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.

Deconstruction of central line insertion guidelines based on the positive deviance approach-Reducing gaps between guidelines and implementation: A qualitative ethnographic research

Background

Despite a proven association between the implementation of prevention guidelines for central line associated blood stream infections (CLABSI) and reduction in CLABSI rates, in practice there is poor adherence. Furthermore, current guidelines fail to address the multiple process on the care continuum. This research is based on the bottom-up "Positive Deviance" (PD) approach, through which multiple creative and safer solutions for central line (CL) insertion were identified that were not previously described in the guidelines. The aim of the study was to deconstruct CLABSI prevention guidelines ("during insertion" process only) through the PD approach, working with physicians to identify additional actions that, in practice, help maintain a sterile environment and contribute to patient safety.

Methods and findings

Our study included a qualitative ethnographic study involving 76 physicians, working in a division of internal medicine and two intensive care units (ICUs). We triangulated findings from a combination of data-collection methods: semi-structured interviews, focused observations, video documentation, Discovery & Action Dialogue (DAD), and simulations. Deconstruction analysis was performed. A total of 23 creative extensions and variations of CL insertion practices were identified.

Conclusions

The PD approach enables the identification of vital nuggets of hidden wisdom missing from the formal explicit CLABSI guidelines, and therefore helps bridge the gap between theory and praxis. During the guideline's deconstruction process, through collaborative staff learning, the written procedure is transformed into a living, breathing and cooperative one. It can reduce hospital stays and save lives, and therefore needs careful attention of healthcare scholars and practitioners.

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.

The Croatian national termbank Struna: a new platform for terminological work

The development of the Croatian Special Field Terminology program (known by its Croatian acronym Struna) began in 2007 as part of an initial coordination project launched at the initiative of the Croatian Standard Language Council, and has since been financed by the Croatian Science Foundation. It is being carried out at the Institute of Croatian Language and Linguistics, which serves as the national coordinator. This paper describes the current design of the e-Struna termbank and explains the adjustments made in the database structure and in the terminographic approach, both to support and reflect the methodological issues concerning interdisciplinary and multidisciplinary work. Based on examples taken from the Croatian anthropological terminology collection special attention is given to two frequently neglected categories of terminological description: context and note.

Croatian anthropological terminology--challenges and dilemmas

This paper describes the project ANTRONA aimed at constructing basic anthropological terminology that covers the entire range of anthropology as a science. It is a part of national language planning oriented terminology management for the Croatian language, and as such it is focused solely at the production of a terminographic database. The major difficulties encountered during the procedural stages of the project are outlined, such as the wide range of the interdisciplinary field of anthropology, including concepts and terms from natural and social sciences and humanities, as well as polysemy and fuzzy boundaries between the lexicon of the general language and specialized language. On the basis of several examples, we argue that terminography should be dealt with primarily by keeping in mind the range of its subsequent applications the aim of which is not only ontological, but also communicative in nature, and that functional pragmatic approach offers a more flexible framework for dealing with the demands of terminology in such an interdisciplinary field.

Barriers to implementing the DSM-5 cultural formulation interview: a qualitative study

The Outline for Cultural Formulation (OCF) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) marked an attempt to apply anthropological concepts within psychiatry. The OCF has been criticized for not providing guidelines to clinicians. The DSM-5 Cultural Issues Subgroup has since converted the OCF into the Cultural Formulation Interview (CFI) for use by any clinician with any patient in any clinical setting. This paper presents perceived barriers to CFI implementation in clinical practice reported by patients (n = 32) and clinicians (n = 7) at the New York site within the DSM-5 international field trial. We used an implementation fidelity paradigm to code debriefing interviews after each CFI session through deductive content analysis. The most frequent patient threats were lack of differentiation from other treatments, lack of buy-in, ambiguity of design, over-standardization of the CFI, and severity of illness. The most frequent clinician threats were lack of conceptual relevance between intervention and problem, drift from the format, repetition, severity of patient illness, and lack of clinician buy-in. The Subgroup has revised the CFI based on these barriers for final publication in DSM-5. Our findings expand knowledge on the cultural formulation by reporting the CFI's reception among patients and clinicians.

[Medical research-ethics applied to social sciences: relevance, limits, issues and necessary adjustments]

Social sciences are concretely concerned by the ethics of medical research when they deal with topics related to health, since they are subjected to clearance procedures specific to this field. This raises at least three questions: - Are principles and practices of medical research ethics and social science research compatible? - Are "research subjects" protected by medical research ethics when they participate in social science research projects? - What can social sciences provide to on-going debates and reflexion in this field? The analysis of the comments coming from ethics committees about social science research projects, and of the experience of implementation of these projects, shows that the application of international ethics standards by institutional review boards or ethics committees raises many problems in particular for researches in ethnology anthropology and sociology. These problems may produce an impoverishment of research, pervert its meaning, even hinder any research. They are not only related to different norms, but also to epistemological divergences. Moreover, in the case of studies in social sciences, the immediate and differed risks, the costs, as well as the benefits for subjects, are very different from those related to medical research. These considerations are presently a matter of debates in several countries such as Canada, Brasil, and USA. From another hand, ethics committees seem to have developed without resorting in any manner to the reflexion carried out within social sciences and more particularly in anthropology Still, the stakes of the ethical debates in anthropology show that many important and relevant issues have been discussed. Considering this debate would provide openings for the reflexion in ethics of health research. Ethnographic studies of medical research ethics principles and practices in various sociocultural contexts may also contribute to the advancement of medical ethics. A "mutual adjustment" between ethics of medical research and social sciences is presently necessary: it raises new questions open for debate.

Towards a unified science of cultural evolution

We suggest that human culture exhibits key Darwinian evolutionary properties, and argue that the structure of a science of cultural evolution should share fundamental features with the structure of the science of biological evolution. This latter claim is tested by outlining the methods and approaches employed by the principal subdisciplines of evolutionary biology and assessing whether there is an existing or potential corresponding approach to the study of cultural evolution. Existing approaches within anthropology and archaeology demonstrate a good match with the macroevolutionary methods of systematics, paleobiology, and biogeography, whereas mathematical models derived from population genetics have been successfully developed to study cultural microevolution. Much potential exists for experimental simulations and field studies of cultural microevolution, where there are opportunities to borrow further methods and hypotheses from biology. Potential also exists for the cultural equivalent of molecular genetics in "social cognitive neuroscience," although many fundamental issues have yet to be resolved. It is argued that studying culture within a unifying evolutionary framework has the potential to integrate a number of separate disciplines within the social sciences.

How old are you now?

Cherkas et al. provide a new, biological approach to a classic problem in anthropology--the estimation of age.

Translators, traitors, and traducers: Perjuring Hawaiian same-sex texts through deliberate mistranslation

In the long history of the West's encounter with Hawaiian culture, which began in the late 1700s with Captain Cook, translators and translations have often been the tools of intentional falsehood, thus demonstrating the truth of the Italian proverb, Traduttore, traditore ("the translator is a traitor")--particularly with regard to same-sex texts. The standards of truth have often been subverted in translation by the demands of foreign religion, hegemony, business, and academe. This subversion continues to this day in the form of the "missionary mentality" in politics and law. The way out of this situation is a brutally honest cleaning-off of the besmirched Hawaiian texts.

Slave ethics and imagining critically applied anthropology in public health research

For several years I considered myself a resident enemy alien of public health research. This polemical article explores this enemy alien subjectivity by looking at an ethnographic case showing how race is figured in public health research, and it asks what this subjectivity might suggest for a medical anthropology struggling to be both more public and interdisciplinary, and more fundamentally ethnological. As I imbue my enemy alien subjectivity with uniquely anthropological images and references, I ask medical anthropologists to reflect upon the specialized nature of a contemporary anthropological imagination and, while doing this, to look to the Nietzschean notion of slave ethics in order to engage with questions of how we might use this self-awareness to create various modes of"postcritical"practice in public health.

Lifelines

BACKGROUND

Life histories are data collection strategies that detail an individual's life Lifelines are a visual depiction of a life history, displaying events in chronological order and noting the importance, or meaning, of events.

APPROACH

A sample lifeline from a study of young women's developmental transitions used to demonstrate the application of this technique to nursing research. A review life histories as well as lifeline techniques, analysis, and applications is included.

DISCUSSION

Life history has been used extensively as a data collection method research, theory development, and clinical practice. The lifeline facilitates recollection and sequencing of personal events. The lifeline activity can be triangulated with other data collection methods such as interviews and focus groups to confirm and complete a life history or to place a particular research construct or clinical problem in the con text of other events.

Sampling issues in qualitative research

While qualitative methodologies have increased in popularity over the past few decades, they have been criticised because of a lack of transparency in procedures and processes. While much of this criticism has been levied at analytical steps, many published qualitative studies give little information about the characteristics of the study sample or the type of sample employed or techniques used. In this paper, Gina Higginbottom aims to provide an overview of the complexity of sampling in qualitative research, and to provoke reflection and consideration of qualitative methodologies. It is hoped that this will encourage nurse researchers to seek out the primary texts and gain greater insight into the various philosophical underpinnings and sampling techniques in qualitative research.

The tempering of medical anthropology: troubling natural categories

This article reviews an approach in medical anthropology that commenced in the early 1980s and that continues to the present day in which biomedical knowledge and practices are systematically incorporated into anthropological analyses. Discussion then focuses on contributions made by feminists and medical anthropologists to the literature on medicalization and resistance, illustrating how the ethnographic approach has been crucial in critically reconceptualizing and situating these concepts historically and cross-culturally. The concept of local biologies is introduced in the third section of the article in creating the argument that the coproduction of biologies and cultures contributes to embodied experience, which, in turn, shapes discourse about the body. Subjective reporting at menopause provides an illustrative case study of local biologies in action. The final part of the article takes up the question of the moral economy of scientific knowledge. Comparative ethnographic work in intensive care units in Japan and North America reveals how a moral economy is put into practice in connection with brain-dead bodies and the procurement of organs from them. Medical anthropological contributions to policy making about biomedical technologies is briefly considered in closing.

Hearing where we're coming from--ethically and professionally

Anthropologists concerned about the discipline's ability to cope ethically and ethnographically with a globalized world should not dismiss too hastily the methodology--and the ethics built into it--that anthropology developed over the last century. This methodology of making "displacing" translations, based on ethnographic experience and a politics of translation, can still provide a workable ethics and a viable labor of ethnography even in the world at present.

Ethical issues in the ethnography of cyberspace

The project of developing an anticipatory anthropology of the future reveals unique ethical opportunities. For example, the increased importance of performance means there is a substantial potential for a substantive "resocialing" of work in organizations, just as the decline of Modernism opens space for collective, situated ethics as opposed to individualized categorical imperatives. An anthropology of the future should address the question of the future of ethics in general. The very possibility of human agency, of informed individual moral action, is brought into question in new ways. The profound flexibility of the computer as a medium carries with it the dangers of hyper-abstraction, while the consolidation of capital reproduction on a global level increases the scope for apparently permanent mystification. Also important are the new ethical challenges raised for those engaged in knowledge "production" or science broadly conceived. These include the necessary effort to acknowledge fully the role of non-human agency, and the potentially profound possibilities in a transformation in the character of knowledge, a correlate, at least in part, of the commodification of knowledge associated with distance learning. These challenges accompany the more overt threats of transgenic entities and ecological degradation. How can one be an ethical intellectual or academic under these circumstances, let alone teach others to be? There are also some specific challenges facing anthropology in particular. Some derive from the increasing "privatization" of ethnography, both in its growing popularity in modes of social reproduction more directly implicated in the reproduction of capital and in the declining academic support for anthropology. In a very specific sense, anthropology has grounded its ethics on an appreciation of and support for the reproduction of "really existing" culture. This ethical compass is not available to the ethnographer who studies the future. How do we participate ethically in the construction of a future in whose character we are inevitably implicated?

Working toward an ethical anthropology. Where do we go from here?

This article posits an ethical anthropology for the 21st century that addresses and informs our understanding of international conflict situations and their solutions while providing methodologies for anthropologists of color to position their issues of concern at the center of social science discourse.

Ethics in anthropology: dilemmas and conundrums

This paper is a call for awareness and continual examination of the multifaceted nature of ethics and closely related ideas as they relate to anthropology. At the very least, the lack of common understanding of these ideas has been and continues to be a pressing prblem for all who practice anthropology. In this vein, abbreviated etymologies of these critical concepts are put forth as prologue to forays into ethics in the academy and of science as context for ethical maneuver. Shifting conditions in anthropology are then described in relation to altered ethical orders with examples of early hints of the contemporary scene being drawn from Oscar Lewis's commentary on the raucous reception in Mexico of his book The Children of Sanchez.

Ethnography: an overview

This article offers an overview of ethnographic research. First, an example from a "traditional" ethnography is presented to make explicit some key aspects of the research process and the underlying logic of ethnography's "abductive" epistemology. Next, ethnography is contrasted and compared with the "received view" (deductive, quantitative) to show how it differs from the usual tradition of "social research." Finally, the way that ethnography and epidemiology are being combined in United States drug use(r) research is described.

Computer analysis of qualitative data: the use of ethnograph

Ethnograph, a code and retrieve software program for computer analysis of qualitative data, was utilized to assist in analyzing the content of in-depth interviews and focus group data. This program requires basic computer hardware and is fairly easy to use. The main advantage of the program is easy access to data dealing with a particular issue and easy retrieval of text for analysis and illustration. However, to get the maximum benefit from this program, documents need to be structured In the format suitable for the software. Among the difficulties encountered were the absence of on-line documents dummy coding, lack of options in printing facility and the tendency for the program to hang whenever there was a printing error.

Evaluating ethnography: considerations for analysis

The informed evaluation of ethnographic reports is essential to the practitioner who is working towards research-based practice. It is also part of the process of developing and refining nursing knowledge. While there are features common to the critical examination of all research, an understanding of ethnographic design and, in particular, of issues of validity and reliability, is a prerequisite for evaluation of ethnographic research reports.

Feminist research: definitions, methodology, methods and evaluation

The literature relating to feminist research both within and beyond nursing is reviewed in this paper. Feminist research is located within a post-positivist paradigm, and various definitions are considered. The distinctive methodological approach of feminist research is discussed, and interviewing and ethnography are evaluated as suitable methods for use in feminist research. Oakley's (1981) paper on interviewing women is subjected to criticism. A final section examines attempts by three sets of writers to propose evaluation criteria for feminist research. The review concludes that a number of paradoxes and dilemmas in feminist research have yet to be resolved.

Forensic archaeology as mortuary anthropology

This paper argues that forensic anthropology is more than just physical anthropology, but should incorporate several subdisciplinary perspectives into a framework of mortuary anthropology. The advantage of this holistic approach is to provide context for the primary roles of physical anthropologists; identification of victims, and assessing manner of death. Mortuary anthropology provides information on processes of disposal and site formation, including the regularity, sequencing, and timing of events, which is complementary to the traditional roles of physical anthropologists. A call is made for more widespread application of this perspective.