Developing an intervention to equip nurses for acute life threatening events (ALTEs) in hospital:a phenomenological approach to healthcare research

Objectives: To understand staff's experiences of acute life threatening events (ALTEs) in a pediatric hospital setting. These data will inform an intervention to equip nurses with clinical and emotional skills for dealing with ALTEs. Method: A mixed design was used in the broader research program; this paper focuses on phenomenon-focused interviews analyzed using interpretative phenomenological analysis (IPA). Results: Emerging themes included staff's relationships with patients and the impact of personhood on their ability to perform competently in an emergency. More experienced nurses described "automatic" competence generated through increased exposure to ALTEs and were able to recognize "fumbling and shaking" as a normal stress response. Designating a role was significant to staff experience of effectiveness. Key to nurses' learning experience was reflection and identifying experiences as "teachable moments." Findings were considered alongside existing theories of self-efficacy, reflective thought, and advocacy inquiry to create an experiential learning intervention involving a series of clinical and role-related scenarios. Conclusion: The phenomenological work facilitated an in-depth reading of experience. It accentuated the importance of exposure to ALTEs giving nurses experiential knowledge to prepare them for the impact of these events. Challenges included bracketing the personhood of child patients, shifting focus to clinical tasks during the pressured demands of managing an ALTE, normalizing the physiological stress response, and the need for a forum and structure for reflection and learning. An intervention will be designed to provide experiential learning and encourage nurses to realize and benefit from their embodied knowledge.

Health related quality of life and perception of stigmatisation in adolescents living with sickle cell disease in Nigeria:a cross sectional study

Background: Sickle cell disease impacts the physical, emotional and psychological aspects of life of the affected persons, often times exposing them to disease associated stigma from the society and alters the health related quality of life (HRQoL). This study compared the HRQoL of adolescents with sickle cell disease with their healthy peers, identified socio-demographic and clinical factors impacting HRQoL, and determined the extent and effects of SCD related stigma on quality of life. Procedure: We conducted a cross-sectional survey among 160 adolescents, 80 with SCD and 80 adolescents without SCD. Socio-demographic and clinical data were collected using a pre-tested questionnaire. HRQoL was investigated using the Short Form (SF-36v2) Health Survey. SCD perceived stigma was measured using an adaptation of a perceived stigma questionnaire. Results: Adolescents with SCD have significantly worse HRQoL than their peers in all of the most important dimensions of HRQoL (physical functioning, physical roles limitation, emotional roles limitation, social functioning, bodily pain, vitality and general health perception) except mental health. Recent hospital admission and SCD related complication further lowered HRQoL scores. Over seventy percent of adolescents with SCD have moderate to high level of perception of stigmatisation. Hospitalisation, SCD complication, SCD stigma were inversely, and significantly associated with HRQoL. Conclusions: Adolescents living with SCD in Nigeria have lower health related quality of life compared to their healthy peers. They also experience stigma that impacts their HRQoL. Complications of SCD and hospital admissions contribute significantly to this impairment. Pediatr Blood Cancer 2015;62:1245-1251.

Bringing engineering education to life – an empirical approach to learning and teaching

Learning and teaching approaches to engineering are generally perceived to be difficult and academically challenging. Such challenges are reflected in high levels of student attrition and failure. In addressing this issue, a unique approach to engineering education has been developed by the paper authors. This approach, which is suitable for undergraduate and postgraduate levels, brings together pedagogic and engineering epistemologies in an empirically grounded framework. It is underpinned by three distinctive concepts: Relationships, Variety & Synergy. Based upon research, the R + V + S approach to Engineering Education provides a learning and teaching strategy, which in enhancing the student experience, increases retention and positively impacts student success [S2]. Based on the study findings, this paper shows how, by designing engineering education around the concepts of Relationships, Variety and Synergy, the student learning experience becomes one that is academically challenging yet beneficial to both students and engineering educators. The challenge is to widen and test the approach in other areas of engineering education, before going on to investigate the value of the approach in other disciplines.

Bringing engineering education to life:an empirical approach

This paper focuses upon the argument that the role played by the engineering profession within today's society has changed markedly over the past several years from providing the foundations for contemporary life to leading societal change and becoming one of the key driver's of future social development. Coining the term 'Engineering-Sociology' this paper contributes to engineering education and engineering education research by proposing a new paradigm upon which future engineering education programmes and engineering education research might build. Developed out of an approach to learning and teaching practice, Engineering-Sociology encapsulates both traditional and applied approaches to engineering education and engineering education research. It suggests that in order to meet future challenges there is a need to bring together what are generally perceived to be two diametrically opposed paradigms, namely engineering and sociology. Building on contemporary theoretical and pedagogical arguments in engineering education research, the paper concludes that by encouraging engineering educators to 'think differently', Engineering-Sociology can provide an approach to learning and teaching that both enhances the student experience and meets the changing needs of society.

Living well to the end:a phenomenological analysis of life in extra care housing

OBJECTIVES: To understand older adults' experiences of moving into extra care housing which offers enrichment activities alongside social and healthcare support. DESIGN: A longitudinal study was conducted which adopted a phenomenological approach to data generation and analysis. METHODS: Semi-structured interviews were conducted in the first 18 months of living in extra care housing. Interpretative phenomenological analysis was used because its commitment to idiography enabled an in-depth analysis of the subjective lived experience of moving into extra care housing. Themes generated inductively were examined against an existential-phenomenological theory of well-being. RESULTS: Learning to live in an extra care community showed negotiating new relationships was not straightforward; maintaining friendships outside the community became more difficult as capacity declined. In springboard for opportunity/confinement, living in extra care provided new opportunities for social engagement and a restored sense of self. Over time horizons began to shrink as incapacities grew. Seeking care illustrated reticence to seek care, due to embarrassment and a sense of duty to one's partner. Becoming aged presented an ontological challenge. Nevertheless, some showed a readiness for death, a sense of homecoming. CONCLUSIONS: An authentic later life was possible but residents required emotional and social support to live through the transition and challenges of becoming aged. Enhancement activities boosted residents' quality of life but the range of activities could be extended to cater better for quieter, smaller scale events within the community; volunteer activity facilitators could be used here. Peer mentoring may help build new relationships and opportunities for interactive stimulation. Acknowledging the importance of feeling-empathic imagination-in caregiving may help staff and residents relate better to each other, thus helping individuals to become ontologically secure and live well to the end.

Exploring care relations in later life: disentangling notions of care and choice

The experience of later life varies widely and is often framed in terms of the active lifestyles of the Third Age and the frailty and abjection of the Fourth Age. This thesis sought to understand how the concepts of care and choice are enacted, experienced and interrelated in the context of both informal and formal care in later life and how older people themselves, their families and significant others understand and experience these concepts. The discourse of personalisation that dominates care services has led to an emphasis on individual choice, control and independence so that those in need of care are faced with what has been described as the ‘logic of choice’, a focus on individual responsibility rather than care. Adopting a Feminist Foucauldian theoretical approach and drawing on Tronto’s (1993) ethic of care, this thesis explores the experiences of older people and their informal carers through dialogical narrative analysis. The stories begin with the recognition by individuals that there is a need for care and how this need is met through negotiations with families and significant others. As needs increase the physical and logistical limits of informal care by individuals are reached, often leading to a need to ‘choose’ formal care. Rather than impacting solely on the care recipient, formal care is shown as being an experience that is shared with informal carers. Indeed, the participants depict how informal care continues alongside formal care and how the boundaries between them become blurred. I argue that a binary division between actively making choices and being a passive recipient are not appropriate to understandings of care. By disentangling the notions of care and choice this thesis explores the extent to which these concepts are relevant to the experience of older people in specific care situations.

Vállalati vezetők innovációs érzékenysége, szemlélete és szándékaik – egy felmérés tapasztalatai (Managers' innovation sensivity, approach, and purposes – experience of a survey)

A magyar vállalatok innovatív képességét felmérő kérdőíves kutatások eltérő eredményeket adtak, ami a piaci szereplők eltérő innováció-értelmezésével magyarázható. A szerzők feltevése szerint a vállalati vezetők jellemzően innovatívnak tartják magukat, és ez alapján jelentős részük fejlesztéseket tervez a jövőben, amelyhez pályázati forrásokat kívánnak igénybe venni. A gyakorlati életben az innováció fogalmát a tudományos definíciónál tágabban értelmezik, a vállalatnál bevezetett újdonságokat (például a piaci versenytársaktól átvett új terméket) is innovációnak értékelik. A vállalati növekedést a finanszírozási nehézségek korlátozzák. A támogatások, a hitelek és a kockázati tőke jellegű források eltérő mértékben játszanak szerepet a vállalatok életében. A szerzők tanulmányukban a vállalatok innovatív tevékenysége és a különböző források megléte közötti kapcsolatot, valamint a pályázati rendszerhez fűződő vállalati tapasztalatokat vizsgálják. /===/ Questionnaire surveys of innovation abilities of the Hungarian enterprises have given different results, which could be explained by different innovation interpretation of the market players. According to the authors' hypothesis the managers consider themselves innovative, and many of them plan developments in the future to realize them with tender sources. In the practice idea of innovation is broader interpreted than the scientific definition, and novelties introduced at the companies (eg. a new product taken over from competitors) is also considered innovation. Corporate growth is limited by financing difficulties. Supports, credits and sources of venture capital character play a role int he corporate life to different extent. Authors investigate the connection between the innovative activity of companies and the existence of several sources, and corporate experience linked to tendering system.

Breaking promises. The Hungarian experience

My main aim is to present the phenomena related to fulfilment and breach of promises and the economic, political and ethical problems arising from these. I discuss questions that we all meet with in daily life and see mentioned in the press, other forums of public discourse, gatherings of friends, or sessions of Parliament. There are some who complain that a building contractor has not done a renovation job properly according to contract. Economists argue over the outcome of late repayments on loans advanced for purchasing real estate. Opposition meetings chide the governing party over unfulfilled campaign promises. I am seeking what is common among these seemingly different cases. Can we see identical or similar behavior patterns and social mechanisms in them? Do they lead to similar decision-making dilemmas and reactions?

Students' recollections of participating in a first year residential learning community experience

The purpose of this qualitative study was to gain an understanding of what participation in a first year residential learning community meant to students 2–3 years after their involvement in the program. Various theories including environmental, student involvement, psychosocial and intellectual, were used as a framework for this case study. Each of the ten participants was a junior or senior level student at the time of the study, but had previously participated in a first year residential learning community at Florida International University. The researcher held two semi-structured interviews with each participant, and collected data sheets from each. ^ The narrative data produced from the interviews were transcribed, coded and analyzed to gain insights into the experiences and perspectives of the participants. Member checking was used after the interview process. A peer reviewer offered feedback during the data analysis. The resulting data was coded into categories, with a final selection of four themes and 15 sub-themes, which captured the essence of the participants' experiences. The four major themes included: (a) community, (b) involvement, (c) identity, and (d) academics. The community theme is used to describe how students perceived the environment to be. The involvement theme is used to describe the students' participation in campus life and their interaction with other members of the university community. The identity theme is used to describe the students' process of development, and the personal growth they underwent as a result of their experiences. The academics theme refers to the intellectual development of students and their interaction around academic issues. ^ The results of this study showed that the participants valued greatly their involvement in the First Year Residents Succeeding Together program (FYRST) and can articulate how it helped them succeed as students. In describing their experience, they most recall the sense of community that existed, the personal growth they experienced, the academic development process they went through, and their involvement, both with other people and with activities in their community. Recommendations are provided for practice and research, including several related to enhancing the academic culture, integrating faculty, utilizing peer influence and providing further opportunities to create a seamless learning environment. ^

Gender across cultures: The immigration experience/Bulgarian immigrants in South Florida

During the last decade, the United States has witnessed a high increase in its immigration flow. Despite recent surge of interest in numerically small ethnic groups, data on Bulgarian immigrants in the United States is almost non-existent. This is the first comprehensive study on the Bulgarian ethnic group in the United States. ^ This study examined the impact of immigration upon the negotiation of cultural prescriptions by Bulgarian immigrants in the United States. Several fundamental Bulgarian prescriptions for daily behavior, such as emphasis on stability rather than mobility, preference for collectivism instead of individualism, and wide use of social critique rather than social approval were tested on U.S. soil. Furthermore, the impact of gender upon cultural appropriation and retention was considered. The study made use of a comprehensive historical analysis of Bulgarian immigration to the United States, statistical descriptions of contemporary Bulgarian immigrants in the United States, and over a three-year long qualitative study of Bulgarian immigrants in South Florida. ^ The results of the study indicated that the transferring of cultural prescriptions due to immigration did not occur unaffected by gender. Bulgarian and U.S. cultural models clashed, intermingled, and resisted each other in various ways depending on the immigrants' gender. At the same time, gender did not solely determine the validity of prescriptions for daily behavior, but it rather acted in concert with other principles of everyday life. In addition, gender impacted significantly the method, type, and structure of the immigration journey. Gender was a very significant variable in the determination of these features of the immigration process, but it did not account independently for historical variations. Other factors, such as larger contexts of reception and rejection also played an important role. ^

Living positive: Life in community among Puerto Rican men living with HIV in Boston

Negative experiences of stigmatization, discrimination, and rejection are common among people living with HIV in the United States, and particularly when they are also members of a minority group. Some three decades after the first cases of AIDS were identified, people infected with HIV continue to be perceived and characterized negatively. While an HIV/AIDS diagnosis is typically associated with negativity, this study investigates the extent to which collective experiences among HIV-positive people result in healthy responses and positive social adjustment. This study is focused on the ways in which HIV-positive Puerto Rican men in Boston live positive despite being diagnosed with HIV. Rather than wrapping themselves in the social stigma of HIV and the isolation that entails, they participate in processes that affirm themselves and their peers. In so doing, they help generate both healthy and meaningful lives for themselves and others. The study examines the process in which Puerto Rican men living with HIV in Boston participate, promote, and reaffirm an HIV community, la comunidad, as a social entity with a unique culture and identity. This study also investigates how this community influences, supports, and encourages the adoption of positive transformations for living long term with HIV. On the basis of nine months of field research, this qualitative study employed both focus groups and interviews with fifty HIV-positive Puerto Rican men in Boston. These men were recruited, using convenience sampling, from different community-based organizations (CBOs) that provide HIV/AIDS services in Boston. The study finds that HIV-positive Puerto Rican men in Boston build community, not in response to social exclusion, but built on shared positive practices and strategies for living healthy with HIV. These men come together to negotiate and form a unique cultural community expressed in norms, beliefs, and practices that, although centered on HIV, are designed for living healthy. These expressions reaffirm a sense of community in everyday settings and transform the lives of these men with positive behaviors and healthy lifestyles. The findings reveal that this transformation takes place in the context of a community, with the support, encouragement, and at times, policing of others. La comunidad is where the lives of these men are transformed as they learn, adopt, and experience living positive with HIV.

Gaining insight into teaching: A phenomenological exploration of the lived experience of Teachers of the Year

What qualities, skills, and knowledge produce quality teachers? Many stake-holders in education argue that teacher quality should be measured by student achievement. This qualitative study shows that good teachers are multi-dimensional; their effectiveness cannot be represented by students' test scores alone. The purpose of this phenomenological study was to gain a deeper understanding of quality in teaching by examining the lived experiences of 10 winners or finalists of the Teacher of the Year (ToY) Award. Phenomenology describes individuals' daily experiences of phenomena, examines how these experiences are structured, and focuses analysis on the perspectives of the persons having the experience (Moustakas, 1994). This inquiry asked two questions: (a) How is teaching experienced by recognized as outstanding Teachers of the Year? and (b) How do ToYs feelings and perceptions about being good teachers provide insight, if any, about concepts such as pedagogical tact, teacher selfhood, and professional dispositions? Ten participants formed the purposive sample; the major data collection tool was semi-structured interviews (Patton, 1990; Seidman, 2006). Sixty to 90-minute interviews were conducted with each participant. Data also included the participants' ToY application essays. Data analysis included a three-phase process: description, reduction, interpretation. Findings revealed that the ToYs are dedicated, hard-working individuals. They exhibit behaviors, such as working beyond the school day, engaging in lifelong learning, and assisting colleagues to improve their practice. Working as teachers is their life's compass, guiding and wrapping them into meaningful and purposeful lives. Pedagogical tact, teacher selfhood, and professional dispositions were shown to be relevant, offering important insights into good teaching. Results indicate that for these ToYs, good teaching is experienced by getting through to students using effective and moral means; they are emotionally open, have a sense of the sacred, and they operate from a sense of intentionality. The essence of the ToYs teaching experience was their being properly engaged in their craft, embodying logical, psychological, and moral realms. Findings challenge current teacher effectiveness process-product orthodoxy which makes a causal connection between effective teaching and student test scores, and which assumes that effective teaching arises solely from and because of the actions of the teacher.

Toward an understanding of how individuals overcome challenges to development: A phenomenological study of an inner -city student's attitude toward academic orientation and life

The purpose of this qualitative case study was to gain an understanding of the phenomenon of academic orientation by seeking the insights into an inner-city Haitian-American middle school student's attitudes and world view toward education and life. A phenomenological approach was used in order to explore the way in which Cindy, a minority student, gives meaning to her lived-experiences in terms of her desire to meet academic expectations and her ability to overcome social adversity and/or other risk factors.^ The study attempted to answer the following two research questions: (1) What provides the focus for Cindy's (the subject's) approach to her school work and/or life? (2) What are the processes that give meaning and direction to academic orientation and life for Cindy? In-depth interviewing was the primary method of data collection. In addition, journal and sketchbook entries and school district records were used and classroom observations made.^ The nature of the study to understand lived-experience facilitated the use of the case study method and a phenomenological method of description. Data analysis was conducted by means of an adapted form of the constant comparative approach. Patterns in the data which emerged were coded and categorized according to underlying generative themes. Phenomenological reflection and analysis were used to grasp the experiential structures of Cindy's experience. The following textural themes were identified and confirmed to be essential themes to Cindy's experience: personal challenge to do her best, personal challenge to want to learn, having a sense of determination, being able to think for self, having a disposition to like self, achieving self-respect through performance, seeing a need to help others, being intrinsically motivated, being an independent learner, attending more to academic pressure and less to peer pressure, having motivational catalysts in her life, learning and support opportunities, and having a self-culture. Using Mahrer's humanistic theory of experiencing, Cindy's development was interpreted in terms of her progression through a sequence of developmental plateaus: externalized self, internalized self, and integrating and actualizing self.^ The findings of this study were that Cindy's desire to meet academic expectations is guided by a meaning construction internal frame of reference. High expectations of self in conjunction with other protective factors found in Cindy's home and school environments were also found to be linked to her educational resilience and success. Cindy's lived-experiences were also found to be related to Mahrer's theory of human development. In addition, it was concluded that "minority" students do not all fit into social categories and labels. ^

Reliability analysis of encapsulation methods for lead -based paint through an accelerated life testing

The adverse health effects of long-term exposure to lead are well established, with major uptake into the human body occurring mainly through oral ingestion by young children. Lead-based paint was frequently used in homes built before 1978, particularly in inner-city areas. Minority populations experience the effects of lead poisoning disproportionately. ^ Lead-based paint abatement is costly. In the United States, residents of about 400,000 homes, occupied by 900,000 young children, lack the means to correct lead-based paint hazards. The magnitude of this problem demands research on affordable methods of hazard control. One method is encapsulation, defined as any covering or coating that acts as a permanent barrier between the lead-based paint surface and the environment. ^ Two encapsulants were tested for reliability and effective life span through an accelerated lifetime experiment that applied stresses exceeding those encountered under normal use conditions. The resulting time-to-failure data were used to extrapolate the failure time under conditions of normal use. Statistical analysis and models of the test data allow forecasting of long-term reliability relative to the 20-year encapsulation requirement. Typical housing material specimens simulating walls and doors coated with lead-based paint were overstressed before encapsulation. A second, un-aged set was also tested. Specimens were monitored after the stress test with a surface chemical testing pad to identify the presence of lead breaking through the encapsulant. ^ Graphical analysis proposed by Shapiro and Meeker and the general log-linear model developed by Cox were used to obtain results. Findings for the 80% reliability time to failure varied, with close to 21 years of life under normal use conditions for encapsulant A. The application of product A on the aged gypsum and aged wood substrates yielded slightly lower times. Encapsulant B had an 80% reliable life of 19.78 years. ^ This study reveals that encapsulation technologies can offer safe and effective control of lead-based paint hazards and may be less expensive than other options. The U.S. Department of Health and Human Services and the CDC are committed to eliminating childhood lead poisoning by 2010. This ambitious target is feasible, provided there is an efficient application of innovative technology, a goal to which this study aims to contribute. ^