Once upon a time: Storytelling as a knowledge translation strategy for qualitative researchers

Identifying the contributors to nursing caring success stories

AIMS

To (a) seek examples of nursing caring success stories and (b) identify the common contributors to these successes. By focusing on the successes of nursing care rather than critically examining failures, this research seeks to provide examples of proven and feasible approaches and processes for improving care.

DESIGN

This study used a narrative inquiry design.

METHODS

Data were collected through group interviews. Four interviews were conducted with a total of 20 nurse participants working in inpatient settings in South Australian hospitals. A thematic analysis approach was used to analyse the data.

RESULTS

Two dominant themes concerning the contributors to caring success were identified. These contributors were (1) the provision of holistic care and (2) the influence of the caring community, which includes family members and other patients. The findings also indicated that the definition of caring success according to nurses is not aligned with organisational performance indicators but is more closely represented by caring values.

CONCLUSION

Success, according to nurses, is not exclusively defined by patient outcomes but includes the approach to, and process of, care delivery.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses value the caring process while working in an environment that primarily values clinical and systems-level outcomes. Nurses want patients and their families, allied health professionals and hospital executives to be involved and invested in the process of care.

IMPACT

This study addressed a gap in the current literature to identify commonalities in nursing success stories, the contributors informing these successes and how these contributors can facilitate improved patient care. Understanding nursing definitions of caring success provides an opportunity to expand upon current accepted industry definitions and perspectives such as key performance indicators.

REPORTING METHOD

Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No direct patient or public contribution.

Healers and midwives accused of witchcraft (1563-1736) - What secondary analysis of the Scottish survey of witchcraft can contribute to the teaching of nursing and midwifery history

BACKGROUND

Nearly 4000 people were accused of witchcraft in Scotland between 1563 and 1736. Some of these were healers, midwives, and nurses.

OBJECTIVE

To investigate Scotland's folk-healers and midwives accused of witchcraft and review their work from a nursing and midwifery perspective.

DESIGN

Secondary analysis of the Survey of Scottish Witchcraft.

METHODS

Those on the Survey with witchcraft accusations relating to folk-healing or midwifery were identified and their biographies were created from Survey data (2021). Individual biographical data were descriptively analysed. Healing/midwifery practice information was tabulated and thematically analysed.

RESULTS

142 individuals were identified (85 % women), 51 % were found guilty, 90 % were executed. Most (98 %) were folk-healers with 10 accused for midwifery reasons. Mainly their work was accused of causing harm. Three themes emerged: their use of rituals; unorthodox religious practices and treatments. Rituals included actions carried out a certain number of times. Religious practices frequently referenced Catholicism. Many of their treatments for ingestion, application or bathing used items still recognised for their health properties. Approximately, 10 % of the 142, mainly in the 1500s/early 1600s, utilised expensive items and complex treatments which had more in common with 'elite' knowledge rather than simple folklore.

CONCLUSIONS

Across all 142 people, many aspects of their work are identifiable within more contemporary nursing and midwifery practice including their use of rituals, treatments, and holism. Mostly the accused were folk-practitioners, but a few (1500s/early 1600s) appear to have been healers working akin to physicians. Following the Protestant reformation (1560) their work, unlike that of physicians, was marginalised, considered unorthodox and harmful because they were women and/or their work reflected Catholicism. European hospital nursing originates in the monastic houses, but little is known about these early religious nurses. This study is novel in suggesting that whoever taught these accused witch/healers may have been connected to the monastic hospitals pre-Reformation.

Silent Tears of Midwives: 'I Want Every Mother Who Gives Birth to Have Her Baby Alive'-A Narrative Inquiry of Midwives Experiences of Very Early Neonatal Death from Tanzania

BACKGROUND

Midwives working in settings with limited clinical resources experience high rates of very early neonatal deaths. Midwives manage the impact of this grief and trauma almost daily, which may affect patient care and their own well-being.

RESEARCH AIMS

To explore how midwives are impacted by and cope with high rates of very early neonatal deaths. To document midwives' insights and local solutions that may reduce very early neonatal deaths in limited resource settings. To document the stories of midwives in order to create awareness and garner support for midwives and their critical work in low resource settings.

METHODS

Narrative inquiry utilizing semi structured interviews. Twenty-one midwives with at least six months experience who had experienced or witnessed very early neonatal death were interviewed. Data were audio recorded and transcribed, and reflexive thematic analysis of transcripts was conducted.

RESULTS AND DISCUSSION

Three themes were identified: (1) deep sadness resulting from very early neonatal deaths leading to internal struggles; (2) use of spirituality, including prayer and occasional beliefs that unexplainable deaths were 'God's plan'; and (3) development of resilience by seeking solutions, educating themselves, taking accountability and guiding mothers. Participating midwives noted that inadequate staff and high caseloads with limited basic supplies hindered their clinical practice. Participants articulated that they concentrated on active solutions to save babies during labour, such as vigilant foetal rate heart monitoring and partogram. Further, reduction and prevention of very early neonatal death is a complex problem requiring multidisciplinary teams and woman-centred care approaches to address issues contributing to the health of mothers and their new-borns.

CONCLUSIONS

Midwives' narratives highlighted ways of coping with grief and deep sadness, through prayer, and further education of both mothers and fellow colleagues to achieve better antenatal and intrapartum care and outcomes. This study gave midwives an opportunity for their voices to be heard and to generate solutions or insights that can be shared with colleagues in similar low-resource settings.

Researchers' and Research Users' Experiences With and Reasons for Working Together in Spinal Cord Injury Research Partnerships: A Qualitative Study

BACKGROUND

Research partnership approaches are becoming popular within spinal cord injury (SCI) health research system, providing opportunities to explore experiences of and learn from SCI research partnership champions. This study aimed to explore and describe SCI researchers' and research users' (RU') experiences with and reasons for conducting and/or disseminating (health) research in partnership in order to gain more insight into potentially ways to build capacity for and foster change to support research partnerships within a health research system.

METHODS

Underpinned by a pragmatic perspective, ten semi-structured timeline interviews were conducted with researchers and RU who have experiences with SCI research partnerships. Interviews focused on experiences in participants' lives that have led them to become a person who conducts and/or disseminates research in partnership. Data were analysed using narrative thematic analysis.

RESULTS

We identified three threads from participants' stories: (1) seeing and valuing different perspectives, (2) inspirational role models, and (3) relational and personal aspect of research partnerships. We identified sub-threads related to experiences that participants draw on how they came to be a person who engage in (health) research partnerships, and sub-threads related to participants' reasons for engaging in research partnerships. While most sub-threads were identified from both researchers' and RU' perspectives (eg, partnership successes and failures), some were unique for researchers (morally the right thing to do) or RU (advocating).

CONCLUSION

Using a narrative and pragmatic approach, this study provided a new understanding of SCI researchers' and RU' partnership experiences over time. We found that participants' research partnership experiences and motivations align with components of leadership theories. The findings from this study may be used to inform strategies and policy programs to build capacity for conducting and disseminating (health) research in partnership, within and beyond SCI research.

Pause, re-think, go virtual … pandemic adaptations from 20 diverse mental health promotion intervention projects across Canada

The Government of Canada's Mental Health Promotion Innovation Fund (MHP-IF) is a platform for learning across diverse projects, facilitated by a Knowledge Development and Exchange Hub. MHP-IF projects were getting underway before the COVID-19 pandemic escalated in 2020 and dramatically shifted their circumstances and activities. Using storytelling methods, this study explored 20 project experiences during the first year of the pandemic, including how and why assumptions, plans, and activities were adapted; early signals about what was working well or not; and how adaptations influenced equity, access, and cultural safety. Project teams generally navigated through four stages: pausing, re-thinking, adapting, and settling into adjustments. Within and across these stages, projects addressed similar processes, including meeting fundamental needs of participants and project teams, managing unanticipated benefits, and engaging with online formats. All projects experienced the pandemic's influence of amplifying both inequities and public and political attention on mental health. This study provides experiential evidence from diverse settings and populations in Canada about pandemic adaptations. The multi-project model and storytelling methods can usefully contribute to additional research, including ways to address inequities and promote cultural safety.

Pragmatic Trials in Long-Term Care: Implementation and Dissemination Challenges and Opportunities

Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce findings that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants identified 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) stakeholder engagement, (2) diversity and inclusion, (3) organizational strain and readiness, and (4) learn from adaptations. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.

Pragmatic Trials in Long-Term Care: Challenges, Opportunities, Recommendations

Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce data that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants recommended 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) engage stakeholders, (2) ensure diversity and inclusion, (3) assess organizational strain and readiness, and (4) learn from adaptations. Specifically related to implementation, participants provided 2 recommendations: (1) integrate interventions into existing workflows and (2) maintain agility and responsiveness. Finally, participants had 3 recommendations specific to dissemination: (1) package the message for the audience, (2) engage diverse audiences, and (3) apply dissemination and diffusion tools. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.

Thinking rhizomatically and becoming successful with disabled students in the accommodations assemblage: Using storytelling as method

The number of disabled students enrolled in higher education institutions is increasing. Yet in disciplines such as nursing, where placements are an important part of student success, students' lived experiences, though an important and necessary aspect of promoting equity, diversity, and inclusion, has been ignored. In this paper, we respond to such issues by creating and utilizing a novel storytelling method that harnesses the antiessentialist philosophy of Deleuze and Guattari. Storytelling empowers students to both describe their experiences and inform institutions on how to better serve them, and we use concepts from Deleuze and Guattari to provide a framework for thinking about students and their pathways toward success as multiple. As we show, applying storytelling as a method through this lens offers an expansion of strategies to put students first and, therefore, promote equity at the administrative, research, educational, and practical levels. We describe how thinking rhizomatically opens new avenues of insight, allowing for the creation of institutional assemblages based on a diverse array of students' needs, enabling them to become successful in their own ways.

Reflecting on knowledge translation strategies from global health research projects in Tunisia and the Republic of Côte d'Ivoire

OBJECTIVES

We describe the knowledge translation strategies in two projects and share lessons learned about knowledge sharing and uptake.

METHODS

To generate findings for dissemination: (1) the Republic of Côte d'Ivoire (RCI) project relied on a multiple case study design to document barriers and facilitators to implementing a community-led prevention strategy targeting Ebola virus disease; and (2) the Tunisia project used several designs to assess a mental health training's effectiveness, and a case study design to explore contextual factors that may influence anticipated outcomes.

RESULTS

To share findings with participants, the RCI project relied on workshops and a pamphlet, and the Tunisia project relied on a structured half-day dissemination workshop and research summary. Facilitators that may have encouraged sharing and using findings include involving champions in dissemination activities, ongoing collaboration, and developing/implementing context-specific knowledge sharing strategies. Barriers include omitting to assess strategies, limited consideration of a wider audience, and the exclusion of a knowledge translation training component.

CONCLUSIONS

Our experiences might be useful to contexts involved in global and public health research that wish to address the "know-do gap."

Giving a voice to patient experiences through the insights of pragmatism

As a philosophical position, pragmatism can be critiqued to distinguish truth only with methods that bring about desired results, predominantly with scientific enquiry. The article hopes to dismiss this oversimplification and propose that within mental health nursing, enquiry enlightened by pragmatism can be anchored to methods helping to tackle genuine human problems. Whilst pragmatists suggest one reality exists, fluctuating experiences and shifting beliefs about the world can inhabit within; hence, pragmatists propose reality has the potential to change. Moreover, pragmatism includes being cognisant of what works to whom reality concerns, making reality context-driven, with a view to understand how actions shape experiences so what is generated has usefulness. Hence, it somewhat follows pragmatism can inform mental health nursing, after all, nursing is a discipline of action, and awareness is needed in how actions produce experiences that patients find helpful. Given the principles of recovery are preferably adopted in mental health care, the paper will explore how pragmatism can help nurses move towards that goal; specifically, with patients voicing their experiences. This is because like pragmatism, recovery subscribes to hope that reality can progress, and through meaningful experiences and beliefs, patients have expertise about personal difficulties alongside how life may flourish, despite mental illness.

Understanding the integration of family caregivers in delirium prevention care for hospitalized older adults: A case study protocol

AIM

To understand family caregiver involvement in delirium prevention care for older adults hospitalized for orthopaedic surgery hospitals and family caregiver integration by nurses.

DESIGN

Multiple-case study.

METHODS

The model of Care Partner Engagement was selected as theoretical framework. Eight cases will comprise an older adult hospitalized a family caregiver and a ward nurse. They will be recruited with a non-probability sampling on two orthopaedic surgery wards in two hospitals. Semi-structured interviews with participants will be audiotaped. Sociodemographic data will be collected. These data, researcher field notes and interview transcripts will be subjected to within- and across-case thematic analysis. Regional ethics committee approved the study protocol in August 2018.

DISCUSSION

The study will allow surgical nursing teams to gain a better understanding of the issues and possibilities regarding family caregiver integration in delirium prevention care for older adults.