"It's Like Finding Your Way Through the Labyrinth": a Qualitative Study of Veterans' Experiences Accessing Healthcare

BACKGROUND

The 2014 Veterans Choice Act and subsequent 2018 Veteran's Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks Act (MISSION Act) are legislation which clarified Veteran access to healthcare provided by non-VA clinicians (community care). These policies are of particular importance to Veterans living in rural areas, who tend to live farther from VA medical facilities than urban Veterans.

OBJECTIVE

To understand Veterans' experiences of the MISSION Act and how it impacted their access to primary care to inform future interventions with a focus on reaching rural Veterans.

DESIGN

Qualitative descriptive design.

PARTICIPANTS

United States (US) Veterans in Northwestern states engaged in VA and/or community care.

APPROACH

Semi-structured interviews were conducted with a purposive sample of Veterans between August 2020 and September 2021. Interview domains focused on barriers and facilitators of healthcare access. Transcripts were analyzed using thematic analysis.

KEY RESULTS

We interviewed 28 Veterans; 52% utilized community care as their primary source of care and 36% were from rural or frontier areas. Three main themes emerged: (1) Veterans described their healthcare experiences as positive but also frustrating (billing and prior authorization were noted as top frustrations); (2) Veterans with medical complexities, living far from healthcare services, and/or seeking women's healthcare services experienced additional frustration due to increased touch points with VA systems and processes; and (3) financial resources and/or knowledge of the VA system insulated Veterans from frustration with healthcare navigation.

CONCLUSIONS

Despite provisions in the MISSION Act, Veteran participants described persistent barriers to healthcare access. Patient characteristics that required increased interaction with VA processes exacerbated these barriers, while financial resources and VA system knowledge mitigated them. Interventions to improve care coordination or address access barriers across VA and community care settings could improve access and reduce health inequities for Veterans-especially those with medical complexities, those living far from healthcare services, or those seeking women's healthcare.

Key aspects of psychosocial needs in palliative care - a qualitative analysis within the setting of a palliative care unit in comparison with specialised palliative home care

BACKGROUND

The number of palliative care patients with complex needs is increasing in developed countries. In addition to physical aspects and symptom control, psychosocial aspects are of great importance for palliative care patients. The aim of this study was to understand which psychosocial aspects are important to patients, relatives and health professionals within the setting of a palliative care unit in comparison with specialised palliative home-care (SPHC).

METHODS

We used a qualitative design based on semistructured interviews, which were coded via qualitative content analysis. The study took place in the state of Hesse, Germany, and data collection was conducted in 2017 (interviews from the ELSAH study, which was conducted in a SPHC) and 2018 (supplementary interviews conducted in a palliative care unit). The results from both settings were compared.

RESULTS

In the palliative care unit, 10 health professionals, 11 patients and 8 relatives were interviewed. In the outpatient setting, we interviewed 30 health professionals, 14 patients and 14 relatives. We identified four key psychosocial issues related to palliative care that were relevant in both the inpatient and outpatient settings: care planning, patient-centred care, a protected environment with feelings of safety, and psychological well-being. In addition, immediate availability of medical staff, greater relief of the relatives and better accessibility of psychological care were more important in the inpatient setting than in the specialised palliative home care setting.

CONCLUSIONS

Knowledge and application of the identified key issues may improve patient-centred palliative care. Accessibility of psychological care and immediate availability of medical staff may be important factors for enhancing psychological well-being in the inpatient palliative care setting. Consideration of the identified key issues may help to develop more collaborative transitions between the palliative care unit and the SPHC and may help to provide palliative care patients and their families with care that is appropriate and feasible for them.

TRIAL REGISTRATION

The underlying comparative study of the outpatient setting of specialised palliative home-care (ELSAH) was registered within the German Clinical Trials Register DRKS-ID: DRKS00012421, ( https://drks.de/search/de/trial/DRKS00012421 ) on 19th May 2017.

A dialog on common morality in medical ethics in a pluralist setting in Iran: a qualitative content analysis

The concept of common morality is fundamental in medical ethics, and lack of universal content and characteristics of common morality is a product of its multifaceted nature. This study aimed to identify the ideas and experiences of academic faculties regarding common morality in a pluralistic setting to promote conceptual knowledge and strengthen moral reasoning and ethical decision-making. The study was conducted using a qualitative method, employing semi-structured in-depth interviews with thirteen faculty members who were selected purposively. In order to assess their ideas and experiences, the transcripts of the interviews were analyzed using the content analysis method through directed and conventional approaches. The interviews were coded manually. Two themes were reflected in the interviews: ontology and epistemology of common morality. The study indicates that the debate about the subjective or objective dependence of common morality questions the coherence of Beauchamp and Childress' common morality (CM) theory, as common morality is the result of various individual and social factor that influence moral and decision -making in pluralistic environments. Additional studies are needed in order to investigate the effect of cultural, social, theoretical, ideological and individual factors on promoting clinical ethical reasoning and decision-making skills.

"I am accustomed to something in my body causing pain": a qualitative study of knee replacement non-improvers' stories of previous painful and stressful experiences

BACKGROUND

Approximately 20% of total knee arthroplasty patients experience persistent postsurgical pain one year after surgery. No qualitative studies have explored previous stories of painful or stressful life experiences in patients experiencing persistent postsurgical pain after total knee replacement. This study aimed to explore stories of previous painful or stressful experiences in life in a cohort of patients that reported no improvement in pain one year after total knee arthroplasty.

METHODS

The study employed an explorative-descriptive qualitative design. Data was collected through semi-structured interviews five to seven years after surgery, with patients who reported no improvement in pain-related interference with walking 12 months after total knee replacement. The data was analyzed using qualitative content analysis.

RESULTS

The sample consisted of 13 women and 10 men with a median age of 67 years at the time of surgery. Prior to surgery, six reported having at least one chronic illness and 16 reported having two or more painful sites. Two main themes were identified in the data analysis: Painful years - the burden of living with long lasting pain, and the burden of living with psychological distress.

CONCLUSIONS

The participants had severe longlasting knee pain as well as longlasting pain in other locations, in addition to experiences of psychologically stressful life events before surgery. Health personnel needs to address the experience and perception of pain and psychological struggles, and how it influences patients' everyday life including sleeping routines, work- and family life as well as to identify possible vulnerability for persistent postsurgical pain. Identifying and assessing the challenges enables personalized care and support, such as advice on pain management, cognitive support, guided rehabilitation, and coping strategies both pre-and post-surgery.

Effective factors on voluntary childlessness and one-child tendency from couples' perspective: Compulsory childlessness or child-avoidance?

Background

Couples' childless and one-child intention is one of the crucial challenges in all societies. Considering the aging of the world's population and the need to review birth control policies, it is necessary to take evidence-based measures. Therefore, the present study aimed to investigate the influencing factors on the tendency of couples to be childless and have only one child.

Methods

The present study is the first part of a mixed (qualitative-quantitative) study. The study is qualitative with a conventional content analysis approach. The research population consists of all couples aged 15-49 in 2021 in Babol city, who were single or childless and had no intention of pregnancy in the future. Sampling is based on the purpose, and the number of samples is 40 couples. To collect data, face-to-face and semi-structured interviews were conducted with the participants.

Results

The results of the analysis include 140 codes, 30 sub-categories, 9 categories(Economic problems, uncertainty in the future security, threatened priorities, uncertainty about the continuation of life, Fear of becoming a parent, lack of support, diminishing religious beliefs, social role modeling and negative experiences) and two themes. These factors indicate the mandatory conditions for childlessness or one- child choice or voluntary child-free.

Conclusion

The results revealed that voluntary childlessness and single-child depend on various aspects. Support of the government, parenting education and efforts to change the attitude of couples by the government can help to improve the health of the family and achieve the goals of population growth policies.

[The value of human resources: experience of critical care nurses during the COVID-19 epidemic]

La pandemia por COVID-19 ha supuesto una crisis sanitaria sin precedentes. La presión asistencial sobre el Sistema Nacional de Salud ha generado escenarios insólitos de demanda especialmente llamativos en algunos servicios o unidades asistenciales como las Unidades de Cuidados Críticos.

Objetivo

Conocer la experiencia de los profesionales enfermeros referida a la atención de personas infectadas por coronavirus en las Unidades de Cuidados Críticos.

Método

Estudio cualitativo de carácter fenomenológico que constituye la segunda fase de un proyecto de metodología mixta. Se realizaron entrevistas a 17 enfermeras que prestaron cuidados en Unidades de Cuidados Críticos a pacientes afectados de COVID-19. Las entrevistas fueron audiograbadas, transcritas y analizadas mediante análisis temático del discurso.

Resultados

En este artículo se muestran los hallazgos en torno al tema «el valor del recurso humano» que matiza su significado a través de los subtemas «no son las camas, es el personal experto», «llevando la carga del paciente» y sufriendo por «no haber cuidado bien».

Discusión

Los profesionales enfermeros expertos se erigen como profesionales líderes en el cuidado del paciente crítico durante la pandemia por COVID-19. Este liderazgo se ejerce desde un perfil enmarcado en una filosofía integradora donde sabiduría, agilidad e intuición son los elementos clave que dan soporte a la identificación y resolución de problemas de forma creativa adaptándose a las necesidades emergentes de los pacientes y equipo de cuidados.

Conclusiones

Los profesionales enfermeros expertos han desempeñado un rol avanzado en la gestión de cuidados y de recursos humanos mediante el ejercicio de un liderazgo eficiente en el entorno clínico. Los cuidados se han visto mermados por la situación de crisis, circunstancia que les genera sufrimiento moral por no haber podido cumplir con los estándares de calidad y excelencia en el cuidado.

Intensive care nurses' experiences of infants and partners' presence on the postoperative ward after an emergency caesarean section; An interview study

It is evident that immediate skin-to-skin care after birth has the potential to improve breastfeeding outcomes and maternal satisfaction after a caesarean section; hence partners and infants should be present on the postoperative ward.

OBJECTIVE

To investigate the intensive care nurses' experiences of having the infant and partner present on the postoperative ward after emergency caesarean sections.

DESIGN

Interviews with semi-structured interviews were conducted and analysed using qualitative content analysis.

SETTING

The interviews were conducted at a hospital in Stockholm, Sweden; where close to 10,000 births occur each year. After a caesarean section the mother is treated on a postoperative ward for at least two hours. Eight intensive care nurses participated in the study.

RESULT

The analysis yields the theme 'The challenges of caring for infants on a postoperative unit' covering the following categories; collision between the intensive care nurse and midwife, responsibility versus knowledge and organisational issues. The study concluded that improved routines and increased continuity between involved clinics could improve care. There is also a need for education for staff involved in caesarean section regarding the benefits of early skin-to-skin care between the mother and her infant.

Exploring Subjective Well-being in Older Age by Using Participant-generated Word Clouds

Purpose of the study

Previous research has overlooked the heterogeneity in older adults' personal conceptions of subjective well-being (SWB), by not taking into account intradomain differences in the conceptions of SWB for different groups of older adults. The aim of this article is therefore to explore (a) older adults' own views on which aspects, categorized under domains, are important to their SWB and (b) which domains and aspects are important to older adults in different contexts and with different characteristics: to men and women, of different ages, and in different housing arrangements.

Design and methods

Sixty-six older adults (aged 65 and older) participated in our study. We asked the participants to freely nominate aspects of SWB that are important to them, using participant-generated word clouds as our exploratory, qualitative data collection method. The data were analyzed using qualitative inductive content analysis.

Results

We found 15 domains based on our participants' conceptions of SWB. The multidimensional domains of social life, activities, health, and space and place were most important to our participants. The domains and aspects were defined and prioritized differently by different groups of participants.

Implications

SWB should be studied as a multidimensional, individualized, and contextualized process to generate meaningful empirical information for researchers and policymakers.

Are "anti-aging medicine" and "successful aging" two sides of the same coin? Views of anti-aging practitioners

OBJECTIVES

This article analyzes data from interviews with anti-aging practitioners to evaluate how their descriptions of the work they do, their definitions of aging, and their goals for their patients intersect with gerontological views of "successful aging."

METHOD

Semistructured interviews were conducted with a sample of 31 anti-aging practitioners drawn from the directory of the American Academy for Anti-Aging Medicine.

RESULTS

Qualitative analysis of the transcripts demonstrate that practitioners' descriptions of their goals, intentionally or unintentionally, mimic the dominant models of "successful aging." These include lowered risk of disease and disability, maintenance of high levels of mental and physical function, and continuing social engagement. Yet, the means and modes of achieving these goals differ markedly between the two groups, as do the messages that each group puts forth in defending their positions.

DISCUSSION

Anti-aging practitioners' adoption of the rhetoric of successful aging reflects the success of successful aging models in shaping popular conceptions of what aging is and an ethos of management and control over the aging process. The overlap between anti-aging and successful aging rhetoric also highlights some of the most problematic social, cultural, and economic consequences of efforts made to reconceptualize old age.