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Ciotti S. "I Get It, I'm Sick Too": An Autoethnographic Study of One Researcher/Practitioner/Patient With Chronic Illness. QUALITATIVE HEALTH RESEARCH 2023; 33:1305-1321. [PMID: 37843470 DOI: 10.1177/10497323231201027] [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: 10/17/2023]
Abstract
This autoethnographic research utilizes reflexivity as a method to explore my self-experience of Lyme disease while holding co-occurring identities as a researcher, health professional, and mother. Awareness of self is central in psychotherapy so that therapists do not adversely impact their clients. This is similar for researchers who are ethically required to acknowledge and reduce any potential risk(s) of harm to their participants. In this study, I describe and systematically analyze my experiences as a patient with symptom-persistent Lyme disease, contextualized through co-occurring identities as a mother, a regulated (mental) health professional, and a scholar investigating the embodied experience of being a Lyme disease patient in the Canadian context. The central research question guiding this study is: "What are my experiences with symptom-persistent Lyme disease?" The results of this study suggest reflexivity is an important practice in both health research and healthcare. Relationships with health professionals have a significant impact on patients' healthcare experiences, and engaging in reflexive practice may improve the responsivity of healthcare professionals toward patients' needs and embodied experiences and serve as a check on pre-existing power relations in healthcare. Further, this research contributes to the current academic knowledge on symptom-persistent Lyme disease by offering a reflexive representation of my experiences as a researcher who is also a health professional and a patient within the Canadian healthcare system. Representations of patients' experiences are critical in advancing health research and ensuring equitable care for patients. Autoethnography offers important insights into patients' disease experiences.
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Affiliation(s)
- Sarah Ciotti
- Department of Child and Youth Studies, Brock University, St. Catharines, ON, Canada
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Tjernström K, Lindberg I, Wiklund M, Persson M. Negotiating the ambiguity of an (in)authentic working life: a grounded theory study into severe perineal trauma. BMC Womens Health 2023; 23:47. [PMID: 36750837 PMCID: PMC9902817 DOI: 10.1186/s12905-023-02191-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND In Sweden, persistent physical and psychological health problems occur in about three in ten women who sustain severe perineal trauma (SPT) during childbirth. As most Swedish women work outside the home, the question of if and how SPT-related morbidity influences working life needs exploration. This study aims to qualitatively explore how women with persistent SPT-related morbidities experience and conceptualise their problems concerning working life. Further, we theorise the findings by applying Simone de Beauvoir's feminist framework of immanence and transcendence as well as authentic and inauthentic life. METHODS Ten interviews with women recruited via a Swedish social media community for perineal trauma were analysed according to Charmaz's constructivist approach to grounded theory. RESULTS The theoretical model and related core category 'Negotiating the ambiguity of an (in)authentic working life' reflected the women's negotiations of immanence as 'the silent covert object' versus transcendence as the 'the resourceful overt subject'. The model also mirrored the conflict of (in)authenticity in working life. An inauthentic working life was experienced when women were denied their subjectivity at work or constructed themselves as subjects in denial of their SPT. On the other hand, women who acknowledged their SPT and were constructed as subjects by 'others' achieved an authentic working life despite SPT. CONCLUSIONS The conflicting gendered process of 'the silent covert object' versus 'the resourceful overt subject' problematised women's vulnerability at work. Aspects that enable subjectification and transcendence are essential for policymakers, employers, healthcare services, and society to eradicate the taboo of SPT and create a working environment characterised by understanding, support, and flexibility. Further, access to adequate care, sick leave, and occupational rehabilitation are essential. Such measures support transcendence towards an authentic working life and, consequently, a more gender-equal working environment that does not deprive women of career opportunities due to a physical ailment.
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Affiliation(s)
| | - Inger Lindberg
- grid.12650.300000 0001 1034 3451Department of Nursing, Umeå University, Umeå, Sweden
| | - Maria Wiklund
- grid.12650.300000 0001 1034 3451Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, Umeå, Sweden
| | - Margareta Persson
- grid.12650.300000 0001 1034 3451Department of Nursing, Umeå University, Umeå, Sweden
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Bidwell P, Sevdalis N, Silverton L, Harris J, Gurol-Urganci I, Hellyer A, Freeman R, van der Meulen J, Thakar R. Women's experiences of the OASI Care Bundle; a package of care to reduce severe perineal trauma. Int Urogynecol J 2021; 32:1807-1816. [PMID: 33475817 PMCID: PMC8295065 DOI: 10.1007/s00192-020-04653-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/10/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Obstetric anal sphincter injury (OASI) is a severe form of perineal trauma that can occur during vaginal birth. Long-term morbidities include anal incontinence and psychosocial disorders. To reduce these injuries within England, Scotland and Wales, the OASI Care Bundle was introduced to 16 maternity units (January 2017-March 2018). The OASI Care Bundle comprises four elements: (1) antenatal information, (2) manual perineal protection, (3) medio-lateral episiotomy (when indicated) and 4) recognition and diagnosis of tears. As part of the project evaluation, a qualitative study was conducted to explore women's experiences of the OASI Care Bundle. METHODS Semi-structured interviews were conducted with women (n = 19) who received the OASI Care Bundle as part of their maternity care. This was to explore their experience of each element. A thematic analysis of the interview data was performed. RESULTS Three themes were identified: (1) memories of touch, whereby women reported that a 'hands-on' approach to perineal protection was a positive experience; (2) midwife as a supportive guide, where women reported that good communication facilitated a calm birth and post-birth diagnosis; (3) education: women need more information about perineal trauma. CONCLUSION This study contributes to the literature through its exploration of women's experiences of perineal protection techniques and diagnosis of perineal trauma. Interviewed women indicated that they did not experience any of the care bundle elements as an intrusion of their physical integrity. Additionally, an urgent need was identified for more information about perineal trauma in terms of risk, prevention and recovery.
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Affiliation(s)
- Posy Bidwell
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.
| | - Nick Sevdalis
- Health Service and Population Research Department, King's College London, De Crespingy Park, London, SE5 8AF, UK
| | - Louise Silverton
- Royal College of Midwives, 10-18 Union Street, London, SE1 1SZ, UK
| | - James Harris
- Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
| | - Ipek Gurol-Urganci
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Alexandra Hellyer
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
| | - Robert Freeman
- University Hospitals Plymouth NHS Trust, Derriford Road, Devon, PL6 8DH, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Ranee Thakar
- Croydon Health Services NHS Trust, 530 London Road, Croydon, CR7 7YE, UK
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Jurczuk M, Bidwell P, Gurol-Urganci I, van der Meulen J, Sevdalis N, Silverton L, Thakar R. The OASI care bundle quality improvement project: lessons learned and future direction. Int Urogynecol J 2021; 32:1989-1995. [PMID: 33988784 PMCID: PMC8295109 DOI: 10.1007/s00192-021-04786-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
Abstract
Rising rates of obstetric anal sphincter injury (OASI) led to a collaborative effort by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) to develop and evaluate the OASI Care Bundle (OASI-CB). The OASI-CB comprises four practices (antenatal discussion about OASI, manual perineal protection, mediolateral episiotomy at 60° from the midline, and systematic examination of the perineum, vagina and ano-rectum after vaginal birth) and was initially implemented as part of a quality improvement (QI) project—“OASI1”—in 16 maternity units across Great Britain. Evaluation of the OASI1 project found that the care bundle reduced OASI rates and identified several barriers and enablers to implementation. This paper summarises the key findings, including strengths, limitations and lessons learned from the OASI1 QI project, and provides rationale for further evaluation of the OASI-CB.
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Affiliation(s)
- Magdalena Jurczuk
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.
| | - Posy Bidwell
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK
| | - Ipek Gurol-Urganci
- Centre for Quality Improvement and Clinical Audit, Royal College of Obstetricians and Gynaecologists, 10-18 Union Street, London, SE1 1SZ, UK.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Louise Silverton
- Royal College of Midwives, 10-18 Union Street, London, SE1 1SZ, UK
| | - Ranee Thakar
- Croydon University Hospitals NHS Trust, 530 London Road, Croydon, CR7 7YE, UK
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Bidwell P, Thakar R, Gurol-Urganci I, Harris JM, Silverton L, Hellyer A, Freeman R, Morris E, Novis V, Sevdalis N. Exploring clinicians' perspectives on the 'Obstetric Anal Sphincter Injury Care Bundle' national quality improvement programme: a qualitative study. BMJ Open 2020; 10:e035674. [PMID: 32907894 PMCID: PMC7482496 DOI: 10.1136/bmjopen-2019-035674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/07/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Obstetric anal sphincter injuries (OASI) can have severe debilitating consequences to women and health systems. The OASI Care Bundle quality improvement programme was introduced in 16 maternity units across England, Scotland and Wales (January 2017 to March 2018) to address increasing OASI rates. OBJECTIVES To explore clinicians' (midwives' and obstetricians') perspectives of the OASI Care Bundle with respect to (1) acceptability, (2) feasibility, and (3) sustainability. DESIGN A qualitative exploratory study using focus groups methodology. SETTING A total of 16 focus groups were conducted in 16 maternity units in England, Scotland and Wales where the OASI Care Bundle was implemented. Focus groups took place approximately 3 months following initial implementation of the care bundle in each unit. PARTICIPANTS A total of 101 clinicians participated, with an average of six per focus group. Participants volunteered to take part and compromised of 37 obstetricians and 64 midwives (including eight students). The majority were female and the mean age was 36.5 years. RESULTS Four main themes emerged: 'Implementation strategies', 'Opportunities to use the OASI Care Bundle', 'Does current practice need to change?' and 'Perceptions of what women want'. Midwives were more likely than obstetricians to report themes alluding to 'what women want' and variations in intrapartum perineal protection techniques. Both professional groups reported similar views of other themes, in particular regarding the supporting clinical evidence. Gaps were identified in clinicians' knowledge and experience of intrapartum perineal management. CONCLUSIONS Adoption of the OASI Care Bundle was associated with a number of cognitive and interpersonal factors, such as personal values, interprofessional working and how the intervention was launched; which both facilitated and impeded adoption. The 'what women want' theme has implications for maternal autonomy and needs further exploration. Our findings can be used by similar initiatives to reduce perineal trauma both nationally and internationally. TRIAL REGISTRATION NUMBER ISCTRN 12143325; https://doi.org/10.1186/ISRCTN12143325.
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Affiliation(s)
- Posy Bidwell
- Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Ipek Gurol-Urganci
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - James M Harris
- Centre for Nursing, Midwifery and Allied Health Professional Research, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Edward Morris
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Vivienne Novis
- Royal College of Obstetricians and Gynaecologists, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London, London, UK
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Rania N. Giving voice to my childbirth experiences and making peace with the birth event: the effects of the first childbirth on the second pregnancy and childbirth. Health Psychol Open 2019; 6:2055102919844492. [PMID: 31065379 PMCID: PMC6487774 DOI: 10.1177/2055102919844492] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This autoethnographic study describes the author's waterbirthing experience to evidence the relationship between fear of childbirth and communication with, and support from, healthcare professionals and the medical process during labour and delivery. The study provides a rereading of the author's experience, which demonstrates how the traumatic consequences of a first childbirth influenced the experience of a second pregnancy and childbirth. This account indicates how lack of training and inadequate communication by medical staff can lead to traumatic childbirth experience. The study enhances understanding of womens' transition to motherhood with implications for practice, education and research of midwives and other medical providers.
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Affiliation(s)
- Nadia Rania
- Department of Education Sciences, University of Genoa, Italy
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Pariseau-Legault P. [From clinical practice to nursing research: Auto-ethnography as a tool for analyzing the researcher’s identity transitions]. Rech Soins Infirm 2019:38-47. [PMID: 30767466 DOI: 10.3917/rsi.135.0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The scientific legitimacy of nursing research depends on its adherence to different scientific criteria. Despite the lack of consensus on predetermined criteria, reflexivity is widely discussed as a strategy to establish rigour in qualitative research. Unfortunately, with the exception of tools such as the reflexive journal, little is said about how reflexivity can be completed. Several recent studies suggest the relevance of autoethnography to support the reflexive approach of nurse researchers. Inspired by the findings of an autoethnography and a narrative literature review, this article examines how this approach can contribute to the reflexivity of the nurse researcher. Autoethnography seems particularly adapted to the professional and academic context in which many nurses evolve. As a reflective tool, autoethnography can promote the development of the researcher's self-awareness, provide analytical tools to help better understand the influence of previous experiences on the relationship to research and report on the transition between different professional identities. In order to contribute to the debate on the use of autoethnography in qualitative research, central elements to this approach are discussed.
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