Do the carers care? A phenomenological study of providing care for patients suffering from alcohol use disorders

Emergency department care experiences among people who use substances: a qualitative study

BACKGROUND

People who use substances (PWUS) encounter significant barriers to accessing care for their complex health needs. As a result, emergency departments (EDs) often become the first point of healthcare access for many PWUS and are a crucial setting for the study of health inequities. This study aimed to understand the ED healthcare experiences of PWUS with the intent of informing ways of improving the delivery of equitable care.

METHODS

This qualitative study was part of a larger cross-sectional, mixed-methods study that examined ED experiences among diverse underserved and equity-deserving groups (EDGs) within Kingston, Ontario, Canada. Participants shared and self-interpreted a story about a memorable ED or UCC visit within the preceding 24 months. Data from participants who self-identified as having substance use experiences was analyzed through inductive thematic analysis.

RESULTS

Of the 1973 unique participants who completed the survey, 246 participants self-identified as PWUS and were included in the analysis. Most participants were < 45 years of age (61%), male (53%), and white/European (57%). 45% identified as a person with a disability and 39% frequently struggled to make ends meet. Themes were determined at the patient, provider, and system levels.

PATIENT

history of substance use and experience of intersectionality negatively influenced participants' anticipation and perception of care. Provider: negative experiences were linked to assumption making, feelings of stigma and discrimination, and negative perceptions of provider care. Whereas positive experiences were linked to positive perceptions of provider care. System: timeliness of care and the perception of inadequate mental health resources negatively impacted participants' care experience. Overall, these themes shaped participants' trust of ED staff, their desire to seek care, and their perception of the care quality received.

CONCLUSIONS

PWUS face significant challenges when seeking care in the ED. Given that EDs are a main site of healthcare utilization, there is an urgent need to better support staff in the ED to improve care experiences among PWUS. Based on the findings, three recommendations are proposed: (1) Integration of an equity-oriented approach into the ED, (2) Widespread training on substance use, and (3) Investment in expert resources and services to support PWUS.

Complex adaptive phenomenology: A conceptual framework for healthcare research

RATIONALE

Healthcare research exploring the lived experiences of health care professionals from different disciplines, such as nursing, medicine, and allied health, has repeatedly highlighted many methodological challenges, especially in understanding the individual human experience within complex systems. In response, complexity theory and phenomenological approaches emerged and evolved in ways that potentially offered researchers frameworks to inform an understanding of the individual human experience. However, while these two theoretical approaches inform a method of inquiry, there is a gap in understanding the phenomenon of 'being' and how this is embodied within complex systems such as the healthcare system.

THE AIMS AND OBJECTIVES

The aim of this paper is to present an integrated theoretical framework, namely complex adaptive phenomenology (CAP). CAP aims to address this inquiry gap by offering a structured conceptual framework wherein complexity theory and phenomenology are complementary but multi-dimensional. The key objective of CAP was to synthesize and integrate two methods of inquiry that examine the relational aspects of 'being', that is the gestalt of perception, action, and context, The authors argue that CAP is well-suited to complex research contexts such as healthcare. The framework focuses on the reciprocal, co-constructive relationships extant between perception, meaning, context, and action that shape experiences of 'being' within complex systems. Complexity theory's connectionist orientation explains the relationships that are formative of the experience of being, while phenomenology explores the manifestations of these formative relationships by attending to the notion of 'being' itself.

CONCLUSION

The authors propose that an integrated framework, of phenomenology and complexity theory, can provide a platform for deeper understandings of the experiences of health professionals and contribute to healthcare scholarship.

Considering "the more" of patients suffering from alcohol use disorders. An illustration of acute nursing care from a lifeworld-led perspective

Purpose

The purpose of this study is to illustrate a theoretical value framework for humanisation of healthcare, a lifeworld-led care that has the potential to support nurses in acute medical units in addressing and meeting both challenges and care needs expressed by patients suffering from alcohol use disorders. Providing care to these patients means working with a very divergent and complex group of patients. When hospitalised in an acute medical unit, nurses are often these patients' first encounter, which gives a unique opportunity to initiate and establish a successful care alliance.

Method

 The present study is a qualitative study based on an amplified secondary analysis of 25 pre-conducted interviews. Following a hermeneutic approach, the analysis was structured in accordance with the conceptual value framework for humanisation of care, drawing on the recognition of the patients' lifeworld as an aspect of importance.

Findings

The study showed that while there were examples of humanising care guided by the patients’ lifeworld present, there were also situations of care that were dehumanising. Conclusion: When letting the patients’ perspective of well-being be the centre of care, the patients’ experience of meaningfulness and sincerity within the provided care was nurtured, and they felt more humanly met.