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Women's responses to potential cardiac symptoms and emergency department care : maintaining personal, social, and physical integrity Turris, Sheila A.


The purpose of this grounded theory study was to explore how women interpreted and made decisions about their symptoms, and how they subsequently interpreted their experiences of care in the emergency department (ED), in the context of seeking treatment for the symptoms suggestive of cardiac illness. Data were drawn from several sources: 100 hours of naturalistic observation, 17 in depth interviews with 16 women who visited one of two urban EDs between June 2005 and June 2006 for the treatment of symptoms suggestive of cardiac illness, and three interviews with expert ED nurses. The basic social psychological process of maintaining integrity was identified. Three distinct phases were apparent including: "resisting disruption," which occurred before arrival in an ED; "suspending agency," which occurred during an ED visit; and "integrating experiences and knowledge," which occurred after discharge. Focusing on the outcome of interest--treatment seeking in the context of symptoms suggestive of cardiac illness--health-care professionals and researchers have often attempted to understand the process by which women make decisions about seeking medical advice, through the framework of medical knowledge. In contrast, the women in this study drew on many forms of knowledge to understand both their symptoms and their subsequent diagnoses. Employing the framework of personal context, rather than medical knowledge, the women analyzed their symptoms, decided between competing courses of action, and ultimately came to understand the events that took place before, during, and after their visits to the ED. The findings of this study suggest that: (1) women's understandings of their symptoms, and their actions in relation to those symptoms, were strongly influenced by the broader context of their lives as mothers and wives; (2) women's perceptions of the ED as a place that is intense, regulated, and besieged played an important role in decisions about treatment seeking; (3) after discharge from the hospital, women strove to make sense of new knowledge and experiences in ways that were congruent with their images of themselves as "good" and "responsible" individuals.

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