The Lived Experience of People with Mental Health and Substance Misuse Problems: Dimensions of Belonging

Introduction: People with co-occurring mental health and substance misuse problems are among the most excluded in society. A need to feel connected to others has been articulated in the occupational science literature although the concept of belonging itself has not been extensively explored within this paradigm. This paper reports findings from research that explored the meaning and experience of belonging for four people living with dual diagnosis in the United Kingdom. Method: Researchers employed an interpretative phenomenological approach to the study. Four semi-structured interviews were carried out. The interviews were guided by questions around the meaning of belonging, barriers to belonging and how belonging and not belonging impacted on participants’ lives. Data analysis facilitated the identification of themes across individual accounts and enabled comparisons. Findings: Data analysis identified four themes – belonging in family, belonging in place, embodied understandings of belonging and barriers to belonging. Conclusion: The findings add further insights into the mutable nature of belonging. A link between sense of belonging and attachment theory has been proposed, along with a way to understand the changeable and dependent nature of belonging through ‘dimensions of belonging’.

Strategisk kompetensutveckling : En organisations strategiska förhållningssätt till kompetensutveckling

I denna fallstudie undersöks hur en kompetensbaserad personalstrategi ter sig inom en organisation. Då det är ett brett område har en avgränsning gjorts och det är enbart kompetensutveckling som berörs. Syftet är att skapa förståelse för det strategiska förhållningssättet till kompetensutveckling inom en organisation. Inom ramen för våra forskningsfrågor undersöks också de verktyg och metoder som en organisation använder sig av för att utveckla rätt kompetens samt de hinder och utmaningar som finns. Det har av tidigare forskning framkommit att ett strategiskt förhållningssätt är avgörande för en organisations överlevnad och framgång. Det finns en samstämmighet kring att organisationer vid valet av kompetensutvecklingsinsatser behöver utgå från verksamhetens behov, kundkrav och framtida mål för att bli gynnsamma. Syftet för insatserna blir därmed avgörande och en central del i det strategiska förhållningssättet till kompetensutveckling. Studien utgår från en fenomenologisk ansats och insamling av data har skett med hjälp av sju semi-strukturerade intervjuer med öppna frågor som utgått från tydliga teman. Studiens intervjuer har genomförts i en politiskt styrd organisation med cirka 5000 anställda och analysen av dessa intervjuer har skett enligt en femstegsmodell där vi avsett att synliggöra de mest väsentliga beståndsdelarna av fenomenet. Studien har tydliggjort hur organisationens strategiska förhållningssätt ser ut och också tydligt påvisat faktorer som gör det svårt att upprätthålla. De verktyg och metoder organisationen använder sig av är exempelvis webbaserad utbildning, ständiga förbättringar, nätverk, händelsehanteringssystem, en utbildningsplattform samt ett formulär för utbildningsförfrågningar. De hinder och utmaningar som synliggjorts är exempelvis utomstående faktorer, ekonomi, ansvarsfördelning och samverkan. Vår studie har också bidragit till en insikt i hur viktigt det är att noga överväga vilken metod som bör användas vid olika typer av kompetensutvecklingsinsatser. Det är viktigt att inte låta fokus hamna på att genomföra det minst kostsamma, utan låta valet av metod syfta till att ge det mest effektiva lärandet. Det är viktigt att i varje skede göra strategiska avvägningar som inte enbart har sin grund i ekonomiska perspektiv vad gäller besparingar och minskade kostnader. Ett intressant område till vidare forskning ser vi i chefsperspektivet. Vi finner detta intressant då det både genom tidigare forskning och genom vår egen studie tydligt har framgått att chefer har en nyckelroll och det finns därför ett intresse att närmre undersöka den roll som chefer delegeras i kompetensutvecklingsinsatser och vilka möjligheter de har i arbetet med dessa frågor.

Chefsintroduktion : En kvalitativ studie om nytillträdda chefers upplevelse av introduktionen till arbetet

Syftet med studien är att skapa en djupare förståelse för hur introduktionen upplevs av nytillträdda chefer samt vilka aspekter som är av betydande relevans för denna upplevelse. Studien har genomförts på en svensk myndighet med omkring 1200 anställda. Studien är av kvalitativ art och empiri har inhämtats genom semistrukturerade intervjuer med åtta verksamma chefer som har personalansvar. Vid tolkning av studiens resultat har vi inspirerats av en fenomenologisk ansats, varpå vi har fokuserat på likheter i respondenternas uppfattning av fenomenet. Av studiens resultat framgår att majoriteten av cheferna upplevt introduktionen som gedigen och informativ. Chefernas framträdande upplevelse har visat sig vara organisationens välkomnande klimat. Majoriteten av cheferna är av åsikten att organisationen möjliggjort för socialisationstillfällen i samband med introduktionen. Flertalet av cheferna föredrar att först installera sig i sin arbetsgrupp innan hela verksamhetsförståelsen kan erhållas. Avslutningsvis har den information som delgivits under introduktionen upplevts som tydlig. Ett flertal av cheferna har samtidigt upplevt den som överväldigande och svåråtkomlig.

Arbetsplatslärande ur ett informellt perspektiv på Husqvarna Group : En kvalitativ fallstudie om medarbetares upplevelser av lärande

Forskning har visat att informellt lärande företräder den största delen av allt lärande förekommande inom arbetsplatser. Syftet med denna studie var att ur ett medarbetarperspektiv undersöka förutsättningar och potentiella förbättringsmöjligheter för arbetsplatslärande, med betoning på det informella lärandet. Studien är kvalitativ och utfördes inom två utvecklingsavdelningar på Husqvarna Group genom semistrukturerade intervjuer med sammantaget sex medarbetare och två chefer. Data analyserades med en fenomenologisk ansats, och resultatet visade i enlighet med tidigare forskning att formellt- och informellt lärande är svårt att särskilja från varandra. Det påvisade även att lärande förekommer oavsett om det finns en strategi och medvetenhet om vad det är. I studien framkom att informellt lärande stod för den huvudsakliga delen av lärandet inom arbetsplatserna, men att det i stor utsträckning figurerade omedvetet bland medarbetarna. Avslutningsvis bedömdes medvetandegörande bland medarbetarna som essentiellt för att ytterligare kunna främja lärande inom avdelningarna.

Key determinants of organisational silence for non-standard workers

Purpose – The purpose of this paper is to identify the key determinants of organisational silence from the perspective of non-standard workers (NSWs). The study focuses on three research themes: first, analysing the experiences motivating NSWs to remain silent; second, analysing the role of the NSW life cycle in the motivation to remain silent, the final theme is evaluation of the impact on organisational voice of an organisation employing a workforce in which NSWs and standard workers (SWs) are blended. Design/methodology/approach – The study utilises a phenomenological approach, as defined by Van Manen (2007), to collect and analyse the phenomenon of organisational silence from the perspective of NSWs. The NSWs are defined as individuals operating via Limited Liability UK registered companies created for the purpose of delivering services to organisations via a contract of services. This study employed a combination of phenomenology and hermeneutics to collect and analyse the data collected from the NSWs using semi-structured interviews (Lindseth and Norberg, 2004). Findings – The study concludes with three core findings. NSWs experience similar motivational factors to silence as experienced by standard workers (SWs). The key differential between a SW and a NSW is the role of defensive silence as a dominant motivator for a start-up NSW. The study identified that the reasons for this is that new NSWs are defensive to protect their reputation for any future contract opportunities. In addition, organisations are utilising the low confidence of new start up NSWs to suppress the ability of NSWs to voice. The research indicates how experienced NSWs use the marketing stage of their life cycle to establish voice mechanisms. The study identified that NSWs, fulfiling management and supervisory roles for organisations, are supporting/creating climates of silence through their transfer of experiences as SWs prior to becoming NSWs. Research limitations/implications – This study is a pilot study, and the findings from this study will be carried forward into a larger scale study through engagement with further participants across a diverse range of sectors. This study has identified that there is a need for further studies on organisational silence and NSWs to analyse more fully the impact of silence on the individuals and the organisation itself. A qualitative phenomenological hermeneutical study is not intended to be extrapolated to provide broad trends. The focus of the phenomenological hermeneutic research methodology is on describing and analysing the richness and depth of the NSW’s experiences of silence in organisational settings. Originality/value – This paper draws together the studies of worker classification, motivators for organisational silence, and the impact of blending SWs and NSWs in an organisational setting. The study demonstrates that academic research to date has focused predominantly on SWs to the exclusion of the 1.5 million, and growing, NSWs in the UK. This study examines these under-represented workers to analyse the participants’ experiences of organisational silence, and its consequences in organisational settings, demonstrating a need for further studies.

Touchpoints: parents and nurses perceptions and satisfaction

O apoio prestado às famílias que vivenciam a parentalidade deve basear-se numa relação de confiança entre enfermeiros e pais. A satisfação dos clientes e dos enfermeiros durante a prestação de cuidados assume grande relevância e pode ser considerada um ganho em saúde. Objetivo: Compreender a experiência e o significado atribuído pelos pais de crianças entre os 11 e os 24 meses e dos enfermeiros que participaram na implementação da metodologia Touchpoints (TP), uma intervenção de enfermagem inovadora. Desenho do Estudo e Métodos: Estudo qualitativo de cariz fenomenológico. A recolha de dados foi efetuada através de (i) diários de itinerância dos enfermeiros que participaram na implementação da metodologia TP e da (ii) técnica de grupos focais realizada junto de 10 pais de crianças do grupo de intervenção. Resultados: os pais consideraram que as sessões TP, implementadas pelos enfermeiros, contribuíram para: Aquisição de conhecimentos e competências; Validação de práticas parentais; Melhoria do comportamento da criança; Confiança parental; Relacionamento interpessoal; Competências profissionais; Competências específicas; Satisfação. Os enfermeiros que participaram no estudo consideraram que a metodologia TP contribuiu para: Mobilização e aplicação dos princípios TP; Processo de aprendizagem; Interesse dos pais; Sentimentos/emoções; Satisfação. Implicações Clínicas: Os enfermeiros que cuidam de famílias devem implementar metodologias inovadoras que facilitem a adaptação à parentalidade, como os Touchpoints. A implementação da metodologia TP contribuiu para a satisfação dos pais e enfermeiros.

O regresso a casa : estudo sobre as vivências, sentimentos e expetativas dos familiares de utentes internados numa unidade de cuidados continuados face á alta

A crescente camada de população idosa que reside em Trás-os-Montes e no Douro e a prevalência de doenças crónicas e incapacitantes, conduz ao aumento do número de pessoas dependentes de cuidados, assim como de uma terceira pessoa que auxilie na satisfação das suas atividades de vida diária. A criação da Rede Nacional de Cuidados Continuados é uma mais-valia constituindo uma resposta adequada a pessoas que se encontram em situação de dependência, assim como aos seus familiares. Face à antevisão de alta da unidade e consequente regresso a casa, o cuidador familiar é, por vezes, assoberbado com múltiplas dúvidas e inseguranças, pelo que, merecem ser compreendidos. Com o objetivo de compreender vivências, sentimentos e expetativas que caraterizam o período que rodeia a alta do familiar da Unidade de Cuidados Continuados onde esteve internado desenvolveu-se o presente estudo que, face ao tipo de problemática a estudar, fez recurso da metodologia qualitativa, enveredando-se pela abordagem fenomenológica. Com base num guião de entrevista, inquiriram-se sete cuidadores informais que tinham, ou tiveram anteriormente, familiares internados numa Unidade de Cuidados Continuados. Perante a eminência da alta os cuidadores informais vivenciam um momento difícil que requer adaptação ao seu novo papel. A prestação de cuidados é uma tarefa exigente, contribuindo para uma ambivalência de sentimentos mencionada pelos participantes do estudo. Os sentimentos positivos traduzem-se em amor e gratificação, enquanto os sentimentos negativos estão relacionados com o medo, ansiedade e insegurança, face ao ato de cuidar. As redes de apoio informal/formal, manifestadas por apoio técnico, psicológico, financeiro e a necessidade de formação são fatores fundamentais, revelados pelos cuidadores informais do estudo. As expetativas referidas pelos participantes do estudo face às Unidades de Cuidados Continuados são: a adequação dos cuidados à situação da pessoa, promoção da autonomia e a humanização dos cuidados em saúde.

Eliciting nature and landscape writing through outdoor experiences

Nature and landscape writing includes creative writing about wild places. However, most authors have a literary background and are not outdoor ‘educators’. Using a hermeneutic phenomenological approach, the reasons suggested are a lack of framing of outdoor experiences for this intent, the need for learning the skills of interpretation and lexicon and the offer of prolonged, powerful experiences and time for creative thinking and responses, such as an extended solo. It is suggested that outdoor educators may be too busy ‘experiencing’ to write, that they do not go ‘slow’ enough or that they are encapsulated in the ‘edginess of existence’ through adventure and just pass through their surroundings rather than connect with them. Outdoor educators have much to offer as they experience metaphorical or literal journeys comprising ‘flow’ rather than episodic encounter through lived experience to create rich embodied stories with ideological and social aspects so often overlooked in narrative.

Memória da história no reabilitar

Dissertação para obtenção do grau de Mestre em Arquitectura, apresentada na Universidade de Lisboa - Faculdade de Arquitectura.

Exploring Aboriginal patients’ experiences of cardiac care at a major metropolitan hospital in Melbourne

Objectives: The aim of the present study was to explore Aboriginal patients' lived experiences of cardiac care at a major metropolitan hospital in Melbourne.Methods: The study was a qualitative study involving in-depth interviews with a purposive sample of 10 Aboriginal patients who had been treated in the cardiology unit at the study hospital during 2012-13. A phenomenological approach was used to analyse the data.Results: Eight themes emerged from the data, each concerning various aspects of participants' experiences: 'dislike of hospitals', 'system failures', 'engagement with hospital staff', 'experiences of racism', 'health literacy and information needs', 'self-identifying as Aboriginal', 'family involvement in care' and 'going home and difficulties adapting'. Most participants had positive experiences of the cardiac care, but hospitalisation was often challenging because of a sense of dislocation and disorientation. The stress of hospitalisation was greatly mediated by positive engagements with staff, but at times exacerbated by system failures or negative experiences.Conclusion Cardiac crises are stressful and hospital stays were particularly disorienting for Aboriginal people dislocated from their home land and community.What is known about the topic? Aboriginal people have higher mortality rates due to cardiovascular diseases compared with other Australians. Along with different factors contributing to the life expectancy gap, Aboriginal people also face significant barriers in the use of the healthcare system.What does this paper add? Aboriginal patients' lived experience of cardiac care at a major metropolitan hospital in Melbourne is explored in this paper. Different issues were revealed during their interaction with the hospital staff and the hospital system in conjunction with their cultural aspect of patient care.What are the implications for practitioners? Positive interactions with staff, ongoing support from family and community, culturally appropriate cardiac rehabilitation programs can improve the cardiac care experiences of Aboriginal patients.

Parent and child experiences of childhood cancer : an interpretative phenomenological analysis approach

A diagnosis of cancer represents a significant crisis for the child and their family. As the treatment for childhood cancer has improved dramatically over the past three decades, most children diagnosed with cancer today survive this illness. However, it is still an illness which severely disrupts the lifestyle and typical functioning of the family unit. Most treatments for cancer involve lengthy hospital stays, the endurance of painful procedures and harsh side effects. Research has confirmed that to manage and adapt to such a crisis, families must undertake measures which assist their adjustment. Variables such as level of family support, quality of parents’ marital relationship, coping of other family members, lack of other concurrent stresses and open communication within the family have been identified as influences on how well families adjust to a diagnosis of childhood cancer. Theoretical frameworks such as the Resiliency Model of Family Adjustment and Adaptation (McCubbin and McCubbin, 1993, 1996) and the Stress and Coping Model by Lazarus and Folkman (1984) have been used to explain how families and individuals adapt to crises or adverse circumstances. Developmental theories have also been posed to account for how children come to understand and learn about the concept of illness. However more descriptive information about how families and children in particular, experience and manage a diagnosis of cancer is still needed. There are still many unanswered questions surrounding how a child adapts to, understands and makes meaning from having a life-threatening illness. As a result, developing an understanding of the impact that such a serious illness has on the child and their family is crucial. A new approach to examining childhood illness such as cancer is currently underway which allows for a greater understanding of the experience of childhood cancer to be achieved. This new approach invites a phenomenological method to investigate the perspectives of those affected by childhood cancer. In the current study 9 families in which there was a diagnosis of childhood cancer were interviewed twice over a 12 month period. Using the qualitative methodology of Interpretative Phenomenological Analysis (IPA) a semi-structured interview was used to explicate the experience of childhood cancer from both the parent and child’s perspectives. A number of quantitative measures were also administered to gather specific information on the demographics of the sample population. The results of this study revealed a number of pertinent areas which need to be considered when treating such families. More importantly experiences were explicated which revealed vital phenomena that needs to be added to extend current theoretical frameworks. Parents identified the time of the diagnosis as the hardest part of their entire experience. Parents experienced an internal struggle when they were forced to come to the realization that they were not able to help their child get well. Families demonstrated an enormous ability to develop a new lifestyle which accommodated the needs of the sick child, as the sick child became the focus of their lives. Regarding the children, many of them accepted their diagnosis without complaint or question, and they were able to recognise and appreciate the support they received. Physical pain was definitely a component of the children’s experience however the emotional strain of loss of peer contact seemed just as severe. Changes over time were also noted as both parental and child experiences were often pertinent to the stage of treatment the child had reached. The approach used in this study allowed for rich and intimate detail about a sensitive issue to be revealed. Such an approach also allowed for the experience of childhood cancer on parents and the children to be more fully realised. Only now can a comprehensive and sensitive medical and psychosocial approach to the child and family be developed. For example, families may benefit from extra support at the time of diagnosis as this was identified as one of the most difficult periods. Parents may also require counselling support in coming to terms with their lack of ability to help their child heal. Given the ease at which children accepted their diagnosis, we need to question whether children are more receptive to adversity. Yet the emotional struggle children battled as a result of their illness also needs to be addressed.

Childhood experiences of cancer : an interpretative phenomenological analysis approach

Pediatric oncology has emerged as one of the great medical success stories of the last 4 decades. The cure rate of childhood cancer has increased from approximately 25% in the 1960’s to more than 75% in more recent years. However, very little is known about how children actually experience the diagnosis and treatment of their illness. A total of 9 families in which a child was diagnosed with cancer were interviewed twice over a 12-month period. Using the qualitative methodology of interpretative phenomenological analysis (IPA), children’s experiences of being patients with a diagnosis of cancer were explicated. The results revealed 5 significant themes: the experience of illness, the upside of being sick, refocusing on what is important, acquiring a new perspective, and the experience of returning to wellbeing. Changes over time were noted because children’s experiences’ were often pertinent to the stage of treatment the child had reached. These results revealed rich and intimate information about a sensitive issue with implications for understanding child development and medical and psychosocial treatment.

A Psychosocial Approach to Understanding Causality Assessment in Early Phase Oncology Clinical Trials: A Phenomenological Study

Research Question: What are the psychosocial factors that affect causality assessment in early phase oncology clinical trials? Methods: Thirty-two qualitative interviews were explicated with the aid of “Naturalistic Decision Making”. Data explication consisted of phenomenological reduction, delineating and clustering meaning units, forming themes, and creating a composite summary. Participants were members of the National Cancer Institute of Canada’s Clinical Trial Group Investigative New Drug committee. Results: The process of assigning causality is extremely subjective and full of uncertainty. Physicians had no formal training, nor a tool to assist them with this process. Physicians were apprehensive about their decisions and felt pressure from their patients, as well as the pharmaceutical companies sponsoring the trial. Conclusions: There are many problem areas when attributing causality, all of which have serious consequences, but clinicians used a variety of methods to cope with these problem areas.

Estimating losses in an entanglement concentration scheme using the phenomenological operator approach to dissipation in cavity quantum electrodynamics

In a previous paper, we developed a phenomenological-operator technique aiming to simplify the estimate of losses due to dissipation in cavity quantum electrodynamics. In this paper, we apply that technique to estimate losses during an entanglement concentration process in the context of dissipative cavities. In addition, some results, previously used without proof to justify our phenomenological-operator approach, are now formally derived, including an equivalent way to formulate the Wigner-Weisskopf approximation.

Martensite Crystallography - the apparent controversy between the infinitesimal deformation approach and the phenomenological theory of martensitic transformations

The aim of this article is to demonstrate that the apparent controversy between the infinitesimal deformation (ID) approach and the phenomenological theory of martensitic transformations (PTMTs) in predicting the crystallographic characteristics of a martensitic transformation is entirely based on unjustified approximations associated with the way in which the ID calculations are performed. When applied correctly, the ID approach is shown to be absolutely identical to the PTMT. Nevertheless, there may be some advantages in using the ID approach. In particular, it is somewhat simpler than the PTMT; it is based on a physical concept that is easier to understand and, most important, it may provide a tool for investigating some of the features of martensitic transformations that have eluded explanation via the PTMT.