Interpretation/analysis methods in hermeneutic interpretive phenomenology

Experiences of gynecologic oncology nurses regarding caring behaviors: a hermeneutic phenomenological study

PURPOSE

This study aims to explore the caring behaviors experiences of gynecologic oncology nurses.

METHODS

This study was conducted with phenomenological hermeneutical approach. This study was carried out 14 nurses working on women with gynecologic cancer. Data were collected through individual interview method by using semi-structured interview guide. Data were analyzed using a phenomenological hermeneutical method.

RESULTS

Caring behaviors experiences of gynecologic oncology nurses were explained by the themes "missed caring behaviors", "transition from work-centered to care-centered approach", and "transition to caring-healing approach". The first theme, "missed caring behaviors" included two subthemes: "focusing on routines" and "superficial relationships". The second theme, "transition from routine to care-centered" included three subthemes: "barrier perception", "off the record" and "controlled attachment". The last theme, "transition to caring-healing" consisted of the subthemes "ideal care conscience", "presenting presence", "looking through her window", "healing with caring behaviors". The main theme was reached as "caring behaviors: the focus of nursing".

CONCLUSION

This study suggests that gynecologic oncology nurses need to adequately and efficiently improve on caring behaviors in an intense caring environment.

Being present: Examining the efficacy of an Internet Mantram Program on RN-delivered patient-centered care

Background

The COVID-19 pandemic highlighted nurses’ compassionate presence during stressful conditions. Strategies to reduce workplace stress are needed.

Purpose

The purpose of this study was to evaluate a stress reduction strategy, an Internet-based Mantram Repetition Program (MRP), for nurses caring for hospitalized Veterans.

Methods

A one group pre-/post-test design was used to assess change in nurses’ perceived outcomes after participating in the MRP. A post-test-only design was used to assess hospitalized Veterans’ perceptions of nursing presence and satisfaction with care. Qualitative interviews were used to supplement quantitative data.

Findings

Patients perceived high levels of presence and satisfaction with care. Post MRP, nurses perceived increased mindfulness, compassion satisfaction, spiritual well-being, and nursing presence. Increased mindfulness was associated with greater compassion satisfaction and less burnout.

Discussion

For nurses working on the front lines of patient care, the potential for experiencing stress and burnout is a reality. Participating in a MRP could lessen these effects and facilitate nursing presence.

'I'm unworthy of being in this space': The origins of shame in medical students

OBJECTIVES

Shame results from a negative global self-evaluation and can have devastating effects. Shame research has focused primarily on graduate medical education, yet medical students are also susceptible to its occurrence and negative effects. This study explores the development of shame in medical students by asking: how does shame originate in medical students? and what events trigger and factors influence the development of shame in medical students?

METHODS

The study was conducted using hermeneutic phenomenology, which seeks to describe a phenomenon, convey its meaning and examine the contextual factors that influence it. Data were collected via a written reflection, semi-structured interview and debriefing session. It was analysed in accordance with Ajjawi and Higgs' six steps of hermeneutic analysis: immersion, understanding, abstraction, synthesis, illumination and integration.

RESULTS

Data analysis yielded structural elements of students' shame experiences that were conceptualised through the metaphor of fire. Shame triggers were the specific events that sparked shame reactions, including interpersonal interactions (eg, receiving mistreatment) and learning (eg, low test scores). Shame promoters were the factors and characteristics that fuelled shame reactions, including those related to the individual (eg, underrepresentation), environment (eg, institutional expectations) and person-environment interaction (eg, comparisons to others). The authors present three illustrative narratives to depict how these elements can interact to lead to shame in medical students.

CONCLUSIONS

This qualitative examination of shame in medical students reveals complex, deep-seated aspects of medical students' emotional reactions as they navigate the learning environment. The authors posit that medical training environments may be combustible, or possessing inherent risk, for shame. Educators, leaders and institutions can mitigate this risk and contain damaging shame reactions by (a) instilling a true sense of belonging and inclusivity in medical learning environments, (b) facilitating growth mindsets in medical trainees and (c) eliminating intentional shaming in medical education.

Fictionalizing dialogue: interpretative phenomenological analysis in organizational research

Purpose

This paper proposes a dialogical approach for analyzing and presenting Interpretative Phenomenological Analysis (IPA) data in organizational research.

Design/methodology/approach

The paper explores the story behind a story, showing how qualitative research can be fictionalized and reflexively framed in contemporary organizational settings, illustrated by IPA research conducted by the authors, into selection interviewing in Australia. Drawing from researchers' narrative notes that reflexively interpret interview data in narrative form, the data were re-interpreted in fictionalized dialogical form, enabling findings to be analyzed and presented more interactively.

Findings

The application of new interpretative techniques, like fictionalized dialogue, contributes to a richer interpretation of phenomena in qualitative organizational and management research, not limited to IPA studies.

Originality/value

Fictionalized dialogue brings to the surface an additional level of analysis that contributes to thematic analysis in a novel manner, also serving as a communicative tool.

Analysis methods in hermeneutic phenomenological research: interpretive profiles

Objective

To describe the development of interpretive profiles for a hermeneutic phenomenological research study.

Methods

literature review was conducted to identify research that has used interpretive profiles. An initial interpretive profile was constructed.

Results

The final outcome was an interpretive profile that contained a case summary and addressed the aims of the researcher's study. The interpretive profile contained background material, coded excerpts, and interpretive comments.

Conclusions

Interpretive profiles can assist emerging scholars in describing self-world relations and experiential variations within and across participants. Interpretive profiles can facilitate the writing of dissertations and manuscripts since the data is systematically archived and easily retrievable.

Views of the Future of Partners of People with Multiple Sclerosis Who Attended a Lifestyle Modification Workshop: A Qualitative Analysis of Perspectives and Experiences

People with multiple sclerosis (PwMS) often experience uncertainty and fear about their futures. Partners of PwMS may share their concerns and experience fears about their own futures, limitations on their lives, ability to work, and becoming a carer. For PwMS, modification of lifestyle-related risk factors has been associated with improved health outcomes. For PwMS who attended residential lifestyle modification workshops (RLMW), sustained improved health outcomes have been demonstrated. Whether improved outcomes for PwMS who engage with lifestyle modification translate to improved partner perceptions of the future, is yet to be explored. We explored the perspectives of partners of PwMS who had attended a RLMW and the impact that the person with MS’s illness and their engagement with lifestyle modification had on their partners’ views of the future. Analysis of 21 semi-structured interviews used a methodology informed by Heidegger’s Interpretive Phenomenology. Three themes emerged: ‘uncertainty’, ‘planning for the future’ and ‘control, empowerment and confidence’. Subthemes included MS and lifestyle modification being a catalyst for positive change; developing a sense of control and empowerment; and hope, optimism and positivity. Lifestyle modification may provide benefits, not only to PwMS, but also to their partners, and should be considered part of mainstream management of MS.

Parents' management of adolescent patients' postoperative pain after discharge: A qualitative study

Background: Short hospital admission periods following pediatric inpatient surgery leave parents responsible for managing their child’s postoperative pain in the community following discharge. Little is known about the experiences of parents caring for their child’s postoperative pain after discharge home following inpatient surgery. Research examining parental postoperative pain management following their child’s day surgery has found that parents are challenged in their pain management knowledge and practices.

Aims: This interpretative phenomenological analysis study sought to understand parents’ experiences caring for their child’s postoperative pain at home.

Methods: Semistructured telephone interviews were conducted with seven parents between 2 weeks and 6 months after their child’s discharge from hospital.

Results: Identified themes were coming home without support, managing significant pain at home, and changes in the parent–child relationship.

Conclusions: Parents could potentially benefit from nurses optimizing educational interventions, from receiving ongoing support of transitional pain teams, and from assistance with return to school planning.

Parents' Perceptions Regarding the Implementation of a Physical Therapy Stimulation Program for Children with Disabilities in Bolivia: A Qualitative Study

The purpose of this study was to explore how parents of children with neuromotor disorders in the department of Chuquisaca (Bolivia) perceive attendance to a physical therapy stimulation program and the expectations they place on the therapy and professional care provided to their children. Semi-structured interviews were conducted with the parents, related to their role in supporting the recommended exercise program for the child, generating topics such as benefits of the therapy for the child, impact on the family, and role of the project in terms of therapy and the physical therapists providing treatment, including both positive and negative aspects of the overall process. This study revealed the importance of understanding the feelings of families receiving intervention under a pioneering program in Bolivia for the detection and treatment of children with neuromotor disorders. Being able to access these types of services provides them with extensive personal, social, and economic support. Knowing their concerns, desires, and demands will allow us to continue to improve and offer the best care for children and families. The professionals involved should also be encouraged to develop effective teaching techniques to promote the inclusion of parents in the stimulation program.

The lived experience of people with intellectual disabilities in post-secondary or higher education

The transformational role education plays in the lives of people with intellectual disabilities has not been fully examined. The purpose of this study was to explore and investigate the meanings people with intellectual disabilities construct of their experiences in post-secondary and higher education. Heideggerian hermeneutic phenomenology was the qualitative methodology adopted for the study. Individual interviews were conducted with 27 people with intellectual disabilities and analysed in stages. These stages included the creation of I-Poems offering a unique opportunity for individual participant voices to be heard. Three core themes emerged to describe living an authentic life: learning (with the emphasis on increased skills, independence and opportunities); relationships (in particular, the importance of friendships), and perceptions including the existing realities of life for those with intellectual disabilities. The findings advance previous work highlighting the link between living a more authentic life and how education transforms how people with intellectual disabilities view themselves.

Understanding Taiwanese Women's Decisional Experiences Regarding Prenatal Screening Procedures And Diagnostics: A Phenomenological Study

PURPOSE

This study sought to understand Taiwanese women's decisional experiences regarding prenatal screening procedures and diagnostics.

METHODS

A hermeneutic phenomenological design guided semistructured interviews with 33 women who were 36 weeks pregnant. Data were collected between February and October 2016. Verbatim transcripts were analyzed following hermeneutic circle to cocreate an understanding of Taiwanese women's decision-making in prenatal screening and diagnostics.

RESULTS

Women's existential experiences were derived from their decision-making process on prenatal screening procedures and diagnostics for chromosomal aneuploidy. These decisional experiences were captured by four theme clusters and eight themes, which were inductively derived from 16 meaning units: (1) accessing health information; (2) considering what was best for my baby; (3) considering family finance; and (4) feeling anxiety posttest.

CONCLUSION

Participants made informed choices on several prenatal screening procedures, ostensibly, based on their personal values and considerations. During the decision-making process, often-cited benefits of genetic screenings were emphasized, but test limitations were often unheeded. A fundamental need for supportive information in decision making was further identified with recommended strategies. Hence, a revision of traditional genetic counseling approaches is recommended. As genomics technologies are increasingly available during antenatal services, women should be sufficiently educated about them to support decision making.

Ethical Data Collection and Recognizing the Impact of Semi-Structured Interviews on Research Respondents

This article explores the complex relationship between researcher and respondent through shared experience and interaction in the interview processes. Ethical considerations related to the balance of power and potential for change in respondents’ professional actions and decisions post-interview are discussed whilst problematizing the concept of truly informed consent. Informed by critical incident analysis, the article draws on the researcher’s experience of undertaking a qualitative-based study founded in the principles of phenomenological hermeneutics. Concluded in 2016, the research investigates the impact of pedagogical training programs on respondents’ teaching practice and engagement with professional learning. Respondents, experienced lecturers working in the adult education sectors in Scotland and Wales, contacted the researcher to share their post-interview experiences. The research was not designed to elicit change in respondents, nor influence professional choice or practice. However, each communication received attributed participating in the research as the source for renewed interest and engagement in professional learning. Although research interviews becoming an enriching experience for respondents is a recorded phenomenon the ascribed effects were profound, potentially life-changing, and not fully anticipated. Ethical considerations for researchers designing and undertaking interview-based research are considered alongside the potential for engagement in research interviews as a catalyst for professional learning in practice.

Facilitating and hindering experiences to the development of humanistic caring in the academic and clinical settings: an interpretive phenomenological study with nursing students and nurses

Objectives This paper reports on nursing students' and nurses' lived experiences mediating their development of humanistic caring. Methods Using interpretive phenomenology, 26 participants were individually interviewed. A five-stage phenomenological analysis based on Benner's (Benner, P. (1994). Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: SAGE) method occurred simultaneously. Results The analysis highlighted that the development of humanistic caring is affected by role models and counterexamples, environments in which humanistic caring is exalted or trivialized, communication-related courses, patient storytelling, and work overload. Conclusions It might be valuable to raise the awareness of nurse educators about their opportunity in shaping the development of students' humanistic caring.

Adolescent Patients' Management of Postoperative Pain after Discharge: A Qualitative Study

BACKGROUND

Adolescents are typically admitted for a short period of time after inpatient surgery, leaving much of their recovery to occur at home. Pain, and thus pain management, is a major component of recovery at home. Research among pediatric outpatient surgical patients has found that pain experienced in the community setting after discharge is often severe and is related to knowledge deficits resulting in inadequate pain management. However, there is little research on community pain management after inpatient surgery.

AIM

This study aimed to explore the pain experiences of seven adolescents who underwent inpatient surgery.

DESIGN

This study used Interpretative Phenomenological Analysis as a methodology.

SETTING

This study took place at a pediatric tertiary care hospital in Canada.

PARTICIPANTS

7 adolescents participated, all of whom underwent inpatient surgery with admission between 2-14 days in length.

METHODS

Semi-structured interviews were conducted 2 to 6 weeks post-discharge.

RESULTS

Three themes were identified that described their experiences, including managing severe pain at home with minimal preparation, changes in the parent-child relationship, and difficulties returning to school and regular activities.

CONCLUSIONS

Involving adolescents directly in discharge education, particularly with the use of novel interventions and coaching, may improve outcomes.

KEY PRACTICE POINTS

Adolescent patients experience significant pain after discharge from hospital after inpatient surgical procedures. Adolescents are in need of adolescent-specific pain management education to increase skill and knowledge and address pain management-related misconceptions. Greater emphasis on involving adolescents in their own pain care and novel intervention could prove useful in improving outcomes.

Humanistic caring, a nursing competency: modelling a metamorphosis from students to accomplished nurses

BACKGROUND

Most nursing regulatory bodies expect nurses to learn to be humanistic and caring. However, the learning process and the developmental stages of this competency remain poorly documented in the nursing literature.

METHODS

The study used interpretive phenomenology, and 26 participants (students and nurses) were individually interviewed. Benner's (1994) method was adapted and concretised into a five-phase phenomenological analysis to assist with intergroup comparisons.

RESULTS

Critical milestones and developmental indicators were identified for each of the five stages of the 'humanistic caring' competency. Satisfaction and meaning at work seemed closely connected to the development of 'humanistic caring'. Links emerged between the development of 'humanistic caring' and three other competencies.

CONCLUSIONS

Nurse educators might insist on the fact that 'humanistic caring' goes beyond nurse-patient communication and that it is integrated in nursing care. The findings highlight that nurses' working conditions should be improved in order to uphold humanistic caring after graduation.

Moral Experiences of Crisis Management in a Child Mental Health Setting: A Participatory Hermeneutic Ethnographic Study

Restraints and seclusion are routinely used in child mental health settings for conflict and crisis management, but raise significant ethical concerns. Using a participatory hermeneutic ethnographic framework, we studied conflict and crisis management in a child mental health setting offering care to children aged 6-12 years old in Quebec, Canada. The use of this framework allowed for an in-depth examination of the local imaginaries, of what is morally meaningful to the people in the setting, in addition to institutional norms, structures and practices. Data collection involved participant observation, interviews, and documentation review, with an interpretive framework for data analysis. We argue that the prevalent view of children shared by staff members as "incomplete human becomings" led to the adoption and legitimization of authoritative norms, structures and practices guided largely by a behavioral approach, which sometimes led to an increased use of control measures for reasons other than imminent harm. Children experienced these controlling practices as abusive and hindering the development of trusting relationships, which impeded the implementation of more collaborative approaches staff members sought to put in place to prevent the use of control measures. Study results are discussed in light of conceptions of children as moral agents.

Storytelling to Capture the Health Care Perspective of People Who Are Homeless

Utilizing a hermeneutic philosophical approach, the researchers explored the perceptions and experiences of people who are homeless in Mobile, Alabama, receiving health care and interacting with health care providers. Using the voice of the participants, discussions among the researchers, and supporting literature reinforcing key concepts, a framework was created illustrating the lived experience. The following themes were identified: social determinants of health, compromised systems, professionalism, dehumanization, engagement, and downward trajectory. The experiences described and themes identified indicate a breakdown in therapeutic relationships between homeless individuals and health care providers, contributing to the continuing destabilization common in this population.

Fear, fight, familiarize: the experiences of people living with relapsing-remitting multiple sclerosis and taking oral medication

Purpose: In addition to becoming familiar with the life changing event of having a chronic illness and exploring its meaning in daily life, people with relapsing-remitting Multiple Sclerosis (RRMS) are faced with important decisions about immunomodulating treatment. Biomedical research on the use of Disease Modifying Therapies (DMTs) mostly focuses on adherence, conceptualized and understood as a behavioral act leading to a desired outcome. Less attention has been paid to the meaning for a person with RRMS of starting and continuing the use of DMTs. Studies on the experiences of people with RRMS taking orally administered DMTs are lacking. The aim of this phenomenological study was to examine the experiences of people with RRMS taking oral medication. Methods: The study was guided by Interpretative Phenomenological Analysis (IPA) and Phenomenology of Practice. 25 persons with RRMS participated in in-depth interviews. Results: In general, participants of this study find themselves in alternating phases that vary by degree of experienced unfamiliarity or familiarity with concern to one's illness, one's changing body, and one's new life. The meaning of taking medication is closely related to these phases. Conclusions: Adherence serves a purpose in the lifeworlds of participants. Medication is the embodiment of this purpose. The pill has inherent meaning.

A Meta-ethnography of Out-of-Hospital Cardiac Arrest Survivors' Meanings on Life and Death

BACKGROUND

Although out-of-hospital cardiac arrest (OHCA) survivors' physiological outcomes have been addressed, less is known on the holistic needs of individuals after OHCA, which hinders our ability to prioritize care around what really matters to survivors.

AIM

The aim of this study was to interpretatively synthesize qualitative findings on OHCA survivors' perceptions and meanings of life and death and existential issues.

METHODS

We used a meta-ethnographic synthesis of published qualitative studies addressing the experiences of OHCA survivors based on a systematic literature search (CINAHL, PsycINFO, Scopus, PubMed). Studies were selected based on predefined inclusion/exclusion criteria. The identified studies were subjected to a quality appraisal based on the Critical Appraisal Skills Programme.

RESULTS

Based on eligibility criteria, 6 phenomenological studies were included, of overall medium to high quality. One core theme, "the reality of death," and 4 main themes were identified: "redefining existence"; "revaluing death"; "being familiar with, yet oblivious of death"; and "living consciously." Emerging from the realization of death, the themes appeared to describe a gradual progression toward living consciously.

CONCLUSIONS

An existential trajectory and a need for meaning are central in the experience of OHCA survivors. When existential issues are not addressed, the ongoing suffering may interfere with survivors' recovery and quality of life. Future research needs to address specific needs and ways to support survivors' meaning-making.

On the path together: Experiences of partners of people with multiple sclerosis of the impact of lifestyle modification on their relationship

Multiple sclerosis (MS) has a major impact on the relationship of couples living with the illness. Although some positives of dealing with MS as a couple have been identified, MS has been associated with higher rates of relationship breakdown and worse Quality of Life (QOL) for both people in the relationship, especially if the person with MS experiences a decline in mental or physical health or develops disability. Modification of lifestyle-related risk factors has been associated with improved outcomes for people with MS, including physical and mental health-related QOL, and these improved outcomes may lead to improved experiences for their partners. We aimed to explore the perspectives and experiences of the partners of people with MS, when the people with MS had undertaken an intensive residential workshop regarding healthy lifestyle, to understand the impact of MS and lifestyle modification on these partners' experiences of their relationship. Within the framework of Heidegger's interpretive phenomenology, semi-structured interviews were thematically analysed. Participants were in a spousal relationship with people with MS who had attended an intensive residential workshop regarding modification of lifestyle-related risk factors between 2002 and 2016. Participants lived in Australia, New Zealand, the United Kingdom and Europe. Three major themes were identified relating to the couple's relationships: providing support, remaining connected and togetherness. Aspects of these themes, not commonly previously reported, included the personal and relationship benefits experienced from providing support with lifestyle modification, improved communication, and the resultant greater sense of closeness. These experiences of partners of people with MS improve our understanding of both the complexities of living with MS and adopting lifestyle modification, and suggest some potential benefits to relationships.

Living With Moral Distress: The Perspectives and Experiences of Iranian Nurse Preceptors

Background and Purpose: Preceptors play a key role in the transition experience of new nurses. Preceptorship is a stressful role and is influenced by contextual factors. There is a lack of sufficient understandings of the perspectives and lived experiences of Iranian nurse preceptors of preceptorship. The aim of this study was to explore the perspective and lived experiences of Iranian nurse preceptors of preceptorship. Methods: A qualitative design using a hermeneutic phenomenological approach was used. Six Iranian nurse preceptors were chosen using a purposeful sampling method from a large paediatric teaching hospital in an urban area of Iran. Data was collected using in-depth semi-structured interviews and was analysed using the Diekelmann et al.'s method of hermeneutic phenomenological analysis. Results: The data analysis resulted in the development of a constitutive pattern of 'living with moral distress', which was constituted of two major themes: 'asking for and being unable' and 'the experience of conflict'. Implications for Practice: The findings of this study can improve nurses' understandings of the preceptor's role and associated factors influencing the implementation of the preceptorship programme. 'Moral distress' caused by the preceptor role can influence nurse preceptors' mental health and also the patient care outcomes. More studies are required to explore this phenomenon in different contexts and cultures and design strategies for reducing the burden of taking this role on nurse preceptors. Also, policies are needed for developing a formal preceptor support system to help preceptors take this stressful and demanding role in healthcare settings.

The dark side of the work of immigrant women caregivers in Spain: Qualitative interview findings

AIM

To analyse the perception that immigrant women caregivers have of their relationship with the person receiving the care and their family and the possible impact those relationships may have on a caregiver's health.

DESIGN

A qualitative study was conducted.

METHODS

Thirty-four semi-structured interviews were applied in the Spanish city of Salamanca from November 2015-November 2016. The "interpretative hermeneutics" technique was used as the framework for the analysis.

RESULTS

The discourse studied indicated that the immigrant women's cultural background, as well as their gender's assumed stereotypes, gave rise to an emotional attachment to the person receiving the care, which could generate a burden. Most of the women interviewed reported situations of abuse from the old people under their care. The fact that increasingly more old people are being cared for by immigrant women renders it necessary for social and health policies to consider this collective.

Adolescent HIV Self-management: Lived Experiences of Adolescents, Caregivers, and Health Care Workers in a South African Context

Adolescence is a complex developmental phase, made more complex by chronic disease. When dealing with treatment and the health impact of chronic diseases, adolescents need to learn to self-manage an array of challenges. Unfortunately, there is a gap in the literature related to chronic disease self-management in adolescents living with HIV. We describe the phenomenon from the perspectives of adolescents, caregivers, and health care workers (HCWs) in South Africa. Individual interviews were conducted with 6 adolescents, 6 caregivers, and 6 HCWs, followed by 5 adolescent focus groups. Interpretive phenomenology guided exploration of social and cultural experiences and found that adolescent self-management required an understanding of HIV and hope for the future. Adolescents also needed skills to prioritize and negotiate care while managing stigma. These processes were facilitated by love and support, primarily from immediate family, and by the adolescent engaging with family, HCWs, and peers.

Being on the juvenile dermatomyositis rollercoaster: a qualitative study

BACKGROUND

Juvenile Dermatomyositis is a rare, potentially life-threatening condition with no known cure. There is no published literature capturing how children and young people feel about their condition, from their perspective. This study was therefore unique in that it asked children and young people what is it like to live with Juvenile Dermatomyositis.

METHODS

Data were obtained from fifteen young people with Juvenile Dermatomyositis, between eight and nineteen years of age from one Paediatric Rheumatology department using audio-recorded interpretive phenomenology interviews. Data were analyzed phenomenologically, using a process that derives narratives from transcripts resulting in a collective composite of participants shared experiences, called a 'phenomenon'.

RESULTS

The overarching metaphor of a rollercoaster captures the phenomenon of living with Juvenile Dermatomyositis as a young person, with the ups and downs at different time points clearly described by those interviewed. The five themes plotted on the rollercoaster, began with confusion; followed by feeling different, being sick, steroidal and scared from the medications; uncertainty; and then ended with acceptance of the disease over time.

CONCLUSION

Young people were able to talk about their experiences about having Juvenile Dermatomyositis. Our findings will aid clinicians in their practice by gaining a deeper understanding of what daily life is like and highlighting ways to enhance psychosocial functioning. Hopefully, this study and any further resulting studies, will raise understanding of Juvenile Dermatomyositis worldwide and will encourage health care professionals to better assess psychosocial needs in the future.

A narrative model for exploring climate change engagement among young community leaders

INTRODUCTION

Decades of widespread knowledge about climate change have not translated into adequate action to address impacts on population health and health equity in Canada. Research has shown that context-based perceptions and interpretations mediate engagement. Exploring climate change engagement involves inquiry into contextual experience.

METHODS

This qualitative study has employed narrative methodology to interpret the meaning of climate change among community leaders in Saskatoon, Saskatchewan, Canada, age 20-40 (n = 10). Climate change narratives were explored both structurally and thematically.

RESULTS

A model was developed to organize results and to describe concepts of fidelity and dissonance within participant narratives. Findings suggested that knowledge of climate change and personal motivation to act did not preclude narrative dissonance, which served as a barrier to a meaningful personal response. Dissonance can result where internal and external barriers mediate mobilization at moments in the plot: (1) moving from knowledge of the challenge to a sense of agency about it; (2) from agency to a sense of responsibility to choose to address it; (3) from responsibility to a sense of capacity to produce desirable outcomes despite contextual challenges; and (4) from capacity to a moral sense of activation in context. Without narrative fidelity, meaningful mobilization can be hindered.

CONCLUSION

A narrative model is useful for exploring climate change engagement and highlights opportunities for a population health approach to address the conditions that hinder meaningful mobilization. By framing climate change narratives with emotional and moral logic, population health framing could help young leaders overcome internal and external barriers to engagement.

The impact of Nursing and Midwifery Council revalidation on the professional identity of academic staff in a higher education institution: A qualitative study

AIMS

To explore Nursing and Midwifery Council (NMC) revalidation as a process experienced by nursing and midwifery academics and its impact on their sense of professional identity.

BACKGROUND

The introduction of revalidation nurses and midwives in the UK in 2016 caused some anxiety amongst registrants in higher education.

DESIGN

A qualitative study using a purposeful sample involving thematic analysis of semi-structured interviews with academic staff.

METHODS

Ten registrants completed a semi-structured interview in a higher education institution.

RESULTS/FINDINGS

Clinical credibility: participants were self-conscious about time away from practice but retained strong links with clinical settings reviewing evidence and reports of current practice. The revalidation process: staff were generally positive about NMC revalidation. Professional identity: participants identified as nurses and midwives first and academics second.

CONCLUSIONS

The findings replicate previous studies about professional identity among healthcare professionals in higher education; this study reports the contribution of revalidation amongst nurses and midwives in higher education institutions.

Sex and intimacy in people with severe asthma: a qualitative study

Introduction

People with severe asthma experience unpredictable daily symptoms requiring an intense treatment regimen impacting on health-related quality of life (QoL). Sexuality contributes to this, yet there is a dearth of research exploring intimacy in people with severe asthma. We aimed to explore the patient's perception of the impact of severe asthma on intimacy, establish their information needs and their perceived role of the healthcare practitioner.

Methods

We have performed a qualitative study guided by Interpretive Phenomenological Analysis. We interviewed patients diagnosed with severe asthma recruited from a dedicated clinic using purposive sampling. Interviews were audio recorded and transcribed verbatim. Using thematic analysis, the data were analysed for emergent themes.

Results

The nine interviews provided unique and detailed insights into their perspectives on how living with severe asthma impinges on sexual intimacy. Four superordinate themes emerged: (1) 'Physical intimacy': including disclosure of physical limitations of severe asthma on intimacy; (2) 'Emotional intimacy': the cyclical impact of the often-negative emotional struggle of living with severe asthma on relationships; (3) 'The role of the healthcare professional': a perceived failure of healthcare professionals (HCPs) to tackle sexual intimacy in consultations and (4) 'Image of self': the reported struggle to deal with negative body image and confusion regarding changing relationship roles.

Discussion

This study is the first to explore the impact of severe asthma on intimacy. We suggest an emphasis on education to raise awareness and help HCPs to address this sensitive topic in this cohort and adopt positive strategies to help improve QoL.

Family caregivers' perceptions of maltreatment of older adults with dementia: findings from the northwest of Spain

Dementia is a neurocognitive disorder that implies a risk factor of maltreatment by family caregivers. In this study, we analyzed both informal caregiver's perceptions of maltreatment and aspects of the caregiver and caregiving behavior that may be associated with maltreatment. We conducted five focus groups (FGs) in three Spanish cities: Segovia, Soria and León. The themes that were identified were related to two levels of maltreatment: (a) relational and (b) institutional. At the relational level, we observed the justification of maltreatment of Older Adults with Dementia (OAswD) by family caregivers during the occurrence of behavioral symptoms. At the institutional level, we noted that lack of support from the government was considered a type of maltreatment. These themes suggest that policy issues related to healthcare should be considered.

Nurses' use of conscientious objection and the implications for conscience

AIMS

To explore the meaning of conscience for nurses in the context of conscientious objection (CO) in clinical practice.

DESIGN

Interpretive phenomenology was used to guide this study.

DATA SOURCES

Data were collected from 2016 - 2017 through one-on-one interviews from eight nurses in Ontario. Iterative analysis was conducted consistent with interpretive phenomenology and resulted in thematic findings.

REVIEW METHODS

Iterative, phased analysis using line-by-line and sentence highlighting identified key words and phrases. Cumulative summaries of narratives thematic analysis revealed how nurses made meaning of conscience in the context of making a CO.

RESULTS

Conscience issues and CO are current, critical issues for nurses. For Canadian nurses this need has been recently heightened by the national legalization of euthanasia, known as Medical Assistance in Dying in Canada. Ethics education, awareness, and respect for nurses' conscience are needed in Canada and across the profession to support nurses to address their issues of conscience in professional practice.

CONCLUSION

Ethical meaning emerges for nurses in their lived experiences of encountering serious ethical issues that they need to professionally address, by way of conscience-based COs.

IMPACT

This is the first study to explore what conscience means to nurses, as shared by nurses themselves and in the context of CO. Nurse participants expressed that support from leadership, regulatory bodies, and policy for nurses' conscience rights are indicated to address nurses' conscience issues in practice settings.

Children's moral experiences of crisis management in a child mental health setting

The experiences of children related to conflict and crisis management in child mental health settings, especially those aged 12 and below, have been rarely studied. This study examined the moral experiences of children related to conflict and crisis management and the related use of restraint and seclusion in a child mental health setting. A 5-month focused ethnography using a participatory hermeneutic framework was conducted in a day hospital programme for children with severe disruptive disorders within a mental health institute. Children considered restraints and seclusion could help them feel safe in certain instances, for example if another child was being aggressive towards them or in exceptional cases to prevent self-injury. However, their own experiences of being restrained were predominantly negative, especially if not knowing the reason for their use, which they then found unfair. Some of the children emphasized the punitive nature of the use of restraints and seclusion, and most children disagreed with these practices when used as a punishment. Children's perspectives also highlighted the limits of the use of a uniform de-escalation approach by the staff to manage crises. Children considered discussing with the staff and developing a relationship with them as more helpful in case of a crisis then the use of a de-escalation approach or coercive strategies.

General Practitioners' Barriers Toward Medication Reviews in Polymedicated Multimorbid Patients: How can a Focus on the Pharmacotherapy in an Outpatient Clinic Support GPs?

Purpose:

The aim of this study was to explore whether general practitioners (GPs) experienced barriers toward medication reviews in polymedicated, multimorbid patients, and how a clinical pharmacologist with a focus on pharmacotherapy can support the GPs in an outpatient clinic.

Design:

The study was descriptive and exploratory and had a qualitative design with a phenomenological/hermeneutic orientation for the interviews.

Participants:

The study comprised 14 interviews with 14 different GPs from the Capital Region of Denmark.

Results:

Three themes emerged from the interviews: (1) The care of patients With polypharmacy is challenged by the lack of professional dialogue and collaboration between GPs and hospital-based clinical pharmacologists, (2) the relationship between the patients with polypharmacy and the GP is characterized by care and individual considerations, and (3) the culture encourages adding medication and inhibits dialogue about medication withdrawal even for patients with polypharmacy.

Conclusion and implications for practice:

This study found that the primary barriers toward multimorbid patients with polypharmacy were the need for communication and teamwork with specialists (cardiologists, neurologists, endocrinologists, etc). Often, GPs felt that the specialists at the hospitals were more concerned about following standards and guidelines regarding specific diseases instead of a more holistic patient approach. To improve management of polypharmacy patients, the GPs suggest that a joint force is necessary, a partner-like relationship with greater transparency regarding information transfer, feedback, and shared decision-making, but also more education in the pharmacological field is essential.

Seeking Chronic Pain Relief: A Hermeneutic Exploration

BACKGROUND

In the United States, chronic pain is experienced by over 39.4 million adults, many of whom are treated with opioid pain medications.

AIM

This research presents an interpretation of the experience of seeking pain relief for a group of people taking opioid pain medications whose pain is not adequately controlled.

METHODS

A concurrent embedded mixed-methods design was used, including a Heideggerian hermeneutic qualitative approach that focuses on the participants' perceptions as a vehicle for understanding the phenomenon of seeking pain relief with descriptive quantitative data in a supporting role. Thirteen interviews and 15 surveys were analyzed, all of which met the following criteria: (1) self-reported chronic pain (persistent pain lasting a minimum of six months), (2) current use of prescription opioid medications, (3) pain not successfully controlled.

RESULTS

The analysis revealed a paradox, which we describe as being lost/finding myself in the health care system. This paradox became the overarching pattern of experience that subsumed several dynamic, overlapping practices described in the patterns: (1) seeking relief as suffering; (2) being classified as an addict but not an addict; (3) living with pain as remembering; and (4) experiencing treatment modalities as fickle possibilities.

CONCLUSION

Explication of and interpretive commentary on these patterns shift the focus from drug seeking to pain relief seeking behaviors in chronic pain sufferers. Such a shift could change the manner in which providers work with chronic pain sufferers to find appropriate treatment modalities.

Meeting the challenge of interpretation: Hearing the voices of people with intellectual and developmental disability through I-Poems

Including the inner perspectives of people who have intellectual disability can pose methodological challenges to qualitative researchers. This article explains how the Listening Guide was applied as an additional step in the analysis during a study which used hermeneutic interviews with people with intellectual disability as the sole method of data collection. An argument is made for the systematic application of the guide with a focus on the use of I-Poems. This article advances qualitative methodological approaches and concludes that this method of drawing attention to the participants' own voices provides a unique basis for interpreting interviews and tasks researchers to examine the use of the Listening Guide.

Optimizing a community-engaged multi-level group intervention to reduce substance use: an application of the multiphase optimization strategy

BACKGROUND

Rates of alcohol and illicit drug use (AIDU) are consistently similar across racial groups (Windsor and Negi, J Addict Dis 28:258-68, 2009; Keyes et al. Soc Sci Med 124:132-41, 2015). Yet AIDU has significantly higher consequences for residents in distressed communities with concentrations of African Americans (DCAA - i.e., localities with high rates of poverty and crime) who also have considerably less access to effective treatment of substance use disorders (SUD). This project is optimizing Community Wise, an innovative multi-level behavioral-health intervention created in partnership with service providers and residents of distressed communities with histories of SUD and incarceration, to reduce health inequalities related to AIDU.

METHODS

Grounded in critical consciousness theory, community-based participatory research principles (CBPR), and the multiphase optimization strategy (MOST), this study employs a 2 × 2 × 2 × 2 factorial design to engineer the most efficient, effective, and scalable version of Community Wise that can be delivered for US$250 per person or less. This study is fully powered to detect change in AIDU in a sample of 528 men with a histories of SUD and incarceration, residing in Newark, NJ in the United States. A community collaborative board oversees recruitment using a variety of strategies including indigenous field worker sampling, facility-based sampling, community advertisement through fliers, and street outreach. Participants are randomly assigned to one of 16 conditions that include a combination of the following candidate intervention components: peer or licensed facilitator, group dialogue, personal goal development, and community organizing. All participants receive a core critical-thinking component. Data are collected at baseline plus five post-baseline monthly follow ups. Once the optimized Community Wise intervention is identified, it will be evaluated against an existing standard of care in a future randomized clinical trial.

DISCUSSION

This paper describes the protocol of the first ever study using CBPR and MOST to optimize a substance use intervention targeting a marginalized population. Data from this study will culminate in an optimized Community Wise manual; enhanced methodological strategies to develop multi-component scalable interventions using MOST and CBPR; and a better understanding of the application of critical consciousness theory to the field of health inequalities related to AIDU.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02951455 . Registered on 1 November 2016.

Conscientious objection and nurses: Results of an interpretive phenomenological study

Background:

While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession.

Research question:

The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario?

Research design:

Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process.

Participants and research context:

Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months.

Ethical considerations:

This study was conducted in accordance with Health Science Research Ethics Board approval and all participants gave consent.

Findings:

Six themes emerged from data analysis: encountering the problem, knowing oneself, taking a stand, alone and uncertain, caring for others, and perceptions of support.

Discussion:

This study offers an initial understanding of what it is like to be a nurse making a conscientious objection in clinical practice. Implications for nursing practice, education, policy, and further research are discussed.

Conclusion:

Addressing ethical issues in nursing practice is complex. The need for education across nursing, healthcare disciplines and socio-political sectors is essential to respond to nurses’ ethical concerns giving rise to objections. Conscience emerged as an informant to nurses’ conscientious objections. The need for morally inclusive environments and addressing challenging ethical questions as well as the concept of conscience are relevant to advancing nursing ethics and ethical nursing practice.

Experiences of RNs Who Voluntarily Withdraw From Their RN-to-BSN Program

BACKGROUND

The number of RN-to-baccalaureate nursing (BSN) programs is increasing; however, nurses continue to voluntarily withdraw at higher rates than expected.

METHOD

A Heideggerian hermeneutic approach was used to interpret the meaning of the experience of RNs, who voluntarily withdraw from their baccalaureate nursing programs. The research aims were to generate a comprehensive understanding of (a) the experiences of RN-to-BSN noncompleters, (b) the meaning noncompleters ascribe to the experience of dropping out, and (c) the interplay between factors that influence dropout decisions.

RESULTS

Two overarching patterns of understanding emerged: Withdrawing as Revisiting Failure, and Withdrawing as Impasse: On One Side of the Divide. The factors that influence whether an RN finishes a baccalaureate nursing program are many, but the effect on dignity and well-being are immeasurable.

CONCLUSION

Voluntary withdrawal from an RN-to-BSN program leaves nurses professionally place-bound, affecting not only the individual nurse but also the profession. [J Nurs Educ. 2017;56(5):260-265.].

Care coordination: Identifying and connecting the most appropriate care to the patients

Although nurses are increasingly expected to fulfill the role of care coordinator, the knowledge and skills required to be an effective care coordinator are not well understood. The purpose of this study was to describe the knowledge and skills required in care coordination practice using an interpretive phenomenological approach. Fifteen care coordinators from 10 programs were interviewed over a 6-month period. Semi-structured face-to-face interviews were audio recorded, transcribed, and analyzed using interpretive phenomenology. The central theme of care coordination practice was bridging the patient and the healthcare systems. To bridge, care coordinators needed to have knowledge of the patient and healthcare system as well as the skills to identify and negotiate treatments appropriate for the patient. The most salient finding and new to this literature was that care coordinators who used their medical knowledge about available treatment options to discern and negotiate for the most appropriate care to the patient made differences in patient outcomes. Nurses with medical and healthcare system knowledge, combined with the skills to navigate and negotiate with others in an increasingly complex healthcare system, are well situated to be care coordinators and generate optimal outcomes. Further investigations of critical care coordinator competencies are needed to support nurses currently enacting the role of care coordinator and to prepare future nurses to fulfill the role.

Patient perspectives on improving osteoarthritis management in urban and rural communities

Introduction

Although there is no cure for osteoarthritis (OA), there are lifestyle modifications that can mitigate symptoms such as pain, and improve management of the disease. This information is not always translated to community-dwelling seniors. Individuals in rural areas often face additional challenges due to geographic isolation and decreased access to community services.

Methods

We used qualitative research methodology (hermeneutic phenomenology) to better understand the lived experiences of urban and rural community-dwelling seniors diagnosed with OA. We explored their sources of information about OA, how they manage their OA pain, and how OA management could be improved in the community. Purposeful sampling was used to recruit 20 information-rich participants (11 urban, 9 rural) in Ontario, Canada. All participants were aged >65 and diagnosed with OA. Semi-structured interviews were conducted, audio recorded, and transcribed verbatim. NVivo 11 Pro qualitative software was used to code transcripts.

Results

Thematic analysis revealed 9 key themes where 8 were common to urban and rural participants, and 1 was unique to rural participants. Most significant among the common themes was the description of the social network as a source of OA information, the trial-and-error approach used for OA management, and the individual contextualization of OA management. Our results suggest that there are several common experiences among urban- and rural-dwelling seniors living with OA, including the desire for support over time, but also a unique experience to rural-dwelling seniors, namely lack of access to local care.

Conclusion

These findings can be used to improve translation of OA information in both urban and rural communities in Canada, highlighting that common strategies may be effective in different contexts for this disease.

End-of-Life Communication: Nurses Cocreating the Closing Composition With Patients and Families

Communication is imperative for end-of-life decision-making; however, descriptions of key strategies used by nurses are missing. A phenomenological approach was used to interpret interviews from 10 hospice/palliative nurses. The overarching pattern is the closing composition. Key communication strategies/patterns include establishing context, acknowledging through attentive listening, making it safe for them to die, planning goals of care, and being honest. Essential is the awareness that nurse, patient, and family all hold expertise in the subject matter. It is imperative that pre-/postnursing licensure curriculum be expanded to include training in mutual influence communication practices and mentoring in the skill of orchestration.

Navigating Interprofessional Spaces: Experiences of Clients Living with Parkinson's Disease, Students and Clinical Educators

When students in interprofessional education and practice programmes partner with clients living with a long-term condition, the potential for a better client and educational experience is enhanced when the focus is on client self-management and empowerment. This paper reports the findings from a phenomenological study into the experiences of five clients, six speech language therapy students, eight physiotherapy students, and two clinical educators participating in a university clinic-based interprofessional programme for clients living in the community with Parkinson's Disease. Collaborative hermeneutic analysis was conducted to interpret the texts from client interviews and student and clinical educator focus groups held immediately after the programme. The overarching narratives emerging from the texts were: "client-centredness"; "who am I/why am I here?"; "understanding interprofessional collaboration and development"; "personal and professional development, awareness of self and others"; "the environment - safety and support". These narratives and the meanings within them were drawn together to develop a tentative metaphor-based framework of "navigating interprofessional spaces" showing how the narratives and meanings are connected. The framework identifies a temporal journey toward interprofessional collaboration impacted by diverse identities and understandings of self and others, varying expectations and interpretations of the programme, intra- and interpersonal, cultural and contextual spaces, and uncertainty. Shifts in being and doing and uncertainty appear to characterise client-driven, self-management focused interprofessional teamwork for all participants. These findings indicate that students need ongoing opportunities to share explicit understandings of interprofessional teamwork and dispel assumptions, since isolated interprofessional experiences may only begin to address these temporal processes.

The experience of stigma in inflammatory bowel disease: An interpretive (hermeneutic) phenomenological study

AIM

To explore experiences of stigma in people with inflammatory bowel disease.

BACKGROUND

Diarrhoea, urgency and incontinence are common symptoms in inflammatory bowel disease. Social rules stipulate full control of bodily functions in adulthood: poor control may lead to stigmatization, affecting patients' adjustment to disease. Disease-related stigma is associated with poorer clinical outcomes, but qualitative evidence is minimal.

DESIGN

An interpretive (hermeneutic) phenomenological study of the lived experience of stigma in inflammatory bowel disease.

METHODS

Forty community-dwelling adults with a self-reported diagnosis of inflammatory bowel disease were recruited purposively. Participants reported feeling stigmatized or not and experiencing faecal incontinence or not. Unstructured interviews took place in participants' homes in the United Kingdom (September 2012 - May 2013). Data were analysed using Diekelmann's interpretive method.

FINDINGS

Three constitutive patterns-Being in and out of control, Relationships and social Support and Mastery and mediation-reveal the experience of disease-related stigma, occurring regardless of continence status and because of name and type of disease. Stigma recedes when mastery over disease is achieved through development of resilience-influenced by humour, perspective, mental well-being and upbringing (childhood socialization about bodily functions). People travel in and out of stigma, dependent on social relationships with others including clinicians and tend to feel less stigmatized over time.

CONCLUSION

Emotional control, social support and mastery over disease are key to stigma reduction. By identifying less resilient patients, clinicians can offer appropriate support, accelerating the patient's path towards disease acceptance and stigma reduction.

Preserving Self: Medication-Taking Practices and Preferences of Older Adults With Multiple Chronic Medical Conditions

PURPOSE

To examine the experiences of older adults with multiple chronic medical conditions when a new medication was added to their existing multiple medication regimen.

DESIGN

A multimethod qualitative design was used. Thirty adults 60 years of age with (a) at least three chronic medical diagnoses, (b) at least five medications at baseline, and (c) a new medication prescription were enrolled in a prospective study of 30 days duration, participating from their homes.

METHODS

In-depth hermeneutic interviews (2 per 15 participants) and self-assessment diaries recorded on electronic tablets (daily per 30 participants) were completed. Transcribed interviews and self-recorded survey data were analyzed using hermeneutical analysis and ecological momentary assessment and content analysis, respectively.

FINDINGS

Common reasons participants did not take medications as prescribed included tolerability, transportation, access to medications, and forgetting. The overarching pattern, "preserving self," was supported by two patterns that subsumed several themes: (a) engaging the powerful hold of my illness, and (b) engaging providers in visioning health.

CONCLUSIONS

A deeper understanding of the impact of receiving a new prescription and of managing medication reveals the challenges patients experience in preserving a sense of self. Healthcare providers of all disciplines should understand the meaning of medication prescribing and medication taking to ameliorate medication-taking difficulties.

CLINICAL RELEVANCE

The provider-patient relationship is often cited as an area that needs to be addressed in healthcare practice. Our study emphasized the patients' voices and their profound needs around medication management. The emphasis on preservation of self is an important finding that focalizes the concern.

Experiences of vulnerability and uncertainty during the Iraq and Afghanistan wars: Stories of wounded service members and the nurses who cared for them

BACKGROUND

The findings reported in this paper were derived from a secondary analysis of selected data from a large clinical knowledge study designed to document the experiential learning of military and federal nurses caring for critically wounded service members (WSMs) of their experience of care from point of injury in the combat zone through their rehabilitation.

FINDINGS

This article describes a picture of vulnerability and uncertainty in both WSMs and their nurses throughout the health care continuum. The concepts of vulnerability and uncertainty had distinct meanings for each group. In many cases, nurses who were deployed revealed a dual encounter with the vulnerability of war along with personal uncertainty about themselves and their patients.

DISCUSSION

To support optimized health care of WSMs and the well-being of caregivers, health care professionals and policy makers must understand the effects and dynamics of serving in a warzone.