from REDCap to IBM SPSS software (Statistics for Windows, Version 27.0). Data reporting on the primary outcome shall be considered by analysis of variance, regression modeling, and determination of two treatment effects: Odds Ratio and Number Needed to Treat. Statistical significance for inferential statistics shall use a two-sided α with p-values fixed at ≤0.05 level of significance and 95% confidence intervals. This protocol has ethical approval from Massey University, New Zealand. Conclusion This novel PPS may reduce the evidence and clinical practice gap on RS delivery and ED patient outcomes, as evidenced by the emergence of COVID-19.
  • Thumbnail Image
    Item
    South Asian immigrants' and their family carers' beliefs, practices and experiences of childhood long-term conditions: An integrative review
    (John Wiley and Sons, Ltd, 2022-07) Sudarsan I; Hoare K; Sheridan N; Roberts J
    Aim The aim was to examine South Asian immigrants' beliefs, practices and experiences of childhood long-term conditions. Design This was an integrative review. Data sources MEDLINE, PsycINFO, PubMed, Scopus and Web of Science were searched for primary peer-reviewed articles published in English between January 2011 and April 2021. Review methods Articles were screened based on PRISMA guidelines. The quality of the studies was evaluated using the Critical Appraisal Skills Programme Checklist for qualitative studies and the Joanna Brigg's Institute Critical Appraisal Checklist for quantitative studies. Results Fourteen studies were included in the review. South Asian immigrant children and their family carers experienced cultural clashes as they attempted to incorporate their cultural beliefs about long-term conditions into a more westernized biomedical approach. Families were overburdened by caregiving and struggled to find additional support for their children. The main findings were categorized into three themes: (1) cultural beliefs; (2) religious, spiritual and complementary and alternative medicine practices and (3) care and support of the child. Conclusion Health-care providers should use a combination of culturally safe management strategies and a nuanced approach to educational initiatives on the biomedical aspects of various long-term conditions to effectively engage South Asian immigrant families with health services. Impact The growth of South Asians worldwide along with the increased burden of long-term conditions among South Asian immigrant children has implications for health service delivery. However, no reviews to date have explored South Asian immigrants' experience of childhood long-term conditions. Incorporating South Asian immigrants' beliefs and practices into the plan of care promotes collaborative decision-making that can lead to better treatment adherence, improved health outcomes and higher patient and family satisfaction. The findings encourage clinicians, researchers and policymakers to develop culturally safe child/family-centred interventions to address the specific needs of South Asian immigrant children with long-term conditions.
  • Thumbnail Image
    Item
    Understanding child and youth migrant wellbeing: Reflections from a systematic literature review in the Western Pacific region
    (Elsevier Ltd, 2021-07-31) Smith M; Spencer G; Fouché C; Hoare K
    One of the key social determinants of health that can impact children and young people is migration. Advances in health research have seen a shift away from a biomedical model of health to understanding health as a multifactorial, holistic state - mentally, physically, and socially. The aim of this article is to illustrate how different methods (i.e., adult-centric, child/youth-centered) and frameworks (i.e., biomedical, strengths-based) can impact on research findings in childhood research. Drawing on findings from a systematic review, we examine the approaches taken in eleven studies investigating the health and wellbeing of young migrants in the Western Pacific region. The systematic review highlighted a range of methods (quantitative surveys, drawings, photo novellas) that were used to capture child/youth perspectives, and identify contextual factors beyond immediate biomedical factors that impacted their wellbeing. Adult-centric biomedical approaches were limited in understanding these broader environmental contexts, yet these approaches were prevalent in this body of literature. We highlight the importance of developing more strengths-based approaches and child/youth-centered methods to gain a comprehensive understanding of social and physical environments that child and youth migrants draw upon to support their wellbeing.
  • Thumbnail Image
    Item
    Understanding the general practice nursing workforce in New Zealand: an overview of characteristics 2015-19
    (CSIRO Publishing, 2021-01-29) Hewitt SL; Sheridan NF; Hoare K; Mills JE
    Limited knowledge about the nursing workforce in New Zealand general practice inhibits the optimal use of nurses in this increasingly complex setting. Using workforce survey data published biennially by the Nursing Council of New Zealand, this study describes the characteristics of nurses in general practice and contrasts them with the greater nursing workforce, including consideration of changes in the profiles between 2015 and 2019. The findings suggest the general practice nursing workforce is older, less diverse, more predominately New Zealand trained and very much more likely to work part-time than other nurses. There is evidence that nurses in general practice are increasingly primary health care focused, as they take on expanded roles and responsibilities. However, ambiguity about terminology and the inability to track individuals in the data are limitations of this study. Therefore, it was not possible to identify and describe cohorts of nurses in general practice by important characteristics, such as prescribing authority, regionality and rurality. A greater national focus on defining and tracking this pivotal workforce is called for to overcome role confusion and better facilitate the use of nursing scopes of practice.