Unlocking intuition and expertise: using interpretative phenomenological analysis to explore clinical decision making

"Black Women Should Not Die Giving Life": The lived experiences of Black women diagnosed with severe maternal morbidity in the United States

OBJECTIVE

We sought to understand the lived experiences of Black women diagnosed with severe maternal morbidity (SMM) in communities with high maternal mortality to inform practices that reduce obstetric racism and improve patient outcomes.

METHODS

From August 2022 through December 2022, we conducted a phenomenological, qualitative study among Black women who experienced SMM. Participants were recruited via social media and met inclusion criteria if they self-identified as Black cisgender women, were 18-40 years old, had SMM diagnosed, and lived within zip codes in the United States that have the top-five highest maternal mortality rates. Family members participated on behalf of women who were deceased but otherwise met all other criteria. We conducted in-depth interviews (IDIs), and transcripts were analyzed using inductive and deductive methods to explore birth story experiences.

RESULTS

Overall, 12 participants completed IDIs; 10 were women who experienced SMM and 2 were mothers of women who died due to SMM. The mean age for women who experienced SMM was 31 years (range 26-36 years) at the time of the IDI or death. Most participants had graduate-level education, and the average annual household income was 123,750 USD. Women were especially interested in study participation because of their high-income status as they did not fit the stereotypical profile of Black women who experience racial discrimination. The average time since SMM diagnosis was 2 years. Participants highlighted concrete examples of communication failures, stereotyping by providers, differential treatment, and medical errors which patients experienced as manifestations of racism. Medical personnel dismissing and ignoring concerns during emergent situations, even when raised through strong self-advocacy, was a key factor in racism experienced during childbirth.

CONCLUSIONS

Future interventions to reduce racism and improve maternal health outcomes should center on the experiences of Black women and focus on improving patient-provider communication, as well as the quality and effectiveness of responses during emergent situations. Précis statement: This study underscores the need to center Black women's experiences, enhance patient-provider communication, and address emergent concerns to mitigate obstetric racism and enhance maternal health outcomes.

Is It Safe Enough? An IPA Study of How Couple Therapists Make Sense of Their Decision to Either Stop or Continue with Couple Therapy When Violence Becomes the Issue

BACKGROUND

Couple therapists will encounter couple violence in their practice at some point. In this context, one of the main questions they must address is whether to continue with conjoint sessions. This study explores how couple therapists make sense of their decision whether or not to continue with conjoint sessions when violence has become an issue.

METHODS

This qualitative study used four semi-structured focus groups and Interpretative Phenomenological Analysis (IPA) to analyse the data from the twelve experienced couple therapist participants.

RESULTS

Our IPA analysis led to three main group experiential themes across the focus groups: (1) Is it safe enough? (2) Do we have a joint and regenerative project? (3) Three key sources for sense making.

CONCLUSION

Partner violence challenges the realm of couple therapy. This article explored how the couple therapists orient themselves and grapple with decision making when violence becomes an issue. The article offers unique insights regarding what the therapists orient themselves towards and how they try to form an impression of whether to continue conjoint sessions. We outline immediate clinical implications and propose measures for building individual and organisational capacity regarding "clinical sense making". Suggestions for further research are also addressed.

N-carbamylglutamate supplementation induces functional egg production in layers by modulating liver transcriptome profiles

Eggs rich in polyunsaturated fatty acids (PUFA), known as functional eggs, are animal products deemed beneficial to human health and possess high economic value. The production of functional eggs involves supplementing exogenous additives with the ability to regulate lipid metabolism. As N-Carbamylglutamate (NCG) serves as an endogenous arginine synthesizer, and arginine acts as the substrate for the formation of nitric oxide (NO), the biological function of NCG is partially mediated by NO. NO is a key regulatory molecule in lipid metabolism, suggesting that NCG may also have the ability to modulate lipid metabolism. In order to assess the capacity of NCG in regulating liver lipid metabolism and its potential application in producing functional eggs, we conducted a study to investigate the effects of dietary supplementation of NCG on production performance, serum, and liver NO levels, yolk fatty acid composition, and the liver transcriptome of layers. In this study, we utilized 30 layers of the Jinghong No.1 breed, all aged 45 wk. All the birds were randomly divided into 2 groups. Each group had 5 replicates, and each replicate had 3 birds. We provided them with different diets: one group received the basic diet, and the other group's diet was supplemented with 0.08% NCG. The experiment lasted for 14 wk. The results did not reveal any positive impact of NCG on production performance. However, NCG supplementation elevated NO levels in serum and liver, along with an increase in yolk PUFA, ω-3, and ω-6 fatty acids. Liver transcriptome analysis identified 124 upregulated differentially expressed genes (DEGs) and 43 downregulated DEGs due to NCG supplementation. Functional annotation using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database highlighted 3 upregulated DEGs (CPT1A, MOGAT1, and CHKA) and 2 downregulated DEGs (FASN and ETNPPL) associated with lipid metabolism. Pathway enrichment analysis revealed that CPT1A was enriched in the AMPK signaling pathway and the PPAR signaling pathway, while FASN was enriched in the AMPK signaling pathway. Thus, CPT1A and FASN are potential functional genes related to lipid metabolism facilitated by NCG supplementation. In summary, our study suggests that NCG supplementation modulates liver lipid metabolism, leading to the production of functional eggs in layers.

Educational intervention with serial album about pregnant women positioning for spinal anesthesia: randomized clinical trial

OBJECTIVE

To evaluate effectiveness of using educational intervention serial album to positioning pregnant women for spinal anesthesia.

METHOD

Randomized clinical trial with 90 women casually assigned to control (CG) and intervention group (IG), in a maternity hospital located in Northeast region of Brazil. The primary endpoint was "achieve correct positioning to perform spinal anesthesia"; and secondary, "how number of spinal cord puncture attempts". Effectiveness was verified using the chi-square test, Fisher's exact test and likelihood ratio.

RESULTS

The positioning was correct in 37 women in each group. There was an association between women in control group remaining still, relaxing shoulders and flexing the spine; and women in intervention group should remain still and relax the shoulders; furthermore there was a statistical association achieved by correct positioning and the number of attempts to access the lumbar puncture.

CONCLUSION

Educational intervention with serial album was effective and contributed to immobility and positioning of pregnant women. Brazilian Registry of Clinical Trials (RBR-3Z7SRD).

Understanding the "gut instinct" of expert coaches during talent identification

Coaches are an integral part of talent identification in sport and are often used as the "gold standard" against which scientific methods of talent identification are compared. However, their decision-making during this process is not well understood. In this article, we use an ecological approach to explore talent identification in combat sports. We interviewed twenty-four expert, international-level coaches from the Olympic disciplines of boxing, judo, and taekwondo (age: 48.7 + 7.5 years; experience: 20.8 + 8.3 years). Findings indicated that when coaches identify talent they rely on "gut instinct": intuitive judgements made without conscious thought, used to direct attention to particular athletes or characteristics. Our analysis revealed four major contributors to coaches' intuition: experiential knowledge, temporal factors, seeing athletes in context, and what can be worked with. Our findings demonstrate that i) athlete selections may be influenced by the coaches' perceived ability to improve certain athletes (rather than solely on athlete ability); and ii) "instinctual" decisions are the result of years of experience, time spent with the athlete, and the context surrounding the decision. Based on these findings, we recommend that future research focuses on the duration and conditions that are required for coaches to confidently and reliably identify talented athletes.

Healthcare professionals providing care coordination to people living with multimorbidity: An interpretative phenomenological analysis

AIMS AND OBJECTIVES

To explore the healthcare professionals (HCP) experience of providing care coordination to people living with multimorbidity.

BACKGROUND

There is increasing interest in improving care of people living with multimorbidity who need care coordination to help manage their health. Little is known about the experiences of HCP working with people living with multimorbidity.

DESIGN

Phenomenological approach to understanding the experiences of HCP.

METHODS

We interviewed 18 HCP, including 11 registered nurses, working in care coordination in Melbourne, Australia. We used interpretative phenomenological analysis to identify themes from descriptions of providing care, identifying and responding to a person's needs, and the barriers and facilitators to providing person-centred care.

RESULTS

We identified four themes as follows: (a) Challenge of focusing on the person; (b) "Hear their story," listening to and giving time to clients to tell their story; (c) Strategies for engagement in the programme; and, (d) "See the bigger picture," looking beyond the disease to the needs of a person. Our results are reported using COREQ.

CONCLUSIONS

The HCP experienced challenges to a traditional approach to care when focusing on the person. They described providing care that was person-centred, and acknowledged that optimal, guideline-oriented care might not be achieved. They took the necessary time to hear the story and see the context of the person's life, to help the person manage their health.

RELEVANCE TO CLINICAL PRACTICE

For registered nurses in care coordination programmes, focusing on the client may challenge traditional approaches to care. Providing care involves developing a relationship with the client to optimise health outcomes. Experienced registered nurses appear to use skills in reflective practice and accept the parameters of care to improve the client's health and well-being.

Clinical judgment and diagnostic reasoning of nursing students in clinical simulation

ABSTRACT Objectives: to determine the degree of association between clinical judgment and diagnostic reasoning of nursing students in clinical simulation. Methods: this is a correlational research design using a quantitative approach. The sample consisted of 41 nursing students who assisted a patient with vaso-occlusive crisis in a high-fidelity clinical simulation setting. The instruments used included the Lasater Clinical Judgment Rubric - Brazilian Version and the Diagnostic Thinking Inventory. Results: clinical judgment was associated with diagnostic reasoning (r=0.313; p=0.046), as well as the “noticing” aspect of clinical judgment with diagnostic reasoning (r=0.312; p=0.047). Conclusions: the results show that skills to interpret patient data are associated with diagnostic reasoning skills. Teaching clinical judgment skills is necessary to develop the diagnostic reasoning of nursing students.