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Lindberg E, Palmér L, Hörberg U. Meaning-oriented thematic analysis grounded in reflective lifeworld research-A holistic approach for caring science research. Scand J Caring Sci 2024. [PMID: 38997813 DOI: 10.1111/scs.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 06/26/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND AND AIM The aim of the present article is to describe meaning-oriented thematic analysis grounded in reflective lifeworld research and to illustrate how the thematic analysis can be integrated in the research process. The article is a methodological paper, including ontological and epistemological assumptions for lifeworld theory. Research based on lifeworld theory is directed towards lived experiences and meanings in everyday life. Research that is founded on the epistemology of the lifeworld can present existential issues important for caring and qualitative research can in particular contribute to existential knowledge needed to understand the world of the patient. DESIGN Theoretical paper. RESULTS Starting with a phenomenon of relevance for caring science, the article argues for lifeworld interviews as a data collection method that can contribute to depth and meaning, and then presents a description of how structures of meaning can be outlined through a meaning-oriented thematic analysis. The research of lived experiences in caring science demands an approach that includes a reflective attitude during the methodological considerations. This article highlights the importance of ontological and epistemological considerations when conducting a meaning-oriented thematic analysis. CONCLUSION The article places meaning-oriented thematic analysis in a wider research process, considering all aspects from collection of data to the creation of meaning-oriented themes.
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Affiliation(s)
- Elisabeth Lindberg
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Lina Palmér
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnæus University, Växjö, Sweden
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Alrayshouni Z, Dayekh A, El-Tassi A, Pakai A. Rationalizing the Influence of Co-Design on Distress, Clinical Decision-Making and Disease Self-Management of Cancer Patients-as-Partners: A Quasi-Experimental Study. Health Expect 2024; 27:e14113. [PMID: 38872504 PMCID: PMC11176735 DOI: 10.1111/hex.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Cancer is regarded as a major worldwide burden. Patient distress has been linked to disease progression. Studies show that engagement strategies affect clinical decision-making and patient outcomes. The optimal engagement method is a partnership that integrates the patient's expertise into the comprehensive co-design of the healthcare system. OBJECTIVES This is the first study to investigate cancer patient-as-partner experience and its impact on distress levels, decision-making and self-management. METHODS It is a quantitative and quasi-experimental study that adopted a partnership committee at a Lebanese hospital. A stratified random sampling approach was used, and data were collected by self-administered questionnaires. We utilized the standardized distress thermometer and PPEET. RESULTS We recruited 100 patient partners. Cancer patients-as-partners had optimal engagement experience in QI projects (mean = 4; SD = 0.4). The main partnership benefit was improved hospitalization experience (49%). Almost half of PP reported no challenges faced (49%). Recommendations for improvement were training (19%), team dynamics management (12%) and proper time allocation (7%). The distress level post-partnership was significantly reduced (t = 12.57, p < 0.0001). This study highlights the importance of partnership and its ability to influence shared decision-making preference [χ2(2) = 13.81, p = 0.025] and self-management practices [F(3, 11.87) = 7.294, p = 0.005]. CONCLUSION Research findings suggest that partners from disadvantaged groups can have optimal partnership experience. A partnership model of care can shape the healthcare system into a people-oriented culture. Further research is needed to explore diverse PP engagement methodologies and their effect on organizational development. PATIENT OR PUBLIC CONTRIBUTION Patients and family members were engaged in the co-design of the study methodology, especially the modification of a research instrument. Patient partners with lived experience were involved in the patient partnership committee as core members to improve healthcare system design and evaluation.
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Affiliation(s)
| | - Alaa Dayekh
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Ahmad El-Tassi
- Nursing Department, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Annamária Pakai
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
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Mathiesen KL, Lindberg E, Nässén K, Cowdell F, Palmér L. "A becoming in the meeting": the interpretations of competence in home care from the perspectives of older people and registered nurses - a meta-ethnography. Int J Qual Stud Health Well-being 2023; 18:2262170. [PMID: 37771312 PMCID: PMC10543340 DOI: 10.1080/17482631.2023.2262170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/09/2023] [Indexed: 09/30/2023] Open
Abstract
AIM The aim of this meta-ethnography was to identify and synthesize qualitative studies focusing on older people's and registered nurses' interpretations of competence in home care. METHODS The meta-ethnography followed the six phases developed by Noblit and Hare (1988). RESULTS In Phase 6, the translation process of the included studies, three themes were identified: i) temporality-the feeling of being of value; ii) dignity-a person, not just a patient; and iii) mutuality of being-togetherness. A synthesis was developed, and the phrase "a becoming in the meeting" emerged. CONCLUSION The sense of becoming includes progress, which means becoming something other than before in relation with others and refers to what constitutes the meeting between the older person and the registered nurse working in home care. Competence originates from becoming in the meeting, and registered nurses should therefore value what they do and hold on to this aspect of caring competence that centres on a caring relationship. It is important for registered nurses working in home care to be able to cultivate a caring relationship.
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Affiliation(s)
- Karoline Lang Mathiesen
- Faculty of Caring Science, Work Life and Social Welfare, Doctoral student, University of Borås, Borås, Sweden
| | - Elisabeth Lindberg
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås,BoråsSweden
| | - kristina Nässén
- Faculty of Caring Science, Work Life and Social Welfare, Senior lecturer, University of Borås, BoråsSweden
| | - Fiona Cowdell
- Professor of Nursing and Health Research and NIHR Knowledge Mobilisation Research Fellow, Birmingham City University, BirminghamUK
| | - Lina Palmér
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Caston S, Greenfield B, Piemonte N, Jensen G. Turning toward suffering: Rethinking the patient- clinician relationship in physical therapy practice. Physiother Theory Pract 2023:1-11. [PMID: 37916508 DOI: 10.1080/09593985.2023.2272844] [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: 04/28/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
In this professional theoretical article, the authors argue that patient care should be centered on connection and that authentically turning toward suffering necessitates an approach to care that transcends medicine's traditional focus on cure and physical restoration and differentiates between pathology and disability. The meaning of illness and suffering for those who have experienced life-changing injuries or illness is explored. Strategies for approaching the lifeworld of these individuals are discussed using the concepts of phenomenology and embodiment, rooted in the work of philosophers from the phenomenological tradition. The authors also propose an approach to patient care offering a case-based example based on postmodernist concepts that elevate connection, relationship, and interdependency above the traditional focus of restoring normality and physical independence for individuals with disabilities. Traditional assumptions about quality of life, illness, and disability are called into question by focusing on the fluidity of being and disability identity, which serves to destabilize static, binary conceptions of individuals as either healthy or ill, disabled, or able-bodied. A postmodern lens invites healthcare practitioners to envision themselves as part of an assemblage that may promote a more expansive view of the relationship between patient and healthcare practitioner.
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Affiliation(s)
- Sarah Caston
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Bruce Greenfield
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicole Piemonte
- Department of Medical Humanities, Creighton University School of Medicine, Phoenix, AZ, USA
- Department of Physical Therapy, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
| | - Gail Jensen
- Department of Physical Therapy, Creighton University School of Pharmacy and Health Professions, Omaha, NE, USA
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Sagen JS, Smedslund G, Simonsen AE, Habberstad A, Kjeken I, Dagfinrud H, Moe RH. Patient engagement in the development and delivery of healthcare services: a systematic scoping review. BMJ Open Qual 2023; 12:e002309. [PMID: 37369560 PMCID: PMC10577732 DOI: 10.1136/bmjoq-2023-002309] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Patient engagement (PE) is required to improve future healthcare services. PE in the development and delivery of healthcare services is likely to be complex but is scarcely described. OBJECTIVES The objective of this scoping review was to summarise primary studies on mesolevel PE regarding structure, process and outcomes. More specifically, the aim was to explore barriers and facilitators to successful PE, how persons are engaged in the process and summarise reported consequences. METHOD A systematic scoping review was conducted, searching the MEDLINE, EMBASE, Cochrane and PsycINFO databases. Primary studies, published between 7 July 2005 and 4 October 2022, were considered for inclusion. Two reviewers extracted data about PE (eg, attributes of PE settings, facilitators and barriers, and outcomes to PE) and the first author coded the extracted data into structural, processual and outcome themes. RESULTS Of 8588 identified records, 37 studies were eligible. Most of the included studies were conducted in Europe (n=19; 51%) and North America (n=13; 35%). Structures that ensure sufficient stakeholder representativeness and PE knowledge through education may facilitate the PE process further, regardless of the environmental setting. Interpersonal relationships with uneven power dynamics were reported as noteworthy processual barriers to meaningful PE, while clearly described roles and tasks were reported as important facilitators. In contrast to hard outcomes with operationalised PE effects, the most noteworthy outcomes of PE were reported as soft processual consequences such as patient representatives improving their self-esteem and feeling valued. CONCLUSIONS Unfortunately, there is a dearth of studies exploring hard and operationalised PE outcomes on healthcare services and patients receiving healthcare. The PE process may be facilitated by dedicated finances to PE education and by ensuring sufficient stakeholder representativeness.
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Affiliation(s)
- Joachim Støren Sagen
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
| | - Geir Smedslund
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Andreas Habberstad
- The Norwegian Federation of Organisations of Disabled People, Oslo, Norway
| | - Ingvild Kjeken
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
| | - Hanne Dagfinrud
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Rikke Helene Moe
- NKRR, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Stephenson C, Flynn A, Overs A, Strickland K. Support needs of people with younger onset Parkinson's disease: An interpretative phenomenological analysis. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jesus TS, Stern BZ, Struhar J, Deutsch A, Heinemann AW. The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature. Clin Rehabil 2022; 37:261-276. [DOI: 10.1177/02692155221126690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To characterize the literature, reported enablers, and gaps on the use of patient experience feedback for person-centered rehabilitation quality improvement and codesign activities. Design Scoping Review. Data sources Scientific databases (PubMed, CINAHL, Rehabdata, Scopus, Web of Science, ProQuest), website searches (e.g. Beryl Institute), snowballing, and key-informant recommendations. Methods Two independent reviewers performed title and abstract screenings and full-text reviews. Eligibility focused on English-language, peer-reviewed (all time) and gray literature (last five years) that used patient experience feedback in rehabilitation improvement activities. The aims, settings, methods, findings, implications, and reported limitations were extracted, followed by content analyses identifying reported enablers and gaps. Results Among the 901 unique references and 52 full texts reviewed, ten were included: four used patient experience surveys for improving patient experiences; six used codesign methodologies to engage patient feedback in service improvement activities. Implementation enablers included securing managerial support, having a structured methodology and facilitator, using efficient processes, engaging staff experiences, and using appreciative inquiry. Reported study gaps included limited follow-up, low sample sizes, analytical limitations, lack of reported limitations, or narrow range of perspectives (e.g. not from people with severe impairments). Conclusion Few examples of the use of patient experience feedback in quality improvement or codesign activities were found in the rehabilitation literature. Patient experience improvement activities relied exclusively on retrospective survey data, which were not combined with often more actionable forms (e.g. qualitative, real time) of patient experience feedback. Further research might consider design of activities that collect and use patient experience feedback for rehabilitation service improvements.
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Affiliation(s)
- TS Jesus
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - BZ Stern
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Struhar
- Nerve, Muscle + Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - A Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- RTI International, Chicago, IL, USA
| | - AW Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Knowing-in-action that centres humanising relationships on stroke units: an appreciative action research study. BRAIN IMPAIR 2022. [DOI: 10.1017/brimp.2021.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
Equal, collaborative and therapeutic relationships centred on the person affected by stroke are important for supporting recovery and adjustment. However, realising these relationships in hospital practice is challenging when there is increasing focus on biomedical needs and organisational pressures. Despite a body of evidence advocating for quality relationships, there remains limited research describing how to achieve this in clinical practice. This appreciative action research (AAR) study aimed to describe the processes involved in co-creating meaningful relationships on stroke units.
Design and methods:
An AAR approach was used to develop humanising relationship-centred care (RCC) within two hospital stroke units. Participants were staff (n = 65), patients (n = 17) and relatives (n = 7). Data generation comprised of interviews, observations and discussion groups. Data were analysed collaboratively with participants using sense-making as part of the AAR cyclical process. Further in-depth analysis using immersion crystallisation confirmed and broadened the original themes.
Findings:
All participants valued similar relational experiences around human connections to support existential well-being. The AAR process supported changes in self, and the culture on the stroke units, towards increased value being placed on human relationships. The processes supporting human connections in practice were: (i) sensitising to humanising relational knowing; (ii) valuing, reflecting and sharing relational experiences with others that co-created a relational discourse; and (iii) having the freedom to act, enabling human connections. The outcomes from this study build on existing lifeworld-led care theories through developing orientations for practice that support relational knowing and propose the development of RCC to include humanising values.
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Møller LA, Martinsen B, Werlauf U, Dreyer P. Ageing with neuromuscular disease: Implications for a lifeworld-led care through a humanising approach. J Clin Nurs 2021; 31:2507-2517. [PMID: 34590372 DOI: 10.1111/jocn.16065] [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: 04/26/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To understand the care and support needs in ageing with neuromuscular disease from a patient-user perspective. BACKGROUND The term neuromuscular disease covers several chronic hereditary or acquired disease subtypes. In the developed countries, advances in symptoms management, technical advancements and rehabilitation initiatives have resulted in increased life expectancy for some subtypes. Life with neuromuscular disease is thus likely to continue into adulthood and old age. However, knowledge of the care and support needs of patients ageing with neuromuscular disease remains sparse. DESIGN Adopting a user-participatory approach embedded in a phenomenological hermeneutic tradition, we conducted two user-group discussions focusing on care and support needs in people ageing with neuromuscular disease. Twenty-five users with neuromuscular disease participated in the group discussions. Data were analysed using a three-stepped analysis method inspired by the French Philosopher Paul Ricoeur. In the analysis process, dialectical movements between a surface interpretation and an in-depth understanding occur. The COREQ checklist was used to report the study. RESULTS Two themes were identified; 'Changes in the sheltering relationships of life require preparation' and 'Ageing introduces a dichotomy between circumstantial normalcy and minority groupness'. An understanding of care and support needs in life with neuromuscular disease was reached revealing a need for a lifeworld-led approach. CONCLUSION Persons ageing with neuromuscular disease crave a fusion of disease- and age-led care and support. This fusion may be achieved through the introduction of a lifeworld-led approach to care and support. RELEVANCE FOR CLINICAL PRACTICE Unmet care and support needs in people ageing with neuromuscular disease may result in patients experiencing fear and concern about their life situation. Healthcare professionals may play a crucial role in creating coherent lives for these persons if they understand the approach proposed herein to uncover the care and support needs in people ageing with neuromuscular disease.
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Affiliation(s)
| | - Bente Martinsen
- Department of Public Health, Section of Nursing, Faculty of Health, Aarhus University, Copenhagen, Denmark
| | - Ulla Werlauf
- The Danish National Rehabilitation Center for Neuromuscular Diseases, Aarhus, Denmark
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.,University of Bergen, Bergen, Norway
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How does a narrative understanding of change in families post brain injury help us to humanise our professional practice? BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
In this paper, we critically explore the discourse of change post brain injury and challenge the dominant discourse of negative change, which alone leaves little room for other perspectives to exist. These negative changes pose a considerable risk to the well-being of families who may benefit from engaging in richer accounts making room for a more coherent and connected sense of self and family post-injury. We explore how narrative approaches provide opportunities for all practitioners to expand their professional scripts and support families to move towards a future which is not dominated by a discourse of loss. While loss and negative change is an important and very real consequence, of brain injury, focusing purely on stories of loss is life limiting for family members and can cause psychological distress. The life thread model is offered as a visible tool for all practitioners to engage with and use while working with families, providing a concrete focus for reflection and discussion of narratives relating to change which otherwise can feel quite abstract in everyday practice. We argue that one way we can humanise our professional practice is to support all practitioners to engage in a narrative understanding of family change following ABI.
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Galvin K. 'Getting back to the matters': Why the existential matters in care. Scand J Caring Sci 2021; 35:679-684. [PMID: 34390265 DOI: 10.1111/scs.13022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kathleen Galvin
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
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Ellis-Hill C, Pound C, Galvin K. Making the invisible more visible: Reflections on practice-based humanising lifeworld-led research - existential opportunities for supporting dignity, compassion and wellbeing. Scand J Caring Sci 2021; 36:1037-1045. [PMID: 34169563 DOI: 10.1111/scs.13013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/13/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The need for dignity and compassion in healthcare is enshrined in policy, but is often difficult to enact in practice and what is precisely meant by these concepts is unclear. In this paper, we have explored theoretical underpinnings which form the basis of a lifeworld-led approach which was used in a research study to support the humanity of service providers and users alike. AIM In this article, we share our analysis of what we have learnt after undertaking an innovative appreciative action research project with patients and staff in a stroke ward with the aim of exploring if a novel phenomenologically driven and philosophically derived humanising framework could be applied in health care. Following the research, we wanted to develop a theoretical understanding of the processes occurring during the research in order to provide a framework and language which could be used to support practical lifeworld developments in the future. We analysed the approach through Participatory and Appreciative Action Reflection. FINDINGS As researchers, we found that the approach was underpinned by four key existential principles. The first principle was recognising a mutually arising reality rather than a reality 'out there'. The second was recognising a reality which was constantly changing rather than 'fixed'. The third was recognising that we needed to work from within, as part of a human living system rather than trying to control reality from the 'outside'. Finally, we recognised that this reality could only be accessed through human knowing, including embodied knowing rather than intellectual knowing alone. These principles challenged many of the usual ways of thinking and working within research and healthcare contexts. CONCLUSION Understanding the processes and reality in this way gave new perspectives; enhancing our understandings and views of ourselves, what is important and most importantly what is possible in caring systems.
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Affiliation(s)
- Caroline Ellis-Hill
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Carole Pound
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Kathleen Galvin
- School of Health Sciences, University of Brighton, Falmer, Brighton, UK
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