Phenomenographic or phenomenological analysis: does it matter? Examples from a study on anaesthesiologists’ work

Healthcare professionals' experiences of eHealth in palliative care for older people: challenges, compromises and the price of dignity

PURPOSE

To explore whether and how eHealth solutions support the dignity of healthcare professionals and patients in palliative care contexts.

METHOD

This qualitative study used phenomenographic analysis involving four focus group interviews, with healthcare professionals who provide palliative care to older people.

RESULTS

Analysis revealed four categories of views on working with eHealth in hierarchical order: Safeguarding the patient by documenting-eHealth is a grain of support, Treated as less worthy by authorities-double standards, Distrust in the eHealth solution-when the "solution" presents a danger; and Patient first-personal contact with patients endows more dignity than eHealth. The ability to have up-to-date patient information was considered crucial when caring for vulnerable, dying patients. eHealth solutions were perceived as essential technological support, but also as unreliable, even dangerous, lacking patient information, with critical information potentially missing or overlooked. This caused distrust in eHealth, introduced unease at work, and challenged healthcare professionals' identities, leading to embodied discomfort and feeling of a lack of dignity.

CONCLUSION

The healthcare professionals perceived work with eHealth solutions as challenging their sense of dignity, and therefore affecting their ability to provide dignified care for the patients. However, healthcare professionals managed to provide dignified palliative care by focusing on patient first.

Working as a physiotherapist in a rapid response team: 'An emotional rollercoaster'

BACKGROUND AND INTRODUCTION

Rapid Response Teams (RRTs) are multidisciplinary, 'hospital at home' services which have developed over the last 10 years, aiming to improve recovery from illness more efficiently, prevent unnecessary hospital admission, and prevent early admission to residential care. However, little is known about the experience of professionals working in these roles.

PURPOSE

The aim of this study was to explore how working in an RRT is experienced and perceived by physiotherapists.

METHODS

This study used phenomenographically inspired methodology. Six participants who were working in RRTs were recruited to this study and all were working in the South of England. Data were collected via semi-structured interviews, and phenomenographic analysis was undertaken.

RESULTS

Participants working in RRTs described a range of varied, concrete lived-through experiences in addition to a more rhetorical discussion of how they conceptualized their work. Six main categories of description were generated from the analysis; each was assigned a metaphor. These included 'the detective,' 'the guru,' 'the lone ranger,' 'the team player,' 'the bricoleur,' and 'an emotional rollercoaster'; all categories were present with varied meanings. 'An emotional rollercoaster' was present within and throughout participants' descriptions of all other categories.

CONCLUSION

This study provides valuable insights into physiotherapists' experience and conceptualization of working within this discipline, which may have implications for physiotherapy practice, workforce development, new and current RR physiotherapy services, RRT health professionals, and physiotherapy education.

Belonging, happiness, freedom and empowerment-a qualitative study of patients' understanding of health in early rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory joint disease, that influences patients' health in different ways, including physical, social, emotional, and psychological aspects. The goal of rheumatology care is to achieve optimal health and personalised care and therefore, it is essential to understand what health means for patients in the early course of RA. The aim of this study was to describe the understanding of health among patients with early RA.

METHODS

The study had a descriptive qualitative design with a phenomenographic approach. Phenomenography is used to analyse, describe, and understand various ways people understand or experience a phenomenon, in this study, patients' understandings of health. Individual semi-structured interviews were conducted with 31 patients (22 women and nine men, aged (38-80) with early RA, defined as a disease duration of < 1 year, and disease-modifying anti-rheumatic drugs (DMARDs) for 3-7 months. The phenomenographic analysis was conducted in 7 steps, and the outcome space presents the variation in understanding and the interrelation among categories. In accordance with the European Alliance of Associations for Rheumatology's (EULAR) recommendations, a patient research partner participated in all phases of the study.

RESULTS

The analysis revealed four main descriptive categories: 'Health as belonging' was described as experiencing a sense of coherence. 'Health as happiness' was understood as feeling joy in everyday life. 'Health as freedom' was understood as feeling independent. 'Health as empowerment' was understood as feeling capable. Essential health aspects in early RA are comprised of a sense of coherence, joy, independence, and the capability to manage everyday life.

CONCLUSIONS

This study revealed that patients' perception of health in early RA encompasses various facets, including a sense of belonging, happiness, freedom, and empowerment. It highlighted that health is multifaceted and personal, emphasizing the importance of acknowledging this diversity in providing person-centred care. The findings can guide healthcare professionals to deepen patients' participation in treatment goals, which may lead to better treatment adherence and health outcomes.

Phenomenography: A useful methodology for midwifery research

AIMS

To outline the theoretical, philosophical, and major assumptions associated with phenomenography and then address the application of a phenomenographical approach within the context of midwifery research.

BACKGROUND

Phenemonography is a little-known qualitative research approach amongst the main design traditions of phenomenology, grounded theory, case study, and ethnography more typically used within midwifery research. Phenomenography aims to describe the qualitatively different ways that people perceive, conceptualize, or experience a phenomenon. Phenemonography has a distinctly different approach from other qualitative methods as it places emphasis on the 'collective' meaning over individual experience.

METHODOLOGY

Phenomenography, as an approach, rests within the interpretivist paradigm recognizing that there are multiple interpretations of reality. Phenomenography emphasizes the various ways that people experience the same phenomenon, including both the similarities and differences. The second-order perspective embraced by phenomenography suggests that the researcher directs themselves towards people's understanding of the world; essentially the world is described as it is understood rather than as it is. It is the reporting about how these different realities appear at a collective level that is the output of phenomenographic research.

FINDINGS

A framework for conducting phenomenographic research is illustrated by outlining the steps within the methodological approach required to undertake a research study using phenemonography.

CONCLUSION

Phenomenography is a qualitative research approach that can usefully be applied in many midwifery contexts where a collective understanding of a phenomena is required. Using a phenomenographic approach can provide the midwifery profession with knowledge about variations in how women and midwives think, and how aspects of different phenomena are experienced in within a midwifery setting.

Using Hypothetical Scenarios to Address Social Desirability Bias: Investigating Student Perceptions, Evaluations, and Motivations of Cheating and Academic Integrity in the General Chemistry Laboratory

Supporting students with upholding the principles of academic integrity is an important aspect of teaching. Academic integrity is especially important in chemistry laboratory classrooms, where students gain hands-on experience related to research and scientific practices. Prior literature on academic integrity largely focuses on catching and preventing cheating, describing various factors commonly associated with cheating behaviors. This body of literature assumes that students neutralize their feelings about cheating to engage in unethical behavior. In contrast, for this study, we began with the assumption that students intend to act ethically; to this end, we sought to investigate students' perceptions, evaluations, and motivations related to cheating and academic integrity. We interviewed 24 students enrolled in general chemistry laboratories and asked questions related to cheating and academic integrity. Additionally, to address concerns about social desirability bias affecting students' responses, we asked students questions involving hypothetical scenarios related to academic integrity that were contextualized within the chemistry laboratory classroom. In our analysis, we found that students held common views about cheating and academic integrity in general but diverged in their responses to the hypothetical scenarios. Our findings suggest the importance of providing clearer, more direct instruction regarding what counts as cheating and how to engage in academically honest behavior within the chemistry laboratory classroom.

"We're back in control of the story and we're not letting anyone take that away from us": patient teacher programs as means for patient emancipation

While patient engagement in healthcare professions education (HPE) has significantly increased in the past decades, a theoretical gap remains. What are the varied reasons as to why patients get involved with HPE programs? With a focus on understanding what drives patient involvement with HPE programs, this study examined how a patient as teacher (PAT) program was experienced by medical students, patient teachers, and faculty within a medical school. Through a phenomenographic approach, this study captures and describes the different ways our study participants experienced a PAT program (the 'phenomenon'). 24 semi-structured interviews were conducted in total, comprised of interviews with patient teachers (N = 10), medical students (N = 10) and program facilitators (N = 4) who participated in a PAT program. Our focus was on participants' description of the program and was grounded in their experiences of as well as their beliefs about it. Our findings captured 4 layers representing the qualitatively different (yet interrelated) ways in which participants experienced/perceived and conceptualized the various aspects of their experience with the PAT program: (1) A productive disruption of the learning space (2) A re-humanization within healthcare (3) A means of empowerment and agency (4) A catalyst for change and emancipation. Our outcome space results can be visually illustrated by a nesting "Matryoshka" doll, representing the four layers and depicting the process of uncovering the less conscious layers of sense-making within this phenomenon. HPE programs that are co-produced with patients and actively involve patients as teachers have the potential, but not guarantee, to be emancipatory. To engage in PAT programs that exhibit an emancipatory potential, we need to consider transformative paradigms of education, which are aligned with social change, and disrupt the traditional teacher-learner hierarchy.

Advising parents when their child has a fever: a phenomenographic analysis of nurses' perceptions when working at a telephone helpline, at primary care or at a paediatric emergency department in Sweden

OBJECTIVES

To describe nurses' perceptions of advising parents when their child has a fever.

DESIGN/METHOD

Inductive, descriptive study with a qualitative, phenomenographic approach.

PARTICIPANTS AND SETTING

A purposive sampling was used. To be included, the 24 online interviewed nurses had to have experience advising parents of febrile children between birth and 5 years of age. They were recruited from three different parts of the healthcare system from four regions in the south of Sweden.

RESULTS

The nurses described advising parents when their child has a fever as four different kinds of balancing acts: balancing between the parents' story and objective assessment, balancing between listening and teaching, balancing between self-confidence and trust in the expert, and balancing between independence and having someone by one's side.

CONCLUSIONS

Giving advice to parents when their child has a fever is a process where the nurse needs to listen, assess and give advice based on the situation. This requires a correct assessment that depends on the parents' story. Creating a trusting relationship is perceived as necessary for parents to assimilate the advice that is provided. What dominates are the nurses' perceptions of the inner qualities required to achieve a balance in the process, for example, the importance of experience and security in their professional role, while it is also necessary to get support from colleagues.

An international consensus on effective, inclusive, and career-spanning short-format training in the life sciences and beyond

Science, technology, engineering, mathematics, and medicine (STEMM) fields change rapidly and are increasingly interdisciplinary. Commonly, STEMM practitioners use short-format training (SFT) such as workshops and short courses for upskilling and reskilling, but unaddressed challenges limit SFT's effectiveness and inclusiveness. Education researchers, students in SFT courses, and organizations have called for research and strategies that can strengthen SFT in terms of effectiveness, inclusiveness, and accessibility across multiple dimensions. This paper describes the project that resulted in a consensus set of 14 actionable recommendations to systematically strengthen SFT. A diverse international group of 30 experts in education, accessibility, and life sciences came together from 10 countries to develop recommendations that can help strengthen SFT globally. Participants, including representation from some of the largest life science training programs globally, assembled findings in the educational sciences and encompassed the experiences of several of the largest life science SFT programs. The 14 recommendations were derived through a Delphi method, where consensus was achieved in real time as the group completed a series of meetings and tasks designed to elicit specific recommendations. Recommendations cover the breadth of SFT contexts and stakeholder groups and include actions for instructors (e.g., make equity and inclusion an ethical obligation), programs (e.g., centralize infrastructure for assessment and evaluation), as well as organizations and funders (e.g., professionalize training SFT instructors; deploy SFT to counter inequity). Recommendations are aligned with a purpose-built framework-"The Bicycle Principles"-that prioritizes evidenced-based teaching, inclusiveness, and equity, as well as the ability to scale, share, and sustain SFT. We also describe how the Bicycle Principles and recommendations are consistent with educational change theories and can overcome systemic barriers to delivering consistently effective, inclusive, and career-spanning SFT.

Nurse anesthetists' perceptions of heat conservation measures in connection with surgery - a phenomenographic study

BACKGROUND

To minimize the risk of perioperative hypothermia, it is recommended that healthcare professionals be familiar with heat conservation measures and use passive and active warming methods, in line with international guidelines. However, there is a low level of adherence perioperatively to the use of heat conservation measures. To understand why, there is a need to capture the nurse anesthetists' perspective. The aim is to describe nurse anesthetists' perceptions of heat conservation measures in connection with surgery.

METHODS

An inductive descriptive design with a phenomenographic approach was chosen. A total of 19 nurse anesthetists participated and were interviewed. Data were analyzed according to Larsson and Holmström's phenomenographic seven-step model.

RESULTS

Six ways of understanding the phenomenon heat conservation measures in connection with surgery were found: the preventive, the useable, the untenable, the caring, the adaptive, and the routine care approach. These approaches were related to each other in a flexible way, allowing for several to co-exist at the same time, depending on the situation.

CONCLUSIONS

Nurse anesthetists want to prevent the patients' heat loss and maintain normothermia, regardless of the type of surgery. This willingness, motivation, and intention enable the use of heat conservation measures. However, there are perceptions that have an impact, such as doubts and uncertainty, access, time and financial constraints, preconditions, routines or habits, and lack of availability of education/training. These barriers will require support from an organizational level to promote lifelong education and guidelines. As well as offer education at the nurse anesthetists' program.

Older Adults' Experiences of How Participating in a Senior Summer Camp Has Affected Their Lives - A Phenomenographic Study

Several municipalities in Sweden organize senior summer camps where older adults can meet and where loneliness and social isolation can be mitigated. Few studies, however, examine how the older adults themselves describe the experience in retrospect and how it might have influenced their daily lives after the stay. This study aims to fill this gap by examining how older adults who participated in a senior summer camp experience the impact the stay has had on their lives. The study has a descriptive qualitative design that uses a phenomenographic approach to explore the variations in the older adults' conceptions of how their participation at the senior summer camp may have affected them. Nineteen older adults aged between 66 and 94 years were interviewed. Three descriptive categories emerge: "Mitigating loneliness," 'Developing as a person' and 'Gaining inspiration.' The study shows that the older adults experience that the stay at the summer camp has had lasting effects on their quality of life. The sense of community at the camp helped them break the experience of loneliness, they improved their self-confidence and gained a positive attitude to life, that it is worth living and that there is much left to experience, regardless of their age.

Contextual variation on teachers’ conceptions of ICT-enhanced teaching in engineering education

Due to the COVID-19 epidemic, higher education all over the world is increasingly reliant on the use of Information and Communication Technology (ICT), which creates several opportunities and problems, especially in the field of engineering education. One of the significant aspects that needs to be bought to the academic attention is how teachers' use of ICT in engineering education has been transformed due to this pandemic. Therefore, the purpose of this study was to investigate views, and practices that define varying conceptions of engineering university teachers' use of ICT in their teaching. Phenomenography, an emerging research approach in engineering education was used as a theoretical and methodological underpinning. A cohort of 14 teachers was selected from two universities in Bangladesh to participate in a semi-structured in-depth interview. The findings revealed five qualitatively different categories of description such as: imparting information, transmitting structured knowledge, offering guided learning, engaging students toward practice and engaging students toward innovation. Relationships among the categories of description revealed four dimensions of variation such as: purpose of using ICT in engineering teaching, role of a teacher, role of a student and TPACK components. The study further found that ICT-usage underpins teacher's pedagogical approach to teaching engineering subjects and therefore provides useful information for university policy makers, teachers and curriculum designers toward quality teaching and learning. A quantitative investigation to determine the impact of the pedagogical approaches to teaching underpinned by ICT-use in engineering education is recommended.

Phenomenographic Approaches in Research About Nursing

We propose that phenomenography is well-suited to research about nursing, given its focus on identifying variation in individuals' experiences, and inclusion of diverse voices and perspectives. Phenomenography explores qualitatively different ways in which a group of people experience a phenomenon, often using semi-structured interviews. The use of phenomenography is especially relevant in research about nursing which provides accounts of the experiences of nurses and patients within complex practice settings. We consider the tenets of phenomenography and examine phenomenography's relationship to and differences from phenomenology. We review literature published about phenomenographic research in nursing and reflect on the potential benefits of phenomenographic research about nursing. This paper adds to knowledge about use of phenomenography in research about nursing.

Physiotherapists' experiences of internet-based neck-specific exercises for patients with chronic whiplash-associated disorders

Objective

Neck-specific exercises for individuals with chronic whiplash-associated disorders (WAD) have shown promising results, but there is also a need for more efficient and flexible ways of rehabilitation, such as use of digital health tools. Understanding physiotherapists' experiences of an internet-based tool may help to improve digital tools within physiotherapy. The purpose of this study was to describe how physiotherapists' experience an internet-based neck-specific exercise program for patients with chronic WAD.

Methods

This study has a qualitative design. Focus group discussions were held with physiotherapists who have been treating patients with chronic WAD, using an internet-based neck-specific exercises program in a randomized controlled multi-center trial in south and central Sweden. Three focus groups were held with three participants in each group. Phenomenography was applied as a research approach for data analysis.

Results

One main category was identified as "internet-based program as a complement to regular rehabilitation," with five descriptive sub-categories: (a) support in patient work; (b) usefulness based on a patient's prerequisites and preferences; (c) physiotherapist and patient interaction; (d) increasing efficiency in rehabilitation; and (e) enabling patient participation, autonomy and self-management.

Conclusions

From a physiotherapy perspective, an internet-based program could work as a method of complementary support to the standard rehabilitation treatment for patients with chronic WAD, as long as it is interactive and adjustable to the individual. The internet-based program could lead to increased autonomy and self-efficacy, and save resources and time for physiotherapists and patients. Further, more research is needed to strengthen these digital tools within the healthcare system.

The ways specialist nursing students understand the work in the ambulance service - a national Swedish phenomenographic study

Objective

Design, sample, and measurements

Findings

Conclusions

The ways social networks shape reflection on early significant clinical experiences in medical school

BACKGROUND

Medical curricula are increasingly providing opportunities to guide reflection for medical students. However, educational approaches are often limited to formalized classroom initiatives where reflection is prescriptive and measurable. There is paucity of literature that explores the personal ways students may experience authentic reflection outside of curricular time. The purpose of this study was to understand how social networks might shape dimensions of reflection.

METHODS

This study employed a qualitative social network analysis approach with a core sample of seven first year undergraduate medical students who described their relationships with 61 individuals in their networks. Data consisted of participant generated sociograms and individual semi-structured interviews.

RESULTS

Many learners struggled to find significant ways to involve their social networks outside of medicine in their new educational experiences. It appeared that some medical students began in-grouping, becoming more socially exclusive. Interestingly, participants emphasized how curricular opportunities such as reflective portfolio sessions were useful for capturing a diversity of perspectives.

CONCLUSIONS

Our study is one of the first to characterize the social networks inside and outside of medical school that students utilize to discuss and reflect on early significant clinical experiences. Recent commentary in the literature has suggested reflection is diverse and personal in nature and our study offers empirical evidence to demonstrate this. Our insights emphasize the importance of moving from an instrumental approach to an authentic socially situated approach if we wish to cultivate reflective lifelong learning.

Examining the Variations in Undergraduate Students' Conceptions of Successful Researchers: A Phenomenographic Study

Undergraduate education represents an important transitional stage in which students make career decisions, and undergraduate research experiences (UREs) play a critical role in training the next generation of science, technology, engineering, and mathematics researchers. Extensive studies have identified the different ways in which researchers and graduate students understand their profession, but little work has focused on undergraduate students. To contribute to this gap in literature, this study examines how undergraduate students conceptualize successful researchers. Data were collected using semistructured interviews with transfer students at a research-intensive university, in which participants articulated how they perceive a successful researcher and how their conception had changed based on their undergraduate experiences. Using phenomenography as the research approach, three conceptions of successful researchers were identified based on variations within the following aspects: process of research, interactions with other researchers, and scope of contribution. Retrospective conceptions were more simplistic, with little appreciation for the complex methodological processes and collaborations needed to meaningfully contribute to the research community. After UREs, participants reported conceptions with more nuanced understanding that successful researchers demonstrate proactive engagement, collaboration, and contribution. These findings can be applied to facilitate meaningful research experiences and target undergraduates' professional development as they are enculturated into the research community.

Parents' Perceptions of the Value of Children's Participation in Pediatric Rehabilitation Services: A Phenomenographic Study

Ensuring that children have opportunities to be involved in decision-making regarding their own care is associated with quality improvement in pediatric rehabilitation. The aim of the study was to explore parents' perceptions of the value of children's participation in pediatric rehabilitation services. Semi-structured interviews were conducted with 17 parents of children with disabilities who visited pediatric rehabilitation services. A phenomenographic analysis method was used. Three categories developed from the analysis describing how participation generated value in terms of empowerment, self-awareness, and independence. The outcome space describes a hierarchical relationship between the categories and their influence on each other. Independence achieved through participation was a core aspect and is at the highest level in the hierarchy since it includes and depends on the outcomes from both empowerment and self-awareness. Parents' perceptions of the value of children's participation in pediatric rehabilitation services include the possibility for the child to use their entire capacity through values created in terms of empowerment, self-awareness, and independence, in order to live the best life possible. Children with disabilities are diverse as a group, and further research to identify barriers and facilitators of participation is needed to adjust interventions within pediatric rehabilitation services to ensure that children with disabilities can be increasingly empowered, self-aware, and independent.

Conceptions of clinical learning among stakeholders involved in undergraduate nursing education: a phenomenographic study

BACKGROUND

To prepare nursing students to become critical, autonomous members of the workforce, an agreement among stakeholders on how this can be achieved in the clinical setting is needed. However, a critical discussion of the clinical learning process in relation to actual and desirable outcomes is lacking in the nursing education literature. This study aimed to map conceptions of the desired process and outcomes of clinical learning among stakeholders involved in undergraduate clinical nursing education.

METHODS

Twenty-five semi-structured interviews about their understanding of clinical learning were conducted with nursing students, supervisors, clinical educators and higher education institute professionals involved in clinical nursing education in a Dutch academic medical center. Data were analyzed using a phenomenographic approach.

RESULTS

Four conceptions were identified: clinical learning as a process to 1) meet curricular demands, 2) learn to deliberately deliver patient care, 3) learn to deliver patient care within the larger (healthcare) context, and 4) become a continuously developing professional. Conceptions 3 and 4 represented a broader, more inclusive perspective on clinical learning than conception 1 and 2. Conceptions were distinguished by five dimensions: role of guidelines from the school; learning opportunities, focus of supervisor; focus of reflection; desirable outcomes of clinical learning.

CONCLUSIONS

Those directly involved in clinical learning in nursing may have qualitatively different understandings of its desired nature and outcomes. Two patterns across conceptions could be discerned: a) a shift in focus from learning as following standards, to following an individualized learning trajectory and b) a shift in focus from increasing patient load, to understanding oneself and the patient within the healthcare context. To prepare nursing students for the future workforce, a flexible, social form of self-regulated learning is warranted, as well as an understanding of one's own role within the healthcare system and a critical attitude towards healthcare. Schools and hospitals should collaborate to integrate these values in the curriculum. The current study adds different ways of applying self-regulated learning as a relevant dimension in understanding clinical learning to the literature. Through the phenomenographic approach we identified conceptions that can be a basis for training and policy development.

Conceptions of quality as family resemblances

Purpose

To consider how quality should be conceptualized to improve understanding for researchers and practitioners, some researchers have discussed quality in terms of an essence or necessary condition. Others have regarded quality as individual and experiential, based on differences in actors’ conceptions of quality. This paper aims to resolve the tension caused by these competing views and propose an appropriate method for future research in the area of quality.

Design/methodology/approach

In many studies, researchers have attempted to understand quality in terms of necessary conditions or through a dualistic ontology. At the same time, an increasing number of researchers have emphasized its experiential nature while discussing quality in conjunction with meeting customers’ expectations. This study investigates how quality can be understood using a conceptual framework based on family resemblances.

Findings

There is no necessary condition or essence by which quality may be conceptualized or defined. This finding resolves the tension that has arisen from the simultaneous search for a common feature and the assertion that quality is experientially created by individuals. The research also highlights that the nature of quality may differ between people, time and place, or some aspects of it may be the same. Regarding quality in terms of family resemblances accommodates actors’ different conceptions of quality. Phenomenography is proposed as an appropriate research approach with its focus on the qualitatively different ways in which actors make sense of phenomena in their lifeworld.

Research limitations/implications

Understanding quality as a family of attributes, and using phenomenography as method, provides methodological clarity to long-standing research issues. Using the approaches outlined in this study will enable empirical studies of quality, in any context, to be conducted soundly and relatively quickly. It will also provide a more inclusive and holistic set of meanings based on the experiences of individuals.

Practical implications

The research provides important insights for researchers and practitioners through clearer conceptions of quality. These include the ability to plan and deliver business outcomes that are more closely aligned with customers’ expectations. Understanding the conceptions of quality, as experienced and determined through family resemblances, has clear implications for researchers and practitioners.

Originality/value

Understanding actors’ conceptions of quality through the lens of family resemblances resolves long-standing research issues. Using phenomenography as method is innovative, as it is an emerging research approach in the business domain.

A phenomenographic study: Exploring the variations of registered nurses' perceived roles and experiences as HIV counselors

OBJECTIVES

The study explored the variations of registered nurses' perceived roles and experiences before, during and after HIV counseling.

METHODS

The study is anchored on Parse's Human Becoming Theory structured around three abiding themes: meaning, rhythmicity, and transcendence. A qualitative phenomenographical approach was used and the data were collected through semi structured, face-to-face, in-depth interview sessions with ten registered nurses who were eligible under the set criterion: HIV counselors employed in both government and private health facilities with HIV Testing and Counseling facilities and services in Iligan City and Cagayan de Oro City. Verbatim transcriptions were analyzed in iterative process using Jan Larssons and Inger Holmstrom's (2007) seven simple steps of phenomenographic analysis. Triangulation and validation established rigor and trustworthiness of the data.

RESULTS

Emergent themes of differences in participants' perceived roles and experiences conveyed in a metaphor: The Employee vs. The Educator; The Professional vs. The Shepherd.

CONCLUSION

The variations ascertained the association of perceived roles and experiences of HIV Counselors and posited equally vast challenges as nursing takes the core in collaboration for the care of persons living with HIV toward a dignified death.

Registered nurses' understandings of emergency medical dispatch center work: A qualitative phenomenographic interview study

Non-urgent and urgent telephone nursing services are increasing globally, and phenomenographic research has shown that how work is understood may influence work performance. This descriptive study makes a qualitative inductive investigation of understandings of emergency medical dispatch center work among registered nurses. Twenty-four registered nurses at three mid Swedish emergency medical dispatch centers were interviewed. Analysis based on phenomenographic principles identified five categories in the interviews: (i) Assess, prioritize, direct, or refer; (ii) Facilitate ambulance nursing work; (iii) Perform nursing care; (iv) Always be available for the public; and (v) Have the person behind the patient in mind. The first constitutes the basis of the work. The second emphasizes cooperation with and support for the ambulance staff. The third entails remotely providing nursing care, whilst the fourth stresses serving the entire population. The fifth and most comprehensive way of understanding work involves having a holistic view of the person in need, including person-centered care. Provision of high-quality emergency medical dispatch center work involves all categories. Combined, they constitute a "work map," valuable for reflection, competence development, and introduction of new staff.

Planting a Seed of Experience - Long Term Effects of a Co-curricular Ecogarden-Based Program in Higher Education in Hong Kong

This paper reports on the long-term effectiveness of a non-formal co-curricular educational program based on a campus ecogarden at a Hong Kong university in developing pro-sustainability awareness, attitudes and behavior among undergraduate students. This service-based, nature-based experiential learning program, termed the Ecogarden Farmer and Biodiversity Surveyor, has been running at the university since 2015. The program is divided into two consecutive phases: a training phase comprising various learning activities and a successive internship phase consisting of the all-round practical tasks involved in managing the garden. A retrospective evaluation of the program using phenomenographic approach and content analysis was adopted to reveal the diversity of students’ learning experience, as the indicators of the success of the program. Of 112 participants from 4 cohorts, 32 completed online questionnaires, and semi-structured interviews were successfully conducted with twelve participants, three from each of the four cohorts. The results indicated that the program’s outcomes could be categorized into five themes. Most outcomes fit into the theme ‘an increase in knowledge and skill level,’ followed by ‘rise in environmental awareness,’‘facilitation of personal growth,’ and ‘enhancement of career development.’ Many structural experiences revealed may suggest the success of the program. The longer the participants had participated in the program, the more in-depth and diversified reflection of the senior participants relating to personal development were mentioned. This study provides critical insights into the validity of retrospective program evaluation for assessing the long-term impact of EfS programs by introducing a cross-sectional study of different cohorts as a serial time-point sampling strategy.

Musculoskeletal physiotherapists' perceptions of health promotion

BACKGROUND

Non-communicable diseases from unhealthy lifestyles account for most preventable deaths in the UK. Physiotherapy training now includes Health Promotion (HP) for the reduction of unhealthy lifestyles such as obesity, smoking, alcohol and inactivity. However, physiotherapists' perceptions of HP in the context of musculoskeletal care in the UK have not been explored.

OBJECTIVES

To explore musculoskeletal physiotherapists' perceptions of HP.

DESIGN

Phenomenographic qualitative research.

METHOD

semi-structured interviews with 7 musculoskeletal physiotherapists.

RESULTS/FINDINGS

Physiotherapist conceptions of HP were analysed using phenomenographic analysis and three main categories emerged. These were the concepts of physiotherapists' self, education in the therapeutic alliance and persons' agency for change. Each category contained a variety of perceptions which were sometimes conflicting, and each category had scope for influencing the others.

CONCLUSIONS

Participants' (physiotherapists) perceptions of their personal and professional self were entwined with perceptions of persons' agency when describing health promotion in their practice. Within the therapeutic alliance concepts of health coaching were discussed but these conceptualisations sometimes contradicted descriptions of experiences. This research may encourage physiotherapists to reflect on their perceptions of, and role in HP.

'Getting them on board': Musculoskeletal physiotherapists conceptions of management of persons with low back pain

OBJECTIVE

Low back pain (LBP) is the leading cause of disability worldwide; however, the majority of LBP is non-specific in nature with no clearly identifiable source of pain. Contemporary understanding of LBP highlights the multidimensional nature of LBP and as a result clinical practice and guidelines have evolved and advocate a multidimensional approach to managing persons with LBP. This change in understanding and practice provides challenges for physiotherapists and persons with LBP, many who have biomedical views. The aim of this study was to explore musculoskeletal physiotherapists conceptions towards the management of LBP.

METHOD

The research employed a phenomenographic inspired approach which aims to explore variations in conceptions, beliefs and understanding of a phenomenon. Six participants (physiotherapists) were interviewed via semi-structured interviews to explore their experiences of managing persons with LBP and the data was analysed using a phenomenographic framework.

RESULTS

Three main categories emerged from the participants descriptions: the perceived role of preferences and expectations, therapeutic alliance development and getting the person "on board".

CONCLUSION

Participants descriptions implied a therapist centred view towards the care they provided for persons with LBP. The perceived role of expectations was a significant aspect within the participants descriptions of the management of LBP. Last, the participants described the perceived development of a therapeutic alliance. These categories suggest how the physiotherapists interviewed in this study conceive the management of LBP, and these findings will provide a greater understanding around the physiotherapy management of LBP.

They Don't See a Lot of People My Color: A Mixed Methods Study of Racial/Ethnic Stereotype Threat Among Medical Students on Core Clerkships

PURPOSE

Stereotype threat is an important psychological phenomenon in which fear of fulfilling negative stereotypes about one's group impairs performance. The effects of stereotype threat in medical education are poorly characterized. This study examined the prevalence of racial/ethnic stereotype threat amongst fourth-year medical students and explored its impact on students' clinical experience.

METHOD

This was an explanatory sequential mixed methods study at 2 institutions in 2019. First, the authors administered the quantitative Stereotype Vulnerability Scale (SVS) to fourth-year medical students. The authors then conducted semistructured interviews among a purposive sample of students with high SVS scores, using a qualitative phenomenographic approach to analyze experiences of stereotype threat. The research team considered reflexivity through group discussion and journaling.

RESULTS

Overall, 52% (184/353) of students responded to the survey. Collectively, 28% of students had high vulnerability to stereotype threat: 82% of Black, 45% of Asian, 43% of Latinx, and 4% of White students. Eighteen students participated in interviews. Stereotype threat was a dynamic, 3-stage process triggered when students experienced the workplace through the colored lens of race/ethnicity by standing out, reliving past experiences, and witnessing microaggressions. Next, students engaged in internal dialogue to navigate racially charged events and workplace power dynamics. These efforts depleted cognitive resources and interfered with learning. Finally, students responded and coped to withstand threats. Immediate and deferred interventions from allies reduced stereotype threat.

CONCLUSIONS

Stereotype threat is common, particularly among non-White students, and interferes with learning. Increased minority representation and developing evidence-based strategies for allyship around microaggressions could mitigate effects of stereotype threat.

How novice and expert anaesthetists understand expertise in anaesthesia: a qualitative study

BACKGROUND

The development of expertise in anaesthesia requires personal contact between a mentor and a learner. Because mentors often are experienced clinicians, they may find it difficult to understand the challenges novices face during their first months of clinical practice. As a result, novices' perspectives may be an important source of pedagogical information for the expert. The aim of this study was to explore novice and expert anaesthetists understanding of expertise in anaesthesia using qualitative methods.

METHODS

Semi-structured interviews were conducted with 9 novice and 9 expert anaesthetists from a German University Hospital. Novices were included if they had between 3 and 6 months of clinical experience and experts were determined by peer assessment. Interviews were intended to answer the following research questions: What do novices think expertise entails and what do they think they will need to become an expert? What do experts think made them the expert person and how did that happen? How do both groups value evidence-based standards and how do they negotiate following written guidance with following one's experience?

RESULTS

The clinical experience in both groups differed significantly (novices: 4.3 mean months vs. experts: 26.7 mean years; p < 0.001). Novices struggled with translating theoretical knowledge into action and found it difficult to talk about expertise. Experts no longer seem to remember being challenged as novice by the complexity of routine tasks. Both groups shared the understanding that the development of expertise was a socially embedded process. Novices assumed that written procedures were specific enough to address every clinical contingency whereas experts stated that rules and standards were essentially underspecified. For novices the challenge was less to familiarise oneself with written standards than to learn the unwritten, quasi-normative rules of their supervising consultant(s). Novices conceptualized decision making as a rational, linear process whereas experts added to this understanding of tacit knowledge and intuitive decision making.

CONCLUSIONS

Major qualitative differences between a novice and an expert anaesthetist's understanding of expertise can create challenges during the first months of clinical training. Experts should be aware of the problems novices may have with negotiating evidence-based standards and quasi-normative rules.

National Student Survey: Reliability and prediction of overall satisfaction scores with special reference to UK Dental Schools

INTRODUCTION

The aim of this study was to assess the reliability of the UK National Student Survey (NSS) (2018) and explore the predictive values of individual questions and question domains on the overall satisfaction score.

METHODS

UK NSS result data (for 2018) were assessed for all those providers that award an undergraduate degree in dentistry. To analyse the correlation of each question item to the overall satisfaction question (question 27), a bivariate 2-tailed Pearson correlation test was conducted, where a P value of <.05 was considered statistically significant. The same test was used to assess such correlation at question domain level. Cronbach's alpha was used to assess the test reliability of the NSS data.

RESULTS

Question 5 ("My course has provided me with opportunities to explore ideas or concepts in depth") had the highest predictive value, explaining 85% of the correlation data to the overall satisfaction question. The strongest positive correlation could be seen at the "teaching on my course" and "learning opportunities" domains, whereby 84% of the data can be explained by each of these variables. The worst predictor domain was assessment and feedback, whereby only 40% of the data could be explained by the correlation line. Cronbach's alpha was 0.952-0.976.

CONCLUSIONS

The NSS is a highly reliable test, both at question and domain levels. The highest predictors of overall satisfaction are teaching, learning opportunities and academic support domains. Assessment and feedback has weak predictive value towards the overall satisfaction score. Question 5 is highly predictive of the overall outcome.

Using Mobile Health and the Impact on Health-Related Quality of Life: Perceptions of Older Adults with Cognitive Impairment

Digital health technologies such as mobile health (mHealth) are considered to have the potential to support the needs of older adults with cognitive impairment. However, the evidence for improving health with the use of mHealth applications is of limited quality. Few studies have reported on the consequences of technology use concerning the older adults’ quality of life. The purpose of this study was to describe perceptions of mHealth and its impact on health-related quality of life (HRQoL) among older adults with cognitive impairment. The study was conducted using a qualitative design with a phenomenographic approach. A total of 18 older participants with cognitive impairment were interviewed. The interviews were analyzed in order to apply phenomenography in a home-care context. The results showed variations in the older adults’ perceptions that were comprised within three categories of description; Require technology literacy, Maintain social interaction, and Facilitate independent living. In conclusion, the development and design of mHealth technologies need to be tailored based on older adults´ needs in order to be understood and perceived as useful in a home-care context. For mHealth to support HRQoL, healthcare should be provided in a way that encourages various forms of communication and interaction.

"I Haven't Given Up and I'm Not Gonna": A Phenomenographic Exploration of Resilience Among Individuals Experiencing Homelessness

Resilience is a factor related to positive health outcomes. Exploring this concept among adults experiencing homelessness can inform interventions while subsequently considering individuals' strengths. A phenomenographic approach was applied to examine this concept among a sample of 22 individuals involved in qualitative interviews. The phenomenographic inquiry identified eight conceptions and found resilience is captured in both positive and negative ways. Conceptions are summarized by two categories, situated in an outcome space which describes the overall resilience experience and the different ways these conceptions are understood and experienced. Categories summarize conceptions as Staying Strong and Sustaining Positive Beliefs, which highlight the construct as being captured by a persistent positive aspect; however, the findings also uniquely describe the influence of negative conceptions toward the overall phenomenon. The findings suggest resilience is recognizable during adversity, and it is a phenomenon that has the potential to be strengthened.

Understanding exercise promotion in rheumatic diseases: A qualitative study among physical therapists

Background: Physical therapists have unique expertise in planning, prescribing, and supporting exercise for patients with rheumatic diseases. Promoting exercise can be a challenge, but descriptions of physical therapists' experiences within the field of rheumatology are limited.Objective: The purpose of this study was to explore and describe ways of understanding exercise promotion among physical therapists working in rheumatology.Design and Method: A phenomenographic approach was used to analyze semi-structured interviews with 25 physical therapists working primarily within the field of rheumatology from eight different physical therapy departments at hospitals across Sweden.Results: Four ways of understanding exercise promotion were identified. These were named: exercise promotion as information and monitoring of the behavior, as facilitation of skills building, as co-creation of awareness, and as the development of independence and self-reflection.Conclusion: Physical therapists in rheumatology understand exercise promotion in various ways that differ with respect to comprehensiveness and patient-centeredness. The physical therapists' use of behavior change techniques serves different purposes in exercise promotion, varying from external control to self-management. The present results might thus be used to develop awareness, knowledge, and skills for more deliberate exercise promotion among physical therapists working with patients having rheumatic diseases.

Principals’ conceptions of teachers’ power basis: a phenomenographic study

Purpose

The purpose of this paper is to describe the various ways in which a group of principals conceptualize the power basis of teachers within teacher–principal interactions.

Design/methodology/approach

The present study takes power as a potential to influence people as it was conceptualized in the taxonomy developed by French and Raven (1959/1968) and Raven (1993). This taxonomy was also used to discuss the conceptions emerged in the interview data. A total of 16 principals, 8 from public schools and 8 from private schools, were interviewed.

Findings

The phenomenographic analysis of the interviews with the 16 principals revealed five ways of understanding teachers’ power basis. These conceptions (in the form of categories of description) were: (a) the principal’s sense of reciprocity, (b) teachers’ field-specific knowledge, (c) teachers’ administrative experience, (d) teachers’ union affiliation and (e) teachers’ legal rights. Categories (a) and (b) were common to all the study’s participants. Category (c) was unique to participants from private schools, while categories (d) and (e) were unique to participants from public schools.

Research limitations/implications

Three topics – the subtler forms of legitimate power, the issue of teacher tenure and the influence of unions on the educational system – appeared to have potential for interesting future studies in the field of educational management.

Practical implications

There is an apparent need to include social power as a course component in preparatory programs for educational administrators. The revised power taxonomy, which took its final form after the revisions made by Raven (1993), appeared to be an adequate explanatory theory to understand the teachers’ bases of power, and as such, it can be used to structure the content of the course about power interactions in school settings. In addition, the Turkish Ministry of National Education should handle the issue of unions’ improper influence over the educational system and take necessary measures in order to maintain the effective functioning of public schools.

Originality/value

To date, subordinates’ bases of power as a research subject has apparently been ignored. The present study is the first to reveal variations in the ways that school principals conceptualize teachers’ basis of power. Although the study data were collected in one city in Turkey, the research implications drawn from its findings can inspire interest in this neglected field of study all around the world.

Factors influencing use of telegenetic counseling: perceptions of health care professionals in Sweden

Genetic counseling services are increasing in demand and limited in access due to barriers such as lack of professional genetic counselors, vast geographic distances, and physical hurdles. This research focuses on an alternative mode of delivery for genetic counseling in Sweden, in order to overcome some of the mentioned barriers. The aim of this study is to identify factors that influence the implementation and use of telegenetic counseling in clinical practice, according to health care professionals in Southeast Sweden. Telegenetic counseling refers to the use of video-conferencing as a means to provide genetic counseling. Qualitative, semi-structured interviews with 16 genetic counseling providers took place and phenomenographic analysis was applied. Significant excerpts were identified in each transcript, which led to sub-categories that constructed the main findings. Three categories emerged from the data: (1) requirements for optimal use, (2) impact on clinical practice, and (3) patient benefits. Each category consists of two or three sub-categories, in total seven sub-categories. These findings could potentially be used to improve access and uptake of telegenetic counseling in Sweden and in other countries with a similar health care system. This could benefit not only remote patient populations, as described in previous research, but also large family groups and patients experiencing obstacles in accessing genetic counseling, such as those with a psychiatric illness or time constraints, and be a useful way to make genetic counseling available in the new era of genomics.

Public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: A phenomenographic study

AIMS AND OBJECTIVES

To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway.

BACKGROUND

Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10%-20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools.

DESIGN

Qualitative interviews were conducted with 18 public health nurses working in the school health services.

METHOD

A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist.

RESULT

The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are as follows: "The formal structure has an impact on interprofessional collaboration"; "The public health nurse is an important, but not always self-evident, partner in interprofessional collaboration"; and "The primary players are the teachers in collaboration."

CONCLUSION

The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible.

RELEVANCE TO CLINICAL PRACTICE

The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school.

How students experience integration and perceive development of the ability to integrate learning

The merits of integrative learning in promoting better educational outcomes are not questionable. However, there are contentious views on how to implement it. In addition, there is scanty evidence on how students experience it and how they develop the ability to integrate learning. In this paper, students' experiences of integration are explored. Using a phenomenographic approach, in-depth interviews and focus group discussions were conducted with students and teachers in an undergraduate medical programme. Analysis of data revealed the "outcome space"-a collective of students' experiences. Using the "anatomy of awareness" framework, the experiences were structured according to how students experience the meaning of integration of learning; the abilities that they perceive are needed to carry it out; the acts of learning that for them are associated with these abilities; and internal and external factors which they perceive to facilitate or hinder it. The research revealed five conceptions of integration and abilities to achieve it, developing with increasing sophistication over time. Teachers' experiences with the curriculum generally supported the students' experiences. To facilitate integrative learning, starting earlier in the programme, intentional contextually directed interventions are suggested.

Factors developing nursing students and novice nurses' ability to provide care in acute situations

Nurses play an important role in detecting, interpreting and deciding appropriate actions to take in order to care for patients in acute situations. Nevertheless, novice nurses are reported as feeling unprepared to provide appropriate care in acute situations. In order to address this issue, it is important to describe factors in nursing education and first year of practice that enable nurses to provide appropriate care in acute situations. 17 novice nurses were interviewed in this qualitative study. A phenomenographic analysis was applied and four categories were discovered: Integrating theory into practice, access to adequate support, experience-based knowledge and personality traits. Results suggest that a variety of factors contribute to novice nurses' ability to provide appropriate care in acute situations. Experience of acute situations and the integration of theory and practice are pivotal in acquiring skills to provide appropriate care. To accomplish this, reflection, practice and/or applied training with a patient perspective is recommended.

'Best fit' caring skills of an interprofessional team in short-term goal-directed reablement: older adults' perceptions

This paper reports a study conducted to illuminate older adults' perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults' reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver-patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care.

"To Cope with Everyday Life, I Need to Sleep" - A Phenomenographic Study Exploring Sleep Loss in Parents of Children with Atopic Dermatitis

PURPOSE

The whole family is affected when a child has atopic dermatitis (AD), and parents experience sleep disruption related to the child's condition leading to physical and mental exhaustion, mood swings, loss of concentration and lower job performance. This study aimed to explore and describe perceptions of sleep in parents of children <2 years old with AD, consequences of parental sleep loss, and what strategies the parents used to manage sleep loss and to improve sleep.

DESIGN AND METHODS

This qualitative interview study had an inductive and descriptive design. Twelve parents (eleven mothers and one father) participated in the study. Data analysis was performed using a phenomenographic approach.

RESULTS

Three categories of description were found: Acceptance and normalization of parental sleep loss; Changed routines and behavior to compensate for sleep loss; and Support is needed to gain sleep and manage daily life.

CONCLUSIONS

Sleep loss due to the child's AD affected the parents' emotional state, mood, well-being, cognitive function, ability to concentrate and take initiative, and sensitivity to stress and sound negatively. The parents managed their sleep loss mainly by changing their behavior and creating new routines, by taking me-time and through support from partners.

PRACTICE IMPLICATIONS

Pediatric nurses should acknowledge sleep loss in parents of small children with AD in time to prevent negative consequences, which affect the well-being of the entire family. Advice on how to improve sleep should be given early to increase the parents' understanding, make them feel safer and strengthen them in their parenthood.

What can dental education gain by understanding student experience of the curriculum?

INTRODUCTION

Within higher education, there is increasing recognition that understanding the ways students experience the educational environment is critical to developing programmes that can educate our future professionals. There is a small body of literature about how students experience the dental educational environment; however, none that adopts a qualitative phenomenographic approach. This study aims to contribute to our understanding by asking what is the variation in the ways dental students experience their curriculum?

METHODS

This study uses a phenomenographic methodology. Phenomenography investigates the variation in the way a group of people experience a situation, and how they ascribe meaning to it. Interviews were conducted with 14 senior dental students at the University of Sydney. Transcripts were analysed using a phenomenographic approach.

RESULTS

Six increasingly sophisticated, qualitatively distinct categories of description were identified from the collective of transcripts: surviving the education system; following a guide or manual, learning how to treat teeth, learning how to meet patient treatment needs, learning how to relate with patients and understanding the complexities of dental practice. The outcome space consists of ways the categories of description are related; considering interactions with teachers, ways of coping with multiple opinions and integration of disciplinary learning.

CONCLUSION

This study provides new insights into the multifaceted and relational ways that dental students experience their educational environment. It could point curriculum designers towards strategies that assist students develop sophisticated understandings about themselves as practitioners, patients and the complexities of dental practice. Suggestions about the practical implications of the findings of this research are given.

Persons' various experiences of learning processes in patient education for osteoarthritis, a qualitative phenomenographic approach

Background: Patient education (PE) is a core treatment of osteoarthritis (OA) with the aim to increase persons' knowledge, self-efficacy, and empowerment. Objective: To describe person's various experiences of learning processes in PE for OA. Design: Phenomenography. Method: Semi-structured interviews were performed with the same persons, pre- (11) and post- (9) education. Results: Various experiences on learning processes were found and were described in an outcome space. Achieving knowledge describes self-regulated learning and strongly relates to Control, which describes a high order cognitive learning skill, and minor to Confirm, which describes a cognitive learning skill based on recognition and application. Receiving knowledge describes the expectancy of learning regulated from the educator and strongly relates to Comply, which describes a low-order cognitive learning skill, and minor to Confirm. Conclusion: Different experiences of motivation and learning impact on persons' learning processes which, in turn, influence the persons' capability to accomplish self-efficacy and empowerment. The outcome space may serve as a basis for discussions between healthcare educators involved in PE to better understand what learning implies and to develop PE further.

Making sense of genetic risk: A qualitative focus-group study of healthy participants in genomic research

OBJECTIVE

It is well known that research participants want to receive genetic risk information that is about high risks, serious diseases and potential preventive measures. The aim of this study was to explore, by qualitative means, something less well known: how do healthy research participants themselves make sense of genetic risk information?

METHOD

A phenomenographic approach was chosen to explore research participants' understanding and assessment of genetic risk. We conducted four focus-group (N=16) interviews with participants in a research programme designed to identify biomarkers for cardiopulmonary disease.

RESULTS

Among the research participants, we found four ways of understanding genetic risk: as a binary concept, as an explanation, as revealing who I am (knowledge of oneself) and as affecting life ahead.

CONCLUSION

Research participants tend to understand genetic risk as a binary concept. This does not necessarily imply a misunderstanding of, or an irrational approach to, genetic risk. Rather, it may have a heuristic function in decision-making.

PRACTICAL IMPLICATIONS

Risk communication may be enhanced by tailoring the communication to the participants' own lay conceptions. For example, researchers and counselors should address risk in binary terms, maybe looking out for how individual participants search for threshold figures.

Barriers to the medication error reporting process within the Irish National Ambulance Service, a focus group study

BACKGROUND

Incident reporting is vital to identifying pre-hospital medication safety issues because literature suggests that the majority of errors pre-hospital are self-identified. In 2016, the National Ambulance Service (NAS) reported 11 medication errors to the national body with responsibility for risk management and insurance cover. The Health Information and Quality Authority in 2014 stated that reporting of clinical incidents, of which medication errors are a subset, was not felt to be representative of the actual events occurring. Even though reporting systems are in place, the levels appear to be well below what might be expected. Little data is available to explain this apparent discrepancy.

AIMS

To identify, investigate and document the barriers to medication error reporting within the NAS.

METHODS

An independent moderator led four focus groups in March of 2016. A convenience sample of 18 frontline Paramedics and Advanced Paramedics from Cork City and County discussed medication errors and the medication error reporting process. The sessions were recorded and anonymised, and the data was analysed using a process of thematic analysis.

RESULTS

Practitioners understood the value of reporting errors. Barriers to reporting included fear of consequences and ridicule, procedural ambiguity, lack of feedback and a perceived lack of both consistency and confidentiality. The perceived consequences for making an error included professional, financial, litigious and psychological.

CONCLUSION

Staff appeared willing to admit errors in a psychologically safe environment. Barriers to reporting are in line with international evidence. Time constraints prevented achievement of thematic saturation. Further study is warranted.

How anaesthesiologists understand difficult airway guidelines-an interview study

BACKGROUND

In the practice of anaesthesia, clinical guidelines that aim to improve the safety of airway procedures have been developed. The aim of this study was to explore how anaesthesiologists understand or conceive of difficult airway management algorithms.

METHODS

A qualitative phenomenographic design was chosen to explore anaesthesiologists' views on airway algorithms. Anaesthesiologists working in three hospitals were included. Individual face-to-face interviews were conducted.

RESULTS

Four different ways of understanding were identified, describing airway algorithms as: (A) a law-like rule for how to act in difficult airway situations; (B) a cognitive aid, an action plan for difficult airway situations; (C) a basis for developing flexible, personal action plans for the difficult airway; and (D) the experts' consensus, a set of scientifically based guidelines for handling the difficult airway.

CONCLUSIONS

The interviewed anaesthesiologists understood difficult airway management guidelines/algorithms very differently.