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Chung JS, Jouk A, Licona NP, Terry JH, Harris OA. In her own words: a phenomenological analysis of stories told by female service members and veterans after traumatic brain injury. Disabil Rehabil 2023; 45:4086-4093. [PMID: 36398683 DOI: 10.1080/09638288.2022.2146766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Given the majority of Service Members and Veterans (SMV) who have sustained a traumatic brain injury (TBI) are male, the female experience with TBI has not been captured in the general understanding of TBI. To improve understanding of the experience of female SMV after TBI utilizing a qualitative phenomenological approach on stories as told by female SMV. MATERIALS AND METHODS Ten female SMV participated in storytelling workshops and created video stories documenting their personal experience with TBI. Workshops were hosted by the VA Palo Alto Health Care System Polytrauma System of Care (VAPAHCS PSC). A grounded thematic analysis was conducted on the video stories. RESULTS Three common content themes emerged from all the stories: (1) negative psychological and emotional impacts of TBI, (2) acceptance and healing process associated with recovery, and (3) military contexts. Negative psychological and emotional impacts included intrapersonal impacts such as negative emotions, suicidal ideation, and dealing with cognitive and physical challenges, and interpersonal impacts in relationships and loss of independence. Notably, all the stories acknowledged an acceptance and healing process, characterized by several subthemes including motivational factors, TBI education, spirituality, and advocacy work. Lastly, each story mentioned military context, highlighting the unique experience within this population. CONCLUSIONS This phenomenological examination adds evidence-based understanding to the experience after TBI among female SMV. Each story uncovered nuanced and multifaceted issues that women experience in their TBI recovery. Our findings provide context to guide future intervention on the care, support, and TBI recovery for the female SMV population.
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Affiliation(s)
- Joyce S Chung
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexandra Jouk
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Nytzia P Licona
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
- University of Illinois Chicago, Palo Alto, CA, USA
| | - Jennifer H Terry
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Odette A Harris
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford University, Stanford, CA, USA
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How older adults with physical impairments maintain their autonomy in nursing homes. AGEING & SOCIETY 2023. [DOI: 10.1017/s0144686x22001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abstract
Autonomy is important to persons, including when they are living in nursing homes. Especially the relational dimension of autonomy is crucial for older adults with physical impairments. They generally have the decisional capacity to make choices about how they want to live their lives, but are often unable, or only partially able, to exercise these decisions themselves. To execute decisions, older adults are dependent on those who support them or care for them. However, little is known about how nursing home residents maintain autonomy in daily life and how others are involved in the decisions and execution of the decisions. To examine how older adults with physical impairments living in nursing homes maintain autonomy in daily life, shadowing, a non-participative observational method, was used. Seventeen older adults were shadowed during the course of one day. The observation ended with a brief interview. After the shadowing, the detailed observation notes were typed out, combined with the verbatim transcript resulting in one extensive report per shadowee. All 17 reports were coded and analysed thematically. Six elements for how older adults maintain autonomy in relation with others were identified, i.e. ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. For all six elements established in this study, it was found that older adults with physical impairments living in nursing homes could only maintain autonomy in daily life when others, such as staff, family and friends, were responsive to signals of the needs of older adults.
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Kvande ME, Delmar C, Lauritzen J, Damsgaard JB. Ethical dilemmas embedded in performing fieldwork with nurses in the ICU. Nurs Ethics 2021; 28:1329-1336. [PMID: 33827342 PMCID: PMC8640261 DOI: 10.1177/0969733021996025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Background: In general, qualitative research design often involves merging together various data collection strategies, and researcher’s may need to be prepared to spend longer periods in the field to pursue data collection opportunities that were not foreseen. Furthermore, nurse researchers performing qualitative research among patients and their relatives often experience unforeseen ethical dilemmas. Aim: This paper aimed to explore aspects of ethical dilemmas related to qualitative nursing research among patients and their relatives in the intensive care unit (ICU). Research design: This paper is based on a qualitative researcher’s personal experience during a hermeneutic phenomenological study involving close observation and in-depth interviews with 11 intensive care nurses. Data were collected at two ICUs in two Norwegian university hospitals. Ethical considerations: The study was approved by the Norwegian Social Science Data Services (NSD). The Regional Committee for Medical and Health Research Ethics (REK) granted dispensation to the project regarding health personnels confidentiality of the patients who were present during the observation (2012/622-4). Findings: Close observation with nurses in the ICU requires the researcher to balance being a qualitative researcher, an ICU nurse and a sensitive fellow human being open to the suffering of the other—that is, being embodied, engaged and affected by sensitive situations and simultaneously constantly stepping back and reflecting on the meaning of those situations. Conclusions: The qualitative researcher’s ethical awareness also entails knowing and acknowledging his or her own vulnerability, which becomes apparent in the researcher-participant relationship and settings in which being a fellow human always overrules the researcher’s role in ethical dilemmas.
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Affiliation(s)
| | | | - Jette Lauritzen
- 317905VIA University College, Denmark; Aarhus University, Denmark
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Dickman NE, Chicas R. Nursing is never neutral: Political determinants of health and systemic marginalization. Nurs Inq 2021; 28:e12408. [PMID: 33651915 DOI: 10.1111/nin.12408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 12/11/2022]
Abstract
The nursing community in the United States polarized in September 2020 between Dawn Wooten's whistleblowing about forced hysterectomies at an immigration center in Georgia and the American Nurses Association's refusal to endorse a presidential candidate despite the Trump administration's mounting failures to address the public health crisis posed by the COVID-19 pandemic. This reveals a need for more attention to political aspects of health outcome inequities. As advocates for health equity, nurses can join in recent scholarship and activism concerning the political determinants of health. In this paper, we examine recent work on the political determinants of health with an aim to add two things. First, we seek to build further on the notion of "political" determinants of health by distinguishing policy and governance structures from dynamics of politicization through appeal to critical disabilities studies. Second, we seek to apply this further nuanced approach to challenge rhetorical uses of "vulnerable populations," where this phrase serves to misrecognize systemic institutionalized forces that actively exploit and marginalize people and groups. By refocusing attention to political systems organized around and perpetuating inequitable health outcomes, nurses and other health care professionals-as well as those whom they serve-can concentrate their effort and power to act on political determinants of health in bringing about more equitable health outcomes.
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Affiliation(s)
- Nathan Eric Dickman
- Humanities and Fine Arts Division, University of the Ozarks, Clarksville, AR, USA
| | - Roxana Chicas
- Emory University School of Medicine, Atlanta, GA, USA
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Reid-Searl K, Levett-Jones T, Lapkin S, Jakimowicz S, Hunter J, Rawlings-Anderson K. Evaluation of the 'Empathic Care of a Vulnerable Older Person' e-simulation. NURSE EDUCATION TODAY 2020; 88:104375. [PMID: 32114402 DOI: 10.1016/j.nedt.2020.104375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 12/03/2019] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Healthcare reports have identified that the nursing care provided to frail older people is sometimes indifferent, unkind, and lacking in empathy. Compelling research indicates that these types of healthcare interactions can result in both emotional and physiological harm. Thus, there is a need for authentic learning experiences that enhance nursing students' empathy towards older people and that they can reflect upon, learn from and transfer to their real-world practice. e-Simulations provide a pragmatic way of addressing this need. AIM The aim of this study was to evaluate the impact of an 'Empathic Care of a Vulnerable Older Person' e-simulation on nursing students' empathy levels. SETTING AND PARTICIPANTS A convenience sample of first year nursing students from one university in the United Kingdom and two Australian universities was recruited for the study. DESIGN AND ANALYSIS A three-group pre-post study was conducted using the Comprehensive State Empathy Scale to evaluate the impact of the effectiveness of the e-simulation. Sample characteristics were summarised using descriptive statistics. Dependent t-tests and analysis of variance (ANOVA) were used to compare the changes in empathy scores pre post and differences between groups. RESULTS A total of 684 nursing students participated in the study; their average age was 23 years. Overall, there was a significant increase in empathy scores from pre-test to post-test. Post-hoc comparison of the three groups indicated that the e-simulation had a greater impact on the empathy levels of participants from Universities 2 and 3, compared to those from University 1. CONCLUSION e-Simulations using narrative methodologies that cater for learners' emotional memory appear to be an effective approach for enhancing empathy towards older people. However, further studies are needed to explore how this learning activity might inform and influence learners' future clinical practice.
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Affiliation(s)
- Kerry Reid-Searl
- CQUniversity, Australia, School of Nursing, Midwifery and Social Sciences, Building 18, Yaamba Road, Rockhampton, Queensland, Australia.
| | - Tracy Levett-Jones
- University of Technology Sydney, Faculty of Health, 235 Jones St, Ultimo, NSW 2007, Australia.
| | - Samuel Lapkin
- Faculty of Science Medicine & Health, University of Wollongong, South Western Sydney Campus, Liverpool, NSW 2170, Australia.
| | - Samantha Jakimowicz
- University of Technology Sydney, Faculty of Health, 235 Jones St, Ultimo, NSW 2007, Australia.
| | - Janet Hunter
- City, University of London, School of Health Sciences, Northampton Square, London EC1V 0HB, UK.
| | - Karen Rawlings-Anderson
- City, University of London, School of Health Sciences, Northampton Square, London EC1V 0HB, UK.
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Gualandi R, Masella C, Viglione D, Tartaglini D. Exploring the hospital patient journey: What does the patient experience? PLoS One 2019; 14:e0224899. [PMID: 31805061 PMCID: PMC6894823 DOI: 10.1371/journal.pone.0224899] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/23/2019] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To understand how different methodologies of qualitative research are able to capture patient experience of the hospital journey. METHODS A qualitative study of orthopaedic patients admitted for hip and knee replacement surgery in a 250-bed university hospital was performed. Eight patients were shadowed from the time they entered the hospital to the time of transfer to rehabilitation. Four patients and sixteen professionals, including orthopaedists, head nurses, nurses and administrative staff, were interviewed. RESULTS Through analysis of the data collected four main themes emerged: the information gap; the covering patient-professionals relationship; the effectiveness of family closeness; and the micro-integration of hospital services. The three different standpoints (patient shadowing, health professionals' interviews and patients' interviews) allowed different issues to be captured in the various phases of the journey. CONCLUSIONS Hospitals can significantly improve the quality of the service provided by exploring and understanding the individual patient journey. When dealing with a key cross-functional business process, the time-space dynamics of the activities performed have to be considered. Further research in the academic field can explore practical, methodological and ethical challenges more deeply in capturing the whole patient journey experience by using multiple methods and integrated tools.
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Affiliation(s)
- Raffaella Gualandi
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
- * E-mail:
| | - Cristina Masella
- Department of Management Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Daniela Viglione
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Daniela Tartaglini
- Department of Nursing, Università Campus Bio-Medico di Roma, Rome, Italy
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Ter Beest H, van Bemmel M, Adriaansen M. Nursing student as patient: experiential learning in a hospital simulation to improve empathy of nursing students. Scand J Caring Sci 2018; 32:1390-1397. [PMID: 29920725 DOI: 10.1111/scs.12584] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/17/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Empathy is an important factor in the relation nurse-patient. To develop empathy in bachelor nursing students is a challenge in nursing education. There are several small experiential learning methods that develop empathy in nursing students, although not in a hospital simulation. By experiencing the role of a patient, nursing students would learn important aspects of empathy. AIM This research will explore what nursing students learn about empathy in the relation nurse-patient, while they lie in bed as a patient seeing the nurse from another perspective. METHODOLOGICAL DESIGN Qualitative descriptive study on 75 reflections of bachelor nursing students. RESULTS Students experienced the need for empathy and were confronted with the patient's experiential world, being dependent, enduring hospital life and needing attention from the nurse. CONCLUSION The change in perspective in the hospital simulation gives nursing students valuable insights in the importance of empathy in the relation patient-nurse. Four themes were identified: endurance, silent scream for attention, scary dependency and confrontation with the role of patient. Students learned about the possibilities and difficulties of empathy in different stages of the simulation. A hospital simulation is a useful and practical method to teach students empathy from the patients' perspective, on condition that there is a solid preparation for experiential learning.
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Affiliation(s)
- Hanneke Ter Beest
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marlies van Bemmel
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marian Adriaansen
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
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Kvande M, Delmar C, Lykkeslet E, Storli SL. Assessing changes in a patient's condition - perspectives of intensive care nurses. Nurs Crit Care 2016; 22:99-104. [PMID: 27651301 DOI: 10.1111/nicc.12258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/13/2016] [Accepted: 08/09/2016] [Indexed: 12/28/2022]
Abstract
AIM To explore the phenomenon of assessing changes in patients' conditions in intensive care units from the perspectives of experienced intensive care nurses. BACKGROUND Providing safe care for patients in intensive care units requires an awareness and perception of the signs that indicate changes in a patient's condition. Nurses in intensive care units play an essential role in preventing the deterioration of a patient's condition and in improving patient outcomes. DESIGN AND METHODS This hermeneutic phenomenological study conducted close observations and in-depth interviews with 11 intensive care nurses. The nurses' experience ranged from 7 to 28 years in the intensive care unit. Data were collected at two intensive care units in two Norwegian university hospitals. The analysis was performed using the reflective methods of van Manen. FINDINGS An overarching theme of 'sensitive situational attention' was identified, in which the nurses were sensitive in relation to a patient and understood the significance of a given situation. This theme was further unfolded in four subthemes: (1) being sensitive and emotionally present, (2) being systematic and concentrating, (3) being physically close to the bedside and (4) being trained and familiar with the routines. CONCLUSIONS Nurses understand each patient's situation and foresee clinical eventualities through a sensitive and attentive way of thinking and working. This requires nurses to be present at the bedside with both their senses (sight, hearing, smell and touch) and emotions and to work in a concentrated and systematic manner. Knowledge about the unique patient exists in interplay with past experiences and medical knowledge, which are essential for nurses to understand the situation. RELEVANCE TO CLINICAL PRACTICE Clinical practice should develop routines that enable nurses to be present at the bedside and to work in a concentrated and systematic manner. Furthermore, providing safe care requires nurses to be sensitive and attentive to each patient's unique situation.
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Affiliation(s)
- Monica Kvande
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Charlotte Delmar
- Section for Nursing, Department of Public Health, Health Faculty Aarhus University, DK & Faculty of Health Science, Aalborg University, DK & University College Diakonova, Oslo, Norway
| | - Else Lykkeslet
- Faculty of Health and Social Care, Molde University College, Molde, Norway
| | - Sissel Lisa Storli
- Department of Health and Care Sciences, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
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van der Meide H, Olthuis G, Leget C. Participating in a world that is out of tune: shadowing an older hospital patient. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:577-585. [PMID: 25577239 DOI: 10.1007/s11019-015-9621-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hospitalization significantly impacts the lives of older people, both physically and psychosocially. There is lack of observation studies that may provide an embodied understanding of older patients' experiences in its context. The aim of this single case study was to reach a deeper understanding of one older patient's lived experiences of hospitalization. The study followed a phenomenological embodied enquiry design and the qualitative observation method of shadowing was used. In April 2011, one older patient was shadowed for 7 days, 5-7 h per day. To facilitate understanding in the reader the experiences are first presented in a story and subsequently analyzed by means of the lifeworld framework. The findings show that hospitalization is experienced as ambiguous safety, disconnected time, the feeling of being partially involved, and the struggle to re-attune to the body.
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Affiliation(s)
| | - Gert Olthuis
- Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Utrecht, The Netherlands
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Abstract
The vulnerability of older hospital patients is increasingly understood in physical terms, often referred to as frailty. This reduces their vulnerability to the functioning body regardless of the psycho-socio-cultural context they are in, and it ignores the role of the hospital environment. This paper starts from a care ethical perspective on care and uses insights from empirical work that shows that hospitalization of older patients is characterized by experiences of uncertainty that give rise to feelings of vulnerability. This paper presents a model that clarifies how vulnerability occurs in the interplay between the embodied subject, others, daily life and the hospital, and shows its dynamic and relational nature. Our complementary perspective of vulnerability is vital for nursing practice in that it starts from the situatedness of the older patient and not only points at what is missing but also at what is of significance to the older patient. Taking into account this perspective helps improving relational care.
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Affiliation(s)
| | - Gert Olthuis
- Radboud University Medical Centre Nijmegen, The Netherlands
| | - Carlo Leget
- University of Humanistic Studies, The Netherlands
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van der Meide H, Olthuis G, Leget C. Feeling an outsider left in uncertainty - a phenomenological study on the experiences of older hospital patients. Scand J Caring Sci 2014; 29:528-36. [DOI: 10.1111/scs.12187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 09/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Gert Olthuis
- Radboud University Medical Centre Nijmegen; Nijmegen The Netherlands
| | - Carlo Leget
- University of Humanistic Studies; Utrecht The Netherlands
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Urban AM, Quinlan E. Not for the faint of heart. QUALITATIVE RESEARCH IN ORGANIZATIONS AND MANAGEMENT: AN INTERNATIONAL JOURNAL 2014. [DOI: 10.1108/qrom-10-2012-1107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose– The purpose of this paper is to share two researcher's experience about the challenges associated with shadowing within the health care context.Design/methodology/approach– Institutional ethnography and shadowing.Findings– Shadowing is increasingly being used as a data collection method, however, before proceeding to use this approach in today's health care environment, the researcher must give thoughtful consideration to the context.Originality/value– This paper provides a reflexive elaboration of the differences between the insider and outsider perspective when using the shadowing data collection method within health care organizations.
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