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Potthoff S, Hempeler C, Gather J, Gieselmann A, Vollmann J, Scholten M. Research ethics in practice: An analysis of ethical issues encountered in qualitative health research with mental health service users and relatives. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:517-527. [PMID: 37639076 PMCID: PMC10725844 DOI: 10.1007/s11019-023-10169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/29/2023]
Abstract
The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as "procedural ethics" and the identification and handling of ethical issues by researchers during the research process as "ethics in practice." While some authors dispute and other authors defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice. This article aims to provide an illustration of research ethics in practice by reflecting on the ways in which we identified and addressed ethical and methodological issues that arose in the context of an interview study with mental health service users and relatives. We describe the challenges we faced and the solutions we found in relation to the potential vulnerability of research participants, the voluntariness of consent, the increase of participant access and the heterogeneity of the sample, the protection of privacy and internal confidentiality, and the consideration of personal and contextual factors.
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Affiliation(s)
- Sarah Potthoff
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany.
| | - Christin Hempeler
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Astrid Gieselmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799, Bochum, Germany
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Slootman M, Mudde AL, The AM. Frontstage nursing and backstage growth: The emotional labour of student nurses in Dutch nursing homes. Nurs Inq 2023; 30:e12570. [PMID: 37303109 DOI: 10.1111/nin.12570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/13/2023]
Abstract
The complex emotional work of nurses calls for more recognition of emotional labour and the incorporation of emotional labour in nursing education. Based on participant observation and semistructured interviews, we describe the experiences of student nurses in two nursing homes for elderly people with dementia in the Netherlands. We analyse their interactions using Goffman's dramaturgical view on the front and backstage behaviour and the distinction between surface acting and deep acting. The study reveals the complexity of emotional labour, as nurses swiftly adapt their communication styles and behavioural strategies between settings, patients, and even between moments within one interaction sequence, which shows that the theoretical binaries fail to fully capture their skills. Although student nurses take pride in their emotionally taxing work, the societal undervaluation of the nursing profession negatively impacts their self-image and ambitions. More explicit recognition of these complexities would enhance their self-appreciation. This calls for a professional 'backstage area' that allows nurses to articulate and strengthen their emotional labour skills. Educational institutions should provide this backstage for nurses-in-training to strengthen these skills as part of the professional skill set.
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Affiliation(s)
- Marieke Slootman
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Youth and Society, Research Group, Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Anne L Mudde
- Youngworks Research Agency, Amsterdam, The Netherlands
| | - Anne-Mei The
- Department of Sociology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Sociale Benadering Dementie, Amsterdam, The Netherlands
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Joschko L, Pálsdóttir AM, Grahn P, Hinse M. Nature-Based Therapy in Individuals with Mental Health Disorders, with a Focus on Mental Well-Being and Connectedness to Nature-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2167. [PMID: 36767534 PMCID: PMC9914984 DOI: 10.3390/ijerph20032167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
In times of social and ecological crises, such as COVID-19 with lockdowns and implementing the impact of climate change, mental health degrades. Being outdoors in nature can be health-promoting, can decrease depression, and increase mental well-being. This pilot study investigated the relationships between nature-based therapy, mental health, and individuals' connectedness to nature. We hypothesize that nature-based therapy has a positive impact on individual mental health and connectedness to nature. A mixed-method approach was used to evaluate the effectiveness of nature-based therapy for young psychosomatic patients. The results demonstrated improvements in mental well-being and connectedness to nature through therapy. Additionally, depression scores decreased. Patients reported the importance of the therapist setting the space, the supportive environment, the poems that fostered the nature connection, improvement at the soul level, and overall doing something meaningful. Every patient experienced nature-based therapy as effective. To conclude, the study gives a first insight into the processes of nature-based therapy in the German population at work and the effectiveness of nature-based therapy. Further questions, e.g., season effects, longitudinal effects, and whether patients with low connectedness to nature gain more out of the intervention remain unanswered.
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Affiliation(s)
- Lilly Joschko
- Department of People and Society, The Swedish University of Agricultural Sciences, 234 22 Lomma, Sweden
| | - Anna María Pálsdóttir
- Department of People and Society, The Swedish University of Agricultural Sciences, 234 22 Lomma, Sweden
| | - Patrik Grahn
- Department of People and Society, The Swedish University of Agricultural Sciences, 234 22 Lomma, Sweden
| | - Maximilian Hinse
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Peña Sánchez EY, Hernández Albarrán L. Experiencias etnográficas y preocupaciones éticas en espacios de atención a la salud en México. REVISTA LATINOAMERICANA DE BIOÉTICA 2022. [DOI: 10.18359/rlbi.5691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
En México, la integración de estudiantes-investigadores de antropología en salud a espacios de atención a la salud es muy reciente, por lo que resulta relevante conocer el proceso histórico y de la misma forma problematizar la interacción de estos con los prestadores de salud, así como con sus usuarios, a fin de discutir sobre la posibilidad de acceso para realizar indagaciones sobre las prácticas etnográficas, funciones y consecuencias de la presencia del investigador social en dicho espacio, desde la visión del estudiante de posgrado. Por lo anterior, se realizaron grupos focales con diez alumnos del área de antropología en salud, en los que se averiguó sobre la experiencia de sus investigaciones en los ámbitos anteriormente mencionados, llegando a la conclusión de que son de relevancia tres ejes: en primer lugar, la preparación de trabajo antropológico para y en la institución, seguido de la performatividad en la institución y, por último, los conflictos tanto administrativos, como operativos en la práctica etnográfica. Estos ejes se desarrollaron en este trabajo, y a través de ellos se plantearon y describieron las tensiones de la práctica profesional antropológica en instituciones de salud, con base en el hecho de que la etnografía en estos espacios confronta a dos disciplinas y lógicas institucionales diferentes. Finalmente, se realizó una reflexión desde las implicaciones éticas del desarrollo de la etnografía en estos espacios, al abrigo de los derechos humanos del usuario-paciente.
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Lundh L. Personvernregler og forskningsetikk: Blir det fortsattmulig å gjøre antropologisk skoleforskning? NORSK ANTROPOLOGISK TIDSSKRIFT 2020. [DOI: 10.18261/issn.1504-2898-2020-03-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lise Lundh
- Oslo Metropolitan University (OsloMet) / Kulturtanken
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Øye C, Sørensen NØ, Dahl H, Glasdam S. Tight Ties in Collaborative Health Research Puts Research Ethics on Trial? A Discussion on Autonomy, Confidentiality, and Integrity in Qualitative Research. QUALITATIVE HEALTH RESEARCH 2019; 29:1227-1235. [PMID: 30623753 DOI: 10.1177/1049732318822294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Collaborative research involving different stakeholders is increasingly becoming a preferred way of doing qualitative research to improve health care services. However, ethical research dilemmas arise when collaborative ties are tight. Based on lessons learned from two qualitative collaborative health care research projects in two different municipalities in Norway and Denmark, respectively, this article illuminates ethical research dilemmas around ethical principles and guidelines of autonomy (informed consent), confidentiality (anonymity), and integrity of research. Accordingly, there is a need to revisit and resume international ethical research guidelines formulated in the Declaration of Helsinki, when it comes to research guidelines of informed consent, anonymity, and integrity of research. Moreover, we suggest that collaborators contemplate and negotiate these ethical research issues to avoid unnecessary misunderstandings, conflicts, and pressures when doing research with stakeholders when collaboration ties are tight.
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Affiliation(s)
- Christine Øye
- 1 Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Hellen Dahl
- 1 Western Norway University of Applied Sciences, Bergen, Norway
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Salzmann-Erikson M, Söderqvist C. Being Subject to Restrictions, Limitations and Disciplining: A Thematic Analysis of Individuals' Experiences in Psychiatric Intensive Care. Issues Ment Health Nurs 2017; 38:540-548. [PMID: 28388251 DOI: 10.1080/01612840.2017.1299265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to describe individuals' experiences of being hospitalized in psychiatric intensive care units (PICUs). Four participants who had previously been admitted in a PICU were interviewed using open-ended questions. The data were analyzed using thematic analysis. Analysis resulted in a synthesis of the various ways patients experienced limitations: (1) Descriptions of Being Limited in the Environment, (2) Descriptions of being Limited in Interactions with Staff, (3) Descriptions of Being Limited in terms of Access to Information, and (4) Descriptions of Having Limited Freedom and Autonomy. Hospitalization is experienced as a life-changing event that shows a kaleidoscopic view of limitation. We stress that the conceptualization of limitation must be considered due to its historical origins, sociopolitical aspirations, and philosophy of care. Thus, nurse practitioners and nursing leaders are advised to put the patient's experience at the center of care, and to involve and integrate patients throughout the recovery process.
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Affiliation(s)
- Martin Salzmann-Erikson
- a Department of Health and Caring Sciences , Faculty of Health and Occupational Studies, University of Gävle , Gävle , Sweden
| | - Cecilia Söderqvist
- b School of Health, Care and Social Welfare, University of Mälardalen , Västerås , Sweden.,c Centre for Clinical Research, Västmanland County Hospital , Västerås , Sweden
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Abstract
In this article, we provide a nuanced perspective on the benefits and costs of covert research. In particular, we illustrate the value of such an approach by focusing on covert participant observation. We posit that all observational studies sit along a continuum of consent, with few research projects being either fully overt or fully covert due to practical constraints and the ambiguous nature of consent itself. With reference to illustrative examples, we demonstrate that the study of deviant behaviors, secretive organizations and socially important topics is often only possible through substantially covert participant observation. To support further consideration of this method, we discuss different ethical perspectives and explore techniques to address the practical challenges of covert participant observation, including; gaining access, collecting data surreptitiously, reducing harm to participants, leaving the site of study and addressing ethical issues.
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Bishop K. Challenging research: completing participatory social research with children and adolescents in a hospital setting. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2016; 7:76-91. [PMID: 24554357 DOI: 10.1177/193758671400700205] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A discussion of the challenges to completing participatory social research with children and adolescents in a hospital setting. BACKGROUND Beginning with the dominant medical culture of hospitals, coupled with a persistent skepticism of social and in particular, qualitative research and its contribution to knowledge in medical circles, restrictive contextual challenges also include attitudinal, methodological, and logistical considerations. Together, these challenges hamper good participatory research practice and the capacity to maintain quality data, as well as impede children's participation in research, which has the capacity to contribute to healthcare design, policy, and planning processes. METHODS Two studies in pediatric settings in Australia, one of which was completed in 2008 and the other which was discontinued in 2011, provide the basis for this research discussion. The discussion addresses the issues that persist in inhibiting the completion of participatory social research and the resulting impacts on research, children's right to participate, and the volume of evidence that is ultimately available from children's perspectives to support and inform healthcare design, planning, and policy in pediatric settings. CONCLUSIONS Recommendations for changes that could strengthen and improve this research experience include building awareness of the potential value of this research; increasing its influence; building the capacity and knowledge of gatekeepers, ethics committees, and researchers working in this context; and recognizing and valuing children's competence and participation. KEYWORDS Evidence-based design, hospital, methodology, patients, pediatric.
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Kendall S, Halliday LE. Undertaking ethical qualitative research in public health: are current ethical processes sufficient? Aust N Z J Public Health 2015; 38:306-10. [PMID: 25091070 DOI: 10.1111/1753-6405.12250] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sacha Kendall
- School of Women's and Children's Health, University of New South Wales
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Ahern C, McKinnon MC, Bieling PJ, McNeely H, Langstaff K. Overcoming the Challenges Inherent in Conducting Design Research in Mental Health Settings. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2015; 9:119-29. [DOI: 10.1177/1937586715602219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Conducting high-quality design research in a mental health setting presents significant challenges, limiting the availability of high-quality evidence to support design decisions for built environments. Here, we outline key approaches to overcoming these challenges. Background: In conducting a rigorous post-occupancy evaluation of a newly built mental health and addictions facility, St. Joseph’s Healthcare, Hamilton, we identified a number of systematic barriers associated with conducting design research in mental health settings. Methods: Our approach to overcoming these barriers relied heavily upon (i) selecting established measures and methods with demonstrated efficacy in a mental health context, (ii) navigating institutional protocols designed to protect vulnerable members of this population, and (iii) designing innovative data collection strategies to increase participation in research by individuals with mental illness. Each of these approaches drew heavily on the expert knowledge of mental health settings and the experiences with mental health, facilities management, and research of a research team that was well integrated within the parent institution. Conclusions: Engaging multiple stakeholders (e.g., care providers, patients, ethics board, and hospital administrators) contributed their trust and support of the research. Traditionally, post-occupancy evaluation researchers are independent of the facilities they research, yet this is not an effective approach in mental health settings. We found that, in working toward solutions to the three obstacles we described, having team members who were well “networked” within the parent institution was necessary. This approach can turn “gatekeepers” into champions for patients’ engagement in the research, which is essential in generating high-quality evidence.
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Affiliation(s)
| | - Margaret C. McKinnon
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Homewood Research Institute, Guelph, Ontario, Canada
| | - Peter J. Bieling
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
| | - Heather McNeely
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
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Abstract
Background: The increase in medical ethical regulations and bureaucracy handled by institutional review boards and healthcare institutions puts the researchers using qualitative methods in a challenging position. Method: Based on three different cases from three different research studies, the article explores and discusses research ethical dilemmas. Objectives and ethical considerations: First, and especially, the article addresses the challenges for gatekeepers who influence the informant’s decisions to participate in research. Second, the article addresses the challenges in following research ethical guidelines related to informed consent and doing no harm. Third, the article argues for the importance of having research ethical guidelines and review boards to question and discuss the possible ethical dilemmas that occur in qualitative research. Discussion and conclusion: Research ethics must be understood in qualitative research as relational, situational, and emerging. That is, that focus on ethical issues and dilemmas has to be paid attention on the spot and not only at the desktop.
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Oute J, Huniche L, Nielsen CT, Petersen A. The Politics of Mental Illness and Involvement—<i>A Discourse Analysis of Danish Anti-Stigma and Social Inclusion Campaigns</i>. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/aasoci.2015.511026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Aas IHM. Collecting Information for Rating Global Assessment of Functioning (GAF): Sources of Information and Methods for Information Collection. CURRENT PSYCHIATRY REVIEWS 2014; 10:330-347. [PMID: 25598769 PMCID: PMC4287015 DOI: 10.2174/1573400509666140102000243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/18/2013] [Accepted: 12/06/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Global Assessment of Functioning (GAF) is an assessment instrument that is known worldwide. It is widely used for rating the severity of illness. Results from evaluations in psychiatry should characterize the patients. Rating of GAF is based on collected information. The aim of the study is to identify the factors involved in collecting information that is relevant for rating GAF, and gaps in knowledge where it is likely that further development would play a role for improved scoring. METHODS A literature search was conducted with a combination of thorough hand search and search in the bibliographic databases PubMed, PsycINFO, Google Scholar, and Campbell Collaboration Library of Systematic Reviews. RESULTS Collection of information for rating GAF depends on two fundamental factors: the sources of information and the methods for information collection. Sources of information are patients, informants, health personnel, medical records, letters of referral and police records about violence and substance abuse. Methods for information collection include the many different types of interview - unstructured, semi-structured, structured, interviews for Axis I and II disorders, semistructured interviews for rating GAF, and interviews of informants - as well as instruments for rating symptoms and functioning, and observation. The different sources of information, and methods for collection, frequently result in inconsistencies in the information collected. The variation in collected information, and lack of a generally accepted algorithm for combining collected information, is likely to be important for rated GAF values, but there is a fundamental lack of knowledge about the degree of importance. CONCLUSIONS Research to improve GAF has not reached a high level. Rated GAF values are likely to be influenced by both the sources of information used and the methods employed for information collection, but the lack of research-based information about these influences is fundamental. Further development of GAF is feasible and proposals for this are presented.
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Affiliation(s)
- I. H. Monrad Aas
- Research Unit, Division of Mental Health and Addiction, Vestfold Hospital Trust, PO Box 2267, 3103 Tönsberg, Norway
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Herrmann WJ, Haarmann A, Flick U, Bærheim A, Lichte T, Herrmann M. Patients' subjective concepts about primary healthcare utilisation: the study protocol of a qualitative comparative study between Norway and Germany. BMJ Open 2013; 3:e002952. [PMID: 23794555 PMCID: PMC3686237 DOI: 10.1136/bmjopen-2013-002952] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 04/10/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In Germany, utilisation of ambulatory healthcare services is high compared with other countries: While a study based on the process data of German statutory health insurances showed an average of 17.1 physician-patient-contacts per year, the comparable figure for Norway is about five. The usual models of healthcare utilisation, such as Rosenstock's Health Belief Model and Andersen's Behavioural Model, cannot explain these differences adequately. Organisational factors of the healthcare system, such as gatekeeping, do not explain the magnitude of the differences. Our hypothesis is that patients' subjective concepts about primary healthcare utilisation play a major role in explaining different healthcare utilisation behaviour in different countries. Hence, the aim of this study is to explore these subjective concepts comparatively, between Germany and Norway. METHODS/DESIGN With that aim in mind, we chose a comparative qualitative study design. In Norway and Germany, we are going to interview 20 patients each with qualitative episodic interviews. In addition, we are going to conduct participant observation in four German and four Norwegian primary care practices. The data will be analysed by thematic coding. Using selected categories, we are going to conduct comparative case and group analyses. ETHICS AND DISSEMINATION The study adheres to the Declaration of Helsinki. All interviewees will sign informed consent forms and all patients will be observed during consultation. Strict rules for data security will apply. Developed theory and policy implications are going to be disseminated by a workshop, presentations for experts and laypersons and publications.
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Affiliation(s)
- Wolfram J Herrmann
- Institute of General Practice and Family Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Alexander Haarmann
- Institute of General Practice and Family Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Uwe Flick
- Alice Salomon Hochschule University of Applied Sciences, Berlin, Germany
| | - Anders Bærheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Thomas Lichte
- Institute of General Practice and Family Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Markus Herrmann
- Institute of General Practice and Family Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Bloomer MJ, Doman M, Endacott R. How the observed create ethical dilemmas for the observers: Experiences from studies conducted in clinical settings in the UK and Australia. Nurs Health Sci 2013; 15:410-4. [DOI: 10.1111/nhs.12052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 01/23/2013] [Accepted: 02/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Melissa J. Bloomer
- School of Nursing and Midwifery; Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - Maggie Doman
- School of Nursing and Midwifery; Education and Society; Plymouth University; Plymouth UK
| | - Ruth Endacott
- School of Nursing and Midwifery; Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
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Walshe C, Ewing G, Griffiths J. Using observation as a data collection method to help understand patient and professional roles and actions in palliative care settings. Palliat Med 2012; 26:1048-54. [PMID: 22179595 DOI: 10.1177/0269216311432897] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Observational research methods are important for understanding people's actions, roles and behaviour. However, these techniques are underused generally in healthcare research, including research in the palliative care field. AIM The aim in this paper is to place qualitative observational data collection methods in their methodological context and provide an overview of issues to consider when using observation as a method of data collection. This paper discusses practical considerations when conducting palliative care research using observation. FINDINGS Observational data collection methods span research paradigms, and qualitative approaches contribute by their focus on 'natural' settings which allow the explanation of social processes and phenomena. In particular, they can facilitate understanding of what people do and how these can alter in response to situations and over time, especially where people find their own practice difficult to articulate. Observational studies can be challenging to carry out: we focus on the potentially problematic areas of sampling, consent and ethics, data collection and recording, data management and analysis. CONCLUSION Qualitative observational data collection methods can contribute to theoretical and conceptual development and the explanation of social processes in palliative care. In particular this contribution to understanding care structures and processes should improve understanding of patients' experiences of their care journey and thus impact on care outcomes.
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Affiliation(s)
- Catherine Walshe
- The School of Nursing, Midwifery and Social Work, University of Manchester, UK.
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Pollock K. Procedure versus process: ethical paradigms and the conduct of qualitative research. BMC Med Ethics 2012; 13:25. [PMID: 23016663 PMCID: PMC3519630 DOI: 10.1186/1472-6939-13-25] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 09/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research is fundamental to improving the quality of health care. The need for regulation of research is clear. However, the bureaucratic complexity of research governance has raised concerns that the regulatory mechanisms intended to protect participants now threaten to undermine or stifle the research enterprise, especially as this relates to sensitive topics and hard to reach groups. DISCUSSION Much criticism of research governance has focused on long delays in obtaining ethical approvals, restrictions imposed on study conduct, and the inappropriateness of evaluating qualitative studies within the methodological and risk assessment frameworks applied to biomedical and clinical research. Less attention has been given to the different epistemologies underlying biomedical and qualitative investigation. The bioethical framework underpinning current regulatory structures is fundamentally at odds with the practice of emergent, negotiated micro-ethics required in qualitative research. The complex and shifting nature of real world settings delivers unanticipated ethical issues and (occasionally) genuine dilemmas which go beyond easy or formulaic 'procedural' resolution. This is not to say that qualitative studies are 'unethical' but that their ethical nature can only be safeguarded through the practice of 'micro-ethics' based on the judgement and integrity of researchers in the field. SUMMARY This paper considers the implications of contrasting ethical paradigms for the conduct of qualitative research and the value of 'empirical ethics' as a means of liberating qualitative (and other) research from an outmoded and unduly restrictive research governance framework based on abstract prinicipalism, divorced from real world contexts and values.
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Affiliation(s)
- Kristian Pollock
- School of Nursing, Midwifery and Physiotherapy, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2HA, UK.
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Øye C, Bjelland AK. Deltagende observasjon i fare? – En vurdering av noen forskningsetiske retningslinjer og godkjenningsprosedyrer. NORSK ANTROPOLOGISK TIDSSKRIFT 2012. [DOI: 10.18261/issn1504-2898-2012-02-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Skorpen A, Anderssen N, Oye C, Bjelland AK. Treatment regimes in a psychiatric hospital and apparent contradictions: report from field work in a lock-up ward illustrated with a constructed case. Int J Ment Health Nurs 2009; 18:409-16. [PMID: 19883412 DOI: 10.1111/j.1447-0349.2009.00630.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The medical approach dominates in Norwegian psychiatry, but mental health nurses and other ward staff hold that milieu therapy constitutes an additional and important treatment approach for psychiatric patients. In this study, we wanted to explore these approaches as they are implemented in inpatient treatment. We conducted a 9-month ethnographic study in two lock-up psychiatric wards in a Norwegian psychiatric hospital. In this article, we present a constructed case, Mary, to illustrate the voices, experiences, and perspectives of patients and staff as observed primarily in the patients' smoking room, the corridor, and the staffroom. From the perspective of staff, we identified at least two professional perspectives concerning patients' daily life: a strong medical-psychiatric view and a weaker therapeutic milieu, which seemed difficult to implement. When considering the view of people in care, we observed that patients' experiences and points of view occurred and remained to a large degree in their smoking room, and patients seemed to have little impact on their own treatment programmes. This stands in sharp contrast to patients' legal rights to participate in any important decisions regarding their treatment and to the espoused person-centred orientation in health care today.
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Affiliation(s)
- Aina Skorpen
- Department of Health, Stord/Haugesund University College, N-5409 Stord, Norway.
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Oeye C, Bjelland AK, Skorpen A, Anderssen N. User participation when using milieu therapy in a psychiatric hospital in Norway: a mission impossible? Nurs Inq 2009; 16:287-96. [DOI: 10.1111/j.1440-1800.2009.00463.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weigl M, Müller A, Zupanc A, Angerer P. Participant observation of time allocation, direct patient contact and simultaneous activities in hospital physicians. BMC Health Serv Res 2009; 9:110. [PMID: 19563625 PMCID: PMC2709110 DOI: 10.1186/1472-6963-9-110] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 06/29/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital physicians' time is a critical resource in medical care. Two aspects are of interest. First, the time spent in direct patient contact - a key principle of effective medical care. Second, simultaneous task performance ('multitasking') which may contribute to medical error, impaired safety behaviour, and stress. There is a call for instruments to assess these aspects. A preliminary study to gain insight into activity patterns, time allocation and simultaneous activities of hospital physicians was carried out. Therefore an observation instrument for time-motion-studies in hospital settings was developed and tested. METHODS 35 participant observations of internists and surgeons of a German municipal 300-bed hospital were conducted. Complete day shifts of hospital physicians on wards, emergency ward, intensive care unit, and operating room were continuously observed. Assessed variables of interest were time allocation, share of direct patient contact, and simultaneous activities. Inter-rater agreement of Kappa = .71 points to good reliability of the instrument. RESULTS Hospital physicians spent 25.5% of their time at work in direct contact with patients. Most time was allocated to documentation and conversation with colleagues and nursing staff. Physicians performed parallel simultaneous activities for 17-20% of their work time. Communication with patients, documentation, and conversation with colleagues and nursing staff were the most frequently observed simultaneous activities. Applying logit-linear analyses, specific primary activities increase the probability of particular simultaneous activities. CONCLUSION Patient-related working time in hospitals is limited. The potential detrimental effects of frequently observed simultaneous activities on performance outcomes need further consideration.
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Affiliation(s)
- Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany.
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Oeye C, Bjelland AK, Skorpen A, Anderssen N. Raising adults as children? A report on milieu therapy in a psychiatric ward in Norway. Issues Ment Health Nurs 2009; 30:151-8. [PMID: 19291491 DOI: 10.1080/01612840802557246] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Milieu therapy is widely used as a therapeutic approach in psychiatric wards in the Nordic countries, but few studies exist that report on what practices a milieu therapy approach implies as seen from an ethnographic perspective. Therefore, there is a need to obtain insight into how milieu therapy unfolds in a psychiatric ward setting. The present ethnographic study aims to explore this in a locked-up psychiatric ward that was tied to a psychodynamic-oriented milieu therapy approach. Metaphors from traditional nuclear family life were widely used. Patients were often understood as harmed children and were taught self-management skills; the staff aimed at providing a caring atmosphere; and the patients seemed to behave, sometimes, in a childlike manner. In a Foucaultian framework, milieu therapy can be seen as a therapeutic normalization technique used to produce self-governing individuals. Milieu therapy "raises" patients in order to transform patients' odd behaviour and nonconforming lifestyles. We see this "raising children" approach as a type of intervention that nicely connects to the national policy of normalization and integration politics towards persons with psychiatric diagnoses.
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Trondsen M, Sandaunet AG. The dual role of the action researcher. EVALUATION AND PROGRAM PLANNING 2009; 32:13-20. [PMID: 19019435 DOI: 10.1016/j.evalprogplan.2008.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 09/18/2008] [Accepted: 09/19/2008] [Indexed: 05/27/2023]
Abstract
This article aims to provide more insight into advantages and challenges of conducting action research with the intention to improve health care. Action research is distinctive in the sense that the researcher has a dual role as both researcher and implementer of the program studied. The article is based on two Norwegian action-oriented studies that aimed to explore the potential role of online self-help groups for breast cancer patients and adolescents with mentally ill parents respectively. We argue that action research can contribute both to the generation of knowledge, as well as a greater sense of ownership to the program among those who are intended to use it. Nonetheless, a potential conflict between the researcher's pursuit of data, and ethical considerations became apparent in the contexts studied here. Bearing these challenges in mind, we still conclude that action research offers an important contribution for the further development of health care services.
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Affiliation(s)
- Marianne Trondsen
- Norwegian Centre for Telemedicine, University Hospital of Northern Norway, P.O. Box 35, N-9038 Tromsø, Norway.
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Abstract
PURPOSE OF REVIEW To summarize important recent contributions to the literature on the subject of ethics in psychiatric research. RECENT FINDINGS Current literature reflects an expansion in the range of psychiatric research on ethics topics. Articles continue to appear on core ethics subjects such as informed consent, but many recent contributions focus on diverse issues such as third-party privacy, the ethics of Internet-based research, revisiting the wisdom of imposing medical ethics requirements on observational research, and psychiatric research ethics as applied to special populations such as children or older persons. SUMMARY Psychiatric research is critical for the elucidation, prevention, and treatment of mental diseases. Increased attention and novel approaches taken to obtain informed consent, correcting therapeutic misconception, and guarding privacy will advance the research enterprise and continue to ensure that the subjective experiences of participants in psychiatric research remain positive.
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Current world literature. Curr Opin Psychiatry 2008; 21:651-9. [PMID: 18852576 DOI: 10.1097/yco.0b013e3283130fb7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Skorpen A, Anderssen N, Oeye C, Bjelland AK. The smoking-room as psychiatric patients' sanctuary: a place for resistance. J Psychiatr Ment Health Nurs 2008; 15:728-36. [PMID: 18844798 DOI: 10.1111/j.1365-2850.2008.01298.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article investigates the significance of the smoking-room for psychiatric patients: for their everyday interactions, activities and perceptions of what is meaningful, also for their positioning as agents concerning their own and fellow patients' illnesses and problems. A social constructionist perspective is used as well as concepts anchored in a phenomenology of architecture and local place. This article is a part of ethnographic study of the daily life within a psychiatric ward using participant observation and conversations and interviews with psychiatric inpatient and staff in a psychiatric hospital. Important themes from our analysis were 'smoking-room as patients''panopticon', 'smoking-room as the patients' sanctuary' and 'patient-led treatment'. We discuss these themes within a framework of seeing the smoking-room as an arena for patient and staff resistance. Patients' resistance is analysed as attempts to maintain their civil status identity and feelings of dignity in an otherwise powerless situation.
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Affiliation(s)
- A Skorpen
- Department of Health, Stord/Haugesund University College, Stord, Norway.
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