Interpretation/analysis methods in hermeneutic interpretive phenomenology

The Lived Experiences of Adults With Sickle Cell Disease Deciding Curative Therapies: A Descriptive Phenomenological Study

BACKGROUND

Bone marrow transplant and gene therapy are high-risk, high-reward treatment options that have the potential to cure sickle cell disease (SCD). Making the decision to pursue curative therapies remains challenging for adults living with SCD and little is known about their experience in deciding to cure it.

PURPOSE

The purpose of this study was to describe the lived experiences of adults living with SCD considering curative treatments.

METHODS

A qualitative descriptive phenomenological study was used for the study. Nine adults with SCD were recruited from a large, urban, academic medical center in the Northeast. Semi-structured interviews were recorded, transcribed, and analyzed using Amedeo Giorgi's 5-step data analysis for descriptive phenomenology.

RESULTS

Five major themes were derived from the data analysis: (1) the never-ending rollercoaster of uncertainty in SCD; (2) the hospital feeling like a second home; (3) the powerful influence of the provider; (4) changing the trajectory of the past in pursuit of new beginnings; and (5) going the distance to access a cure. The results revealed that the participants' experiences in deciding to pursue curative therapies were multifactorial, they had limited access to educational material, they delayed seeking curative therapies, and they required complex care management to navigate health systems when seeking curative options.

CONCLUSION

Findings underscored the importance of nurses understanding the experience of living with SCD, the patient-provider relationship, and barriers to accessing care. Findings can influence policies on SCD care pre- and post-transplant, and inform nursing practice and nursing education.

The liminal space between hope and grief: The phenomenon of uncertainty as experienced by people living with relapsing-remitting multiple sclerosis

BACKGROUND

People with the chronic disease Multiple Sclerosis are subjected to different degrees of profound uncertainty. Uncertainty has been linked to adverse psychological effects such as feelings of heightened vulnerability, avoidance of decision-making, fear, worry, anxiety disorders, and even depression. Research into Multiple Sclerosis has a predominant focus on the scientific, practical, and psychosocial issues of uncertainty. In comparison, existential uncertainty has been under-researched, even though it might pose a greater burden to those experiencing it.

OBJECTIVE

To understand the lived experience of uncertainty for people living with relapsing-remitting Multiple Sclerosis.

METHODS

This study followed a phenomenological research design, employing elements of both the Reflective Lifeworld Approach and Phenomenology of Practice. Seventeen people with a recent (<1 year) diagnosis of relapsing-remitting Multiple Sclerosis were included. In-depth interviews were conducted immediately after inclusion.

RESULTS

The lived experience of uncertainty can be described as a stumbling motion across the liminal space between hope and grief while dealing with oscillating feelings of unrest concerning the body, self, and others. The following four constituents further illuminate the meaning of the phenomenon: Having to constantly (re)define unfamiliar and intangible bodily changes on one's own; Unsteady navigating amidst a destabilization of the imagined life; Relating to others as a source of, mirror or buffer for uncertainty; Going through overwhelming fears and worries while clinging to one's own logic.

CONCLUSION

Adding to existing qualitative and phenomenological research into MS and theories on uncertainty, this study portrays uncertainty as a multifaceted experience. The findings imply the need for a continuous attunement of healthcare practitioners to the expectations, fears, avoidance techniques, and other uniquely personal circumstances of people with Multiple Sclerosis.

Lived experiences and illness perceptions of older adults with age-related hearing loss before the use of hearing aids: An interpretative phenomenological study

Age-related hearing loss is a chronic health condition. This qualitative study applied the Common-Sense Model of Self-Regulation to explore the lived experiences and illness perceptions of older adults with age-related hearing loss. Twenty older adults ≥ 65 years of age with hearing loss were recruited by purposive sampling. Data were collected with face-to-face semi-structured interviews. Interpretive phenomenological analysis analyzed the interview data. Four overarching themes described the experience of hearing loss: 1) awareness, 2) impacts, 3) coping, and 4) appraisal. These highlight of how participants perceived and reacted to progressive hearing loss before adopting hearing aids. The impact of hearing loss was diverse and complex and included fatigue, stress, and interpersonal conflicts. Participants responded with changes in behaviors that were proactive or avoidant. Our findings may help clinicians understand how older adults perceive and manage age-related hearing loss, which could guide the development of effective individual and family-focused interventions.

Attachment-Based Family Therapy for LGBTQ Youth in a Community Setting: A Community-Engaged, Qualitative Pilot Study of Youth and Parent Experiences

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth who experience family rejection are at increased risk for depression and suicide. Attachment-Based Family Therapy (ABFT) demonstrates promising results for reducing this risk with LGBTQ youth. This community-participatory, mixed-method study piloted the use of ABFT with LGBTQ youth. Fourteen families completed treatment with adolescent youth, pre- and post-individual and family interviews, and a measure of youth mental health. Post-therapy, 80% of youth showed a significant reduction in psychological distress. The qualitative thematic analysis constructed four themes describing how families present to therapy with emotional distress, caregiver support needed during ABFT, how caregivers acquired new listening and communication skills, and LGBTQ youth experiences of finding freedom to explore and talk about sexual and gender identities. Implications from the study suggest the need to challenge heteronormative emotional structures of families for increasing emotional support of fathers with their LGBTQ children.

Exploring the lived experience of economic insecurity and health among people accessing charity-run food provision services in Bristol, UK

The UK has experienced alarming increases in the number of individuals living with food insecurity as a result of the rise in the cost of living. The mechanisms linking household economic insecurity to food insecurity, and perceived health outcomes, are not well understood. The aim of this study was to explore how individuals with lived experience of food insecurity are coping with the rise in the cost of living, the trade-offs they might be making between food and other household expenses, and how these might impact eating behaviours and health outcomes. Using a qualitative inductive approach rooted in hermeneutic phenomenology, nine semi-structured interviews were conducted among individuals using charity-run food provision services in Bristol, UK. Narrative accounts from these interviews were analysed thematically. Almost all participants were recipients of benefits at the time of interviews and were living under high levels of economic insecurity. The rise in the cost of living forced complex budget management strategies, including relying on donated food and shoplifting. It also influenced eating behaviours through altered cooking strategies to save energy, substituting food for cheaper, less-nutritious, alternatives, and rationing meals. Food insecurity was experienced as a form of psychosocial violence, engendering high levels of stress, particularly for individuals with diet-related chronic diseases. There is therefore an urgent need for policies that tackle structural causes of overall household economic insecurity, and improve economic access to adequate nutritious foods, to prevent further entrenching social inequalities.

Shared experiences among successful hearing aid users with high hearing aid self-efficacy

OBJECTIVE

While targeted rehabilitation can enhance hearing aid self-efficacy (HASE), little research has been done to determine the factors contributing to its predictive value. By investigating the experiences of individuals who successfully use HAs and have high levels of HASE, we hoped to illuminate specific strategies and/or sources of support these individuals share that might explain why high HASE is often linked to successful outcomes.

DESIGN AND STUDY SAMPLE

This qualitative study explored the experiences of five older adults who were successful HA users and reported having high HASE. Semi-structured interview guides were developed using the transtheoretical model of behavioral change as a framework. Interviews were analyzed thematically and holistically.

RESULTS

Participants attributed their HA success to: intrinsic motivation to improve their hearing, confident self-reliance when making health decisions, willingness to act on advice from trusted others, pro-social personal attributes, positive expectations about HA outcomes, and actively pursuing an optimal HA outcome.

CONCLUSIONS

For these participants, internal factors related to emotional state and source of motivation, and, to a lesser extent, verbal persuasion played a crucial role in their long-term success. This suggests that external influencers might be less impactful in facilitating success for those with high HASE.

Unveiling the heterogeneous utilisation of the same digital patient management platform: case studies in primary healthcare in Sweden

BACKGROUND

The utilisation of digital technology in primary healthcare, particularly digital patient management platforms, has gained prominence, notably due to the global pandemic. These platforms are positioned as substitutes for face-to-face consultations and telephone triage. They are seen as a potential solution to the escalating costs associated with an aging population, increasing chronic conditions, and a shrinking healthcare workforce. However, a significant knowledge gap exists concerning the practical aspects of their implementation and their effect on the utilisation of digital patient management in primary healthcare.

METHODS

This study addresses this gap by conducting a comprehensive analysis of three case studies involving the implementation of a specific digital patient management platform. Over a period of three years, we examine how the practicalities of implementation shape the adoption and utilisation of a digital patient management platform in three different clinics.

RESULTS

Our findings revealed that differences in implementation strategies directly influenced variations in utilisation. The successful utilisation of the platform was achieved through a bottom-up decision-making process that involved the employees of the primary healthcare clinics. Onsite training, close collaboration with the eHealth provider, and a structured patient onboarding process played crucial roles in this utilisation. In contrast, a top-down approach at two of the primary healthcare clinics led to limited utilisation of the platform into daily workflows. Furthermore, making the platform a part of everyday work meant putting accessibility, by working as a team of physicians, at the forefront of continuity of care, with patients being managed by their designated physician. Additionally, it was observed that digital patient management proved most effective for addressing simple patient issues such as skin rashes, rather than complex cases, and did not reduce the demand for phone triage.

CONCLUSION

Only one of the three clinics studied effectively integrated digital patient management into its daily operations, and did so by aligning objectives among management and all categories of healthcare professionals, employing a bottom-up decision-making process, collaborating with the eHealth service provider for regular platform adjustments to clinic needs, and implementing active patient onboarding. This sociotechnical integration resulted in high platform utilisation. In contrast, the other two clinics faced challenges due to incoherent objectives among diverse healthcare professional employees and top management, a top-down decision-making approach during implementation, limited collaboration with the eHealth service provider, and passive patient onboarding. The findings indicate that these factors negatively affected utilisation and led to low platform adoption as well as disrupted the sociotechnical balance.

Evaluating a novel hospital-based online health community to address palliative and psychosocial care factors for chronically ill adolescent and young adult patients

OBJECTIVES

Chronically ill adolescent and young adult (AYA) patients experience barriers to accessing psychosocial care. AYAs who receive palliative and psychosocial care experience numerous benefits from these services. However, we still lack research investigating age-appropriate programs targeting AYAs' psychosocial needs that are delivered virtually and extend beyond the hospital setting. Streetlight is a palliative care program designed for chronically ill AYAs that offers the Streetlight Gaming League (SGL), an online health community (OHC) combining peer-based support, online gaming, and community events. We evaluated the usefulness, acceptability, and potential effectiveness of SGL through an assessment of chronically ill AYAs' lived experiences.

METHODS

We used a qualitative evaluation approach grounded in hermeneutic phenomenology. Questionnaires and interviews were conducted with 9 chronically ill AYAs to elicit in-depth accounts of their lived experiences of using SGL. Descriptive statistical analysis was performed on questionnaire data. Phenomenological data analysis, informed by hermeneutic analysis, was used to analyze interviews.

RESULTS

AYAs reported positive experiences with SGL and valued the ability to engage in various content while having few participation expectations. They also described psychosocial benefits, including reprieve from illness, sense of community, and solidarity through mutual understandings and shared experiences.

SIGNIFICANCE OF THE RESULTS

Findings highlight the usefulness and acceptability of a virtual palliative psychosocial care program for chronically ill AYAs. Findings also suggest the effectiveness of SGL and support using an OHC to meet the psychosocial needs of AYAs. This study can guide future programming and implementation of online palliative psychosocial care programs in other hospital settings, resulting in similar beneficial and meaningful experiences.

Sociocultural interactions and self-perception of health in older adults from an active participation centre: A qualitative study

INTRODUCTION

Promoting healthy ageing is a global priority. Active Participation Centres are potentially key in fostering psychosocial and emotional health, contributing to a fulfilling and active lifestyle for older adults.

AIMS

The study explores self-perceived health, perceptions of sociocultural participation, emotions that emerged when sociocultural participation, and preferences among older adults engaged in community socio-cultural activities from an Active Participation Centre.

METHODS

We realised a hermeneutic study; interviews with nine older participants were conducted. Hermeneutic considerations were employed for data analysis.

RESULTS

Findings reveal the centre's significance as a therapeutic space, positively influencing emotional well-being, fostering social connections, and offering diverse activity preferences.

CONCLUSION

This study underscores the nuanced interplay between sociocultural engagement and self-perceived health, emphasising the need for holistic approaches to promote well-being among older adults attending Active Participation Centres.

Advance care planning as perceived by marginalized populations: Willing to engage and facing obstacles

BACKGROUND

Health disparities exist in end-of-life (EOL) care. Individuals and communities that are marginalized due to their race, ethnicity, income, geographic location, language, or cultural background experience systemic barriers to access and receive lower quality EOL care. Advance care planning (ACP) prepares patients and their caregivers for EOL decision-making for the purpose of promoting high-quality EOL care. Low engagement in ACP among marginalized populations is thought to have contributed to disparity in EOL care. To advance health equity and deliver care that aligns with the goals and values of each individual, there is a need to improve ACP for marginalized populations.

AIM

To describe how patients from marginalized populations experience and perceive ACP.

METHODS

We used an interpretive phenomenological approach with semi-structured qualitative interviews. Participants were recruited from four primary care clinics and one nursing home in a US Pacific Northwest city. Thirty patients from marginalized populations with serious illness participated in individual interviews between January and December 2021. Participants were asked to describe their experiences and perceptions about ACP during the interviews.

RESULTS

The mean age of 30 participants was 69.5; 19 (63%) were women; 12 (40%) identified as Asian/Pacific Islanders, 10 (33%) as Black; and 9 (30%) were non-native English speakers. Our three key findings were: 1) patients from marginalized populations are willing to engage in ACP; 2) there were multiple obstacles to engaging in ACP; and 3) meaningful ACP conversations could happen when clinicians listen. Although participants from marginalized populations were willing to engage in ACP, a fragmented and restrictive healthcare system and clinicians' biased behaviors or lack of interest in knowing their patients were obstacles. Participants who felt their clinicians took time and listened were encouraged to engage in ACP.

CONCLUSION

Patients from marginalized populations are willing to engage in ACP conversations despite a common belief otherwise. However, obstacles to meaningful ACP conversations with healthcare providers exist. Clinicians need to be aware of these obstacles and listen to build trust and engage marginalized patients in mutually meaningful ACP conversations.

Understanding collaborative and coordinated care in a mental health and well-being context: Essential elements for effective service integration

Multiple system reforms in Australia, including the National Disability Insurance Scheme (NDIS), are changing mental health (MH) and disability-related service provision, whilst policy drivers continue to require service integration. This has necessitated service providers discovering new ways of working collaboratively to achieve an integrated model of care. This qualitative study examined what does and does not work to support collaborative and coordinated care (CCC), as essential components of service integration. The study sample (n = 59) included four cohorts: health and community service leaders (n = 16), staff (n = 23); MH service consumers with complex needs (n = 10), and MH carers (n = 10). Thematic analysis from interviews was applied to data from each cohort to identify overarching themes that described the lived experience of current CCC delivery. COREQ and EQUATOR guidelines were applied to reporting the findings. Themes emphasized CCC is enabled by the development and sustainability of positive working relationships, and depth of knowledge across health and community services. Unnavigable service systems, stigmatization, perceived power differentials, multiple and rapid service reforms and Fee-For-Service (FFS) models provide significant barriers to CCC. Recommendations include the need for accessible service navigation, consumer-friendly service environments, a stable workforce, standardization of knowledge across sectors, outcome measures and funding attached to CCC as part of a raft of potential changes.

Development of the Readiness for Hospital Discharge Scale for Patients with Bile Duct Carcinoma Catheterized After Percutaneous Transhepatic Cholangial Drainage: A Validity and Reliability Study

Objective

We develop the Readiness for Hospital Discharge Scale (RHDS) for patients with bile duct carcinoma catheterized after percutaneous transhepatic cholangial drainage (PTCD) and test the reliability and validity of the scale, so as to provide a quantitative tool for evaluating the discharge readiness of patients catheterized after PTCD.

Methods

The initial scale was developed following literature review, qualitative interviews, expert consultation, and other methods based on Meleis' Theory of Transition. We selected a total of 286 patients with bile duct carcinoma catheterized after PTCD from four tertiary A-grade hospitals in Nantong City. We conducted a cross-sectional survey using the initial scale to test the validity and reliability of the scale.

Results

RHDS for patients catheterized post-PTCD consisted of five dimensions, with a cumulative variance contribution rate of 74.6%. The Cronbach's α coefficient of the scale was 0.856, and that of each dimension was between 0.740 and 0.891; the scale-content validity index (S-CVI) was 0.875.

Conclusion

RHDS for patients with bile duct carcinoma catheterized after PTCD developed in this study, has good reliability and validity, and can be a useful tool for evaluating the discharge readiness of patients with bile duct carcinoma catheterized after PTCD.

A Critical Comparison of Focused Ethnography and Interpretive Phenomenology in Nursing Research

Choosing an appropriate qualitative methodology in nursing research is a researcher's first step before beginning a study. Such a step is critical as the selected qualitative methodology should be congruent with the research questions, study assumptions, data gathering and analysis to promote the utility of such research in enhancing nursing knowledge. In this paper, we compare focused ethnography by Roper and Shapira and interpretive phenomenology by Benner. Though these methodologies are naturalistic and appear similar, both have different methodological underpinnings. The historical, ontological, epistemological, and axiological philosophy guiding each methodology are described. In addition, the methodological underpinnings of both methodologies and a justification for use in nursing research are provided. This paper will assist future researchers who aim to employ these methodologies in nursing research.

Understanding Family Caregivers' Needs in Coping with the Behavioral and Psychological Symptoms of People with Dementia: A Hermeneutic-Phenomenological Study

Background

Alzheimer's disease and related dementias (ADRD) are progressive conditions. Family caregivers of patients, especially those caring for patients with ADRD exhibiting behavioral and psychological symptoms of dementia (BPSD), undergo significant physical and mental changes during long-term care. While most researchers have focused on the specific needs of family caregivers, the comprehensive understanding of these needs is limited. In this study, Alderfer's existence, relatedness, and growth theory was used to develop an interview framework to systematically and comprehensively understand the needs of family caregivers of individuals with ADRD.

Objective

The objective of this study was to understand family caregivers' needs in coping with BPSD in individuals with ADRD, aiming to alleviate caregivers' stress and promote their overall well-being.

Methods

This study used a hermeneutic-phenomenological interview research design. Data were collected via remote conferences involving interviews with 17 participants selected via maximum variation sampling. The Colaizzi seven-step method was utilized, and the interview contents were analyzed using NVivo 12.0 software.

Results

The needs of family caregivers in coping with the BPSD of individuals with ADRD could be summarized into three themes, namely existence needs, relatedness needs, and growth needs, and 10 sub-themes.

Conclusions

The study findings provide new insights into the needs of family caregivers in coping with patients exhibiting BPSD. Family caregivers experience significant negative emotions, poor caregiving experiences, heavy caregiving burdens, and a desire for professional assistance and policy support.

Voiceless and vulnerable: An existential phenomenology of the patient experience in 21st century British hospitals

Current health policy, high-profile failures and increased media scrutiny have led to a significant focus on patient experience in Britain's National Health Service (NHS). Patient experience data is typically gathered through surveys of satisfaction. The study aimed to support a better understanding of the patient experience and patients' expression of it through consideration of the aspects of the patient experience on NHS wards which are by their nature impossible to capture through patient satisfaction surveys. Existential phenomenology was used to develop an in-depth exploratory narrative, expressed through the voices of the participants. Data collection involved in-depth face-to-face interviews with 12 purposively sampled participants, with analysis by means of hermeneutics. Though the individuality of each experience was apparent and cannot be overemphasised, common factors emerging from the data included uncertainty and unexpectedness, suffering and finitude, the futility of feedback and bureaucracy and absurdity. Overall, participants demonstrated how their individual personalities and expectations affected their response both to illness or injury and to their hospital admissions, highlighting feelings of vulnerability and voicelessness as a response to hospitalisation. The findings of this study provide useful insight into the patient experience on British hospital wards, and the value of an existential-phenomenological approach is demonstrated.

Nurses' lived experience of peacebuilding

Nursing has a unique opportunity to address issues of structural violence that contribute to poor health outcomes. Models for designing nursing care relative to the social determinants of health can be adapted from the discipline of peace studies and the phenomenon of peacebuilding. The aim of this qualitative study was to describe the lived experience of peacebuilding from the perspective of community or public health nurses. Interviews were conducted with eight participants. Attributes of the peacebuilder included fostering human relationships that value the inherent worth and dignity of others, nurturing a character of humility and moral courage, and contemplating the personal cost of engaging in prolonged processes of peacebuilding. Practices of peacebuilding included mediating conflict through multilayered processes, accompanying others to places of empowerment, and utilizing interdisciplinary teaching and learning to build capacity for change. Increasing an understanding of the lived experience of peacebuilding by nurses is relevant to nursing research, theory, and practice, and adds to a broader understanding of peacebuilding.

"Knowing the Noise That Surrounds the Athlete": A Qualitative Study Exploring the Health-Seeking Behaviors of Athletes With Limb Deficiency Drawing on the Experiences and Perceptions of the Medical Staff and Athletes

OBJECTIVE

The aim of the study is to explore the health-seeking behaviors of athletes with limb deficiency, drawing on the experiences and perception of the sports medicine team and athletes.

DESIGN

The study used an interpretive hermeneutic phenomenological methodology with a subtle realist paradigmatic view to investigate commonality in unique experiences within reality. Data collection was completed with two focus groups in December 2019 and March 2020. Thirteen participants took part including athletes and sports medicine team members (physiotherapists, doctors, and strength and conditioning coaches) working in parasports. Focus group manuscripts were transcribed verbatim from audio recordings. An inductive, iterative process was used to identify themes and subthemes, with processes in place to establish rigor.

RESULTS

Two themes and five subthemes emerged in relation to the "internalization and adjustment to social identity" and "the importance and impact of factors, which impact the athlete social identity."

CONCLUSIONS

Health-seeking behaviors of athletes with limb deficiency were influenced by a unique blend of personal and environmental factors that contribute toward social identity. The sports medicine team require specific awareness of factors that may diminish health-seeking behaviors to deliver a personalized approach and negate consequences.

Moral Breakdowns and Ethical Dilemmas of Perioperative Nurses during COVID-19: COREQ-Compliant Study

(1) Background: The COVID-19 pandemic has led to an increase in the complexity of caregiving, resulting in challenging situations for perioperative nurses. These situations have prompted nurses to assess their personal and professional lives. The aim of this study was to explore the experiences of perioperative nurses during the first wave of the COVID-19 pandemic, with a specific focus on analyzing moral breakdowns and ethical dilemmas triggered by this situation. (2) Methods: A qualitative design guided by a hermeneutical approach was employed. Semi-structured interviews were conducted with 24 perioperative nurses. The interviews were transcribed and thematically analysed following the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. (3) Results: The findings revealed three main categories and ten subcategories. These categories included the context in which moral breakdowns emerged, the ethical dilemmas triggered by these breakdowns, and the consequences of facing these dilemmas. (4) Conclusions: During the first wave of COVID-19, perioperative nurses encountered moral and ethical challenges, referred to as moral breakdowns, in critical settings. These challenges presented significant obstacles and negatively impacted professional responsibility and well-being. Future studies should focus on identifying ethical dilemmas during critical periods and developing strategies to enhance collaboration among colleagues and provide comprehensive support.

Analysing Power Relations among Older Norwegian Patients and Spanish Migrant Nurses in Home Nursing Care: A Critical Discourse Analysis Approach from a Transcultural Perspective

Power relations in care are the link between patients and nurses regarding communication and the ability to act in this context. It can be affected when there is cultural interference between members, putting mutual understanding at risk in healthcare situations. This study analyses power relations in healthcare situations between older Norwegian patients and Spanish migrant nurses regarding active listening, shared decision-making, and patient participation. We performed a hermeneutical study endorsed in critical discourse studies framework from a transcultural perspective. A purposive sampling included older Norwegian patients living alone and Spanish migrant nurses working in Norway. Eleven face-to-face semi-structured interviews were conducted with older patients and four via videoconference with migrant nurses. The analysis followed hermeneutic considerations by Crist and Tanner, and linguistic analysis was performed. Shared decision-making and active listening situations sometimes showed a power imbalance that negatively influenced older Norwegian patients. However, Spanish migrant nurses were also conditioned by care organising institutions. This power triangle negatively affected the relationship between the older patients and migrant nurses, resulting in a lack of communication, personnel, time and trust. The migratory experience influenced the care provided by Spanish migrant nurses, shaping a series of cultural competencies acquired through the migratory process.

[Experiencing brain death, physician view-a phenomenological approach]

AIM

The aim of the study was to examine how physicians experience caring for (potentially) brain-dead patients.

METHODS

Episodic interviews were conducted. Their evaluation was based on Benner's interpretative phenomenology.

RESULTS

Eleven physicians were interviewed. The following phenomena were extracted from the data: (1) encounter with the relatives, (2) making relatives understand brain death, (3) brain death is death, (4) experience of the nurses and (5) burdens.

CONCLUSION

The results show the complexity that is perceived by physicians when caring for a (potentially) brain-dead patient. The transition from saving the patient's life to preserving organs or switching off the equipment and informing the relatives requires a high level of expertise on the part of the physicians. The patients' symptoms provide the physicians with clear diagnostic procedures and any remaining ambiguities in the (treatment) process should be resolved.

Emergency care for youth who experience suicidality and identify as LGBTQ

INTRODUCTION

Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of youth who identify as LGBTQ+ and sought emergency care for suicidality as adolescents.

METHODS

Hermeneutics phenomenology is the research method used in this study. Youth who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents were recruited; fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described their gender identity as male, female, non-binary, transgender female, and their sexual orientation as: female, demisexual, bisexual, gay, homosexual, lesbian, queer, asexual, and transgender.

RESULTS

This study establishes that youth who identify as LGBTQ+ seeking emergency care for suicidality value: coping and control, acceptance from others and self, communicating with me about me, and moving beyond danger and distress. Lack of psychological safety-from the emic perspective-emerged as a critical finding.

CONCLUSION

This research has strong implications for public health, policy, and research. Future research must seek to understand ways in which psychological safety is assessed in healthcare if we are to more deeply understand and effectively address the impact on health equity.

Introducing SAMMSA, a Five-Step Method for Producing 'Quality' Qualitative Analysis

Qualitative health research is ever growing in sophistication and complexity. While much has been written about many components (e.g. sampling and methods) of qualitative design, qualitative analysis remains an area still needing advanced reflection. Qualitative analysis often is the most daunting and intimidating component of the qualitative research endeavor for both teachers and learners alike. Working collaboratively with research trainees, our team has developed SAMMSA (Summary & Analysis coding, Micro themes, Meso themes, Syntheses, and Analysis), a 5-step analytic process committed to both clarity of process and rich 'quality' qualitative analysis. With roots in hermeneutics and ethnography, SAMMSA is attentive to data holism and guards against the data fragmentation common in some versions of thematic analysis. This article walks the reader through SAMMSA's 5 steps using research data from a variety of studies to demonstrate our process. We have used SAMMSA with multiple qualitative methodologies. We invite readers to tailor SAMMSA to their own work and let us know about their processes and results.

Building a Transition Program for Senior Nurse Leaders

Professional development educators undertake a primary role in building organizational transition programs for nurses. Transitions of senior nurse leaders are complex and poorly understood. A Hermeneutic phenomenological study was conducted to investigate the lived experiences of nine novice senior nurse leaders. Four principle themes and five subthemes are identified so that professional development educators may customize situation-specific learning for senior nurse leader onboarding.

Opportunities for Patient Participation in Perioperative Malnutrition Care: A Qualitative Study

Introduction

In the perioperative period of hospitalization, barriers to food intake are common due to special nutritional needs, compromised nutritional status, and metabolic stress. Good nutritional care call for an interdisciplinary approach. And patients themselves may also play an essential role in managing nutritional care.

Objective

This study aimed to explore how patients with malnutrition experience nutritional care, their perspectives on patient participation, and their own role in malnutrition care in the perioperative period of hospitalization.

Methods

A qualitative study was conducted using an interpretive phenomenological approach. To follow patients' experiences, in-depth longitudinal interviews were undertaken before, during, and after hospitalization. Interview transcripts were analyzed thematically using open, axial, and selective coding and interpreted in an iterative process.

Results

Fifty-six interviews were undertaken with 26 patients with malnutrition scheduled for surgery and during the perioperative period of hospitalization. Four themes were identified: (1) unawareness and stigmata about being malnourished, (2) feasibility of optimal nutritional care, (3) needs and expectations for self-management, and (4) barriers and facilitators of taking own responsibilities in nutritional care.

Conclusion

Awareness and responsiveness to patients' perspectives, motivation, and compliance are prerequisites for patient participation in malnutrition care. This requires good communication between healthcare professionals and patients in all phases of hospitalization.

Exploring the lived experience of mental health and coping during unemployment

BACKGROUND

Unemployment is known to involve various psychosocial challenges that can negatively impact mental health. However, the intricacies of how individuals experience these challenges and strive to cope within the context of varied sociocultural and individuating factors, remain comparatively understudied. The present qualitative study used an interpretative phenomenological approach to explore the lived experiences of mental health and coping during unemployment.

METHODS

Fifteen Australian adults who had recently experienced unemployment (for ≥3 months in the last 2 years), despite being available for and able to work, participated in semi-structured interviews from August to September 2021. Maximum variation sampling ensured participants represented diverse sociodemographic backgrounds. Interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis within NVivo12 software.

RESULTS

Four major themes were identified: 1) disrupted identity and direction in life; 2) navigating conflicting views of contribution and progress; 3) knowing how to cope is not enough; and 4) unemployment as a catalyst for new understandings. Unemployment disrupted participants' sense of purpose, identity and visions for the future. It signified a perceived failure to meet societal standards of value based upon the economic functions of work, which participants struggled to reconcile with their own priorities for work that satisfied psychosocial needs. Participants were aware of effective coping strategies, although these had mixed positive and negative effects on mental health, or were difficult to mobilise during unemployment. The COVID-19 pandemic, while normalising unemployment to some degree, exacerbated future uncertainty and prevented engagement with known coping strategies (e.g., social interaction). However, unemployment could also instigate growth through re-defining markers of achievement, re-aligning goals with one's core values, and developing greater compassion.

CONCLUSIONS

Experiences of mental health and coping during unemployment share complex relationships both with each other and with broader personal and sociocultural contexts. Service providers may better meet the mental health needs of those experiencing unemployment by balancing the economic and psychosocial functions of work, understanding that coping is a wholistic issue that goes beyond knowledge of effective strategies, and being aware of the opportunities for self-development that unemployment can create.

Children and adolescents' mental health during the COVID-19 pandemic: A qualitative study of their experiences

TOPIC

Public health measures implemented in response to the COVID-19 pandemic severely disrupted children and adolescents' (C&A) lives, affecting their sense of structure, predictability, and security.

PURPOSE

To examine C&A' experiences during the COVID-19 pandemic to better understand how this context and its associated public health measures affected them and their mental health, and to identify helpful coping strategies.

SOURCES USED

The study was guided by a participatory hermeneutic framework. Semistructured interviews were conducted with 25 C&A aged 6-17 years during the first and second pandemic waves. Participants' interviews were analyzed following a narrative synthesis approach, through which C&A' experiences were contrasted and contextualized to highlight relevant themes.

CONCLUSIONS

Participants described a distinct pattern related to their mental health as the pandemic unfolded, which followed the severity of the pandemic in the province. Negative repercussions on their mental health were linked to the loss of social activities, imposed public health measures, transition to online learning, and challenges with family relationships. Certain youth shared positive societal and moral reflections triggered by the pandemic context. Coping strategies reported include: having a variety of hobbies; expressing their emotions; and accessing financial and material resources. This study highlights the importance of supporting C&A' mental health during crisis situations such as a pandemic. Their perspectives are vital for clinical practice and policy improvement, particularly to find means for social engagement while maintaining safety.

Parenting Pre-teens During COVID-19 in a Rural Midwestern Community: An Interpretive Phenomenological Study

To uncover the experiences of parenting Generation Z pre-teen children in rural communities impacted by the Stay Home Missouri order from April through May 2020. Researchers have focused on urban parents, leading to gaps in understanding the impact of the COVID-19 quarantine on rural parents and children. A qualitative study employing interpretive phenomenology. 14 white cis-male-sexed fathers and cis-female-sexed mothers living in midwestern rural communities participated in this study. Semi-structured interviews with 14 participants parenting pre-teen children were conducted. The interviews were analyzed using interpretive phenomenology. The COREQ checklist was followed. One theme that emerged from the narratives was the study participants' understandings of parenting, discovered when their routines were disrupted by the Stay Home Missouri order. This theme involved three sub-themes: 1) responding to the challenges of protecting pre-teen children; 2) coping with disrupted social relationships; and 3) renegotiating responsibilities. Professionals who work with families need to find ways to assist parents during and after a health emergency that requires quarantine. COVID-19 is not the first pandemic to endanger humanity, and the next pandemic-or a future variant of SARS-could require an additional period of local, regional, or national quarantine. Implications for professionals supporting parents during periods of severe disruption-such as future public health crises as well as large scale quarantines-are offered to assist with preparation for and coping with severe disruptions to parenting.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00507-9.

"Pandemic Fatigue! It's Been Going On since March 2020": A Photovoice Study of the Experiences of BIPOC Older Adults and Frontline Healthcare Workers during the Pandemic

The coronavirus disease 2019 (COVID-19) pandemic intensified the stressful and already difficult circumstances of communities of color. Yet, there is no current photovoice research highlighting the lived experiences of these communities from two perspectives-the older adults (OAs) and the frontline healthcare workers (FLHWs). This qualitative study used photovoice to visually portray the struggles of Black, Indigenous, and persons of color (BIPOC) OAs (n = 7) and younger FLHWs (n = 5) who worked with older adults during the pandemic and how they coped and recovered from the challenges of the pandemic. The investigators conducted a three-day training of ten research assistants (RAs) who were paired with either an OA or an FLHW for the photovoice sessions conducted in four stages. Upon examination of the narratives, focus group transcriptions, and photo stories, it became clear that participants faced different challenges during the pandemic, such as the fear of COVID-19 exposure, struggles to adopt COVID-19 mitigation strategies, workplace challenges, and social isolation. Amid this crisis of suffering, isolation, and sadness, participants employed two major strategies to deal with the challenges of the pandemic: positive reappraisal and self-care practices. The findings have implications for clinical social workers, mental health counselors, faith communities, nurse managers and administrators, and policymakers.

The Lived Experience of Healthcare Workers in Preventing Falls in Community Dwelling Individuals with Dementia

Older adults living with dementia have at least twice the risk of falling compared to their peers living without cognitive impairment. There is evidence for the effectiveness of standard interventions in falls prevention in community dwellings, but they may not translate to individuals with Mild Cognitive Impairment (MCI) or dementia. A qualitative enquiry, adopting an interpretive research design underpinned by a phenomenological approach using semi-structured interviews with four healthcare workers from the field was adopted. Data were analysed using Interpretive Phenomenological Analysis to identify themes. Four major themes were developed: on-going assessment is important in guiding interventions and influencing change, knowledge and experience informs practice, individuals living with dementia have complex physical and cognitive needs, and teamwork is essential in falls prevention strategies, which highlighted falls prevention in this context being multifactorial and complex. The findings found that combining physical and cognitive strategies as part of falls prevention has potential benefits for this population, including reducing falls risks and maintaining function. Targeted training and awareness raising within a supportive multi-disciplinary team structure is required, underpinned by on-going, person-centred assessments.

Nursing Students and Nurses' Recommendations Aiming at Improving the Development of the Humanistic Caring Competency

BACKGROUND

Most nursing education programs prepare their students to embody humanism and caring as it is expected by several regulatory bodies. Ensuring this embodiment in students and nurses remains a challenge because there is a lack of evidence about its progressive development through education and practice.

PURPOSE

This manuscript provides a description of nursing students' and nurses' recommendations that can foster the development of humanistic caring.

METHODS

Interpretive phenomenology was selected as the study's methodological approach. Participants (n = 26) were recruited from a French-Canadian university and an affiliated university hospital. Data was collected through individual interviews. Data analysis consisted of an adaptation of Benner's (1994) phenomenological principles that resulted in a five-stage interpretative process.

RESULTS

The following five themes emerged from the phenomenological analysis of participants' recommendations: 1) pedagogical strategies, 2) educators' approach, 3) considerations in teaching humanistic caring, 4) work overload, and 5) volunteerism and externship.

CONCLUSION

The findings suggest the existence of a challenge when using mannikins in high-fidelity simulations with the intention of developing humanistic caring. The findings also reaffirm the importance of giving concrete and realistic exemplars of humanistic caring to students in order to prevent them from making "communication" synonymous to "humanization of care".

Limited use of local anesthesia for open inguinal hernia repair: a qualitative study

PURPOSE

Local anesthesia for open inguinal hernia repair is recommended by guidelines but is rarely used in clinical practice in several countries. This study aimed to explore physician's considerations in choosing type of anesthesia and barriers for implementing local anesthesia for open hernia repair in clinical practice.

METHODS

We performed individual semi-structured interviews of surgeons and anesthesiologists. Transcribed data were condensed, coded, categorized, and formulated into themes in an inductive qualitative content analysis.

RESULTS

Twenty two participants from seven public hospitals were included in the study. Participants described a standardized setup for general anesthesia with use of intravenous propofol/remifentanil and a laryngeal mask and were generally satisfied with this setup. Their considerations in choosing anesthesia could be described in four themes: (1) Intraoperative pain and quality of surgical technique, (2) Communication and teaching, (3) Logistics, and (4) Clinical routines.

CONCLUSION

Participants considered intraoperative pain and quality of surgical technique, communication and teaching, logistics, and clinical routines as important factors when choosing anesthesia for open inguinal hernia repair and these factors acted as barriers for implementing of local anesthesia in Danish public hospitals. In this setting, implementation strategies should, therefore, be multimodal to address these barriers. The potential workload in such an effort should be justified by evidence supporting specific types of local anesthesia comapared with general anesthesia with use of propofol/remifentanil and a laryngeal mask.

Impact of deep vein thrombosis on adolescent athletes: Navigating an invisible disability

Background

Injury in adolescent athletes that threatens their sport participation can result in a sense of identity loss during critical years for identity development, creating the potential for significant mental health challenges. The specific effect of deep vein thrombosis (DVT) in this vulnerable population has not been characterized.

Purpose

To describe the impact of DVT diagnosis, treatment, and long-term complications on the mental well-being of athletes who sustained a DVT during adolescence and to identify strategies to improve the quality of care for these patients.

Methods

Using a qualitative study design, athletes with a history of DVT during adolescence and their parents were recruited to participate in semistructured interviews. Interviews were transcribed and analyzed using thematic analysis. Participants were recruited until reaching thematic saturation.

Results

In total, 19 participants (12 athletes, 7 parents) were recruited. Athletes were mainly males (67%), median age at time of DVT was 15 years (range, 12-18 years), and median age at study participation was 19 years (range, 16-34 years). Thematic analysis revealed four main themes: Theme 1: DVT posed a threat to sport participation; Theme 2: at a personal level, there were significant mental health challenges; Theme 3: at a societal level, DVT is an invisible disability; and Theme 4: physical, psychological, and transition support are important to improve the care of these patients.

Conclusion

Deep vein thrombosis threatens an athlete's participation in sport, resulting in a significant and complex impact on their mental well-being. Heightened awareness and a multidisciplinary approach are needed to help young athletes navigate the consequences of DVT.

Hiding and seeking: Children's lived experiences during COVID-19

A qualitative study explored the perspectives and lived experiences of school-age children during COVID-19 using a child rights lens. Twenty children between the ages of 7 and 12 participated in open-ended, virtual interviews. Our hermeneutic analysis found children's right to play and education were severely compromised leaving children to navigate between two worlds: the adult world of public health restrictions and that of their childhood. Despite challenges and lost childhood opportunities, children emerged as competent social agents and responsible citizens. Planning for future pandemics should include policies and practices that balance public health needs with the protection of children's rights.

A first voice perspective of people experiencing homelessness on preferences for the end-of-life and end-of-life care during the COVID-19 pandemic

Objective

People experiencing homelessness often encounter progressive illness(es) earlier and are at increased risk of mortality compared to the housed population. There are limited resources available to serve this population at the end-of-life (EOL). The purpose of this study was to gain insight into preferences for the EOL and end-of-life care for people experiencing homelessness. Utilizing an interpretive phenomenology methodology and the theoretical lens of critical social theory, we present results from 3 participants interviewed from August to October 2020, with current or previous experience of homelessness and a diagnosis of advanced disease/progressive life-threatening illness.

Results

A key finding focused on the existential struggle experienced by the participants in that they did not care if they lived or died. The participants described dying alone as a bad or undignified way to die and instead valued an EOL experience that was without suffering, surrounded by those who love them, and in a familiar place, wherever that may be. This study serves to highlight the need for improvements to meet the health care and social justice needs of people experiencing homelessness by ensuring equitable, humanistic health and end-of-life care, particularly during the context of the COVID-19 pandemic.

Optimization of a new adaptive intervention using the SMART Design to increase COVID-19 testing among people at high risk in an urban community

BACKGROUND

COVID-19 has impacted the health and social fabric of individuals and families living across the USA, and it has disproportionately affected people living in urban communities with co-morbidities, those working in high-risk settings, refusing or unable to adhere to CDC guidelines, and more. Social determinants of health (SDH), such as stigmatization, incarceration, and poverty, have been associated with increased exposure to COVID-19 and increased deaths. While vaccines and booster shots are available, it will take time to reach herd immunity, and it is unclear how long newly developed vaccines provide protection and how effective they are against emerging variants. Therefore, prevention methods recommended by the Centers for Disease and Control (CDC)-i.e., testing, hand-washing, social distancing, contact tracing, vaccination and booster shots, and quarantine-are essential to reduce the rates of COVID-19 in marginalized communities. This project will adapt and test evidence-based HIV interventions along the prevention and treatment cascade to help address COVID-19 prevention needs.

METHODS

The study aims to (1) optimize an adaptive intervention that will increase rates of testing and adherence to New Jersey State COVID-19 recommendations (testing, social distancing, quarantine, hospitalization, contact tracing, and acceptance of COVID-19 vaccination and booster shots) among high-risk populations and (2) identify predictors of testing completion and adherence to New Jersey recommendations. This study follows Community Based Participatory Research (CBPR) principles to conduct a Sequential, Multiple Assignment Randomized Trial (SMART) with 670 COVID-19 medically/socially vulnerable people. Participants will be recruited using a variety of strategies including advertisements on social media, posting fliers in public places, street outreach, facility-based, and snowball sampling. Participants complete a baseline survey and are randomized to receive navigation services or an electronic brochure. They then complete a follow-up 7 days after baseline and are randomized again to either continue with their original assignment or switch to the other intervention or critical dialog or brief counseling. Participants then complete a 5-week post-baseline follow-up. Guided by the COVID-19 Continuum of Prevention, Care, and Treatment, the analysis will explore the factors associated with COVID-19 testing within 7 days of the intervention.

DISCUSSION

This paper describes the protocol of the first study to use SMART following CBPR to adapt evidence-based HIV prevention interventions to COVID-19. The findings will inform the development of an effective and scalable adaptive intervention to increase COVID-19 testing and adherence to public health recommendations, including vaccination and booster shots, among a marginalized and difficult-to-engage population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04757298 . Registered on February 17, 2021.

The Patient Lived-Experience of Ventral Capsulotomy for Obsessive-Compulsive Disorder: An Interpretive Phenomenological Analysis of Neuroablative Psychiatric Neurosurgery

Ventral Capsulotomy (VC) is a surgical intervention for treatment-resistant Obsessive-Compulsive Disorder (OCD). Despite clinical studies, little is known about patient perception and lived experience after neurosurgery for severe OCD. To examine the lived experiences of patients who have undergone VC for severe, treatment-resistant OCD through qualitative analysis. We conducted semi-structured interviews with six participants treated with VC for OCD. Interviews were analyzed using Interpretive Phenomenological Analysis. The following themes emerged: (1) After years of conventional treatments, patients felt neurosurgery was their “last hope” and described themselves as “desperate,” (2) While some described the surgery as a “supernatural experience,” patients also demonstrated understanding of the scientific procedure, its risks and potential benefits, (3) The surgical experience itself was positive or neutral, which was linked to trust in the clinical team, (4) Post-surgery, participants described months of heightened fear as they awaited lesion formation and functional improvement. (5) Patients consistently contextualized outcome in the context of their own life goals. Patients undergoing VC have positive views of this neurosurgical intervention, but psychiatric neurosurgical teams should anticipate patient discomfort with the time needed to achieve behavioral improvement following surgery and emphasize the importance of post-operative psychiatric care.

Acknowledging caregivers' vulnerability in the managment of challenging behaviours to reduce control measures in psychiatry

BACKGROUND

The management of challenging behaviours in inpatient with intellectual disability and/or autism spectrum disorders can lead to an escalation of control measures. In these complex situations where patients have an intellectual disability/autism spectrum disorder accompanied by a psychiatric comorbidity, the experiences of caregivers related to the crisis management have rarely been studied.

PURPOSE

This study examined the moral experiences of caregivers related to challenging behaviours' management and alternatives to control measures.

RESEARCH DESIGN

Using Charles Taylor's hermeneutic framework, a 2-month focused ethnography with a participatory approach was used.

PARTICIPANTS AND RESEARCH CONTEXT

Sixteen caregivers were interviewed in a Canadian mental health setting for adults with intellectual disability/autism spectrum disorder and psychiatric comorbidity.

ETHICAL CONSIDERATIONS

The research was conducted in compliance with the Declaration of Helsinki and local Research Ethics Board approval. Written informed consent was collected systematically from participants.

FINDINGS

By accounting for caregivers' moral experiences, this study sheds light on a neglected dimension of the care relationship: the vulnerability of the caregiver. We highlight the main barriers and facilitators to alternatives to control measures. First, a caregiver's vulnerability was characterised by the overall impact of challenging behaviours and the moral distress associated with the use of control measures and exclusion mechanisms of intellectual disability/autism spectrum disorder patients. Second, a strong ambiguity between care and control measures and a lack of inclusive approaches were identified as the two main barriers to challenging behaviour management. Third, the involvement, both professional and personal, of caregivers was deemed necessary to implement alternatives to control measures.

DISCUSSION

A conflict of values opposes two conceptions of autonomy: a rational autonomy, which is counterproductive to the reduction of control measures, versus a relational autonomy based on shared vulnerability.

CONCLUSION

The recognition of caregiver's vulnerability is a benchmark to create alternative approaches, which defuse the logic of control and promote an ethics of care within which caregivers' self-concern can be understood as fostering mutual respect.

Academic-clinical nursing partnership use an evidence-based practice model

AIMS AND OBJECTIVES

The purpose of this study was to compare the experience of a new clinical model with traditional clinical teaching and examine the effects of evidence-based practice strategies among staff and student nurses.

BACKGROUND

This provides an innovative approach to nursing student clinical learning that emphasised the academic-clinical partnership with the use of a new model called the Evidence-based Clinical Academic Partnership (ECAP) model. The model incorporates three main components (a) unit transformation into an innovative hybrid version of a dedicated education unit (hDEU); (b) Evidence-in-Action (EIA) rounding; and (c) the cognitive apprenticeship theoretical framework.

DESIGN

This pilot study used a mixed-method, quasi-experimental design.

METHODS

The quantitative portion included a pre-test, post-test non-randomised quasi-experimental design using self-reported survey data. The qualitative methodology used was a hermeneutic phenomenological approach to data interpretation of three focus groups with staff nurses and unit leaders. SQUIRE 2.0 guidelines were followed (Ogrinc et al., 2016).

CONCLUSIONS

The themes that emerged emphasised relationships and the partnership with this innovative approach to clinical teaching. The staff nurses emphasised the need for a collaborative approach and having the presence of the academic faculty member as a way to support the teaching and learning aspects with students.

RELEVANCE TO CLINICAL PRACTICE

This study did provide significant contributions to the development of an innovative clinical model and highlighted the importance of the academic-clinical partnership with the education of undergraduate nursing students. The study results provided insight to the ways the hDEU framework may be strengthened, such as increased communication and partnership in the implementation of the ECAP model. Implementing curricular change to include innovative clinical models within a nursing programme is vital in this time of healthcare transformation.

You can't report your feelings: The hidden labor of managing threats to safety by women in global public health fieldwork

Increasing job market demand for and availability of Canadian and U.S. global academic health programs in post-secondary education increases student demand to participate in internationally based fieldwork, while supportive resources remain weakly developed. Previous studies indicate provisions to protect the health, safety, and well-being of women students remain inadequately addressed during training, while more research to identify needs, expectations, gaps, and best practices would inform policy and practice to improve conditions for women working off-campus on global public health studies. One approach, reported here, is to document and better understand the lived experience of U.S. or Canadian women graduate students participating in global public health fieldwork. Participant in-depth phenomenological interviews and guided writing exercises aimed to capture lived experience descriptions for 25 women. A phenomenology of practice was applied throughout the research process, following Max van Manen's qualitative methodology approach. Loss of environmental familiarity, combined with graduate students' lack of power, created considerable hidden labor described by women in working to keep themselves safe from sexual and gender-based violence (SGBV) while participating in global public health fieldwork. Women shared specific experiences exemplifying how this can be both alleviated and/or intensified through a range of negotiated strategies, coping styles, and management techniques. Additionally, women recalled laboring as students to avoid or reduce instances of SGBV, that then, precluded them from having any material "of substance" to report once returned home. These findings offer new meaning structures, language for a foreign experience, or ways to describe, conceive of, and respond to global public health fieldwork that hold the potential to positively affect individuals' experiences, institutional understanding, and thus practice, of future women students in global public health.

Exploring the nature and focus of feedback when using video playback in gynecology laparoscopy training

BACKGROUND

Feedback about intraoperative performance remains a cornerstone of surgical training. Video playback offers one potential method for more effective feedback to surgical residents. More research is needed to better understand this method. This study explores the nature of instructional interactions and feedback in the operating room (OR) and when using video playback during post-operative review in obstetrics and gynecology (OBGYN) training.

METHOD

This case study occurred between September 2016 and February 2017. Three OBGYN residents and five OBGYN supervising surgeons were involved in six laparoscopic cases. Intraoperative and video playback dialogues were recorded and analysed, the former deductively using codes identified from published literature, and the latter both deductively, using the same codes, and inductively, with codes that emerged from the data during analysis.

RESULTS

1090 intraoperative interactions were identified within 376 minutes of dialogue. Most interactions were didactic, instructing the resident how to use an instrument to perform a task. Deductive analysis of postoperative video playback review identified 146 interactions within 155 minutes. While the most common interaction type remained didactic, a teaching component was included more often. It became apparent that deductive analysis using the intraoperative codes did not adequately capture the nature and focus of feedback during video playback. Hermeneutic phenomenological analysis identified more dialogic video playback sessions with more resident-initiated questions and reflection.

CONCLUSIONS

This study demonstrates that the nature of feedback during video playback is fundamentally different from that in the OR, offering a greater potential for collaborative and improved learning.

In the "Shadow of Shame": A Phenomenological Exploration of the Nature of Shame Experiences in Medical Students

PURPOSE

Shame occurs when an individual blames a globally flawed self for a negative outcome. Much of the focus on shame in medical education has been directed toward graduate medical education with less recognition paid to shame occurring in medical school. In particular, while research has explored the triggers of medical students' shame, little is known about what shame feels like, what it makes an individual want to do, and what perceived effects it causes. Thus, this study asks: After shame has been triggered in medical students, how is it experienced?

METHOD

The authors selected hermeneutic phenomenology to provide a rich description of the structures and meaning of medical students' lived experiences of shame. Sixteen medical students from a private medical school in the United States were recruited for the study. Data were collected using one-on-one semistructured interviews and analyzed in accordance with Ajjawi and Higgs' 6 steps of hermeneutic analysis.

RESULTS

Data analysis yielded component parts of participants' shame experiences, including affective feelings, physical manifestations, cognitive processes, action tendencies, and effects. Analysis of the relationships among these component parts yielded specific phenomenological structures, including patterns of shame (e.g., chronic shame, flashbacks), self-evaluative processes (e.g., battling voices, skewed frames of reference), and perceived effects of shame (e.g., isolation, psychological distress). An overarching theme of shame as a destabilizing emotion emerged across the dataset.

CONCLUSIONS

Shame is a complex emotion in medical students that, through its destabilizing effects, can lead to withdrawal, isolation, psychological distress, altered professional identity formation, and identity dissonance. The authors highlight the possibility that shame may be occurring as a response to educational trauma, present a metaphor of dominoes to conceptualize the destabilizing nature of shame, and outline the implications for individuals and institutions in medical education.

A Mixed-Methods Exploration of Adolescents' Lived Realities of HIV Stigma: "It's Something You Wear, Something That's Like a Shadow All Over Where You Go"

ABSTRACT

This study aimed to explore how adolescents living with HIV experience stigma and the contextual factors influencing such. The authors used an exploratory, sequential, mixed-method design, including interpretive phenomenological individual interviews and focus groups with adolescents ages 13 to 18 years, their caregivers, and health care workers (n = 56) and a cross-sectional survey (n = 385) in health care facilities in the Western Cape, South Africa. Data were analyzed using an equal-status sequential mixed-methods analysis approach. Enacted, perceived, and anticipated stigma fueled fears of rejection and affected disclosure patterns of adolescents living with HIV. Experiencing HIV-related stigma was associated with being an older adolescent, being disclosed to after the age of 12 years, and residing with one's biological mother. Internalized stigma was associated with poor adherence and viral nonsuppression. Multifaceted interventions involving various individuals and groups across ecological systems are needed to interrupt the stigma process and mitigate its effects.

Experiences of African American Mothers Following the Death of Their Infants

OBJECTIVE

To explore the lived experiences of African American mothers after the death of their infants.

DESIGN

Qualitative, interpretive phenomenologic study.

SETTING

Northeast Louisiana.

PARTICIPANTS

Seven self-identified African American women whose infants died during the first year of life; the women's ages ranged from 18 to 38 years at the time of the infant's death.

METHODS

Heidegger's interpretive phenomenologic approach guided the data collection and analysis. The women were interviewed using in-depth questioning to determine the meaning of the infant loss experience and their subsequent efforts to cope.

RESULTS

Six themes represented the experiences of loss for the mothers: Shattered Dreams, Questioning God, Dissociation, Paralyzing Fear, Left in the Dark, and Uniqueness of Grieving. Three themes affected the women's efforts to cope after their loss: Authentic Presence, Spiritual Empowerment, and Disconnectedness.

CONCLUSION

African American women who experienced infant death described intense feelings of loss, guilt, and isolation. These negative emotions can potentially affect their physical and psychological health. These findings may help health care providers develop culturally sensitive understanding of African American mothers' experiences of loss and equip providers to provide holistic assessment, appropriate support, and treatment for these vulnerable women.

What just happened? Student perspectives on health promotion placements during COVID-19

Issue addressed

The emergence of COVID‐19 forced the health industry to re‐imagine its role and drove Work Integrated Learning (WIL) practicums into virtual spaces, adding complexity for students in these programs. Studies documenting the impact of these outcomes as well as the student experience during these tumultuous times are few, and therefore this study investigated students’ lived experience using data sourced from personal observations and insights and subsequent analysis of their own narratives.

Methods

This qualitative study involved researchers applying a thematic analysis to online student blogs which documented their experiences as posted in the discussion forums. Recruitment resulted in a final dataset of 27 providing informed consent, representing a total 36% response rate.

Results

Several themes were identified, including: (a) a need for guidance regarding the shift from group work as assignments to teamwork as a workplace practice, (b) to further develop effective communication and technology skills, (c) learn more about productive time management and (d) further understand transitioning from student to practitioner.

Conclusions

This study affirmed that working virtually has a comparable capacity to foster positive, pre‐professional identity and thinking more as a practitioner, despite the absence of a face‐to‐face setting.

So what?

Findings revealed (a) what educators can expect now that approaches to WIL have expanded, (b) how to prepare students for more diverse experiences in circumstances requiring sudden change and (c) how to reconfigure the curriculum and procedures to provide more supportive resources for students and agencies alike.

Experiences of gestational surrogacy for gay men in Canada

This paper reports on findings from a qualitative study that examined how Canada's socio-political context influenced gestational surrogacy for same-sex male couples. Semi-structured interviews were conducted with gay fathers and gestational surrogates to investigate supports and barriers of pursuing surrogacy. Questions explored publicly available information, policies and practices of fertility clinics and hospitals, post-birth resources and cultural attitudes regarding same-sex parenthood. Findings suggest that in Canada, a global leader in LGBT rights and inclusive same-sex parenting legislation, participants encountered inadequate same-sex inclusive resources and insufficient provider competencies. The aim of this study was to inform individual and institutional recommendations to counteract biases in fertility care and post-birth services. Following interview analysis, five key strategies were identified: (1) more accessible information on paths to same-sex parenthood; (2) more inclusive fertility clinic and hospital practices; (3) recognition of same-sex fatherhood in formal documentation; (4) post-birth resources such as formula feeding, play groups and first aid courses intended for same-sex parent families; and (5) shifts in cultural attitudes of same-sex parenthood and, specifically, gay fatherhood. Approaches that subvert heteronormative discourses embedded in fertility and reproduction are required to legitimise and support same-sex parent families.

The experiences of family resilience from the view of the adult children of parents with bipolar disorder in Chinese society

AIMS

This study explored how adult children perceived family resilience, barriers to develop family resilience and how cultural values influence their experience of parents with bipolar disorder in Chinese society.

DESIGN

A qualitative design with an interpretive phenomenological analysis of data was employed.

METHODS

Twenty adults who had lived with parents with bipolar disorder during childhood were recruited from the acute psychiatric ward when their parents were admitted to the hospital. They described their experiences of perceived family resilience and barriers to resilience (October 2013-September 2015). Semi-structured interviews were conducted in the hospital meeting room or at a convenient location.

FINDINGS

Six themes were identified in family resilience: ill parents try to be good parents, parents' personal strengths, parents' positive attitudes towards mental illness, flexibility of family role, cohesive relationships between family members, and families' social connections. Three themes were identified in the barriers to develop family resilience: poor parenting/family function, conflict between parents and poor mental health literacy.

CONCLUSION

Children's views of family resilience could transform their suffering from lived experiences with a mentally ill parent to a positive growth experience. Family resilience includes well and ill parents' efforts and social network's help to maintain family function. However, the conflicts between well and ill parents and poor family function result in a traumatic growth experience.

IMPACT

To enhance a positive growth experience, family resilience programs for a parent with bipolar disorder aiming to cultivate both the ill and well parents' inner strength and their competence of parenting skills with connecting their social network to maintain family function is needed. Moreover, early stress-reduction intervention needs to be developed for children who did not experience family resilience.

Designing interview guides on stress and coping related to parenting pre-teen children: an example from a hermeneutic phenomenological study

AIMS

To develop a semi-structured interview guide on stress and coping related to parenting pre-teen children for a hermeneutic phenomenological research study.

DESIGN

Hermeneutic phenomenological research approach which describes the development of an interview guide with semi-structured questions.

METHODS

Ovid MEDLINE, CIHAHL, ERIC, SCOPUS, Web of Science, JSTOR, Education Source, PsyINFO and ProQuest were searched to identify possible interview guides with questions related to stress and coping. The literature was searched in 2019 and included manuscripts from 1970-2019. An initial interview guide was constructed. Mock interviews were used to confirm the rigour of the guide.

RESULTS

The final outcome was a semi-structured interview guide on stress and coping related to parenting pre-teen children.

CONCLUSION

The development of this semi-structured interview guide is relevant to hermeneutic phenomenological researchers who are interested in discovering how personal background meanings and interpersonal concerns shape parents' day-to-day stress appraisals and coping with parenting pre-teen children.

Being a woman, being a soldier, being a mother: a qualitative analysis of perceptions of pregnancy on working lives of women in the Spanish Armed Forces

INTRODUCTION

Thirty-two years after Spain first allowed women to join the armed forces, 12% of active troops are women, although there are no data on how many of them are mothers. There is a lack of research related to the impact of motherhood on their careers and the challenges they face as well. Previous quantitative research, within North Atlantic Treaty Organization (NATO) forces, has focused on the increased vulnerability and reduced performance of women returning to service after childbirth. However, no study to date has examined the narratives of these women.

METHODS

A qualitative, cross-sectional study was carried out by means of individual interviews which were subsequently analysed employing the interpretative approach of hermeneutic phenomenology. All the interviews were conducted by videoconference, being recorded for subsequent transcription and analysis with MAXQDA v.2018.

RESULTS

Servicewoman reported experiencing fear of informing their command chain of their pregnancy. Many women described feelings of constantly having to prove their worth, and thus perceived the physical restrictions associated with pregnancy and/or postpartum as a threat to their previous achievements. This sometimes led to behaviours that posed a risk to the health of mothers and babies, or eventually resulted in both acute and chronic conditions.

CONCLUSIONS

Some restrictions put in place to protect them during their pregnancies become a source of additional anxiety. Returning to active service, we found that women's desire to fulfil their duties can cause long-term damage to their physical and psychological health. The attitudes servicewomen perceive towards pregnant women and mothers seems to exert a strong influence on the risks they are willing to assume. Understanding and addressing the needs of servicewomen after childbirth, either now, as active members of the Armed Forces, or in the foreseeable future, as veterans, is crucial to both military and civilian healthcare providers.