Combining Critical Ethnography and Critical Discourse Analysis in Mental Health Nursing Research

BACKGROUND

It is uncommon to combine critical ethnography with critical discourse analysis (CDA) in health research, yet this combination has promise for managing challenges inherent in critical mental health nursing research.

OBJECTIVES

This article describes a methodologically innovative way to address issues that arise in the context of critical mental health nursing research.

METHODS

This article draws on two studies that each employed a combination of critical ethnography and CDA in the context of mental health nursing research, discussing the challenges and implications of this approach.

RESULTS

Although the combination critical ethnography and CDA presents several challenges, it also provides a framework for researchers to sustain a critically reflective stance throughout the research process. This facilitates the process of reanalyzing and reflecting on how healthcare practices and knowledge both support and are constrained by hegemonic discourses.

DISCUSSION

This combination has the potential to facilitate the production of new, emancipatory knowledge that will assist nurses in understanding issues of structural inequity within the healthcare system.

Dominant Worldviews, Institutional, and Contextual Factors Affecting Cancer Care: Evidence From an Institutional Ethnonursing Study in Nigeria

INTRODUCTION

Cancer remains a significant health burden in Nigeria and requires the efforts of all stakeholders to address it. Little is known about how the worldviews of Nigerian patients with cancer and other institutional factors affect cancer management in Nigeria. This paper draws evidence from an ethnonursing study conducted in a Nigerian cancer care setting.

METHOD

This study adopted a qualitative design using an ethnonursing approach. The study was conducted in one of the primary cancer treatment centers owned by the federal government of Nigeria. Data collection was conducted using participant observation, interviews, and field notes. Data collected were analyzed using NVivo 12 and presented as categories and sub-categories.

RESULTS

Analysis yielded two themes and seven sub-themes. The major themes included (1) dominant worldview and (2) institutional/contextual factors. Participants attributed life, living, and death as being controlled by a supreme being. Cancer care was constrained by unfavorable institutional factors such as lack of equipment, staffing, and intensified workload.

DISCUSSION

Cancer institutions should provide more cancer care infrastructure that will facilitate the work of nurses and other health care workers. There should be an enabling environment that would attract and retain nurses in the cancer wards. The hospital environment should be made conducive for the cancer care providers, patients with cancer, and their relatives.

Capturing the Dynamics of Homelessness Through Ethnography and Mobile Technology: Protocol for the Development and Testing of a Smartphone Technology-Supported Intervention

BACKGROUND

US military veterans who have experienced homelessness often have high rates of housing transition. Disruptions caused by these transitions likely exacerbate this population's health problems and interfere with access to care and treatment engagement. Individuals experiencing homelessness increasingly use smartphones, contributing to improved access to medical and social services. Few studies have used smartphones as a data collection tool to systematically collect information about the daily life events that precede and contribute to housing transitions, in-the-moment emotions, behaviors, geographic movements, and perceived social support.

OBJECTIVE

The study aims to develop and test a smartphone app to collect longitudinal data from veterans experiencing homelessness (VEH) and to evaluate the feasibility and acceptability of using the app in a population that is unstably housed or homeless.

METHODS

This study's design had 3 phases. Phase 1 used ethnographic methods to capture detailed data on day-to-day lived experiences of up to 30 VEH on topics such as housing stability, health, and health behaviors. Phase 2 involved focus groups and usability testing to develop and refine mobile phone data collection methods. Phase 3 piloted the smartphone mobile data collection with 30 VEH. We included mobile ethnography, real-time surveys through an app, and the collection of GPS data in phase 3.

RESULTS

The project was launched in June 2020, and at this point, some data collection and analysis for phases 1 and 2 are complete. This project is currently in progress.

CONCLUSIONS

This multiphase study will provide rich data on the context and immediate events leading to housing transitions among VEH. This study will ensure the development of a smartphone app that will match the actual needs of VEH by involving them in the design process from the beginning. Finally, this study will offer important insights into how best to develop a smartphone app that can help intervene among VEH to reduce housing transitions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53022.

Pragmatic patchwork ethnography, a call to action for health, nutrition and dietetic researchers

Qualitative research methods are increasingly used in nutrition and dietetics research. Ethnography is an underexploited approach which seeks to explore the diversity of people and cultures in a given setting, providing a better understanding of the influences that determine their choices and behaviours. It is argued that traditional ethnography, that is, the methodology of living within participant communities, is a dated practice, with roots in colonialism, accessible to only researchers with the means, connections and status to conduct such research, typically white, privileged males. This paper proposes a formal interpretation of 'patchwork ethnography', whereby research is carried out in situ around existing modern-day commitments of the researcher, thus enabling more researchers within health, nutrition and dietetic practice to benefit from the rich data that can be discovered from communities. This review proposes the concept that pragmatic patchwork ethnography is required, proposing a framework for implementation, providing researchers, particularly within the fields of human nutrition, dietetics and health, the accessibility and means to deploy a meaningful client-centric methodology. We present pragmatic patchwork ethnography as a modern method for use within multiple healthcare settings, thus adding a progressive brick in the wall of qualitative research.

Critical ethnography and its others: Entanglement of matter/meaning/madness

Beginning with a critical examination of the humanist assumptions of critical ethnography, this article interrogates and surfaces problems with the ontological and epistemological orientations of this research methodology. In drawing on exemplar empirical data from an arts-based project, the article demonstrates the limitations in the humanist-based qualitative research approach and advances a postdualist, postrepresentationalist direction for critical ethnography called entangled ethnography. Using data from a larger study that examined the perspectives of racialized mad artists, what is demonstrated in this inquiry is that the entanglement of bodies, objects, and meaning-making practices is central to working with the ontologically excluded, such as those who find themselves in various states of disembodiment and/or corporeal and psychic distribution. We propose the redevelopment of critical ethnography, extended by entanglement theory (a critical posthuman theory), and suggest that for it to be an inclusive methodology, critical ethnography must be conceptualized as in the process of becoming and always in regeneration, open to critique, extension, and redevelopment.

Key Informants in Applied Qualitative Health Research

Identifying and recruiting key informants is a widely used sampling strategy in applied qualitative health research. Key informants were first conceptualized within ethnography, but there is little methodological guidance about how to use this technique outside of that research tradition. The objective of this article is to offer practical suggestions about how existing methods for data collection with key informants could be translated to methodologies commonly used in applied qualitative health research. This article delineates how key informants could be conceptualized and sampled and how data sufficiency can be approached. The article prompts deeper consideration of the politics of representation and epistemic power that are inherent to the use of key informants in applied qualitative health research.

"A becoming in the meeting": the interpretations of competence in home care from the perspectives of older people and registered nurses - a meta-ethnography

AIM

The aim of this meta-ethnography was to identify and synthesize qualitative studies focusing on older people's and registered nurses' interpretations of competence in home care.

METHODS

The meta-ethnography followed the six phases developed by Noblit and Hare (1988).

RESULTS

In Phase 6, the translation process of the included studies, three themes were identified: i) temporality-the feeling of being of value; ii) dignity-a person, not just a patient; and iii) mutuality of being-togetherness. A synthesis was developed, and the phrase "a becoming in the meeting" emerged.

CONCLUSION

The sense of becoming includes progress, which means becoming something other than before in relation with others and refers to what constitutes the meeting between the older person and the registered nurse working in home care. Competence originates from becoming in the meeting, and registered nurses should therefore value what they do and hold on to this aspect of caring competence that centres on a caring relationship. It is important for registered nurses working in home care to be able to cultivate a caring relationship.

Defining focused ethnography: Disciplinary boundary-work and the imagined divisions between 'focused' and 'traditional' ethnography in health research - A critical review

This article offers the first critical review of focused ethnography, an increasingly popular research method across health disciplines. Focused ethnographers, we argue, exemplify the practice of methodological boundary work, defining their method in contrast to the 'traditional' ethnographic approach of anthropology and sociology. To examine this boundary work, we collected two samples of health research articles published over the last decade and compared how focused ethnographers and medical anthropologists described, justified, and practised ethnography. We found that the core characteristics most often asserted to differentiate focused ethnography from conventional ethnography were: a more limited study timeframe and scope; a limited subpopulation sample; more concentrated research questions; the inclusion of insider researchers; and more orientation towards applied results. We show, however, that these are imagined binaries that fail to map onto actual differences of practice in the two samples and which obscure many similarities between them. By contrast, we identified four alternative differences between the two methods of ethnography. These centre on understandings of 'research time'; the very meaning of ethnography; the relationship of researchers to 'data'; and the presumed best method of social intervention. We therefore define focused ethnography as a versatile method of ethnography that attends to specific epistemological expectations within the health sciences regarding valid proof and empirical description, the boundaries of research, the nature of research relationships, and the duty to improve biomedicine. Ultimately, our study highlights that methodological boundary-work matters, because assumed differences and unexpressed misunderstandings can prevent productive dialogue and fruitful collaboration between disciplines to address pressing health problems.

Introducing SAMMSA, a Five-Step Method for Producing 'Quality' Qualitative Analysis

Qualitative health research is ever growing in sophistication and complexity. While much has been written about many components (e.g. sampling and methods) of qualitative design, qualitative analysis remains an area still needing advanced reflection. Qualitative analysis often is the most daunting and intimidating component of the qualitative research endeavor for both teachers and learners alike. Working collaboratively with research trainees, our team has developed SAMMSA (Summary & Analysis coding, Micro themes, Meso themes, Syntheses, and Analysis), a 5-step analytic process committed to both clarity of process and rich 'quality' qualitative analysis. With roots in hermeneutics and ethnography, SAMMSA is attentive to data holism and guards against the data fragmentation common in some versions of thematic analysis. This article walks the reader through SAMMSA's 5 steps using research data from a variety of studies to demonstrate our process. We have used SAMMSA with multiple qualitative methodologies. We invite readers to tailor SAMMSA to their own work and let us know about their processes and results.

Embedding cultural studies in public health higher education: the role of medical anthropologists

Medical Anthropology is a body of knowledge with universal application. It bridges the gap between socio-cultural elements and public-health challenges; as a result, many medical anthropologists have raised the importance of culture in health matters. While public health pedagogy revolves around the ‘Germ Theory’ and the biomedical explanations of disease and illnesses; it is also very important to put the bio-sociocultural phenomena of health into consideration through an in-depth understanding of the social-cultural dimensions of health, healthcare and health-management. This is because ethnographic conceptions and the understanding of diseases, illnesses and wellbeing are germane to the success of public health. Embedding medical anthropological epistemology and research methods in public health higher education in Nigeria will contribute to the advancement of medical training through the use of ethnographic epistemology and methods, whereby vivid case studies of the social-cultural dimensions of public health issues would be subjected to critical discourse in the classroom. Utilizing ethnographic epistemological and methodological research cum pedagogical approaches in public health higher education will yield considerable success.

Individual, healthcare professional and system-level barriers and facilitators to initiation and adherence to injectable therapies for type 2 diabetes: A systematic review and meta-ethnography

AIMS

To review and synthesise the contemporary qualitative evidence, relating to the individual, healthcare professional and system-level barriers and facilitators to injectable therapies in people with type 2 diabetes, and evaluate (using an intersectional approach to explore the diverse perspectives of different identities) whether views have changed with treatment and guideline advancements.

METHODS

A meta-ethnography approach used. Eight databases searched from the years 2006 (GLP-1 analogues introduced) to February 2021. Study selection (using a pre-defined inclusion criteria), quality appraisal and data extraction, conducted independently by two reviewers.

RESULTS

Screened 7143 abstracts, assessed 93 full-text papers for eligibility and included 42 studies-using data from 818 individuals with type 2 diabetes and 160 healthcare professionals. Studies covered a diverse range of views from healthcare professionals and individuals, including those relating to older adults and people from ethnic migrant backgrounds, and 10 studies rated moderate to strong research value. Key themes abstracted: barriers (physical/psychological/social) and facilitators (motivation/capability/opportunity).

CONCLUSIONS

The first synthesis of contemporary qualitative data to adopt an intersectionality approach and explore diverse views relating to barriers and facilitators that influence engagement with injectable treatments for type 2 diabetes. A model is presented to help patients, health practitioners and policy makers identify barriers and facilitators and understand the complex interplay of physical, psychological and social factors involved when prescribing injectable therapies. Despite advances in injectable treatments and guidelines, findings highlight the many barriers that still exist and show how strongly held culturally-specific health beliefs of people from diverse socio-economic and ethnic backgrounds can become substantial obstacles to treatment.

The uses and abuses of tree thinking in cultural evolution

Modern phylogenetic methods are increasingly being used to address questions about macro-level patterns in cultural evolution. These methods can illuminate the unobservable histories of cultural traits and identify the evolutionary drivers of trait change over time, but their application is not without pitfalls. Here, we outline the current scope of research in cultural tree thinking, highlighting a toolkit of best practices to navigate and avoid the pitfalls and 'abuses' associated with their application. We emphasize two principles that support the appropriate application of phylogenetic methodologies in cross-cultural research: researchers should (1) draw on multiple lines of evidence when deciding if and which types of phylogenetic methods and models are suitable for their cross-cultural data, and (2) carefully consider how different cultural traits might have different evolutionary histories across space and time. When used appropriately phylogenetic methods can provide powerful insights into the processes of evolutionary change that have shaped the broad patterns of human history. This article is part of the theme issue 'Foundations of cultural evolution'.

Anorexia: a literature review of young people's experiences of hospital treatment

Anorexia nervosa is characterised by significantly low body weight, a fear of weight gain and persistent efforts to prevent the restoration of normal weight. It has potentially life-threatening physical and psychological complications, and many young people with anorexia present to hospital in a seriously compromised physical condition. While their physical symptoms require urgent treatment, addressing their emotional and psychological needs is equally important if they are to progress towards recovery. However, the conflicting thoughts common in anorexia mean that young people often feel highly ambivalent about treatment, which makes the disorder particularly challenging to treat. This article details a literature review undertaken to explore the perceptions and experiences of young people who have received hospital treatment for anorexia, with the aim of offering children's nurses insights into how they can optimally support these patients. The findings demonstrate the importance of listening to young people, treating them as individuals and understanding their experiences, in addition to addressing their physical health needs.

Mapping styles of ethnobiological thinking in North and Latin America: Different kinds of integration between biology, anthropology, and TEK

Ethnobiology has emerged as an important transdisciplinary field that addresses the epistemic and political value of Traditional Ecological Knowledge (TEK) through an integration of biological and social sciences. In North and Latin America, ethnobiology encompasses a diversity of approaches towards TEK but there is no consensus on how TEK relates to biological and anthropological research. The aim of this article is to develop an account that helps to map integration strategies in ethnobiological approaches in North and Latin America that jointly embrace biology, anthropology, and TEK. Borrowing the notion of 'styles of reasoning' and the framework of integrative pluralism from philosophy of science, we argue that ethnobiologists across the Americas have developed heterogeneous research programs. At the same time, we argue that these styles of reasoning tend to converge in prioritizing biological perspectives and are often limited in their understandings of cultural practices due to a lack of substantive ethnographic methods.

Re-analysing Ebola spread in Sierra Leone: The importance of local social dynamics

BACKGROUND

The 2013-15 Ebola epidemic in West Africa was the largest so far recorded, and mainly affected three adjacent countries, Guinea, Liberia and Sierra Leone. The worst affected country (in terms of confirmed cases) was Sierra Leone. The present paper looks at the epidemic in Sierra Leone. The epidemic in this country was a concatenation of local outbreaks. These local outbreaks are not well characterized through analysis using standard numerical techniques. In part, this reflects difficulties in record collection at the height of the epidemic. This paper offers a different approach, based on application of field-based techniques of social investigation that provide a richer understanding of the epidemic.

METHODS

In a post-epidemic study (2016-18) of two districts (Bo and Moyamba) we use ethnographic data to reconstruct local infection pathways from evidence provided by affected communities, cross-referenced to records of the epidemic retained by the National Ebola Response Commission, now lodged in the Ebola Museum and Archive at Njala University. Our study documents and discusses local social and contextual factors largely missing from previously published studies.

RESULTS

Our major finding is that the epidemic in Sierra Leone was a series of local outbreaks, some of which were better contained than others. In those that were not well contained, a number of contingent factors helps explain loss of control. Several numerical studies have drawn attention to the importance of local heterogeneities in the Sierra Leone Ebola epidemic. Our qualitative study throws specific light on a number of elements that explain these heterogeneities: the role of externalities, health system deficiencies, cultural considerations and local coping capacities.

CONCLUSIONS

Social issues and local contingencies explain the spread of Ebola in Sierra Leone and are key to understanding heterogeneities in epidemiological data. Integrating ethnographic research into epidemic-response is critical to properly understand the patterns of spread and the opportunities to intervene. This conclusion has significant implications for future interdisciplinary research and interpretation of standard numerical data, and consequently for control of epidemic outbreaks.

Ethnography of texts: a literature review of health and female homosexuality in Brazil

This paper reviews the literature on health and female homosexuality in Brazil and, along the way, outlines an alternative approach to reviewing academic literature. Rather than summarising the contents of previously published papers, we relate to these publications primarily as partakers in the creation of knowledge. Inspired by Actor-Network Theory (ANT), we apply ethnographic methods to understand the papers as study participants endowed with action. We also draw on the notions of inscription and intertextuality to trace the complex relationship between the findings in the articles and the realities outside of them. We claim that 'evidence' is the product of translational processes in which original events, such as experiments, blood tests and interviews, are changed into textual entities. In addition, text production is seen as an absorption of everything else surrounding its creation. When events are turned into articles, the text incorporates the political environment to which original events once belonged. We thus observe a political text inscribed into the written evidence of sexually transmitted infections, and the practice of publishing about scientific vulnerabilities emerges as political action. In contrast with traditional ways of reviewing literature in medical scholarship, this article offers a reminder that although there is a connection between textual evidence and the reality outside publications, these dimensions are not neutrally interchangeable.

Documenting a cultural landscape using point-cloud 3d models obtained with geomatic integration techniques. The case of the El Encín atomic garden, Madrid (Spain)

A country’s cultural landscapes are an important part of its heritage. The growing need to identify, catalogue and preserve these resources has led to a rapid change in the management and inventorying of heritage in general and of cultural landscapes in particular. The main aim of this work is to develop and apply an updated and integrated methodology for capturing and processing geo-information for the digital documentation of cultural heritage. The proposed case study is the atomic garden in the Finca El Encín (Madrid), a singular space with unique biogeographical features created over 60 years ago. The results of the case study validate the method, consisting of an unmanned aerial platform equipped with sensors to obtain point clouds and aerial images in conjunction with point clouds and images captured with a terrestrial laser scanner.

Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction

BACKGROUND

Video-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like.

OBJECTIVE

Using conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations.

METHODS

We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients), 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography (combining analysis of communication with an appreciation of the context in which it takes place), we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime).

RESULTS

Patients had been selected by their clinician as appropriate for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow (eg, technical issues with audio and/or video), and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient (and, in some cases, a relative) to simultaneously follow instructions and manipulate technology (eg, camera) to make it possible for the clinician to see and hear adequately.

CONCLUSIONS

A remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/10913.

Quadangulation: A New Methodology Combining Ethnographic Research and Quality Improvement Projects in Health Science Research

The purpose of this paper is to describe quadangulation as a methodology for conducting and analyzing combined ethnographic studies and quality improvement (QI) projects into one comprehensive investigation to improve the quality of health care. A comprehensive base of cultural influences in all health-care delivery settings, obtained from the design, implementation, and interpretation of a rigorous ethnographic investigation, and a QI project is new proposed methodology, called quadangulation. This new methodology has the potential to influence transformational cultural change, quality whole-person patient-centered care, and improved population health, through in-depth qualitative and quantitative analysis of cultural influences and clinical problems.

Clueless: An ethnographic study of young men who participate in the seduction community with a focus on their psychosocial well-being and mental health

In the last decade, a cross-national community of like-minded young men has emerged, commonly known as ‘the seduction community’. This community is led by professional ‘pick-up artists’ who teach these young men a variety of techniques and mindsets with the stated aim of improving their success with women, or ‘game’. There has been little research on the men who participate in this community, and none from a mental health angle. As such, this study is propelled by two specific objectives, namely documenting and understanding (i) the reasons why young men join the seduction community; and (ii) the impacts of community involvement on participants’ lives. To meet these aims, we used an inductive qualitative methodology giving ample scope for bottom-up understandings to emerge. Specifically, we recruited young men participating in the seduction community for an in-depth qualitative interview (N = 34) to explore self-reported motives and impacts. Interviews were augmented by lengthy participant observation, and data was analyzed by content analysis techniques. The results reveal that men often join the community to address a range of psychosocial deficits, and that community involvement successfully equips participants with numerous valued social and communication skills. The community appears to fill a void in providing a place of hope, fellowship and learning for young (often immigrant) men. The findings are summarized in five themes (i) loneliness and social inclusion; (ii) lack of male role models and need for guidance; (iii) mental health and well-being issues; (iv) skill acquisition and personal development; and (v) the dark side of pick-up. Interestingly, some of the practices commonly taught and utilized within the community resemble aspects of Cognitive Behavioral Therapy and mental health peer support. This may explain its evident appeal. We conclude by reflecting on the implications of the findings for official mental health service provision for young men.

Ethnography, ethnobiology and natural history: narratives on hunting and ecology of mammals among quilombolas from Southeast Brazil

BACKGROUND

As a leading practice of Homo sapiens' environmental experience for hundreds of millennia, hunting continues to evoke key research inquiries in the fields of archaeology, human ecology, and conservation biology. Broadly speaking, hunting has been mainly a subject of qualitative-symbolic and quantitative-materialistic schemata of analyze, among anthropologists and biologists, respectively. However, the phenomenological dimension of the hunting experience, in the course of individuals` everyday life, received little academic attention until this century. This study analyzes the daily praxis of hunting among quilombolas (descendants from runaway African slaves) in Southeast Brazil, making use of an ethnographic approach of phenomenological orientation, which dialogue with central ethnobiological issues. The authors also report the local ecological knowledge about mammals hunted in the area, and its relationship to the scientific literature on this subject.

METHODS

Between 2016 and 2019, the authors made use of participant observation and informal interviews among eight key local participants, in three quilombola communities in the Ribeira Valley (São Paulo, Brazil). Fragments of authors' field notes and parts of interviewers' speeches make up the core results obtained.

RESULTS

Articulating local knowledge to scientific literature, this study yielded a hybrid and comprehensive narrative about natural history of the mammals in the area. The authors also accessed elementary aspects of research participants' experience in hunting, such as strategies, tactics, motivations, and feelings. They reveal a set of human behavior dispositions that seems to emerge only in the context of the action, modulating the praxis of hunting on the course of individuals' everyday life.

CONCLUSION

Ethnography, ethnobiology, and natural sciences backgrounds were systematically articulated in this research. This made possible to get a contextualized and multifaceted understanding of hunting praxis in the Ribeira Valley, an important socioenvironmental context of Atlantic Forest in Brazil. The role of an ethnographic approach applied to ethnoecological and biological conservation issues is especially considered here.

A meta-ethnography to understand the experience of living with urinary incontinence: 'is it just part and parcel of life?'

BACKGROUND

Urinary incontinence (UI) is highly prevalent and affects the lives of many men and women. We aimed to conduct a qualitative evidence synthesis (QES) to explore the experience of living with UI and to develop a conceptual model that can help us to understand this experience, and the potential barriers to appropriate healthcare.

METHODS

We used the methods of meta-ethnography developed by Noblit and Hare and recently refined for larger studies. Meta-ethnography involves identifying concepts from the studies and abstracting these concepts into a line of argument. We searched for studies that explored the experience of adults with UI. We used the GRADE-CERQual framework to assess confidence in review findings.

RESULTS

We screened 2307 titles, 429 abstracts, 107 full texts and included 41 studies (36 unique samples) in the synthesis. We organised the concepts into 26 conceptual categories, which we further abstracted into 6 themes: (1) Am I ill or is this normal? (2) It effects who I am and how I feel; (3) I feel stigmatised, ashamed and guilty; (4) talking can be difficult but it can help; (5) keeping incontinence under control; (6) have I got to the point that I need help? Our model conceptualises living with UI as navigating antagonists: Is UI normal or am I ill? Do I need help or am I managing? Do I keep UI to myself (and manage alone) or do I tell other people (and get the support that I need)? Do I use control strategies that focus on concealing (avoid risky situations, wear pads) versus, I use strategies that focus on improving the bodily function to improve continence. Our model highlights the experience of stigma, shame and guilt which exert a pull towards concealment.

CONCLUSIONS

The culture of secrecy and profound sense of shame is barrier to seeking help. An environment which reduces the shame and stigma of UI may help people to switch the focus to strategies that will improve continence, rather than conceal incontinence.

Agitation near the end of life with dementia: An ethnographic study of care

Background and objectives

Agitation is common in people living with dementia especially at the end of life. We examined how staff interpreted agitation behavior in people with dementia nearing end of life, how this may influence their responses and its impact on the quality of care.

Research design

Ethnographic study. Structured and semi-structured non-participant observations (referred to subsequently in this paper as “structured observations”) of people living with dementia nearing the end of life in hospital and care homes (south-east England) and in-depth interviews with staff, conducted August 2015-March 2017.

Methods

Three data sources: 1) detailed field notes, 2) observations using a structured tool and checklist for behaviors classed as agitation and staff and institutional responses, 3) staff semi-structured qualitative interviews. We calculated the time participants were agitated and described staff responses. Data sources were analyzed separately, developed continuously and relationally during the study and synthesized where appropriate.

Results

We identified two main ‘ideal types’ of staff explanatory models for agitation: In the first, staff attribute agitated behaviors to the person’s “moral judgement”, making them prone to rejecting or punitive responses. In the second staff adopt a more “needs-based” approach in which agitation behaviors are regarded as meaningful and managed with proactive and investigative approaches. These different approaches appear to have significant consequences for the timing, frequency and quality of staff response. While these models may overlap they tend to reflect distinct organizational resources and values.

Conclusions

Care worker knowledge about agitation is not enough, and staff need organizational support to care better for people living with dementia towards end of life. Positional theory may help to explain much of the cultural-structural context that produces staff disengagement from people with dementia, offering insights on how agitation behavior is reframed by some staff as dangerous. Such behavior may be associated with low-resource institutions with minimal staff training where the personhood of staff may be neglected.

Health geography and the 'performative' turn: making space for the audio-visual in ethnographic health research

The purpose of this paper is to critically reflect on the added value of video in ethnographic research that seeks to understand peoples' lived experiences of health and place. Of particular interest is the potential for video to elicit the embodied, multisensory and relational nature of people's place experiences that are the focus of much recent health geography research. We draw on our experiences of using video in an ethnographic study that sought to explore the experiences of people with intellectual disabilities engaged in nature based (or 'green care') therapeutic interventions for health and wellbeing. We argue that video has the potential to capture aspects of people's wellbeing experiences that may be lost using other methods, such as observational field noting. Consideration is also given to how researchers using video methods should seek to (re)present people's wellbeing experiences, as well as the practical and ethical challenges that this approach has for those working in the field of health geography.

'He usually has what we call normal fevers': Cultural perspectives on healthy child growth in rural Southeastern Tanzania: An ethnographic enquiry

Introduction

While parents’ construction of and actions around child growth are embedded in their cultural framework, the discourse on child growth monitoring (CGM) has been using indicators grounded in the biomedical model. We believe that for CGM to be effective, it should also incorporate other relevant socio-cultural constructs. To contribute to the further development of CGM to ensure that it reflects the local context, we report on the cultural conceptualization of healthy child growth in rural Tanzania. Specifically, we examine how caregivers describe and recognize healthy growth in young children, and the meanings they attach to these cultural markers of healthy growth.

Methods

Caregivers of under-five children, including mothers, fathers, elderly women, and community health workers, were recruited from a rural community in Kilosa District, Southeastern Tanzania. Using an ethnographic approach and the cultural schemas theory, data for the study were collected through 19 focus group discussions, 30 in-depth interviews, and five key informant interviews. Both inductive and deductive approaches were used in the data analysis.

Results

Participants reported using multiple markers for ascertaining healthy growth. These include ‘being bonge’ (chubby), ‘being free of illness’, ‘eating well’, ‘growing in height’, as well as ‘having good kilos’ (weight). Despite the integration of some biomedical concepts into the local conceptualization of growth, the meanings attached to these concepts are largely rooted in the participants’ cultural framework. For instance, a child’s weight is ascribed to the parents’ adherence to postpartum sex taboos and to the nature of a child’s bones. The study noted conceptual differences between the meanings attached to height from a biomedical and a local perspective. Whereas from a biomedical perspective the height increment is considered an outcome of growth, the participants did not see height as linked to nutrition, and did not believe that they have control over their child’s height.

Conclusions

To provide context-sensitive advice to mothers during CGM appointments, health workers should use a tool that takes into account the mothers’ constructs derived from their cultural framework of healthy growth. The use of this approach should facilitate communication between health professionals and caregivers during CGM activities, increase the uptake and utilization of CGM services, and, eventually, contribute to reduced levels of childhood malnutrition in the community.

Addressing the polypharmacy challenge in older people with multimorbidity (APOLLO-MM): study protocol for an in-depth ethnographic case study in primary care

INTRODUCTION

Polypharmacy is on the rise. It is burdensome for patients and is a common source of error and adverse drug reactions, especially among older adults. Health policy advises clinicians to practice medicines optimisation-a person-centred approach to safe, effective medicines use. There has been little research exploring older patients' perspectives and priorities around medicines-taking or their actual practices of fitting medicines into their daily lives and how these are shaped by the wider context of healthcare.

METHODS AND ANALYSIS

We will conduct an in-depth multisite ethnographic case study. The study is based in seven clinical sites (three general practices and four community pharmacies) and includes longitudinal ethnographic follow-up of older adults, organisational ethnography and participatory methods. Main data sources include field notes of observations in the home and clinical settings; interviews with patients and professionals; cultural probe activities; video recordings of clinical consultations and interprofessional talk; documents. Our analysis will illuminate the everyday practices of polypharmacy from a range of lay and professional perspectives; the institutional contexts within which these practices play out and the sense-making work that sustains-or challenges-these practices. Our research will adopt a 'practice theory' lens, drawing on the sociology of organisational routines and other relevant social theory guided by ongoing iterative data analysis.

ETHICS APPROVAL

The study has HRA approval and received a favourable ethical opinion from the Leeds West Research Ethics Committee (IRAS project ID: 205517; REC reference 16/YH/0462).

DISSEMINATION

Aside from academic outputs, our findings will inform the development of recommendations for practice and policy including an interactive e-learning resource. We will also work with service users to co-design patient/public engagement resources.

Enriching medical trainees' learning through practice: a video reflexive ethnography study protocol

INTRODUCTION

Supporting medical students' and junior doctors' development in busy clinical settings is challenging. As opportunities for developing trainees, for example, traditional bedside teaching, are decreasing, teaching outside of clinical practice is increasing. However, evidence suggests that effective learning through practice arises via an interplay between, first, what experiences are afforded by clinical settings and, second, how trainees engage with these affordances. Many studies investigating clinician learning through practice focus on only one of these two factors. Yet, a well-recognised methodological challenge of enabling learners to articulate how and what they are learning through practice exists. We need, therefore, to understand how this relationship plays out in practice in ways that enrich learning.

METHODS AND ANALYSIS

This protocol describes a video reflexive ethnographic approach to illuminate how learning through practice in hospital settings occurs and can be enriched. The study will be conducted in two phases. In phase I, senior clinicians from emergency medicine, medicine and surgical specialties will be interviewed about how they guide trainees' learning through practice. These forms of guidance, analysed using the framework method, will inform phase II comprising observations of practice in: (1) emergency, (2) medical and (3) surgical departments. Video recorded episodes of clinicians' guiding learning through practice will be shared and appraised in reflexive sessions with each clinical team. Relational interdependent learning theory informs the design and data analyses to elicit and evaluate strategies for guiding learning through practice.

ETHICS AND DISSEMINATION

Ethical approval has been received from both healthcare and university settings. The findings should provide important insights for clinicians about workplace learning practices. Findings will be disseminated across the project phases and to diverse audiences-locally, nationally and internationally. The dissemination strategy will use seminars, grand rounds, conference presentations and academic papers to articulate practical, theoretical and methodological findings.

Ethnography for Radiographers: A Methodological Insight for Prospective Researchers

In recent years, ethnography has become a methodology of choice for exploring radiographic practices. This article adds to the existing evidence base by providing detailed methodological accounts of two experienced researchers. It aims to provide a critical methodological lens to prospective researchers who may also use ethnography as their methodology of choice. The author's reflect on their experiences of utilising ethnography as a methodological approach. Here, accounts of the original tools aligned to undertaking ethnographic research in radiography are discussed and how these can be used to uncover original phenomena. The article identifies the researchers' own positionality and reflexivity as researchers and how this impacted on data collection. In short, this article provides a detailed account of undertaking ethnography as a methodological approach within diagnostic radiography. The experiences documented can provide prospective researchers an insight of the researchers' position within the fieldwork.

Possibilities for interprofessional learning at a Swedish acute healthcare ward not dedicated to interprofessional education: an ethnographic study

OBJECTIVES

Almost all healthcare today is team-based in collaboration over professional borders, and numerous students have work-based learning in such contexts. However, interprofessional learning (IPL) in clinical settings has mostly been systematically explored in specially designed contexts dedicated to interprofessional education (IPE). This study aimed to explore the possibilities for IPL activities, and if or how they occur, in an acute ward context not dedicated to IPE.

DESIGN AND SETTING

Between 2011 and 2013 ethnographic observations were performed of medical and nursing students' interactions and IPL during early clerkship at an acute internal medicine ward in Sweden. Field notes were taken and analysed based on the framework of IPE: learning with, from and about.

PARTICIPANTS

21 medical, 4 nursing students and 30 supervisors participated.

RESULTS

Learning with-there were no organised IPE activities. Instead, medical and nursing students learnt in parallel. However, students interacted with staff members from other professions. Learning from-interprofessional supervision was frequent. Interprofessional supervision of nursing students by doctors focused on theoretical questions and answers, while interprofessional supervision of medical students by nurses focused on the performance of technical skills. Learning about-students were observed to actively observe interactions between staff and learnt how staff conducted different tasks.

CONCLUSION

This study shows that there were plenty of possibilities for IPL activities, but the potential was not fully utilised or facilitated. Serendipitous IPL activities differed between observed medical and nursing students. Although interprofessional supervision was fairly frequent, students were not learning with, from or about each other over professional borders.

Exploring the "like" in the psychological interaction of users on fan community: A netnography analysis

Little is known about the psychology behind fans joining fan community pages in a blog context; the factors driving them to like, share, and comment on posts on fan community pages; or the manner in which fans experience and interact with such pages. These topics were not given sufficient explanation in past research. This study aimed to explore the special situations and unique online experiences that fans community experience in a blog context. A netnography analysis was conducted through online interviews and field observations. Three phases of contextual experiences were determined, including observing and collecting data online, active participation, and emergent design. The contribution of this study is its establishment of the fan community experience model, which is a substantive theory, and its suggestion of nine propositions that can provide insights into fan community page interaction and experience models.

Contested domains of biological similarities and sociocultural diversity

Scientists and social scientists often read the same text differently. They also construct categories having the same nomenclature independently. Many of us also work in isolated domains, rarely reading texts researched and documented by others. We conduct our research within the defined format of our disciplines. We engage with others only when contestations emerge and challenge some of the rooted paradigms of each other's disciplines. This paper reflects the reactions of a social scientist to texts on population genetics and attempts to arrive at the genetic theory of the origin of ethnological history of human populations in India. Inadvertently, most of these intensely researched and passionately documented DNA evidence present a serious challenge to the discourse of cultural pluralism and social diversity that the humanist perspective of science and social science takes pride in documenting. This paper is based on secondary resource materials and the methodology adopted is that of narrative research.

Cultural Experiences, Patterns, and Practices of American Indian Women With Polycystic Ovary Syndrome: An Ethnonursing Study

Introduction: Knowledge is needed about the cultural experiences, patterns, and practices of American Indian women with polycystic ovary syndrome (PCOS), so nurses can provide culturally congruent care. Method: A qualitative, ethnonursing study based on Leininger's theory of culture care diversity and universality. Data were collected from 13 key informants living on a reservation in the Western United States. Data were analyzed with Leininger's four phases of qualitative analysis. Results: Three universal themes were identified: (1) control of PCOS symptoms is important for the cultural well-being of tribal women, (2) culturally congruent PCOS education and health care are important with variations in approaches to treatment, and (3) tribal culture is important with variations in use of tribal practices. Discussion: Tribal culture affects the health care beliefs and practices of American Indian women with PCOS. The findings can be used to improve culturally congruent care for women with this chronic condition.

A methodological systematic review of meta-ethnography conduct to articulate the complex analytical phases

BACKGROUND

Decision making in health and social care requires robust syntheses of both quantitative and qualitative evidence. Meta-ethnography is a seven-phase methodology for synthesising qualitative studies. Developed in 1988 by sociologists in education Noblit and Hare, meta-ethnography has evolved since its inception; it is now widely used in healthcare research and is gaining popularity in education research. The aim of this article is to provide up-to-date, in-depth guidance on conducting the complex analytic synthesis phases 4 to 6 of meta-ethnography through analysis of the latest methodological evidence.

METHODS

We report findings from a methodological systematic review conducted from 2015 to 2016. Fourteen databases and five other online resources were searched. Expansive searches were also conducted resulting in inclusion of 57 publications on meta-ethnography conduct and reporting from a range of academic disciplines published from 1988 to 2016.

RESULTS

Current guidance on applying meta-ethnography originates from a small group of researchers using the methodology in a health context. We identified that researchers have operationalised the analysis and synthesis methods of meta-ethnography - determining how studies are related (phase 4), translating studies into one another (phase 5), synthesising translations (phase 6) and line of argument synthesis - to suit their own syntheses resulting in variation in methods and their application. Empirical research is required to compare the impact of different methods of translation and synthesis. Some methods are potentially better at preserving links with the context and meaning of primary studies, a key principle of meta-ethnography. A meta-ethnography can and should include reciprocal and refutational translation and line of argument synthesis, rather than only one of these, to maximise the impact of its outputs.

CONCLUSION

The current work is the first to articulate and differentiate the methodological variations and their application for different purposes and represents a significant advance in the understanding of the methodological application of meta-ethnography.

Improving reporting of meta-ethnography: the eMERGe reporting guidance

AIMS

The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting.

BACKGROUND

Evidence-based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta-ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta-ethnography reporting guidance is needed to improve reporting quality.

DESIGN

The eMERGe study used a rigorous mixed-methods design and evidence-based methods to develop the novel reporting guidance and explanatory notes.

METHODS

The study, conducted from 2015 to 2017, comprised of: (1) a methodological systematic review of guidance for meta-ethnography conduct and reporting; (2) a review and audit of published meta-ethnographies to identify good practice principles; (3) international, multidisciplinary consensus-building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes.

FINDINGS

Recommendations and good practice for all seven phases of meta-ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance.

CONCLUSION

The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta-ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta-ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta-ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho-oncology, Review of Education, and BMC Medical Research Methodology.

Engaging a Community Leader to Enhance Preparation for In-Depth Interviews With Community Members

In-depth interviews allow for rich exploration of stakeholders' experiences. Preparation for in-depth interviews generally consists of literature reviews and researchers' review of their own culture and understanding of a topic. We supplemented these strategies with serial "ethnographic interviews" with a single community leader to enhance our preparation for community-based in-depth interviews with Latina, immigrant, Spanish-speaking mothers and to facilitate stakeholder engagement in a research project. After an extensive literature review, we conducted a series of four 1-hour interviews with a key informant in preparation for individual in-depth interviews with 12 parents. The ethnographic interviews with the community leader provided insight into environmental context, cultural categories, and stakeholder priorities, which helped shape the research question, in-depth interview guide, sampling strategy, and interpretive analytic process. We found that ethnographic interviews can provide critical insights for preparing in-depth interview guides and can enhance the information gained while facilitating meaningful stakeholder engagement.

How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study

OBJECTIVES

Occupational therapy, physiotherapy and speech and language therapy are central to rehabilitation after a stroke. The UK has introduced an audited performance target: that 45 min of each therapy should be provided to patients deemed appropriate. We sought to understand how this has influenced delivery of stroke unit therapy.

DESIGN

Ethnographic study, including observation and interviews. The theoretical framework drew on the work of Lipsky and Power, framing therapists as 'street level bureaucrats' in an 'audit society'.

SETTING

Stroke units in three English hospitals.

PARTICIPANTS

Forty-three participants were interviewed, including patients, therapists and other staff.

RESULTS

There was wide variation in how therapy time was recorded and in decision-making regarding which patients were 'appropriate for therapy' or auditable. Therapists interpreted their roles differently in each stroke unit. Therapists doubted the validity of the audit results and did not believe their results reflected the quality of services they provided. Some assumed their audit results would inform commissioning decisions. Senior therapy leaders shaped priorities and practices in each therapy team. Patients were inactive outside therapy sessions. Patients differed regarding the quantity of therapy they felt they needed but consistently wanted to be more involved in decisions and treated as individuals.

Patients Scheduled for General Anesthesia: Betwixt and Between Worrying Thoughts and Keeping Focus

PURPOSE

The purpose of the research was to explore the interaction between cancer patients and Registered Nurse Anesthetists (RNAs) before general anesthesia from the patients' perspective.

DESIGN

Focused ethnography was used as method for data collection.

METHODS

Surgical patients' interactions with the RNAs were observed during preparations for general anesthesia and further explored during an interview on the first or second postoperative day. Methodological concepts of Grounded Theory structured the analysis.

FINDINGS

The core variable describes patients being in an intermediate position, not knowing the outcome of the anesthetic and surgical procedures. The core variable is elaborated by subcore variables describing patients' coping strategies and need for care.

CONCLUSIONS

Patients' experiences of being cared for and supported in their coping strategies by RNAs will substantiate patients' predisposed confidence in the RNA and the anesthetic procedure. This will support patients in keeping focus in a highly technological environment.

"I Would Like to Be Heard." Communicating With Singaporean Chinese Patients With Dementia: A Focused Ethnography Study

INTRODUCTION

Although first-generation Singaporean Chinese were mainly immigrants from Mainland China, the communication patterns of Singaporean Chinese in the present-day context differs from Mainland Chinese. This difference could be attributed to the subculture but is not conclusive. This study aimed to explore the experiences of nursing staff communicating with Singaporean Chinese with dementia in Singapore.

METHOD

A focused ethnographic study was conducted in a long-term care setting for people with dementia, where data were obtained using nonparticipant observations and semistructured interviews. Data analyses were conducted using Braun and Clarke's thematic analysis.

RESULTS

Nineteen nursing staff were interviewed. The central theme of "embracing diversity and accepting differences" was supported by three subthemes: acknowledging cultural differences, understanding the patients, and overcoming communicative challenges.

CONCLUSIONS

This study highlighted the need for nurses to understand cultural characteristics among Singaporean Chinese with dementia especially on emotional expressions when they are not understood by others.

Toward an Ethical Reflective Practice of a Theory in the Flesh: Embodied Subjectivities in a Youth Participatory Action Research Mural Project

The focus of this paper is to demonstrate how embodied subjectivities shape research experiences. Through an autoethnography of my involvement in a Youth Participatory Action Research (YPAR) after-school program with low-income and working-class youth of Color from predominantly Latinx communities I examined my embodied subjectivities, via an ethical reflective practice, as these surfaced in the research context. Autoethnography is presented as a tool to facilitate an ethical reflective practice that aligns with heart-centered work. Drawing from an epistemology of a theory in the flesh (Anzaldúa & Moraga, 1981), embodied subjectivities are defined by the lived experiences felt and expressed through the body, identities, and positionalities of the researcher. The article concludes with implications for the development of community psychology competencies that attend to the researcher's embodied subjectivities.

Ethnography in Nutrition and Dietetics Research: A Systematic Review

Ethnography is a qualitative research approach used to learn about people and their culture. There is a need to explore the application and use of ethnographic methodology in nutrition and dietetics research to inform future research and practice. Our aim was to examine the extent, range, nature, and contribution of ethnographic methodology in nutrition and dietetics research. Eight electronic databases were searched using a defined search strategy until November 2017. No restrictions were placed on language, date, or study design of original research. Two authors independently assessed titles and abstracts, then full-text records, against inclusion criteria. Hand-searching of reviews identified in the database search was undertaken. Quality assessment was conducted using the Critical Appraisal Skills Programme checklist. Data were described narratively. A total of 2,185 records were identified, with 92 studies from public health nutrition (n=72), clinical nutrition (n=13), and foodservice (n=7) practice areas meeting inclusion criteria. Common research areas included infant/child feeding, food choice, diabetes, nutrition in schools and food insecurity. In addition to observation, frequently reported data collection techniques were interview (n=85), focus groups (n=17), and document analysis (n=10). Ethnographic research was most often reported from North America (n=31), Europe (n=16), and Australia/Oceania (n=13). This research approach was shown to inform dietetic research and practice by illuminating sociocultural factors that influence dietary beliefs and practices, practitioner training opportunities, evaluating nutrition education methods, informing programs and interventions, identifying nutrition policy and guideline focus areas, and the need for new approaches and communication strategies. Ethnography can increase understanding of complex food and nutrition-related health issues and their contributing factors across public health nutrition, foodservice, and clinical dietetic practice. It can be used to explain health inequalities, direct policy, and inform more effective intervention design and delivery. Wider uptake of this research approach as a stand-alone or complementary study design will advance efforts to improve health and wellbeing through food and nutrition.

Expressive instructions: ethnographic insights into the creativity and improvisation entailed in teaching physical skills to medical students

INTRODUCTION

Creativity and improvisation are recognized as important aspects of training expertise in domains such as business and the arts, yet rarely discussed in medical education. This article examines how creativity and improvisation play out in the ways teachers give 'expressive instructions' to medical students when teaching physical skills.

METHODS

Ethnographic fieldwork was conducted in a medical school in Maastricht, the Netherlands, with first, second and third year students learning physical examination skills. Over 230 h of fieldwork was conducted in the Skills Lab, including 34 tutorials of 1.5 h duration, with 11 different teachers and over 500 students. Patterns found in the fieldnotes were thematically analyzed using an inductive approach, drawing on sociological theories of craftsmanship.

RESULTS

Findings showed that teachers improvise beyond the standardized lesson structure and classroom set-up, giving what we call, drawing on sociological theory, 'expressive instructions'. This was visible in two main ways: 1) by teachers using their own bodies; 2) by teachers using materials that came to hand.

DISCUSSION

This research highlights the important yet underexplored role of creativity and improvisation in teaching physical skills. Creativity and improvisation appear to be particularly important when training expertise in skills that are difficult to articulate and thus require expressive instructions, due for example to their sensory nature. Focusing on how expressive instructions play out in medical education offers insights into the tacit components of expertise development, a process which builds upon a long period of teachers' skilled practice.

The experiences of medical students with dyslexia: An interpretive phenomenological study

This article explores the experiences of U.K. medical students with dyslexia, using an interpretive phenomenological approach. This project began with a review of the literature, highlighting a void of qualitative research. We then conducted a collaborative autoethnography. This paper forms the next stage in this series of research. We aimed to elicit meaning and understanding from the lived experiences of our participants. Eight U.K. junior doctors with dyslexia were interviewed over the telephone in an in-depth, unstructured manner. Audio recordings were transcribed verbatim and thematically analysed with the aid of a template analysis. Experiences of helplessness and hopelessness were common. These may be a result of a fear of stigmatization and personal feelings of inadequacy. They may also be fuelled by the incidents of bullying and belittling from other medical students that were reported. An important meta-theme was of fear and lack of understanding. A lack of pastoral support was also reported. Their experiences of medical school assessments are also reported. More may need to be done to educate teachers and clinical supervisors on dyslexia.

Phytoliths as an indicator of early modern humans plant gathering strategies, fire fuel and site occupation intensity during the Middle Stone Age at Pinnacle Point 5-6 (south coast, South Africa)

The study of plant remains in archaeological sites, along with a better understanding of the use of plants by prehistoric populations, can help us shed light on changes in survival strategies of hunter-gatherers and consequent impacts on modern human cognition, social organization, and technology. The archaeological locality of Pinnacle Point (Mossel Bay, South Africa) includes a series of coastal caves, rock-shelters, and open-air sites with human occupations spanning the Acheulian through Middle Stone Age (MSA) and Later Stone Age (LSA). These sites have provided some of the earliest evidence for complex human behaviour and technology during the MSA. We used phytoliths-amorphous silica particles that are deposited in cells of plants-as a proxy for the reconstruction of past human plant foraging strategies on the south coast of South Africa during the Middle and Late Pleistocene, emphasizing the use and control of fire as well as other possible plant uses. We analysed sediment samples from the different occupation periods at the rock shelter Pinnacle Point 5-6 North (PP5-6N). We also present an overview of the taphonomic processes affecting phytolith preservation in this site that will be critical to conduct a more reliable interpretation of the original plant use in the rock shelter. Our study reports the first evidence of the intentional gathering and introduction into living areas of plants from the Restionaceae family by MSA hunter-gatherers inhabiting the south coast of South Africa. We suggest that humans inhabiting Pinnacle Point during short-term occupation events during Marine Isotope Stage (MIS) 5 built fast fires using mainly grasses with some wood from trees and/or shrubs for specific purposes, perhaps for shellfish cooking. With the onset of MIS 4 we observed a change in the plant gathering strategies towards the intentional and intensive exploitation of dry wood to improve, we hypothesise, combustion for heating silcrete. This human behaviour is associated with changes in stone tool technology, site occupation intensity and climate change.

Multiple Researcher Roles in Video-Reflexive Ethnography

Hospital-based video-reflexive ethnography (VRE) is a collaborative visual methodology used by researchers and/or health professionals to understand, interpret, and optimize health professionals' work practices and patients' experiences. For more than a decade, the VRE methodology has spread throughout (research) institutions and hospitals internationally, and VRE has evolved and broadened. Different ways of doing VRE have implications for the role of the researcher. A thorough examination of the consequences for the researcher's position is the central focus of this article. We outline three typical styles of researcher engagement with VRE: clinalyst, affect-as-method, and planned obsolescence. We argue that by examining these different styles of doing VRE research, academic researchers can then critically review and carefully choose which styles of VRE research best meet the needs of their research questions, their field relationships, their disciplinary background, and the expectations of their clinical research collaborators.

Hominin skeletal part abundances and claims of deliberate disposal of corpses in the Middle Pleistocene

Humans are set apart from other organisms by the realization of their own mortality. Thus, determining the prehistoric emergence of this capacity is of significant interest to understanding the uniqueness of the human animal. Tracing that capacity chronologically is possible through archaeological investigations that focus on physical markers that reflect "mortality salience." Among these markers is the deliberate and culturally mediated disposal of corpses. Some Neandertal bone assemblages are among the earliest reasonable claims for the deliberate disposal of hominins, but even these are vigorously debated. More dramatic assertions center on the Middle Pleistocene sites of Sima de los Huesos (SH, Spain) and the Dinaledi Chamber (DC, South Africa), where the remains of multiple hominin individuals were found in deep caves, and under reported taphonomic circumstances that seem to discount the possibility that nonhominin actors and processes contributed to their formation. These claims, with significant implications for charting the evolution of the "human condition," deserve scrutiny. We test these assertions through machine-learning analyses of hominin skeletal part representation in the SH and DC assemblages. Our results indicate that nonanthropogenic agents and abiotic processes cannot yet be ruled out as significant contributors to the ultimate condition of both collections. This finding does not falsify hypotheses of deliberate disposal for the SH and DC corpses, but does indicate that the data also support partially or completely nonanthropogenic formational histories.

Life's end: Ethnographic perspectives

In this introduction to the special issue, Life's End: Ethnographic Perspectives, we review the field of anthropological studies of death and dying. We make the argument that, largely because of its sub-disciplining into the larger field of the anthropology of religion, ritual and symbolism, the focus of anthropological research on death has been predominantly on post- rather than pre-death events, on death's beginnings rather than life's ends. Additionally, we argue that an anthropological aversion to the study of dying may also lie in the intimacy of the discipline's principal method, ethnography. Contrastingly, we argue that this very methodological intimacy can be a source of insight, and we offer this as a rationale for the special issue as a whole, which comprises eight ethnographic studies of dying and social relations at life's end from across Africa, Australia, Europe, and North America. Each of these studies is then summarized, and a rationale for their presentation around the themes of "structures of dying," "care for the dying," "hope in dying," and "ending life" is presented.

Much ado about mice: Standard-setting in model organism research

Recently there has been a practice turn in the philosophy of science that has called for analyses to be grounded in the actual doings of everyday science. This paper is in furtherance of this call and it does so by employing participant-observation ethnographic methods as a tool for discovering epistemological features of scientific practice in a neuroscience lab. The case I present focuses on a group of neurobiologists researching the genetic underpinnings of cognition in Down syndrome (DS) and how they have developed a new mouse model which they argue should be regarded as the "gold standard" for all DS mouse research. Through use of ethnographic methods, interviews, and analyses of publications, I uncover how the lab constructed their new mouse model. Additionally, I describe how model organisms can serve as abstract standards for scientific work that impact the epistemic value of scientific claims, regulate practice, and constrain future work.

Influencing everyday activities in a nursing home setting: A call for ethical and responsive engagement

This study focuses on influence that older adults, living in nursing homes, have over everyday activities. Everyday activities are key to sustain a sense of stability, predictability, and enjoyment in the local world of people's everyday and therefore a critical dimension of the person-centeredness framework applied within gerontology. This narrative ethnographic study aimed to shed light on how influence can be situated contextually, and how it can emerge through activities as well as how it is negotiated in everyday by frail older adults living in a nursing home. Residents, staff members, and significant others from one nursing home in an urban area of Sweden participated in this study. Data were gathered through fieldwork, including participant observation and formal and informal conversations during a period of 6 months. Data were analyzed through a narrative interpretative approach. The findings are presented in narrative form as exemplars. The exemplars-Craquelures as justification, Seeking a place for other life worlds and An almost perfect trip-reveal a gap between the client-centeredness framework and lived experiences regarding older adults' influence in everyday activities. The role of everyday activities in the context of frailty is discussed in terms of ethical and responsive engagement, and implications for health-care practices are considered.

ISeeYou - Evaluation of a woman-centred care pilot project in Bachelor midwifery education and research

AIM

to evaluate the ISeeYou project that aims to equip first year Bachelor midwifery students to support them in their learning of providing woman-centred care.

METHODS

the project has an ethnographic design. First year midwifery students buddied up to one woman throughout her continuum of the childbirth process and accompanied her during her antenatal and postnatal care encounters. Participant-observation was utilised by the students to support their learning. The Client Centred Care Questionnaire (CCCQ) was administered to collect data about women's care experiences. The project was evaluated using the SWOT model.

MAIN FINDINGS

54 first year students completed the project and observed and evaluated on average eight prenatal visits and two postnatal visits. Students gained insight into women's lived experiences during the childbirth process and of received care throughout this period. Students reported that this was meaningful and supported and enhanced their comprehension of women-centred care. Logistic issues (lectures, travel, time) and being conscious of their role as an 'outsider' sometimes constrained, but never hindered, the students in meeting the requirements of the project. Overall, the project provided students with opportunities to expand competencies and to broaden their outlook on midwifery care.

CONCLUSION

the project offers students unique and in-depth experiences supporting and augmenting their professional competencies and their personal, professional and academic development.

Ethnographic analysis on the use of the electronic medical record for clinical handoff

The objective of this study was to understand the social elements of clinical and organizational interactions of the key stakeholders in the specific context of an electronic dashboard used by the emergency department (ED) and inpatient medicine teams at the time of clinical referral and handover. An electronic handover function is utilised at the ED-inpatient interface at this institution and has given clinicians the ability to better communicate, monitor the department and strive to improve patient safety in streamline the delivery of care in the acute phase. This study uses an ethnographic qualitative research design incorporating semistructured interviews, participant observation on the ED floor and fieldwork notes. The setting for this research was in the ED at a tertiary University affiliated hospital. Triangulation was used to combine information obtained from multiple sources and information from fieldwork and interviews refined into useable chunks culminating in a thematic analysis. Thematic analysis yielded five central themes that reflected how the clinical staff utilised this IT system and why it had become embedded in the culture of clinical referral and handover. Efficient time management for improved patient flow was demonstrated, value added communication (at the interpersonal level), the building trust at the ED-inpatient interface, the maintenance of mutual respect across medical cultures and an overall enhancement of the quality of ED communication (in terms of the information available). A robust electronic handover process, resulted in an integrated approach to patient care by removing barriers to admission for medical inpatients, admitted via ED. The value proposition for patients was a more complete information transfer, both within the ED and between departments.