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Beck M, Martinsen B, Missel M, Simony C, Engelke E, van Manen M. Alongside: Exploring the Meaningfulness of Significant Moments in Others' Lives Through Observation and Interview. QUALITATIVE HEALTH RESEARCH 2024; 34:707-716. [PMID: 38130185 DOI: 10.1177/10497323231210495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
How do we explore the meaningfulness of others' experiences? What means do we have to access their experiencing of the world? How do we express our understandings of others' experiences of body and place without reducing them to objectification? In this methodological paper, we reflect on how we can gain valuable insights into the lived experiences of others through research activities that are conducted 'alongside' participants. Phenomenological concepts of intentionality and embodiment are considered as we draw on an empirical example of exploring the experiences of hospitalized patients with neurological diseases through observations and interviews. The aim is to unfold alongside as an epistemological stance to explore the meaning of another's lifeworld. We strive to show that personal presence and engagement within this approach contains relational, existential, and aesthetic dimensions worth considering.
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Affiliation(s)
- Malene Beck
- Department of Pediatrics, Zealand University Hospital, Region Zealand, Denmark
- Faculty of Health, Institute of the Regional Health, University of Southern Denmark, Odense, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Bente Martinsen
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Malene Missel
- Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Charlotte Simony
- Faculty of Health, Institute of the Regional Health, University of Southern Denmark, Odense, Denmark
- Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naesteved, Slagelse and Ringsted Hospital, Region Zealand, Denmark
| | - Eileen Engelke
- College of Health Professions, Lienhard School of Nursing, New York City, NY, USA
- St. John's University, Queens New York, NY, USA
| | - Michael van Manen
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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Treleaven E, Matthews-Rensch K, Garcia D, Mudge A, Banks M, Young AM. Mealtimes matter: Measuring the hospital mealtime environment and care practices to identify opportunities for multidisciplinary improvement. Nutr Diet 2024. [PMID: 38246600 DOI: 10.1111/1747-0080.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/08/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
AIMS Hospital inpatients often eat poorly and report barriers related to mealtime care. This study aimed to measure and describe the mealtime environment and care practices across 16 acute wards in a tertiary hospital to identify opportunities for improvement. METHODS A prospective cross-sectional audit was undertaken over a two-month period in 2021. A structured audit tool was used at one breakfast, lunch and dinner on each ward to observe the mealtime environment (competing priorities, lighting, tray table clutter) and care practices (positioning, tray within reach, mealtime assistance). Data were analysed descriptively (%, count), with analyses by meal period and ward to identify variation in practices. RESULTS A total of 892 observations were completed. Competing priorities (59%), poor lighting (43%) and cluttered tray tables (41%) were common. Mealtime assistance was required by 300 patients (33.6%; 5.9% eating assistance, 27.7% set-up assistance) and was provided within 10 min for 203 (66.7%) patients. A total of 54 patients (18.0%) did not receive the required assistance. We observed 447 (50.2%) patients lying in bed at meal delivery, with 188 patients (21.1%) sitting in a chair. Competing priorities, poor lighting, poor patient positioning and delayed assistance were worse at breakfast. Mealtime environments and practices varied between wards. CONCLUSION This audit demonstrates opportunities to improve mealtimes in our hospital. Variation between wards and meal periods suggest that improvements need to be tailored to the ward-specific barriers and enablers. Dietitians are ideally placed to lead a collaborative approach alongside the wider multidisciplinary team to improve mealtime care and optimise intake.
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Affiliation(s)
- Elise Treleaven
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Kylie Matthews-Rensch
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Dwayne Garcia
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Alison Mudge
- Internal Medicine Research Unit, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Greater Brisbane Medical School, University of Queensland, Brisbane, Australia
| | - Merrilyn Banks
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Adrienne M Young
- Dietetics and Food Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
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Bendsen BB, Jensen D, Westmark S, Krarup AL, Riis J, Melgaard D. The Quality of Life in Citizens with Oropharyngeal Dysphagia—A Cross-Sectional Study. J Clin Med 2022; 11:jcm11144212. [PMID: 35887975 PMCID: PMC9322035 DOI: 10.3390/jcm11144212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Dysphagia is a risk factor that impaires an individual’s experience of mealtimes. Few studies contribute to the knowledge on the health-related quality of life (HRQoL) of citizens with oropharyngeal dysphagia (OD) living independently. The aim of this study involves evaluating the HRQoL in citizens living independently and suffering from OD. This cross-sectional study was performed in seven municipalities in Denmark between March 2019 and December 2020. The 90 citizens included (54% female, mean age 76.6 years (SD 0.8)) were ≥18 years, as well as diagnosed with OD using the volume-viscosity swallow test and Minimal Eating Observation Form version II. The Dysphagia Handicap Index-DK, Barthel 20, and European Quality of Life-5 Dimensions were fulfilled. Of the participating citizens, 66% of them needed additional time to eat, 64% coughed while eating, and 58% coughed while drinking. Additionally, 60% reported having a dry mouth, 62% needed to drink to succeed with swallowing foods, and 57% had to swallow multiple times. About one-third felt embarrassed when eating with others. They could not enjoy eating in the same manner as they had previously, and/or felt handicapped or limited. OD was shown to have had a high impact on the QoL in citizens with OD living independently. Focus is needed on xerostomia, as well as on the psychological aspects pertainings to mealtimes for citizens with OD.
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Affiliation(s)
- Bettina Burgdorff Bendsen
- Department of Physiotherapy and Occupational Therapy, Municipality of Hjørring, Bistrupvej 3, 9800 Hjoerring, Denmark;
| | - Diana Jensen
- Center of Rehabilitation, Municipality of Tønder, Carstensgade 6-10, 6270 Toender, Denmark;
| | - Signe Westmark
- Center for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjoerring, Denmark; (S.W.); (J.R.)
| | - Anne Lund Krarup
- Department of Neuro-Gastroenterological Research, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjoerring, Denmark;
- Department of Acute Medicine and Trauma Care, Aalborg University Hospital, Hobrovej, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Johannes Riis
- Center for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjoerring, Denmark; (S.W.); (J.R.)
| | - Dorte Melgaard
- Center for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800 Hjoerring, Denmark; (S.W.); (J.R.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Correspondence: ; Tel.: +45-2628-1086
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Beck M, Engelke E, Birkelund R, Martinsen B. Aesthetics sets patients 'free' to recover during hospitalization with a neurological disease. A qualitative study. Int J Qual Stud Health Well-being 2021; 16:1992843. [PMID: 34747349 PMCID: PMC8583855 DOI: 10.1080/17482631.2021.1992843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with neurological symptoms are particularly sensitive to the quality of the sensory impressions to which they are exposed to during hospitalization. AIM To understand the meaning of aesthetic experiences to patients afflicted with neurological diseases during hospitalization on a neurological unit. METHOD Fifteen patients were invited to "walk and talk" supplemented by semi-structured interviews conducted in newly established aesthetic tableaus within the neurology unit. Data analysis was inspired by the hermeneutic phenomenological methodology of van Manen. RESULT The data analysis identified three overarching themes that unfolded in the patients' experiences of a more aesthetic environment. The themes were: 1) A safe place to avoid noisiness, 2) An invitation to homey activities, 3) A thoughtful consideration for being ill. CONCLUSION Aesthetic elements can enable a thoughtful and needed consideration that withholds momentarily imaginative and hopeful experiences to patients in a vulnerable situation. Thus, aesthetics, together with peace and quietness, can set vulnerable patients free to retreat and recover from the symptoms of neurological diseases.
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Affiliation(s)
- Malene Beck
- Department of Neurology,Zealand University Hospital, Roskilde, Denmark
| | - Eileen Engelke
- College of Health Professions, Lienhard School of Nursing, Pace Universityr, Teachers College, Columbia University, New York City, NY, USA
| | - Regner Birkelund
- Department of Regional Health Research, Institute of Health Service Research (IRS), University of Southern Denmark, Odense, Denmark
| | - Bente Martinsen
- Institute of Health, Department of Nursing Science, Aarhus University, Campus Emdrup, Copenhagen, NV, Denmark
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Larsen KL, Schjøtler B, Melgaard D. Patients' experiences eating in a hospital - A qualitative study. Clin Nutr ESPEN 2021; 45:469-475. [PMID: 34620357 DOI: 10.1016/j.clnesp.2021.06.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 05/12/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Even though there is a lot of focus on nutrition in hospitals, patients often continue to lose weight during their stay. A meal is a complex activity. Several factors have an influence on the intake of nutrition. The purpose of the study is to identify the experiences of patients about eating situations, wishes and needs in connection with meals during their stay in the hospital. METHODS Twenty individual semi structured interviews were conducted at the North Denmark Regional Hospital and Aalborg University Hospital, Thisted. The inclusion criteria were age ≥18, cognitively and linguistically capable of participating and able to consume food ≥24 h. The participants were selected based on sex, age, and surgical and medical departments to ensure a broad representation. RESULTS The patients experienced that the health professionals were friendly and caring and the food was really good. Despite general satisfaction, the patients reported many different experiences that are presented in the following themes: "The care relationship," "Meeting the system," "Influence from the surroundings," and "Social interaction with fellow patients and physical discomfort". The care relationship is considered to be essential. Some patients felt that they were met by helpful and accommodating health professionals while others felt rejected and corrected. The patients reacted to the health professionals being busy by adapting their expectations to the system and accepting the conditions. Hospital surroundings with catheter bags and IV drips influenced the patients and diminished their desire for food. The physical surroundings could make it difficult to sit comfortably when eating. Some patients wanted the company of other patients during their meal but would like to be able to choose with whom they shared their meals. Some patients tended to feel exposed and found it undignified and preferred to eat alone. CONCLUSIONS The study indicates that it is important to ensure individual settings for the patients during meals and the focus should be on the relationship between patients and health professionals.
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Affiliation(s)
- Karen L Larsen
- Department of Quality and Patient Safety, North Denmark Regional Hospital, Denmark.
| | - Brigitte Schjøtler
- Department of Clinical Medicine and Acute Medicine, Staff Managements, Thisted, Aalborg University Hospital, Denmark.
| | - Dorte Melgaard
- Centre for Clinical Research, North Denmark Regional Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Beck M, Engelke E, Birkelund R, Martinsen B. Becoming a nomad when hospitalized with a neurological disease: a phenomenological study. Int J Qual Stud Health Well-being 2020; 15:1815487. [PMID: 32930071 PMCID: PMC7534284 DOI: 10.1080/17482631.2020.1815487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Patients with a neurological disease are affected by their ability to maintain focus and are easily disturbed by outside stimuli. Few studies have investigated how sensory impressions from the physical environment contribute to patient’s wellbeing during hospitalization. However, no studies have explored the meaning of the environment to patients with a neurological disease during hospitalization. To understand what it is like to be a patient in a hospitalized environment at the neurological department. Nine patients were interviewed. Data analysis was inspired by the hermeneutic phenomenological methodology of van Manen. Four themes were identified: Perceiving unrest leading to despair; Angling for attention from staff; Being in a vacuum of imposed passivity; Seeking breathing spaces. The study provides insight into how environment plays a significant role in relation to existential issues for patients during hospitalization. Hence, the patients illuminate the experience of becoming nomads lurking around to find breathing spaces when they were not offered a calm and familiar environment. Patients shared that a hospital interior can be appealing and uplifting, decreasing their experiences of placelessness and thereby supporting them in a life situation where they feel less threatened concerning their health and wellbeing.
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Affiliation(s)
- Malene Beck
- Department of Neurology, Zealand University Hospital , Roskilde, Denmark
| | - Eileen Engelke
- Lienhard School of Nursing, Pace University , New York, NY, USA.,Teachers College, Columbia University , New York, NY, USA
| | - Regner Birkelund
- Section of Health Services Research Lillebaelt Hospital, University of Southern Denmark, Vejle Hospital , Vejle, Denmark
| | - Bente Martinsen
- Institute of Health, Department of Nursing Science, Aarhus University , Copenhagen, Denmark
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Missel M, Birkelund R. Ricoeur's narrative philosophy: A source of inspiration in critical hermeneutic health research. Nurs Philos 2019; 21:e12254. [PMID: 31087495 DOI: 10.1111/nup.12254] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/14/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
Patient-centred care has gained ground in health service following a health policy initiative aimed at changing the paternalistic culture towards one with more patient involvement. Development of knowledge relating to people's lived experiences of illness is important in this context. Literature in the field of health science describes methods for exploring what is at stake for people affected by illness, and the French philosopher Paul Ricoeur has been a significant source of inspiration. Especially, Ricoeur's interpretation theory has been construed and applied in different, often schematic, methodological variations, whereas his narrative philosophy is a little used source of inspiration. Health science has been characterized by a biomedical awareness of method and the idea that there is a direct and immediate path to patients' experiences, a viewpoint that can be traced back to Descartes and the philosophy of subjectivism. Opposed to Descartes, Ricoeur says that we are already embedded in a world of traditions and meanings over which we have no control. According to Ricoeur, we leave traces when we express ourselves, and traces are formed by the world of meanings and traditions to which we belong. Often, the sense in the traces is hidden, making it impossible to directly understand individual's experiences. Reflection on an individual's lived experiences must take place via the narratives in which the individual expresses themselves. The centrepiece of Ricoeur's narrative philosophy is the threefold mimesis, which is an approach to understanding the meaning of peoples' lived experiences. The philosophical hermeneutics of Gadamer plays an important role in Ricoeur's theory of interpretation, although he has criticized Gadamer for failing to include one dimension in his philosophy; he finds this dimension in Habermas' ideology critique. Ricoeur's ideology critique is absent in health science research, which is why it has been made a focal point in this article.
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Affiliation(s)
- Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Regner Birkelund
- Institute of Regional Health Research, University of Southern Denmark & Lillebaelt Hospital, Vejle, Denmark
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Beck M, Birkelund R, Poulsen I, Martinsen B. Hospital meals are existential asylums to hospitalized people with a neurological disease: A phenomenological-hermeneutical explorative study of the meaningfulness of mealtimes. Nurs Open 2019; 6:626-634. [PMID: 30918713 PMCID: PMC6419126 DOI: 10.1002/nop2.246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/26/2018] [Accepted: 01/07/2019] [Indexed: 11/29/2022] Open
Abstract
AIM Hospital meals are challenging for neurological patients. Patients struggle with both physical eating disabilities and social issues during mealtimes. The aim of this study was to examine the meaningfulness of the phenomenon of hospital meals for hospitalized patients with a neurological disease. DESIGN Interviews (N = 23) with neurological patients were analysed and interpreted to gain in-depth comprehensive knowledge of the phenomenon of hospital mealtimes. METHOD Data were analysed and interpreted in a three-phased process using a phenomenological-hermeneutic approach inspired by Paul Ricouer. RESULTS Four themes were identified: (a) A lonely ride together with others; (b) Letting the chaotic setting fade into the background; (c) Mechanical activity with great personal significance; and (d) Humanizing the setting when eating in the hospital. Mealtimes were supporting existential moments to patients. Offering a calm mealtime setting was experienced by the patients as an asylum where uplifting and comforting feelings were raised.
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Affiliation(s)
- Malene Beck
- Institute of Health, Department of Nursing ScienceAarhus UniversityCopenhagenDenmark
- Neurology DepartmentZealand UniversityCopenhagenDenmark
| | - Regner Birkelund
- Section of Health Services Research Lillebaelt HospitalUniversity of Southern DenmarkVejleDenmark
- Vejle HospitalVejleDenmark
| | - Ingrid Poulsen
- Institute of Public Health, Department of Nursing ScienceAarhus UniversityAarhusDenmark
- TBI Unit, Research Unit on Brain Injury Rehabilitation, RUBRIC, Department of NeurorehabilitationGlostrup Hospital, Copenhagen UniversityHvidovreDenmark
| | - Bente Martinsen
- Institute of Health, Department of Nursing ScienceAarhus UniversityCopenhagenDenmark
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