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Item A comparison of the revised Delirium Rating Scale (DRS–R98) and the Memorial Delirium Assessment Scale (MDAS) in a palliative care cohort with DSM–IV delirium(Cambridge, 2015-08) O'Sullivan, Roisin; Meagher, David; Leonard, Maeve; Watne, Leiv Otto; Hall, Roanna J.; Maclullich, Alasdair M. J.; Trzepacz, Paula; Adamis, Dimitrios; Department of Psychiatry, IU School of MedicineObjective: Assessment of delirium is performed with a variety of instruments, making comparisons between studies difficult. A conversion rule between commonly used instruments would aid such comparisons. The present study aimed to compare the revised Delirium Rating Scale (DRS–R98) and Memorial Delirium Assessment Scale (MDAS) in a palliative care population and derive conversion rules between the two scales. Method: Both instruments were employed to assess 77 consecutive patients with DSM–IV delirium, and the measures were repeated at three-day intervals. Conversion rules were derived from the data at initial assessment and tested on subsequent data. Results: There was substantial overall agreement between the two scales [concordance correlation coefficient (CCC) = 0.70 (CI95 = 0.60–0.78)] and between most common items (weighted κ ranging from 0.63 to 0.86). Although the two scales overlap considerably, there were some subtle differences with only modest agreement between the attention (weighted κ = 0.42) and thought process (weighted κ = 0.61) items. The conversion rule from total MDAS score to DRS–R98 severity scores demonstrated an almost perfect level of agreement (r = 0.86, CCC = 0.86; CI95 = 0.79–0.91), similar to the conversion rule from DRS–R98 to MDAS. Significance of results: Overall, the derived conversion rules demonstrated promising accuracy in this palliative care population, but further testing in other populations is certainly needed.Item Crafting Stories in Hermeneutic Phenomenology Research: A Methodological Device(Sage, 2017) Crowther, Susan; Ironside, Pam; Spence, Deb; Smythe, Liz; School of NursingHermeneutic phenomenology, as a methodology, is not fixed. Inherent in its enactment are contested areas of practice such as how interview data are used and reported. Using philosophical notions drawn from hermeneutic phenomenological literature, we argue that working with crafted stories is congruent with the philosophical underpinnings of this methodology. We consider how the practical ontic undertaking of story crafting from verbatim transcripts is integral with the interpretive process. We show how verbatim transcripts can be crafted into stories through examples taken from interview data. Our aim is to open dialogue with other hermeneutic phenomenological researchers and offer alternate possibilities to conventional ways of work with qualitative data. We argue that crafted stories can provide glimpses of phenomena that other forms of data analysis and presentation may leave hidden. We contend that crafted stories are an acceptable and trustworthy methodological device.Item “Failure Looks Like this Child is Still in Limbo”: Foster Parent Experiences of Failed Pre-adoptive Placements(Office of the Vice Chancellor for Research, 2013-04-05) Bloomquist, Kori R.; Helfenbein, Robert J.Pre-adoptive or “waiting” children are those who have a case plan of adoption and/or whose parental rights have been terminated. There are currently over 107,000 pre-adoptive children in the United States, and on average, they have been living in foster care for over three years. A lack of permanency is associated with a milieu of negative consequences while achieving permanent, stable relationships is significant in developing a sense of self and overall, long-term well-being. Failed pre-adoptive placements represent a significant barrier to achieving permanency; however, the phenomenon of failed pre-adoptive placements has been underexplored. This study uses phenomenology, a philosophical method and study of experience, to explore how pre-adoptive foster parents make meaning of their experiences of failed pre-adoptive placements. Participants fostered at least one pre-adoptive child with the intent, willingness, and/or openness to adopt the child, but the placement did not result in an adoption and the child moved to an alternative placement. The primary research question for this study is “What is the experience of a foster parent who has had a failed pre-adoptive placement?” Findings from in-depth interviews reveal that pre-adoptive foster parents enter into pre-adoptive placements with multiple motivations and personal expectations. Experiences which do not confirm these expectations often contribute to decisions to end a pre-adoptive placement. Participants are at times motivated by fear and feel compelled to make decisions to end placements on behalf of alternative roles (i.e. biological mother, spouse, neighbor, etc.). Pre-adoptive parents appear to have a future orientation that serves as a guiding force in decisions to continue or end a pre-adoptive placement. Participants describe feelings of grief, loss, and inadequacy. Findings contribute to the body of knowledge and have implications for foster and pre-adoptive training and support and encourage greater understandings within child welfare for improved permanency planning and practice.