Perspective Transformation Theory and the Donald Woods Experience: From Racist to Anti-Apartheid Activist

This paper chronicles White South African journalist Donald Woods’ life (1933-2001) as he transformed from holding racist beliefs that Blacks were “people who were there to be your servants,” to becoming one of his country’s leading anti-apartheid activists. Adult learning and development via perspective transformation theory are explored.

Influence of gender and life stressors on longitudinal depression treatment outcomes among older primary care patients

Purpose: Depression in older females is a significant and growing problem. Females who experience life stressors across the life span are at higher risk for developing problems with depression than their male counterparts. The primary aim of this study was (a) to examine gender-specific differences in the correlates of depression in older primary care patients based on baseline and longitudinal analyses; and (b) to examine the longitudinal effect of biopsychosocial risk factors on depression treatment outcomes in different models of behavioral healthcare (i.e., integrated care and enhanced referral). Method: This study used a quantitative secondary data analysis with longitudinal data from the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study. A linear mixed model approach to hierarchical linear modeling was used for analysis using baseline assessment, and follow-up from three-month and six-month. Results: For participants diagnosed with major depressive disorder female gender was associated with increased depression severity at six-month compared to males at six-month. Further, the interaction between gender and life stressors found that females who reported loss of family and friends, family issues, money issues, medical illness was related to higher depression severity compared to males whereas lack of activities was related to lower depression severity among females compared to males. Conclusion: These findings suggest that gender moderated the relationship between specific life stressors and depression severity similar to how a protective factor can impact a person's response to a problem and reduce the negative impact of a risk factor on a problem outcome. Therefore, life stressors may be a reliable predictor of depression for both females and males in either behavioral health treatment model. This study concluded that life stressors influence males basic comfort, stability, and survival whereas life stressors influence females' development, personal growth, and happiness; therefore, life stressors may be a useful component to include in gender-based screening and assessment tools for depression. ^

This was uncalled for : Dave Eggers' A heartbreaking work of staggering genius subverts the genre of traditional autobiography as an attempt at rendering his life

The purpose of this thesis was to explore why and how the author Dave Eggers subverts the genre of traditional autobiography in his memoir A Heartbreaking Work of Staggering Genius. I compared Eggers' work to Gertrude Stein's The Autobiography of Alice B. Toklas and William S. Burroughs' Junky. I found that like Stein and Burroughs, Eggers utilized various rhetorical devices outside of traditional autobiography because he could not find the means to express himself within the genre. Eggers employed various rhetorical methods reserved for fictional texts, such as stream of consciousness, characterization, and irony, in order to reconcile his feelings towards his parents' deaths and render those feelings in his memoir. I established that Eggers concluded his memoir with impossibility of arriving at one Meaning that could summate his tragic experience. Thus, I proved that Eggers gave the reader the only authentic interpretation he could: the memoir as a small, incomplete glimpse into his life.

The effects of hydroperiod on the life-history parameters of Lucania goodei (fundulidae) in the Florida Everglades

In aquatic ecosystems, hydrological fluctuation may generate a gradient of lifehistory responses associated with marsh drying. This study was conducted in the Florida Everglades to document spatial and temporal variability in growth and survivorship of the bluefin killifish (Lucania goodei) from six populations along a hydroperiod gradient. The otolith-microstructure analysis of field-collected fish was used to estimate growth rate and those data were combined with field-density estimates for survivorship analysis. Otolith analysis revealed that L. goodei is extremely short-lived with no variation in growth rates and very little spatial or temporal variation in survivorship. These results suggest that bluefin killifish populations experience similar life histories across a diversity of hydroperiods either through well-mixed populations homogenizing these vital rates, or more likely, that a multitude of factors force L. goodei to respond to these "stressors" in a similar fashion across hydroperiod gradients.

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.

Patterns in personal experience narratives: storytelling at cod harbour - a Newfoundland fishing community

This study is concerned with storytelling as a part of the folk culture of a fishing community on the north east coast of Newfoundland. The study is based on field work done in the community throughout the summer of 1969 during which I tape recorded oral narratives along with other folklore and folklife material . The principal genre discussed is the personal experience narrative which is an account of the experiences of either the narrator, someone in his kin network, orhis friends. It was found that a large number of community residents communicate in narrative form and that the narratives function to substantiate conversation preceeding the narrativei have a didactic function; function as a means of entertainment~ and reflect the narrators' and the community's value system. The methods employed in collecting the material were the directive and the non-directive interview techniques and participant observation. Collecting was done mainly among fishermen between fifty and eighty years of age and who, on -the average, had not gone beyond the sixth grade in school. Since the narratives are so much a part of the environment, I give an account of the community culture. The principal things that I deal with are the community's history, economy, education, religion, and social life which includes rites of passage, calendar customs , social events, visiting patterns, and gossip. Information in each of these categories is based primarily on oral reports, narratives and documented materials. After a discussion of the storytelling process in the community, I deal specifically with four male narrators. For each I give biographical information, discuss his repertoire, telling situations, style, and give a sampling of his narratives. The fourth narrator is discussed in more detail than the first three. The narratives of the latter comprise the final chapter in the study, and have been analyzed to show what they tell us about the narrator's style, his value system, and the community culture.

Work-life Balance and Gender Regime After the Economic Transition

Work-life balance (WLB) is a key issue in our societies in which there is increasing pressure to be permanently available on demand and to work more intensively, and when due to technological change the borders between work and private life appear to be dissolving. However, the social, institutional and normative frames of a region have a huge impact on how people experience work and private life, where the borders between these spheres lie and how much control individuals have in managing these borders. Based on these arguments, this editorial to the special issue Work-life balance/imbalance: individual, organisational and social experiences in Intersections. EEJSP draws attention to the social institutions, frameworks and norms which have an effect on experience, practices and expectations about work-life balance. Concerning the time horizon, this editorial focuses on the change of regime as a reference point since socialist and post-socialist eras differ significantly, although there is still some continuity between them. The authors of this introduction offer an overview of the situation in CEE (Central and Eastern Europe) based mainly on examples of Visegrad countries.

Nurses' knowledge of advance directives and perceived confidence in end-of-life care: a cross-sectional study in five countries

Nurses' knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses' knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n = 1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients' symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

Life Experiences of Youth Who Were Born with HIV Infection in Puerto Rico: The Voices of Young Survivors

The effectiveness of antiretroviral therapy (ART) transformed the pediatric HIV epidemic. The disease changed significantly over the course of three decades: while early in the epidemic it was almost always fatal, it has become a chronic condition. This study examined how perinatally-infected youth experience the impact of HIV in their lives. A qualitative study using interpretative phenomenological analysis (IPA) was conducted. Twenty in-depth interviews were carried out among 12 women and 8 men aged 18 to 30 years in Puerto Rico. These were conducted in Spanish, audio-recorded, transcribed and translated into English. While narrating their experiences, participants were interpreting what the situation meant to them and how they make sense of it. Three topics emerged: (1) perception and response to treatment and illness, particularly their lived experiences with ART; (2) disclosure experiences; and (3) family matters. Most participants challenged their therapy, in most cases to force their caregivers to disclose their status. Problems with adherence were attributed to busy schedules or forgetfulness. Participants experienced the disfiguring adverse effects of ART, which they endured for years without being informed that ART was the cause of these. Participants’ experiences with disclosure demonstrated the importance of validating them as individuals capable of managing their health. The paternalistic approach of withholding their diagnosis to spare them suffering resulted in increased anxiety. Participants acknowledged the difficulties of revealing their HIV status to their partners. They referred to family and friends as essential in coping with HIV. However, some encountered discrimination and stigma within their families. Participants who had suffered the loss of their parents found other parental figures such as adoptive parents or other family members. Most participants expressed a desire to have children. Perinatally HIV-infected youth will require health services for the rest of their lives. The adult health care into which they transition should consider their needs and journey. Services should consider including family members. This study underscores the need for improved access to mental health services. It is also essential to transcend medical treatment and develop a broader perspective of health care. Health care services should include reproductive decision-making counselling services.

Development of Independent Living Skills in Project Panther LIFE Students during the Summer Residential Program

Project Panther LIFE: Panther Learning Is For Everyone is an ongoing collaborative partnership between Florida International University (FIU), Miami-Dade County Public Schools (M-DCPS), and Parent to Parent of Miami, Inc. to develop, implement, support, and expand a non-degree postsecondary transition program for students with intellectual disabilities (ID). In Summer 2014, the program launched its first on-campus three-week Summer Residential Program (SRP) which focused on the development of independent living skills and self-determination skills An overview of the SRP components, program support systems, and benefits of the experience will be given through the perspective of key personnel, partnerships, and students.

“Considering there’s supposedly nothing wrong with me, it’s not a life”: Women’s Narratives of Distress, Visiting Herbalists, and Being Well in the 21st Century

Distress can have a profoundly negative impact on the well-being of women (who are the main receivers of treatment for distress). Distress also poses a huge financial problem for the United Kingdom, the cost of which is predicted to reach over £26bn by 2026. A growing body of research has shown that various medicinal plants have potential to treat different aspects of distress. However, there is little research investigating the patient experience of western herbal practice (WHP), and none investigating women’s experiences of WHP for distress. In response, this longitudinal study utilised interviews with twenty-six women who were visiting herbalists for distress across the south-east of The United Kingdom to elicit their stories of distress, as well as their experiences of WHP. The narratives were analysed from a constructionist standpoint, using inductive thematic analysis. The participants’ narratives highlighted the profound impact of everyday distress, whilst feelings associated with distress (anxiety, low mood, isolation, shame and guilt) were frequently communicated via the use of metaphors. These negative feelings, often combined with unsuccessful biomedical encounters, frequently led to the women feeling desperate when first visiting a herbalist. The participants’ experiences of WHP showed that an accessible practitioner and good therapeutic relationship combined with flexible herbal treatment, allowed women with diverse stories of distress to overcome feelings of desperation. Ongoing support allowed the women to feel like they had a safety net as they journeyed from a place of distress, back into the wider world. These findings were supported by more unusual negative accounts, which showed how the herbal therapeutic process could be unsuccessful if elements were missing. This research is of significance as it helps to deepen our understanding of women’s experiences of distress – particularly perceptions of stigma which surround feelings of shame (linked to an inability to cope) and guilt (linked to the perceived impact of distress on others). The research also has relevance for WHP, as it highlights which positive aspects of WHP are of particular importance to women patients who are living with distress.

Music therapy, in tuning at the end of life

In this article music therapy is presented as a helpful tool to support the persons (and their relatives) living at the end of their life and, also, as a non pharmacological and complementary therapy in an integral and holistic medicine. What we report here comes from the direct experience, nourished after many years of interventions and reflections in oncology and palliative care units. We’re talking about silence, music, therapy, models and techniques. We will read and feel therapeutic sessions… but above all, we’re talking about life, conscience and love.

Palliative Medicine:Scoping the level and extent of service provision to people with intellectual disability at end of life Poster Presentation

Background: Concerns exist about the end of life care
that people with intellectual disabilities receive. This population
are seldom referred to palliative care services and
inadequate data sets exist about their place of death.
Aim: To scope the extent of service provision to people
with intellectual disabilities at the end of life by specialist
palliative care and intellectual disability services in one
region of the United Kingdom.
Methods: As part of a larger doctoral study a regional survey
took place of a total sample (n=66) of specialist palliative
care and intellectual disability services using a postal
questionnaire containing forty items. The questionnaire
was informed by the literature and consultation with an
expert reference group. Data were analysed using SPSS to
obtain descriptive statistics.
Results: A total response rate from services of 71.2%
(n=47) was generated. Findings showed a range of experience
among services in providing end of life care to people
with intellectual disabilities in the previous five years, but
general hospitals were reported the most common place of
death. A lack of accessible information on end of life care
for people with learning disabilities was apparent. A few
services (n=14) had a policy to support this population to
make decisions about their care or had used adapted Breaking
Bad News guidelines (n=5) to meet their additional
needs. Both services recognised the value of partnership
working in assessing and meeting the holistic needs of
people with intellectual disabilities at end of life.
Conclusions: A range of experience in caring for people
with intellectual disabilities was present across services,
but more emphasis is required on adapting communication
for this population to facilitate them to participate in their
care. These findings could have international significance
given that studies in other countries have highlighted a
need to widen access to palliative care for this group of
people.

Nurses' experiences of pain management for people with advanced dementia approaching the end of life: a qualitative study

AIMS AND OBJECTIVES: To explore hospice, acute care and nursing home nurses' experiences of pain management for people with advanced dementia in the final month of life. To identify the challenges, facilitators and practice areas requiring further support.

BACKGROUND: Pain management in end-stage dementia is a fundamental aspect of end of life care; however, it is unclear what challenges and facilitators nurses experience in practice, whether these differ across care settings, and whether training needs to be tailored to the context of care.

DESIGN: A qualitative study using semi-structured interviews and thematic analysis to examine data.

METHODS: 24 registered nurses caring for people dying with advanced dementia were recruited from ten nursing homes, three hospices, and two acute hospitals across a region of the United Kingdom. Interviews were conducted between June 2014 and September 2015.

RESULTS: Three core themes were identified: challenges administering analgesia, the nurse-physician relationship, and interactive learning and practice development. Patient-related challenges to pain management were universal across care settings; nurse- and organisation-related barriers differed between settings. A need for interactive learning and practice development, particularly in pharmacology, was identified.

CONCLUSIONS: Achieving pain management in practice was highly challenging. A number of barriers were identified; however, the manner and extent to which these impacted on nurses differed across hospice, nursing home and acute care settings. Needs-based training to support and promote practice development in pain management in end-stage dementia is required.

RELEVANCE TO CLINICAL PRACTICE: Nurses considered pain management fundamental to end of life care provision; however, nurses working in acute care and nursing home settings may be under-supported and under-resourced to adequately manage pain in people dying with advanced dementia. Nurse-to-nurse mentoring and ongoing needs-assessed interactive case-based learning could help promote practice development in this area. Nurses require continuing professional development in pharmacology. This article is protected by copyright. All rights reserved.

Ethical reasoning through simulation: a phenomenological analysis of student experience

Background
Medical students transitioning into professional practice feel underprepared to deal with the emotional complexities of real-life ethical situations. Simulation-based learning (SBL) may provide a safe environment for students to probe the boundaries of ethical encounters. Published studies of ethics simulation have not generated sufficiently deep accounts of student experience to inform pedagogy. The aim of this study was to understand students’ lived experiences as they engaged with the emotional challenges of managing clinical ethical dilemmas within a SBL environment.

Methods
This qualitative study was underpinned by an interpretivist epistemology. Eight senior medical students participated in an interprofessional ward-based SBL activity incorporating a series of ethically challenging encounters. Each student wore digital video glasses to capture point-of-view (PoV) film footage. Students were interviewed immediately after the simulation and the PoV footage played back to them. Interviews were transcribed verbatim. An interpretative phenomenological approach, using an established template analysis approach, was used to iteratively analyse the data.

Results
Four main themes emerged from the analysis: (1) ‘Authentic on all levels?’, (2)‘Letting the emotions flow’, (3) ‘Ethical alarm bells’ and (4) ‘Voices of children and ghosts’. Students recognised many explicit ethical dilemmas during the SBL activity but had difficulty navigating more subtle ethical and professional boundaries. In emotionally complex situations, instances of moral compromise were observed (such as telling an untruth). Some participants felt unable to raise concerns or challenge unethical behaviour within the scenarios due to prior negative undergraduate experiences.

Conclusions
This study provided deep insights into medical students’ immersive and embodied experiences of ethical reasoning during an authentic SBL activity. By layering on the human dimensions of ethical decision-making, students can understand their personal responses to emotion, complexity and interprofessional working. This could assist them in framing and observing appropriate ethical and professional boundaries and help smooth the transition into clinical practice.