The experiences of international students in a Canadian faculty of nursing: A narrative inquiry study

BACKGROUND

In response to the global need for nursing faculty, and nurses in leadership and advanced clinical practice roles, students from different countries come to Canada for their graduate nursing education. The positive reputation and the perceived advantages of the education system are particularly compelling to applicants from the countries located in the Global South. However, these students come from different social, historical, political, cultural, and educational backgrounds that deeply influence their learning experiences in Canada.

OBJECTIVE AND METHODOLOGY

The aim of this narrative inquiry study was to understand the experiences of international graduate nursing students. The focus was to unravel two puzzles of this inquiry: What stories across social, historical, political, cultural, and educational borders shaped students' identities and ways of knowing? How did the experience in Canada impact their identities?

SETTING AND PARTICIPANTS

Participants were invited from a Master of Nursing program at a research-intensive University in Western Canada.

METHODS

Participants engaged in series of conversations over a period of one year.

RESULTS

Multiplicity of borders and identity making, border making, and border crossing, were the threads that resonated across the narrative accounts.

CONCLUSION

These narrative threads provided insights into the lived experiences of tensions, the shifting of identities, and the day-to-day challenges that international students face while learning in Canada. Being aware of these experiences and acknowledging them could be a significant stride towards addressing the issues of racism, inequity, and exclusion for international students within Canadian graduate nursing education.

Patient and user perspectives

OBJECTIVE

To develop an in-depth understanding of how people with COPD exercise power in the self-management of their illness.

METHODS

This was a narrative inquiry using Foucault's concepts of power, knowledge and agency as a conceptual framework. Up to three unstructured interviews were conducted with 31 people with COPD in the Republic of Ireland. Thematic template analysis was used to analyse the data. The COREQ checklist was used to report this qualitative study.

RESULTS

The findings of the study show that participants exercised power through mobilising agency in two main ways. They resisted the imposition of power by leveraging different types of knowledge. They also engaged in practices designed to operate on the self and the body in order to achieve happiness and health. However, this agency was constrained by the imposition of power by health care professionals.

CONCLUSION

The findings expand the understanding of self-management as a complex and multi-dimensional concept that is negotiated and constructed by people with COPD, using their own knowledge and agency.

PRACTICE IMPLICATIONS

Honouring the considerable skills and resources that people with COPD mobilise to self-manage should form the heart of person-centred self-management support.

A Narrative Inquiry of Critical Events Supporting Professional Identity Formation in Introductory Pharmacy Practice Experiences

OBJECTIVE

Professional identity formation (PIF) is the process of internalizing a profession's core values and beliefs so that one begins to think, act, and feel like a member of that profession. PIF occurs over an individual's professional socialization in stages, precipitated by critical moments or experiences. The purpose of this study was to answer the following: (1) What are the critical events for pharmacy student PIF in introductory pharmacy practice experiences?; and (2) How do these events support or challenge PIF?

METHODS

This study used critical event narrative inquiry methodology. A critical event is an experience that creates a change in understanding and affects professional performance. Semistructured interviews were conducted with pharmacy students who completed introductory pharmacy practice experience rotations in community (first year) and hospital (second year) settings. Interviews were coded and analyzed using narrative analysis.

RESULTS

Twelve first-year and 10 second-year students participated in this study. Narratives revealed that common experiential education experiences resulted in a deeper understanding of core role elements (ie, professional autonomy, responsibility, interprofessional collaboration, and patient-centered care), leading to changes in agency, knowledge, and anticipated future behaviors. While first-year participants' narratives mainly focused on understanding pharmacist roles ("what"), second-year participants focused on understanding the process to fulfill those roles ("how to"). Emotions, assuming responsibility, external validation, and preceptor guidance supported these events.

CONCLUSION

Critical events in introductory pharmacy practice experiences affect and shape pharmacy students' PIF. These events are relevant to pharmacy education because these experiences can result in changes in knowledge, agency, or future behaviors for students.

Critical approaches to English language teacher education: A narrative inquiry into trainee teachers' experiences as speakers of English

Working within the framework of critical language teacher education, this article concerns itself with the disenfranchising experiences of a group of trainee English language teachers as speakers of English in the world. It presents the results of a mixed-method narrative inquiry carried out with 198 trainee teachers studying undergraduate and postgraduate degrees in Teaching English as a Foreign Language in the South of Spain. Both a questionnaire and structured interviews were used to collect participants' narratives of the disenfranchising experiences they have had as English speakers, their reflections on the factors that played a role in those experiences and their tools to manage them. The ATLAS.ti program was used to carry out the content analysis of the narratives, using both deductive and inductive categories. Results point to the need to address the interrelation of language, power and identity as part of teacher training programs and adopt a critical perspective in English language teacher education in order to equip future teachers to better understand communication and the factors that play a role in it, balance power inequalities in communicative interactions and deal with disenfranchising experiences as English speakers in the world.

"I was able to take it back": Seeking VBAC after experiencing dehumanizing maternity care in a primary cesarean

In this article, we present findings from a qualitative narrative analysis that examined the pregnancy, primary cesarean, and subsequent birth experiences of women in the United States. Using a maximal variation sampling strategy, we recruited participants via social media and networking to participate in semistructured interviews. Twenty-five women from diverse backgrounds and geographic locations across the U.S. participated, eight self-identified as racialized and seventeen as non-Hispanic, White. Data were analyzed iteratively using Clandinin and Connelly's approach to Narrative Inquiry. Across their narratives, participants described their experiences of maternity care that were either generally negative (dehumanizing care) or positive (humanized care). They further described how their experiences of dehumanizing or humanized care impacted their decision-making for subsequent births, mental health, relationships with the healthcare system, early parenting birth satisfaction, and family planning. Findings suggest that regardless of ultimate mode of birth, what was most important to women was how they are treated by their maternity care team. We suggest practice changes that may improve the experience of maternity care for primary cesarean and subsequent births, especially among those made marginal by systems of oppression.

"Nothing's changed, baby": How the mental health narratives of people with multiple and complex needs disrupt the recovery framework

The dominant narrative in mental health policy and practice has shifted in the 21st century from one of chronic ill health to a 'recovery' orientation. Knowledge of recovery is based on narratives of people with lived experience of mental distress. However the narratives of people experiencing structural inequalities are under-represented in recovery research. Meanwhile, uses of recovery narratives have been critiqued by survivor-researchers as a co-option of lived experience to serve neoliberal agendas. To address these twin concerns, we undertook a performative narrative analysis of two 'recovery narratives' of people with multiple and complex needs, analysing their co-construction at immediate/micro and structural/macro levels. We found two contrasting responses to the invitation to tell a recovery story: a narrative of personal lack and a narrative of resistance. We demonstrate through reflexive worked examples how the genre of recovery narrative, focused on personal transformation, may function to occlude structural causes of mental distress and reinforce personal responsibility in the face of unchanging living conditions. We conclude that unacknowledged epistemological assumptions may contribute to co-constructing individualist accounts of recovery. A critical, reflexive approach, together with transparent researcher positionality, is imperative to avoid the epistemic injustice of a decontextualised form of recovery narrative.

Patient's experiences of diabetes care at a tertiary health facility in Lilongwe, Malawi

BACKGROUND

Little is known about experiences of rural people with diabetes care at a tertiary health facility in low-income settings. Understanding their experiences is essential for developing effective diabetes care interventions.

METHODS

The study employed a qualitative narrative inquiry. Participants were identified at a diabetes clinic at a tertiary-level healthcare facility. Ten participants from the rural areas attending the diabetes clinic were purposively selected. Data were collected through in-depth interviews in the privacy of the homes of the study participants and analysis was done using the Riessman approach to thematic narrative analysis.

RESULTS

In this study, the following four themes emerged: (1) the long pathway to a diagnosis of diabetes; (2) Poverty-related hardships and diabetic clinic attendance; (3) The impact of health worker attitudes and behavior on diabetes care; and (4) Low resources and their impact on self-management.

CONCLUSIONS

Rural-based patients living with diabetes encounter enormous challenges as they access diabetes care. One of the challenges is delayed diagnosis of diabetes. There is a need to introduce point-of-care (POC) testing to improve diabetes diagnosis. In addition, there is a need to strengthen awareness campaigns among the population so that people are well informed about the signs and symptoms of diabetes to promote early diagnosis. Diabetes care must be decentralized from tertiary hospitals to primary health centers. This will improve access to diabetes care and reduce the burden associated with traveling a long distance to access diabetes care in Malawi.

Perspectives on creative well-being of older adults

The growing aging population has become a significant global issue in recent years, increasing the need for research that examines aging-related phenomena such as personal growth and development in later life. A major challenge in achieving this aim is the prevailing deficit perspective on aging, which is so pervasive that it often overshadows older adults' contributions to society and diminishes the opportunities encountered in older adulthood. Although perspectives on the nature of aging are gradually changing in a positive way, and the developments in medicine are improving health-related aspects of aging, it is still a worldwide challenge to eradicate negative stereotypes around aging. This article explores empirical perspectives on aging by analyzing diverse narratives gathered from open-ended interviews we conducted in Finland from 2019 to 2021. Focusing on their aging experiences and the value of a broad range of creative engagements and interventions that older adults have joined voluntarily, the study aims to provide a better understanding of personal perspectives of aging, the creative well-being of older adults, and the growing diversity of experiences within the older age group. Based on the findings of this study, we highlight the importance of promoting older adults' engagement in art-based interventions to enhance their creativity and well-being in later life, as well as fostering aging-friendly co-creative approaches in such interventions by involving the older adults themselves in the process.

A narrative inquiry into caregivers' experiences and management after a relative's suicide attempt in a rural community in Northeast Thailand

Suicide attempts have long-term negative consequences for families. This study reports a narrative inquiry using a social constructionist perspective to investigate how caregivers in rural northeast Thailand describe their experiences and management strategies following a family member's suicide attempt. From thematic analysis, three themes emerged: (1) distress and embarrassment, (2) managing to prevent re-attempts, and (3) letting go and moving on with my life. The implications discussed for mental health professionals include recognizing caregivers' experiences and developing more effective ways to manage the risk of future attempts.

Voices of Australian Mature-Age Bachelor of Counselling Students: Telling Stories of Learning and Teaching Transitions

The COVID-19 pandemic imposed transformations on the higher education context of the twenty-first century that adversely impact students' learning in certain disciplines. On a mission to adopt ethics of care in research and practice, this research focuses on counselling education and its unique characteristics, by signifying counselling students' voices in such changing contexts. A qualitative exploratory multiple case study design informed by narrative inquiry was used, followed by a voice-centred relational method of analysis. Findings revealed voices, relationships, dominant narratives and power relations that influence counselling students' learning experiences. Implications for future research and practice for counselling education are highlighted.

The Impact of the Pandemic and Protests on Identity and Purpose: A Narrative Inquiry with an International Chinese Student

For Chinese international students attending colleges and universities, COVID-19 and protests related to racism intertwined to create impactful experiences. In this narrative inquiry study, Emma's experiences as a graduate student culminate in her story of identity and racism. Narrative themes of personal and cultural identity, experience and interactions with racism, privilege, and advocacy and social responsibility were constructed.

Nonurgent Pediatric Interhospital Transfers: A Narrative Enquiry of Nurses' Experiences in Australia

INTRODUCTION

This study aimed to explore nonurgent pediatric interhospital transfers through the lens of nurses' experiences and perceptions when undertaking these transfers.

METHODS

Using a narrative inquiry approach, data were collected via semistructured interviews with registered nurses (N = 7) who had experience undertaking patient transfers between nonurgent low-acuity and urgent high-acuity hospital settings.

RESULTS

Findings established the following 8 themes: ensuring transfer preparation for risk mitigation, practicing confident advocacy, being accountable for risk mitigation of the deteriorating patient during transfer, maintaining standardized procedure, using training and mentorship to support confidence, maintaining interhospital and intrahospital relationships, recognizing the significance of transfer on families, and acknowledging the burden of transfer and delay.

DISCUSSION

By exploring the stories and experiences of emergency nurses who undertake pediatric interhospital transfers, a deep investigation of the risks and challenges has been described, an area often underrepresented in the literature. Findings from this study highlight important learnings for pediatric interhospital transfer that add value to the wider body of evidence.

"It really puts me in a bind", professionalism dilemmas reported by Chinese residents

Residents play a pivotal role in the healthcare system. However, few tools have systematically revealed the dilemmas and challenges faced by residents. This study aimed to develop a checklist for professionalism dilemmas based on a behavior-based professionalism framework and to examine the range and proportion of professionalism dilemmas heard of, witnessed, or experienced by Chinese residents. Mixed methods were used, comprising qualitative (document analysis and focus group interviews) and quantitative (a small-scale questionnaire survey) data. Document analysis summarized professionalism dilemma items from previous publications. For focus group interviews, we used narrative inquiry to explore and make sense of residents' experiences and perceptions of professionalism dilemmas. A small-scale questionnaire survey was conducted during each focus group to investigate the proportion of professionalism dilemma items that residents reported to have heard of, witnessed, or experienced. Through document analysis and focus group interviews, we developed a checklist of professionalism dilemmas based on a behavior-based professionalism framework. The checklist included 58 items over four domains, with 10 sub-domains (compassion, respect, communication, collaboration, integrity, duty, pursuit of excellence, fair stewardship of health care resources, patient confidentiality, and informed consent). We also sought a preliminarily subjective impression by exploring the proportion of residents who have heard of, witnessed, and experienced each of the professionalism dilemma items and residents' perspectives when faced with professionalism dilemmas. Residents inevitably encounter or experience a diverse range of professionalism dilemmas. This checklist of professionalism dilemmas that was developed could prove to be a significant reference for targeted professionalism education, both for the resident as well as for faculty. It can also act as a helpful tool for improving hospital management guidelines and patient education.

Semi-structured interview for self-esteem regulation research

There are numerous controversies in research exploring personality dynamics and intrapsychic processes, e.g. insufficient insight provided by available measures such as self-report questionnaires. As a consequence, new methods are developed. Some of the recent theories indicate that self-esteem is not a stable personality trait, but a dynamic construct fluctuating as a result of (mostly) social interactions. I present a semi-structured interview protocol as a method of data collection which can provide rich verbal and non-verbal material referring to self-esteem regulation. Analysis system is not included as there can be many different approaches to use collected data, e.g. qualitative content analysis or narrative inquiry methods. In this paper, I present exemplary statements of participants corresponding to every part of the interview. The examples are explained considering theoretical background. Finally, the strengths and limitations of presented method are discussed, as well as possible research areas to explore with it.

Perceptions and experiences of leadership in undergraduate nurse education: A narrative inquiry

BACKGROUND

This research explored the experiences and perceptions of leadership preparation in pre-registration nursing education. The development of leadership skills in the pre-registration period is often considered a continuous process, and evidence suggests there has been an inconsistent approach to leadership within undergraduate nurse education. Exploring perceptions of experiences in this area was deemed important to guide future leadership development for undergraduate nursing students and formed the rationale for this Doctoral study.

DESIGN AND METHODS

The phenomena of interest were the expectations, experiences and perceptions of student nurses, academics, and nurses in preparation for the role of leadership. A narrative methodology to learning and contexts of learning was applied, data collection included semi structured interviews conducted early in 2020. Metaphorical associations through images are thought to support leadership development and philosophies; therefore, photographic elicitation was used to evoke association and emotions, facilitate reflection, and enable expression. The framework for narrative inquiry combined with the theoretical background was used for data analysis.

RESULTS

Leadership is perceived to be an important aspect of the role of a qualified nurse and should be considered as central to learning development for undergraduate students. While all participants valued the importance of leadership in nursing, this research revealed how each narrated experience of leadership holds emotional impact on how leadership is viewed in self and others.

CONCLUSIONS

Participants' experience shaped each story of perceptions of leadership, both within education and in clinical practice. Students' narratives revealed tensions between expectations of leadership, defining leadership and associating their experiences with a personal vision of self as leader in the future role, along with a perceived disconnect between the social and cultural experiences and context of learning. Tensions within the experiences of the academics also revealed a juxtaposition between aligning their experience of leadership with the educational preparation of students and the experiences from clinical leadership, within the social constructs of dual professions and learning contexts.

Silent voices of the midwives: factors that influence midwives' achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry

BACKGROUND

In Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery).

METHODS

This was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes.

RESULTS

Thematic analysis of the midwives' responses revealed three factors that influence successful resuscitation: 1. Hands-on training ("HOT") with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills; 2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and. 3. Strategies that reduce barriers. Immediately after birth, live resuscitation can commence at the mother's bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation. The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research.

CONCLUSIONS

Training in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of "HOT" real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife's beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.

Lost voices: Using a case study to illustrate narrative inquiry: Research brief

INTRODUCTION

In this study, we tested the feasibility of using a narrative inquiry - three-dimensional space inquiry to elicit the experiences of an adult family member who shared her journey of care and advocacy for her husband situated in a dementia care unit.

BACKGROUND

The voices of family members are rarely heard in relation to their experiences about being included in or making decisions about their loved one's care. Shared decision-making has been an important patient-centred approach to nursing care since the 1990s; however, it is often not a reality in aged care facilities.

METHOD

An interview was conducted with one adult family member using the three-dimension space that is inspired by narrative theorists to analyse the narrative.

RESULTS

Three themes were identified in the responses: communication between staff and family, staffing in the dementia care unit, and loss of voice and shared decision making.

CONCLUSION

Results of this study indicate that narrative inquiry supports the telling of personal experiences around a problem and then using that information to raise awareness of those issues that are not always heard but which are essential for change in health care policy and practice.

Non-binary reproduction: Stories of conception, pregnancy, and birth

Background: Many non-binary individuals AFAB (assigned female at birth) seek gestational parenthood. However, the limited available literature is often focused on trans men and overlooks the conception, pregnancy, and birth experiences of non-binary parents. Aims: The study aimed to capture the unique reproduction narratives of non-binary people AFAB. Methods: Five non-binary individuals volunteered to participate in this study. Data were collected using largely unstructured, in-depth, tape-recorded interviews. Thematic analysis of the verbatim transcripts and tape recordings yielded a chronological, cohesive narrative for each participant. Four participants reviewed their narrative and confirmed that their story was accurately represented. The individual narratives were then woven into one collective narrative, and common themes across the participants' stories were identified. Results: Before conception, most participants considered how to balance their medical and social transitions with their reproductive goals. Conception was relatively easy and straightforward for the four participants who used their partner's sperm. The gendered nature of, and language surrounding, pregnancy greatly impacted participant's reproductive experiences, leading to feelings of isolation and loneliness, difficulties finding maternity clothes and gender dysphoria. Participants desired gender-affirming care and reported mostly positive experiences with their healthcare providers. Their gender identity influenced their experiences of parenthood, as well as the decisions they made regarding the disclosure of their gender identity to others, their gender presentation, chestfeeding, and parental designations. Discussion: The cisnormative and heteronormative scripts that surround pregnancy shaped the reproductive narratives of those who participated in this research. The findings reinforce the importance of inclusive, gender-affirming healthcare and social support services.

Synchronous teaching and asynchronous trauma: Exploring teacher trauma in the wake of Covid-19

Following the onset of COVID-19, major subsections of our global society have shifted and mutated from the status quo of operation, especially in the field of education. A system that served far more social functions than just basic literacy and numeracy instruction, education has shifted out of the school buildings and into living rooms and spare bedrooms across the world. This research investigated the physical and psychological implications of traversing and functioning in this new virtual world that educators found themselves operating in. This study utilized narrative inquiry and survey data in order to gather mixed method data to gain a deeper understanding of the impact of COVID-19 and how educators processed and coped with the transition to distance learning. The findings illuminated narratives of trauma and managing stress in the face of the pandemic. Additional study may focus on replicating this research across multiple research locations.

Marginalised voices in wound care: Experiences of people who inject drugs living with leg ulceration "The Gutter, the Nick or a Box!!"

Portraying the authentic voice of people who inject drugs (PWID) through narrative means is novel in contemporary literature. The study explored the experiences of PWID living with chronic leg ulceration using qualitative methodology set in a naturalistic paradigm. Led from the perspective of a nurse-researcher in the field of wound management, the study is original from a purist narrative perspective and offers a unique opportunity to gain a rare glimpse into the daily life of PWID as reported in their own words. The methodology chosen was diaries conducted over four weeks, followed by semi-structured interviews. The study was set in North London (UK); participants were recruited from three sites: a general acute NHS hospital, the community and a non-NHS clinical facility. Complete data collection took over 12 months. Open coding was used for word-by-word scrutiny of each diary entry and thematic analysis. The qualitative data software tool NVivo Version-10 was used to support this analysis. Ten participants completed the data collection process: seven males and three females (age range 35-62 years), with heterogeneous socio-economic and cultural backgrounds. The findings revealed the detailed suffering participants endured living with their ulcer: pain, shame and healing were among the emerging themes. The self-blame and punishment triggered by stigma was a detriment to the mental and physical health of participants. Those in contact with specialist wound care services saw a significant improvement in wound healing and this had a positive impact on their wellbeing and their overall outlook on life. This research contributes to science and practice by understanding the lives of PWID living with leg ulceration. It provides a platform from which to engage both generalist and specialist healthcare practitioners and has the potential to inform and improve current service provision of leg ulcer care for this population and to influence medical and social policy-making in this field.

"I just became like a log of wood … I was paralyzed all over my body": women's lived experiences of tonic immobility following rape

Tonic immobility is considered the last involuntary self-protecting act/mechanism experienced by victims of rape when they are under attack. It is associated with trauma related mental health risks post-rape. Despite this, tonic immobility has not received priority as an area of research on Nigerian female victims of rape. As a result, little has been known about this phenomenon by nurses and other professionals who are involved in the care and management of rape survivors in Nigeria. The limited knowledge about tonic immobility as a phenomenon might have resulted in mismanagement and secondary victimization of rape victims experiencing manifestations suggestive of tonic immobility during or after rape. This study was a qualitative narrative inquiry that explored, analysed, and interpreted the lived experiences suggestive of tonic immobility, and the meaning attached to such experiences by victims. A sample of fourteen Nigerian women who self-identified as rape victims was utilized. Individual semi-structured, in-depth interviews were conducted to generate data. Thematic data analysis revealed four overarching themes: namely (i) Tonic immobility as an Altered Physical State, (ii) Tonic Immobility as Mental Paralysis, (iii) Painful Loss of Self-defence, and (iv) Constant Self-blame. The findings provided an insight into the traumatic experience of raped women and the psychological implication of tonic immobility as extreme defence mechanism. This study will prove invaluable to nurses and other professionals/stakeholders involved in the care and management of rape victims; to help them develop and use appropriate strategies for management and prevention of secondary victimisation.

"Moving forward despite adversity": The lives of Korean older adults with schizophrenia

INTRODUCTION

Older adults with schizophrenia experience aging-related challenges and chronic psychiatric difficulties. However, their uniqueness is understudied. Aim This study explored three life stories to illuminate schizophrenia's trajectory.

METHOD

A narrative inquiry method was used to elicit rich narratives in chronic patients' lives. Two men and one woman suffering from chronic schizophrenia for more than 20 years were engaged in conversation three times.

RESULTS

The analysis revealed one main theme expressing their fundamental perspective on their lives: "moving forward despite adversity." Three subthemes emerged: living with the mental disorder, giving and receiving support, and adaptation to old age. They reflected on their interpersonal relationships, failures, and successes in the context of the challenges of schizophrenia. They indicated adapting to schizophrenia, exchanging social support with loved ones, and meeting aging-related challenges with confidence. They were hopeful about brighter personal futures than their pasts.

DISCUSSION

Family and community supports were very important; self-acceptance positively influenced their successful community living.

IMPLICATIONS FOR PRACTICE

For effective long-term treatment of older adults with schizophrenia, mental health policies should focus on meeting the social needs of patients and families and reorient programs away from the medical model limited to symptom reduction.

'This disease would suit better those who have money': Insulin-Treated Diabetes Illness Experience in rural Malawi

Background

Understanding the illness experience among rural-based insulin-treated diabetic patients has implications for practice and policy. However, there is a lack of in-depth knowledge about insulin-treated diabetic patients' illness experiences in rural Malawi. We explored the experiences of people living with insulin-treated diabetes in rural Malawi.

Research Designs and Methods

The study used a qualitative narrative inquiry. Participants were identified at Kamuzu Central Hospital Diabetes Clinic. The hospital is a tertiary level health care facility. We purposively selected 10 participants from rural areas attending the clinic. Data were collected through in-depth interviews in the privacy of the homes of the study participants and analysis was done using Riessman approach of thematic narrative analysis.

Results

The following five themes emerged: (1) diabetes perceived as the illness for the rich; (2) ‘everything is on a standstill’; (3) dietary challenges of the diabetes illness experience; (4) drug-related challenges associated with the diabetes illness experience and (5) experiencing physical effects of the diabetes illness.

Conclusion

Rural-based insulin-treated diabetic patients struggled to live with the illness in the context of low resources. There is a need for multi-factorial approaches at both the community and system levels so as to support people living with diabetes in the rural areas in order to improve their experiences.

A(nother) time for nature? Situating non-human nature experiences within the emotional transitions of sight loss

Sight impairment is experienced by approximately 253 million people worldwide, including people of all generations, at all life course stages. Caught between past and present embodiments of the world, people often express feelings of loss with the onset of sight impairment. This paper examines the role of nonhuman nature encounters as a contingent resource amongst individuals navigating these emotional transitions. It responds to recent calls to attend to the life course in both critical disability studies and the growing body of work linking nonhuman nature relations to human wellbeing. The paper draws on findings from a qualitative study that combined in-depth narrative interviews with in situ go-along interviews to explore how 31 people with sight impairment in England describe and experience a sense of wellbeing (or otherwise) with nature across their everyday lives and life trajectories. The data were analysed using inductive narrative thematic analysis. While nonhuman nature encounters were valued by many participants in promoting a sense of freedom, relatedness, pleasurable sensory immersion, opportunities for exploration and 'skilling up', this paper cautions against generalised or overly Romantic tropes of what nonhuman nature can 'do' through key sight loss junctures, and for whom. It highlights the value of providing timely and sensitive social scaffolding and nurturing creativity to open up meaningful opportunities to engage with nonhuman nature and to counter feelings of loss exacerbated by identity-limiting life course narratives and disability stereotypes. Informed by the stories shared by participants to chart and situate their experiences of sight loss, we call for a new identity politics within and beyond the growing movement to 'connect' people to nonhuman nature for wellbeing; a politics that affirms diverse forms of more-than-human embodiment, recognising how and why such relations may weave into - and indeed out of - people's varied, interdependent life course trajectories.

A critical narrative inquiry to understand the impacts of an overdose prevention site on the lives of site users

BACKGROUND

Globally, communities are struggling to gain support for harm reduction strategies being implemented to address the impacts of substance use. A key part of this discussion is understanding and engaging with people who use drugs to help shape community harm reduction strategies. This study focused on how an overdose prevention site has influenced the lives of people who use drugs.

METHODS

A critical narrative method was utilized, centred on photo-narratives. Twenty-seven individuals accessing an overdose prevention site were recruited to participate in preliminary interviews. Sixteen participants subsequently took photographs to describe the impact of the site and participated in a second round of interviews. Through independent coding and several rounds of team analysis, four themes were proposed to constitute a core narrative encompassing the diverse experiences of participants.

RESULTS

A key message shared by participants was the sense that their lives have improved since accessing the site. The core narrative proposed is presented in a series of four themes or "chapters": Enduring, Accessing Safety, Connecting and Belonging, and Transforming. The chapters follow a series of transitions, revealing a journey that participants presented through their own eyes: one of moving from utter despair to hope, opportunity, and inclusion. Where at the outset participants were simply trying to survive the challenges of chaotic substance use, through the relationships and services provided at the site they moved towards small or large life transformations.

CONCLUSIONS

This study contributes to an enhanced understanding of how caring relationships with staff at the overdose prevention site impacted site users' sense of self. We propose that caring relationships are an intervention in and of themselves, and that these relationships contribute to transformation that extends far beyond the public health outcomes of disease reduction. The caring relationships at the site can be a starting point for significant social changes. However, the micro-environment that existed within the site needs to extend beyond its walls for true transformative change to take place. The marginalization and stigmatization that people who use drugs experience outside these sites remains a constant barrier to achieving stability in their lives.

How Can Physicians in Training Tap into the Wisdom of Senior Physicians?

This piece reflects on an innovative project that we undertook: interviewing master physicians across the world of oncology and asking them what was their secret to success. It provides insights into the answers received from over fifty interviews and the process that was followed.

Listening to women's voices: the experience of giving birth with paramedic care in Queensland, Australia

Background

Unplanned out-of-hospital birth is generally assumed to occur for women who are multiparous, have a history of a short pushing phase of labour or are experiencing a precipitate birth. However, there is little research that examines the woman’s perspective regarding factors that influenced their decision on when to access care. This research aimed to explore women’s experience of unplanned out-of-hospital birth in paramedic care. Due to the size of the data in the larger study of ‘Women’s experience of unplanned out-of-hospital birth in paramedic care’ [1], this paper will deal directly with the women’s narrative concerning her decision to access care and how previous birth experience and interactions with other healthcare professionals influenced her experience.

Method

Narrative inquiry, underpinned from a feminist perspective, was used to guide the research. Twenty-two women who had experienced an unplanned out-of-hospital birth within the last 5 years in Queensland, Australia engaged in this research.

Results

The decision of a woman in labour to attend hospital to birth her baby is influenced by information received from healthcare providers, fear of unnecessary medical intervention in birth, and previous birth experience. All themes and subthemes that emerged in the women’s narratives relate to the notion of birth knowledge. These specifically include perceptions of what constitutes authoritative knowledge, who possesses the authoritative knowledge on which actions are based, and when and how women use their own embodied knowledge to assess the validity of healthcare workers’ advice and the necessity for clinical intervention.

Conclusions

The women interviewed communicated a tension between women’s knowledge, beliefs and experience of the birth process, and the professional models of care traditionally associated with the hospital environment. It is essential that information provided to women antenatally is comprehensive and comprehensible. The decisions women make concerning their birth plan represent the women’s expectations for their birth and this should be used as a means to openly communicate issues that may impact the birth experience.

Amplifying the Voices of Indigenous Elders through Community Arts and Narrative Inquiry: Stories of Oppression, Psychosocial Suffering, and Survival

Researchers and practitioners in community psychology have an important role to play in supporting decolonial work including promoting opportunities for reclamation, healing, and acknowledgment of history. In this article, we discuss research undertaken alongside a community arts and cultural development project that sought to support Aboriginal people in Western Australian to create an archive of their stories for current and future generations; stories that could serve as resources for healing, reclamation, and for examining a painful and unjust past. Narrative approaches have been promoted in community psychology to advance empowerment research and practice alongside marginalized, excluded, and minoritized groups. We report on findings from a critical narrative inquiry of the stories shared through the project and in conversational interviews with four Noongar Elders to explicate the history and ongoing legacy of racialized oppression in their lives as well as cultural continuity and survival evident in the stories. Community researchers and practitioners can play a role in amplifying those stories as part of the co-intentional work of decolonization.

Integrating Pastoral and Clinical Identities: A Narrative Inquiry of Pastoral Counselors

Narrative inquiry methodology was used to understand the lived experiences of two ordained pastoral counselors who obtained licensure as clinical mental health professionals, particularly in terms of their identity development and integration of pastoral and clinical identities. Data analysis from semi-structured interviews revealed rich experiences with five themes: the journey; God's call; self and identity; the role of mentors; and relationships. Implications for research and practice associated with pastoral counseling and counselor education are discussed.

Women's recovery, negotiation of appearance, and social reintegration following a burn

The gendered nature of postburn coping has received scant research attention in South Africa, a country that has a high rate of burns with significant concentrations among women. In this study, narratives that emerged from in-depth interviews with seven women were examined. The narratives emphasized essential needs of these burn survivors for personal support, the complexities of negotiating intimate relationships, struggles with the humiliation from family and friends, in some instances strained relationships with children, the support found through religious beliefs and institutions, and often frustratingly slow psychological acceptance of scars. These difficulties faced by women survivors of burns have highlighted the need to include religion/spirituality, intimate male partners, and women's children into the psychological recovery process, in an attempt to assist women's journey to psychological and emotional healing after burn.

A novel use of photovoice methodology in a leadership APPE and pharmacy leadership elective

BACKGROUND AND PURPOSE

The purpose of this article is to describe and assess the effectiveness of an innovative teaching approach in an advanced pharmacy practice experience (APPE) and leadership elective.

EDUCATIONAL ACTIVITY AND SETTING

Three cohorts of students [(2014: n = 14), (2015: n = 17), (2016: n = 19)] were introduced to the photovoice (PV) method in their leadership APPE. PV required students to take, present, and discuss photographs within their cohorts. PV was used as a teaching method with the intention that the process would compel students to be involved in leadership development throughout experiential rotations, participate in discussions related to leadership development, and engage in creative activity. Group discussions from the class of 2014 were recorded and transcribed. Students from all cohorts were asked to participate in an electronic survey containing items based on PV learning objectives. All students were asked to participate in semi-structured interviews about PV.

FINDINGS AND DISCUSSION

The inductive coding method was used to identify themes from discussion transcripts. Analysis of themes revealed 51.5% of the PV photographs related to emotional intelligence. Development of others and strong teams were themes represented in 44.3% of photographs. Survey data indicated all respondents agreed PV was a valuable method to describe learning in leadership. Interview coding revealed themes related to emotional intelligence and development of teams.

SUMMARY

The PV method was an effective teaching tool in a leadership APPE and elective course. PV is a teaching method to be utilized in a variety of experiential learning environments to better enhance the professional development of pharmacy students.

Crossing a Line: A narrative of risk-taking by older women serving as caregivers

BACKGROUND

Caregiving carried out by adults for other adults is increasing around the world as the demographics of many industrialized countries shift toward an older population with escalating care needs toward the end of life. Although much has been written about caregiving, few studies document the experiences of providing care as narrated by the caregivers.

AIM

To explore the everyday experiences of older adults serving as primary informal caregivers to significant others.

METHODS

A process of narrative inquiry was used via repeated interviews with three older women caregivers providing care to family members or friends. The data were analyzed using storyboarding techniques and identifying critical turning points, culminating in a poetic transcription of the resulting narrative.

RESULTS

These caregivers describe a tension that exists across their experiences and communication with authorities on whom they rely for guidance and collaboration. Situations in which this tension pushes the caregivers to act in ways that represent risk to themselves or their care recipients are central to the collective narrative.

CONCLUSION AND SIGNIFICANCE

The everyday experiences of older adult caregivers include not only familiar care routines, but also advocacy on behalf of care recipients and negotiations with external authorities, resulting at times in unwelcome risk-taking. Their narrative warrants attention due to the lack of power described by caregivers when acting on behalf of their care recipients and the need for those in authority to recognize their dilemma.

Narrative descriptions of miyo-mahcihoyān (physical, emotional, mental, and spiritual well-being) from a contemporary néhiyawak (Plains Cree) perspective

Background

There are unequivocal health disparities, both physical and mental, between the Indigenous and non-Indigenous peoples of Canada.

Methods

Utilizing narrative inquiry, 15 néhiyawak (Plains Cree people) between 18 and 71 years of age from Thunderchild First Nation were interviewed to explore what improved their mental health and well-being and what they needed to attain optimal mental health and well-being. By posing questions that focused on the positive, the strengths and resilience of the néhiyawak came to the forefront.

Results

Narrative thematic analysis of interview data consistently revealed four overarching themes that highlighted what positively impacted néhiyawak mental health and well-being and their perceived needs to attain optimal mental health and well-being: relationships; spiritual beliefs and cultural practices; tānisīsi wāpahtaman pimātisiwin (worldview); and ēkwa ōhi kikwaya piko ka-ispayiki kīspin ka-nohtē-miyo-mahcihoyān (these are the things that need to happen if I want to be healthy). The néhiyawak in this study described holistic health determinants that correlate with the medicine wheel and the determinants of health, and described these holistic health determinants as making a positive difference to their mental health and as necessary for them to obtain optimal mental health and well-being.

Conclusions

These results suggest that mental health programming and interventions should be harmonious with Indigenous culture; utilize a holistic approach that takes physical, emotional, mental, and spiritual well-being into consideration; and address the existing mental health disparities using the determinants of health as a framework, with an increased focus on the current socio-economic status of Indigenous peoples in Canada.

Ménière's disease and biographical disruption: Where family transitions collide

People's lived experiences of chronic illness have garnered increasing research interest over the last 30-40 years, with studies recognising the disruptive influence of illness onset and progression, both to people's everyday lives and to their biographical selves. We extend this body of work, drawing on the experiences of people living with Ménière's disease; a long-term progressive vestibular disorder characterised by unpredictable episodes of debilitating vertigo, tinnitus and permanent sensorineural hearing loss. In response to calls for more critical examination of the wider biographical contexts in which chronic illnesses are encountered, we draw on 28 in-depth narrative interviews with Ménière's patients and their family members to discuss how personal chronic illness experiences may be closely entwined with, and deeply shaped by, the life transitions (illness-related and otherwise) of 'linked others'. Interviews were conducted in south west England from January to June 2015. Focusing on intersecting transitions of parenthood, caregiving and retirement, we explore how and why familial relationships can both facilitate and hinder adaptation to a lifetime of chronically disrupted normalities, contributing to fluctuating experiences of 'cherished time', 'anomalous time' and 'turbulent time'. In so doing, we suggest that the onset and progression of chronic illness could usefully be re-conceptualised as one of many 'biographical oscillations' encountered during the life course that serve to re-route us between continually shifting life trajectories. In recognising life's dynamism and challenging the identity-limiting and self-damaging nature of entrenched cultural life course constructions, we suggest value in recognising alternative ways of 'living well' when negotiating the wide-ranging biographical maps that life can follow.

Midwifery practice during birth: Ritual companionship

BACKGROUND

There is an expectation that midwifery practice is woman centred and promotes physiology. In addition, midwives must assess the wellbeing of mother and baby, and monitor the progress of labour. It is important to understand how midwifery actions and interactions influence the birth experience for women.

AIM

The aim of this study was to explore midwifery practice during physiological birth from the perspective of both midwives and mothers.

METHOD

A narrative inquiry involving face-to-face in-depth interviews was used to gather data. The participants were 10 midwives and 10 women who had recently attended or experienced an uncomplicated physiological birth. Data was analysed to identify themes occurring across the narratives.

FINDINGS

Two types of midwifery practice were identified from the data: rites of passage and rites of protection. Rites of passage were synergistic with women's needs during birth and involved managing distractions and reflecting internal wisdom. Rites of protection involved performing clinical assessments to determine wellbeing and labour progress. These practices could contradict the rites of passage by disrupting aloneness and reinforcing external wisdom.

CONCLUSION

Midwives performed two types of practices which intersected with women's experience of birth in differing and contested ways. Conceptualising the role of the midwife as a 'ritual companion' and actions and words as rituals enables a deeper exploration of the values transmitted and reflected by midwifery practice. This study contributes to a discourse about midwifery practice during birth, women's experience of birth, and the influence of the institution on the nature of mother-midwife relationship.

Listening in the dark: why we need stories of people living with severe and enduring anorexia nervosa

A bold step forward in our approach to Severe and Enduring Anorexia Nervosa invites new paradigms for research and practice. It provides an opportunity for us to explore fault lines, both in our communities of practice and the social structures that inform them. This paper serves to question the medical metaphors on which treatment has been based, in favour of alternative perspectives that resonate more clearly with the lived experience of those for whom it has failed. We invite the consideration of alternative metaphors, which can disrupt the notion of heroic patients (and therapists), mediate against acts of self-silencing and sensitising us to more radical acts of listening. Beyond the randomised trials and manuals it is time for us to listen to the realities of suffering, the minutiae of resistance and the life that can still be lived.

The meaningfulness of time; Narratives of cancer among chronically ill older adults

This study, using ethnographically-based interviews, sought to describe how chronically ill older adults experience a new cancer diagnosis and the effects of this on their interpretations of personal health, aging, and the future. Three semi-structured interviews were conducted with each of the fifteen informants. We asked questions that explored each individual's life history, chronic illness occurrence, and direct experiences with cancer. Interviews were structured to provide social and historical contexts to enhance our understanding of the informants' illness narratives. Interview transcripts were analyzed thematically to describe how individuals described the cancer experience, its meaning, and its consequences. One of the major findings of our study was the role of cancer in disrupting individual biography, an interruption that fragmented time into three distinct segments: the Recalled Past, the Existent Present, and the Imagined Future. We highlight three main themes around the experience of illness-related time: (1) disruption found in individual biographical accounts as a result of fragmented time dimensions; (2) altered projections of a continuous sense of self into the future; and (3) modified treatment decisions resulting from a perceived altered life course and the finitude of advancing age. We further introduce the concept of Anomalous Time as a permutation of time central to individual experiences of cancer. Implications for how older adults understood their cancer and individual reactions relevant to seeking care are discussed.

At pains to consent: A narrative inquiry into women's attempts of natural childbirth

BACKGROUND

With only 1.2% of all annual U.S. births registered as out-of-hospital births, national trends show an increase in medicalised hospital births. Caesarean sections have become the most common surgical procedure in the U.S.; Caesarean section rates have increased from 20.6% in 1997 to 31.5% in 2009. Furthermore, in 2009, 67% of hospital births utilised epidural analgesia and 26% used oxytocin augmentation. In response to the increased medicalisation of childbirth within the U.S., some women resist standardised medical procedures and instead choose to labour and birth without medical intervention.

AIM

The purpose of this study was to understand and contextualise the childbirth experiences of first-time mothers who planned to have a natural childbirth (without medical intervention) in the Midsouthern United States.

METHODS

Using narrative inquiry, we collected data from six participants through semi-structured life-story interviews.

FINDINGS

Utilising thematic analysis, four recurring themes emerged: (1) benefits and limitations of pre-labour self-education; (2) labouring women's experiences of relationality; (3) the importance of birth stories and expectations; and (4) the creation of false dilemmas and complexities of "informed choice."

DISCUSSION AND CONCLUSION

The women's stories suggest that U.S. medical establishments, the media, and society need to empower pregnant and birthing women by creating new narratives of labour and positive spaces of relationality. Furthermore, health care professionals need to critically examine their usage of the medical model of care while respecting women's choices and agency.

Contrasting stories of life-threatening illness: a narrative inquiry

BACKGROUND

Advances in science and technology have resulted in longer lives for people with life-threatening illnesses. However, little research compares the stories of people with different life-threatening illnesses.

OBJECTIVES

The objectives of this study were to explore and contrast how people story and re-story life-threatening illness specifically cancer, chronic kidney disease (CKD) and HIV.

DESIGN

Narrative inquiry within a social constructionist perspective was used.

METHODS

A total of 113 in-depth interviews were conducted with 32 participants over a period of three years.

PARTICIPANTS

Study participants included 32 people: 10 with cancer, 14 with CKD and 8 with HIV/AIDS. Participants varied in age (37-83 years old, mean=61.2 years), gender (17 men and 14 women), location (urban and rural), time post-diagnosis (median=8 years), intensity or invasiveness of treatment, and prognosis (continuous treatment, remission, cure, palliative).

RESULTS

Participants described living with a life-threatening illness as a delicate balance. They focused on living their lives yet were fully and acutely aware of their own mortality. There was an undercurrent of sustained uncertainty that permeated their lives. Stories of life-threatening illness differed across the three illness groups and shifted over time as disease trajectories changed. Each disease brought specific challenges. With cancer, turning points and uncertainty were prominent. With CKD, a stealthy beginning to life-extending treatment through dialysis or transplant was evident, and with HIV, a shift from a perceived death sentence to a focus on hope and living was notable.

CONCLUSIONS

Findings revealed that trajectories of illness for participants living with cancer, CKD and HIV are complex and differ markedly across the groups. Narratives shifted across all of the illness groups as participants navigated and re-storied the terrains of their life-threatening illness. Findings illuminated the need for health care providers to focus on person specific and contextualized aspects of the illness experience.

Extending stakeholder theory to promote resource management initiatives to key stakeholders: a case study of water transfers in Alberta, Canada

Many attempts to implement resource management initiatives in Canadian and international communities have been resisted by stakeholders despite inclusion of their representatives in the decision-making process. Managers' failure to understand stakeholders' perspectives when proposing initiatives is a potential cause of this resistance. Our study uses marketing thought to enhance stakeholder theory by bringing in an audience-centric perspective. We attempt to understand how stakeholders perceive their interests in an organization and consequently decide how to influence that organization. By doing so, we investigate whether a disconnect exists between the perceptions of managers and those of stakeholders. Natural resource managers can utilize this knowledge to garner stakeholder support for the organization and its activities. We support this claim with findings from a water transfer plebiscite held in the Canadian province of Alberta. Sixteen personal interviews employing narrative inquiry were conducted to document voters' (i.e., irrigators') interpretations.

'The engine just started coughing!' - Limits of physical performance, aging and career continuity in elite endurance sports

This research examines male endurance athletes' experience of aging and/or reaching the perceived limits of physical performance. More specifically, the current study aimed to explore how existential meanings attached to these experiences are connected with athletes' decision-making concerning career continuity and retirement. Life story interviews were conducted with 10 Finnish runners and/or orienteers aged between 25 and 62 and the data was analyzed with an existential-narrative framework. Four major storylines related to aging were identified: The end of an era, putting things in perspective, the attitude has to change and winning was never the only motive. Our results suggest that endurance athletes possess diverse ways of bringing meaning to the experience of aging, both confirming and resisting the dominant cultural narrative of decline. While three athletes' stories confirmed the normativity of retirement when unable to improve their results anymore, other athletes demonstrated career continuity and positive aspects in the late career years, such as lack of competitive anxiety, finding perspective and increased enjoyment in running. We suggest that through awareness of alternative narratives, sport psychology consultants may be able to help their clients to explore new meanings in the potentially challenging and beneficial experiences of aging and athletic retirement.