Thesis Sounding Board - page 4
Well, the dreaded semester has begun: Intro to the Thesis Project. :eek: I'm early in the stages here and was hoping to bounce off some ideas related to my possible thesis topic. First, I am... Read More
Feb 17, '03The one statistic that my mind automatically sought that wasn't there was ... "What proportion of alcoholics relapse?" Are there any numbers (even estimates) of that?
There were relapse statistics for other addictions, namely heroin and such. All other sources simply agree that the relapse rate for alcoholism is "high."
Feb 17, '03I figured you had looked and couldn't find relapse stats, but thought I should point it out anyway.
Ok ... now that I've had a little more time to think ... here are my thoughts on questions and methodology.
Each of the major methodologies has been developed to answer different types of questions. You'll be much better off if you match you methodology to the question. Trying to fit a square peg (question) into a round hole (methodology) usually causes stress and strain that you don't need. Some students "fall in love" with a certain methodology and then try to use it even though their question is not well-suited for it. Or perhaps they have an advisor with expertise in a certain methodology, so they try to use that methodology in spite of the fact that their question doesn't match well, etc.
For Phenomenology, the heart of the question should be: "What is the lived experience of ...?" It is a broad question of exploration that yields a result of overall themes that encompass many different specific aspects of an experience. The basic question for the participants would be something like, "Tell me about your experience with relapsing."
For Grounded Theory Research -- the question is usually phrased something like, "What is the process of ...?" This question and this methodology might be a very good fit for your interest in the causes of relapse. You could ask your participants to describe the process of relapsing to you. Your results would be a model that captures the common features of the process of relapsing -- what events or feelings led up to the relapse, how they "decided" to relapse, etc. By illuminating the process of how relapse occurs, you make it possible for people to intervene in the early stages of that process -- before the relapse actually occurs.
Qualitative Descriptive is a term sometimes used for studies that simply choose to describe and/or explore something at a very beginning, general level. A suitable research question might be, "To explore the causes of relapse as perceived by those who have relapsed." Your broad question to the participants would be to ask them to tell you about the events and feelings that led to relapse. Your results would be a summary of their responses, looking for both common themes and unique differences.
I am a little concerned that you seem to have decided early on that you want to use Phenomenology, but yet your underlying question is about identifying the causes -- instead of wanting to understand the lived experience. Your underlying mission to identify the causes may not match up well with the intended results of a Phenomenologic study (description/theme of lived experience). Be careful about that.
You might get the proposal through committee with a mis-match that subtle, but you might struggle later in the interpretation phase as your methodology pushes you toward the development of a common theme of meaning -- and your gut wants you to develop a list of causative factors. It's best to reconcile your question and your methodology in the beginning -- and avoid finding yourself "fighting" with your chosen methodology.
Just my $.02,
Feb 17, '03Unfortunately, the source I have at my desk is a little bit old but these might give you a jumping off point. I searched alcoholism, recidivism, and relapse. Then combined recidivism and relapse individually with alcoholism. Try that with a more recent version of CINAHL and see what you get. That's pretty much a quick and dirty search. Would be glad to help if you'd like to dp something a bit more thorough.
TI: Helping the alcoholic patient recover.
ID: C.E.U.; Statistics; Illustration; Tables-or-Charts
SO: American-Journal-of-Nursing. 1995 Aug; 95(8): 22-30 [7 refs]
DD: Uncover Company. (http://uncweb.carl.org Tel:1-800-787-7979.)
AB: About 30% of acute care patients are alcoholic, and alcohol contributes to about 100,000 deaths in the United States annually. Given the widespread epidemiology of the disease, nurses must be knowledgeable in its assessment and treatment. This extended case review addresses signs and symptoms of alcoholism, assessment points, drugs used in alcohol withdrawal, psychosocial support, and ways of preventing relapse. Also appearing are discussions of the role of heredity in alcoholism, methods of communicating with the uncooperative patient, and the pharmacology of alcohol.
TI: Transcending alcoholic denial.
ID: Research; Tables-or-Charts
SO: Image-The-Journal-of-Nursing- . 1995 Sum; 27(2): 121-6 [25 refs]
AB: OBJECTIVE: To describe the internal processes that alcoholics experience as they transcend denial.
DESIGN: Longitudinal, qualitative field study using grounded theory methodology.
SETTING: Alcoholism inpatient treatment facility and the community.
POPULATION: 42 alcoholics, 33 men and 9 women, between the ages of 18 and 66.
METHODOLOGY: The author resided in an inpatient alcoholism treatment center for 28 days to observe the recovery process. Discharged patients were then followed for 3 years, with interviews conducted bimonthly during the first 2 years and quarterly during the third. Observational notes recorded what was seen, heard, and experienced; interpretive notes facilitated coding and data analysis; and procedural notes guided the author in pursuing new directions. The constant comparative method was used to analyze the data.
RESULTS: A basic social process theory of transcending alcoholic denial emerged from the data. The stages of the theory are as follows: (1) reacting to the critical event; (2) role disaffiliation; (3) ambiguous anticipation; (4) peer affiliation; and (5) acceptance.
CONCLUSIONS: Nurses can use this theory to confront denial and, hopefully, prevent relapse in alcoholic patients.
TI: Understanding alcoholism relapse: a case study illustrating the integration of two theories.
SO: Nurse-Practitioner. 1994 Apr; 19(4): 67-9 [12 refs]
AB: The potential for relapse is a continuous threat for recovering alcoholics, most of whom will relapse within the first few years following treatment. Although relapse prevention is a challenge to nurse practitioners and clinical specialists, having an understanding of the factors leading to relapse can assist nurses in planning individualized care. This article presents a unique perspective on alcoholism relapse by integrating two theories--the interactional approach theory and the theory of recovery and goal setting. Case studies illustrate this perspective.
TI: Evaluation of the Congruence Model with rehabilitating substance abusers.
ID: Research; Tables-or-Charts
SO: International-Journal-of-Nursing-Studies. 1994 Feb; 31(1): 97-108 [38 refs]
AB: OBJECTIVE: To evaluate the Congruence Model as a family nursing approach used with indigent substance abusing families, both by assessing it independently and by comparing it to other treatment approaches.
DESIGN: Comparative studies.
SETTING: 2 long term residential treatment facilities.
POPULATION: Part 1: A convenience sample of 20 indigent inner-city substance abusing patients and their families. Part 2: A convenience sample of 118 patients.
METHODOLOGY: Part 1: Subjects completed 8 weeks of family counseling based upon the Congruence Model and a follow-up interview, An external evaluator determined the level of possible goal attainment. Goal attainment was evaluated prior to counseling, after 4 weeks, at the end of counseling, and at 1 month following discharge from the treatment facility. At the end of counseling, subjects evaluated the Congruence Model. Part 2: The sample was divided into 3 groups to receive either family treatment according to the Congruence Model, treatment using ALANON, or no treatment. Subjects completed scales to assess family functioning toward the beginning of treatment, toward the end of treatment, and 1 month after discharge from the treatment facility. Data analysis for both studies included descriptive statistics, paired t tests, multiple measure analysis of variance (MANOVA), one-way analysis of variance, and chi square.
RESULTS: Part 1: Client and family goal attainment increased significantly over the time of counseling, and they expressed positive opinions overall about the Congruence Model. Part 2: Family treatment and ALANON both had positive effects on family growth. There was no significant difference between the groups in terms of relapse rates. Subjects who did not relapse were significantly more likely to be employed.
CONCLUSIONS: Although it is difficult to evaluate the efficacy of the Congruence Model, the results of the study do lend support to its use in the treatment of substance abusing clients and their families. It was not possible to determine the superiority of the Congruence Model over ALANON. Limitations of this study include the small sample size, large subject dropout rate, and inherent differences between groups.
TI: Coping strategies of abstainers from alcohol up to three years post-treatment.
SO: Image-The-Journal-of-Nursing-Scholarship. 1993 Spr; 25(1): 29-35 [32 refs]
ER: Errata listed in: Image J Nurs Sch 1993 Sum; 25(2): 87.
AB: OBJECTIVES: To describe coping strategies used by abstainers from alcohol following treatment and to determine whether these strategies are consistent with Prochaska and DiClemente's theoretical model of change.
DESIGN: Longitudinal, phenomenological study based on interviews, journal records, and mail questionnaires.
POPULATION: A sample of 23 individuals who had abstained from alcohol for one year following alcoholism treatment, including 14 men and 9 women, aged 34-60.
METHODOLOGY: Participants were interviewed at 12 and 18 months post-treatment; they were surveyed by mail at 36 months post-treatment. They were also asked to complete "critical incident" journals describing high risk situations that threatened their abstinence. Interview transcripts were coded in a 4-step process: 1) interview data were reviewed to identify phases of the Prochaska and DiClemente model; 2) interview data were re-read to identify abstainers' experiences as they went through the phases of change; 3) the experiences identified were analyzed for commonality and gender differences; and 4) the phases of change were named and predominant themes associated with each phase were identified. Mail surveys were analyzed by frequencies.
RESULTS: Hallmarks of successful change include a paradigm shift, taking responsibility for oneself, making changes in oneself and one's environment, seeking social support and recognizing cues of relapse. Abstainers' experiences generally followed the 4-stage process described by Prochaska and DiClemente, but the coping strategies they employed were not consistent with the theory's 10 "processes of change."
CONCLUSIONS: Many of the keys to successful change can be learned, and are transferable to other alcohol-dependent persons.
TI: Validation of addictions nursing diagnoses in a sample of alcohol abstainers 1 year posttreatment.
ID: Research; Tables-or-Charts
SO: Archives-of-Psychiatric-Nursing. 1992 Dec; 6(6): 340-6 [16 refs]
AB: This study examined the fit between 26 Addictions Nursing diagnoses and a sample of clients who had maintained abstinence from alcohol use for 1 year after inpatient treatment for alcohol abuse. Data were obtained from interview transcriptions of 26 successful abstainers. Investigator identification of diagnoses were validated by expert nurse clinicians. Although participants had been abstinent for a year, 73% of the sample showed defining characteristics of 17 of the 26 diagnoses. In addition, the raters identified 3 human responses for which no diagnoses exist, 8 diagnoses that do not have defining characteristics that fit the data, and 13 additional defining characteristics that could be added to the list.
TI: A field study of couples recovering from alcoholism.
ID: Model; Research
SO: Issues-in-Mental-Health-Nursing. 1992 Oct-Dec; 13(4): 333-48 [23 refs]
AB: Effective recovery from alcoholism demands commitment from both partners in a marriage. The focus of this qualitative study was to learn how couples progressed through recovery and how they achieved their goals conjointly. The Model of Recovering Alcoholics' Behavior Stages and Goal Setting was used as the theoretical base. Twenty-eight couples participated in the study. The author used analytic fieldwork to learn if spouses of alcoholics conformed to the same stages as indicated by the model and to learn the interactive effects of alcoholics' and spouses' stages. As a result, the author developed the Model of Alcoholic Spouses' Behavior Stages and Goal Setting. The research has implications for planning nursing care, determining when to intervene individually versus conjointly, and identifying indicators of relapse.
Feb 27, '03Dr. Kate,
Thank you so much for the info!
My next thing was now trying to jam this project into a theoretical framework, but I have a question regarding appopriateness. First, the only "theory" I can see applying to it would be the Stress and Coping theory, but I think it might be like jamming a square peg into a round hole. So I was thinking how acceptable it is to base your study off of a philosophical framework, such as the concepts of Heideggar, or realism or whatever.