Experiencing information use for early career academics’ learning: A knowledge ecosystem model

Purpose This study explores the informed learning experiences of early career academics while building their networks for professional and personal development. The notion that information and learning are inextricably linked via the concept of ‘informed learning’ is used as a conceptual framework to gain a clearer picture of what informs early career academics while they learn and how they experience using that which informs their learning within this complex practice: to build, maintain and utilise their developmental networks. Methodology This research employs a qualitative framework using a constructivist grounded theory approach (Charmaz, 2006). Through semi-structured interviews with a sample of fourteen early career academics from across two Australian universities, data were generated to investigate the research questions. The study used the methods of constant comparison to create codes and categories towards theme development. Further examination considered the relationship between thematic categories to construct an original theoretical model. Findings The model presented is a ‘knowledge ecosystem’, which represents the core informed learning experience. The model consists of informal learning interactions such as relating to information to create knowledge and engaging in mutually supportive relationships with a variety of knowledge resources found in people who assist in early career development. Originality/Value Findings from this study present an alternative interpretation of informed learning that is focused on processes manifesting as human interactions with informing entities revolving around the contexts of reciprocal human relationships.

‘Blessed are the young, for they shall inherit the national debt’: Solidarity between generations in the Irish crisis

Ireland has gained a reputation for peaceable acceptance of austerity following a European Union/International Monetary Fund bailout in 2010. While proponents of austerity praise Ireland’s stoicism, critics of global capitalism argue that individuals and families are paying for mistakes made by elites. However, little is known about the strategies people adopt to cope with cutbacks to welfare entitlements. Drawing on a study of solidarity between generations living in Ireland in 2011–12, this article explores the lived experience of economic crisis and austerity. One hundred interviews with people of all ages and socio-economic backgrounds are analysed using constructivist grounded theory. Data show how austerity impacts differentially according to socio-economic status. While solidarity between generations leads to re-distribution of resources within families, providing some security for people with access to family resources, it reinforces inequality at societal level. We conclude that reliance on family promotes ‘coping’ rather than ‘protesting’ responses to austerity.

Women (Re)Negotiating Care across Family Generations: Intersections of Gender and Socioeconomic Status

Changing Generations, a study of intergenerational relations in Ireland undertaken between 2011 and 2013 by the Social Policy and Ageing Research Centre (SPARC), Trinity College, Dublin, and the Irish Centre for Social Gerontology (ICSG), NUI Galway, used the Constructivist Grounded Theory method to interrogate support and care provision between generations. This article draws on interviews with 52 women ages 18 to 102, allowing for simultaneous analysis of older and younger women’s perspectives. The intersectionality of gender and class emerged as central to the analysis. Socioeconomic positions shape contrasting forms of interdependency among family generations, ranging from “enmeshed” lives among lower socioeconomic groups to “freed” lives among higher socioeconomic groups. Women are initiating changes in how care and support flow across generations. Older women in higher socioeconomic groups are attuned to how emotional capital women expend across family generations can constrain (young) women’s lives. In an expression of solidarity, older women are renegotiating the place of care labor in their own lives and in the lives of younger women. A new reciprocity emerges that amounts to women “undoing gender.” This process is, however, deeply classed as it is women in higher socioeconomic groups whose resources best place them to renegotiate care.

Attending Physician Variability: A Model of Four Supervisory Styles

Purpose: There is wide variability in how attending physician roles on teaching teams, including patient care and trainee learning, are enacted. This study sought to better understand variability by considering how different attendings configured and rationalized direct patient care, trainee oversight, and teaching activities. 

Method: Constructivist grounded theory guided iterative data collection and analyses. Data were interviews with 24 attending physicians from two academic centers in Ontario, Canada, in 2012. During interviews, participants heard a hypothetical presentation and reflected on it as though it were presented to their team during a typical admission case review. 

Results: Four supervisory styles were identified: direct care, empowerment, mixed practice, and minimalist. Driven by concerns for patient safety, direct care involves delegating minimal patient care responsibility to trainees. Focused on supporting trainees’ progressive independence, empowerment uses teaching and oversight strategies to ensure quality of care. In mixed practice, patient care is privileged over teaching and is adjusted on the basis of trainee competence and contextual features such as patient volume. Minimalist style involves a high degree of trust in senior residents, delegating most patient care, and teaching to them. Attendings rarely discussed their styles with the team. 

Conclusions: The model adds to the literature on variability in supervisory practice, showing that the four styles reflect different ways of responding to tensions in the role and context. This model could be refined through observational research exploring the impact of context on style development and enactment. Making supervisory styles explicit could support improvement of team competence.

Principles of fatigue in residency education: a qualitative study

Background: Proposals to implement fatigue-management strategies in residency education assume that medicine shares the view
of other risk-adverse industries that fatigue is hazardous. This view is an essential underpinning of fatigue-management strategies
that other industries have embedded as part of their workplace occupational health and safety programs. We sought to explore how
residents understand fatigue in the context of their training environment.

Methods: We interviewed 21 residents in 7 surgical and nonsurgical programs at Western University in 2014. All participants met the
inclusion criteria of routinely working 24-hour call shifts while enrolled in their training program. Data collection and analysis occurred iteratively in keeping with constructivist grounded theory methodology and informed theoretical sampling to sufficiency.

Results: Four predominant principles of fatigue captured how the social learning environment shaped residents’ perceptions of
fatigue. These included the conceptualization of fatigue as (a) inescapable and therefore accepted, (b) manageable through experience, (c) necessary for future practice and (d) surmountable when required.

Interpretation: This study elaborates our understanding of how principles of fatigue are constructed and reinforced by the training
environment. Whereas fatigue is seen as a collective hazard in other industries, our data showed that, in residency training, fatigue
may be seen as a personal challenge. Consequently, fatigue-management strategies that conceptualize fatigue as an occupational
threat may have a limited impact on resident behaviour and patient safety.

The meaning of multiple medication use in adults: A qualitative study

Over half of prescribed medications are not taken as prescribed, resulting in health and economic consequences. Using constructivist grounded theory, 15 interviews were conducted to develop a theory on understanding the medication adherence choices of individuals, who were between the ages of 40 to 55, were diagnosed with a chronic condition, and taking three or more medications. The results indicate that participants are engaging in self-management strategies, with massive variance in adherence behaviours. Medications are sacrificed for personal and financial reasons, resonating with feelings of fear for the person’s current situation and future. Individuals are struggling with who they have become to who they once were, which becomes related to their medications. Finally, individuals are citing the impact of their physician; citing barriers to communication and Canada’s health care system. Participants’ experiences provided an understanding of the meanings individuals associate with their medications and how this impacts their decision-making.

Exploring Body-Related Experiences among Individuals with Spinal Cord Injury

Using modified constructivist grounded theory, the purpose of the present study was to explore body-related experiences, specifically body image, in people with spinal cord injury. A total of nine participants (five women, four men) who had a broad range of body image experiences (from very negative to very positive) were interviewed. Most participants explained experiencing a fluctuating body image that varied from day-to-day. Negative body image experiences were represented by appearance, weight concerns, and function with all body image experiences encompassed by self-presentational concerns and tactics (an unanticipated finding). Positive body image was represented by acceptance, appreciation and gratitude of the body. Interestingly, negative body image experiences were not found to be represented by the opposite of positive body image experiences as they were each distinct. These findings have direct implications for medical professionals in hospital and rehabilitation settings to understand the importance of body image after spinal cord injury.

Modèle de l’engagement et de l’abandon de traitement de l’adolescent avec trouble de personnalité limite

Plus de la moitié des adolescents suicidaires dont une large proportion présente un trouble de personnalité limite (TPL) abandonnent leur traitement. Les conséquences de leur défection sont préoccupantes considérant la récurrence de leurs conduites suicidaires et le fait que cette pathologie augmente le risque d’une évolution défavorable à l’âge adulte. À partir d’une méthode de théorisation ancrée constructiviste, cette étude visait à comprendre les processus associés à l’instabilité du mode de consultation des adolescents avec TPL. Elle a permis de spécifier les vulnérabilités à l’abandon des adolescents avec TPL et celles de leurs parents et mis au jour que l’atténuation des problèmes d’accessibilité, la préparation au traitement, l’adaptation des soins aux particularités du TPL et finalement la prise en compte de la disposition à traiter des soignants constituent des réponses déterminantes pour leur engagement. Les processus de désengagement ont également été spécifiés. Des perceptions négatives à l’égard du traitement, du soignant ou du fait d’être en traitement génèrent une activation émotionnelle. Celle-ci induit ensuite des attitudes contre-productives qui évoluent vers des comportements francs de désengagement. Dans ce contexte, des réponses du dispositif de soins telles une régulation insuffisante de l’engagement, des impairs thérapeutiques et des demandes paradoxales précipitent l’abandon de traitement. Finalement, les processus impliqués dans l’abandon de traitement ont été formalisés dans le Modèle de l’engagement et de l’abandon de traitement des adolescents avec TPL. Celui-ci illustre que des processus distincts caractériseraient les abandons précoces et les abandons tardifs des adolescents avec TPL. L’abandon précoce résulterait de l’échec du dispositif de soins à profiter de l’impulsion de la demande d’aide pour engager l’adolescent et le parent lors de ce premier moment critique de sa trajectoire de soins. En contrepartie, les abandons tardifs traduiraient les défaillances du dispositif de soins à adopter des mesures correctives pour les maintenir en traitement lors d’un deuxième moment critique marqué par leur désengagement. Les taux d’abandon de traitement de ces jeunes pourraient être diminués par un dispositif de soins qui reconnaît les périls inhérents au traitement de cette clientèle, se montre proactif pour résoudre les problèmes de désengagement, intègre des mécanismes de soutien aux soignants et favorise une pratique réflexive.

Representation and misrepresentation of scientific evidence in contemporary tobacco regulation:a review of tobacco industry submissions to the UK Government consultation on standardised packaging

BACKGROUND: Standardised packaging (SP) of tobacco products is an innovative tobacco control measure opposed by transnational tobacco companies (TTCs) whose responses to the UK government's public consultation on SP argued that evidence was inadequate to support implementing the measure. The government's initial decision, announced 11 months after the consultation closed, was to wait for 'more evidence', but four months later a second 'independent review' was launched. In view of the centrality of evidence to debates over SP and TTCs' history of denying harms and manufacturing uncertainty about scientific evidence, we analysed their submissions to examine how they used evidence to oppose SP. METHODS AND FINDINGS: We purposively selected and analysed two TTC submissions using a verification-oriented cross-documentary method to ascertain how published studies were used and interpretive analysis with a constructivist grounded theory approach to examine the conceptual significance of TTC critiques. The companies' overall argument was that the SP evidence base was seriously flawed and did not warrant the introduction of SP. However, this argument was underpinned by three complementary techniques that misrepresented the evidence base. First, published studies were repeatedly misquoted, distorting the main messages. Second, 'mimicked scientific critique' was used to undermine evidence; this form of critique insisted on methodological perfection, rejected methodological pluralism, adopted a litigation (not scientific) model, and was not rigorous. Third, TTCs engaged in 'evidential landscaping', promoting a parallel evidence base to deflect attention from SP and excluding company-held evidence relevant to SP. The study's sample was limited to sub-sections of two out of four submissions, but leaked industry documents suggest at least one other company used a similar approach. CONCLUSIONS: The TTCs' claim that SP will not lead to public health benefits is largely without foundation. The tools of Better Regulation, particularly stakeholder consultation, provide an opportunity for highly resourced corporations to slow, weaken, or prevent public health policies.

Remolding a company through a compliance program : the case of Siemens

Abstract : Since at least the 1980's, a growing number of companies have set up an ethics or a compliance program within their organization. However, in the field of study of business management, there is a paucity of research studies concerning these management systems. This observation warranted the present investigation of one company's compliance program. Compliance programs are set up so that individuals working within an organization observe the laws and regulations which pertain to their work. This study used a constructivist grounded theory methodology to examine the process by which a specific compliance program, that of Siemens Canada Limited, was implemented throughout its organization. In conformity with this methodology, instead of proceeding with the investigation in accordance to a particular theoretical framework, the study established a number of theoretical constructs used strictly as reference points. The study's research question was stated as: what are the characteristics of the process by which Siemens' compliance program integrated itself into the existing organizational structure and gained employee acceptance? Data consisted of documents produced by the company and of interviews done with twenty-four managers working for Siemens Canada Limited. The researcher used QSR-Nvivo computer assisted software to code transcripts and to help with analyzing interviews and documents. Triangulation was done by using a number of analysis techniques and by constantly comparing findings with extant theory. A descriptive model of the implementation process grounded in the experience of participants and in the contents of the documents emerged from the data. The process was called "Remolding"; remolding being the core category having emerged. This main process consisted of two sub-processes identified as "embedding" and "appraising." The investigation was able to provide a detailed account of the appraising process. It identified that employees appraised the compliance program according to three facets: the impact of the program on the employee's daily activities, the relationship employees have with the local compliance organization, and the relationship employees have with the corporate ethics identity. The study suggests that a company who is entertaining the idea of implementing a compliance program should consider all three facets. In particular, it suggests that any company interested in designing and implementing a compliance program should pay particular attention to its corporate ethics identity. This is because employee's acceptance of the program is influenced by their comparison of the company's ethics identity to their local ethics identity. Implications of the study suggest that personnel responsible for the development and organizational support of a compliance program should understand the appraisal process by which employees build their relationship with the program. The originality of this study is that it points emphatically that companies must pay special attention in developing a corporate ethics identify which is coherent, well documented and well explained.

A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol.

Introduction and background: Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. Methods and analysis: The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients’ needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the ‘Timing it Right’ framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventions throughout the recovery process. Ethics and dissemination: The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database (study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups.

Processus d’adaptation des personnes vivant avec la schizophrénie et ayant un soutien social limité

Résumé : La schizophrénie est un trouble mental grave qui affecte toutes les facettes de la vie de la personne. En outre, le manque de soutien social est un problème important qui contribue à l’aggravation de la maladie, notamment en influençant négativement la capacité d’adaptation. Chez les personnes atteintes de schizophrénie, la capacité à utiliser des stratégies d’adaptation adéquates et efficaces est essentielle afin d’améliorer la santé, le bien-être et la prévention des rechutes. Cette recherche utilise la conception de l’adaptation de Roy (2009). De nombreuses études confirment la présence de difficultés d’adaptation chez ces personnes. De plus, le processus d’adaptation lui-même reste mal connu. La question de recherche était : Quel est le processus d’adaptation des personnes vivant avec la schizophrénie lorsque leur soutien social est limité ? Cette question sous-tendait deux objectifs : 1) décrire le processus d’adaptation des personnes atteintes de schizophrénie dans un contexte de soutien social limité et 2) contribuer au développement du modèle de Roy dans le contexte des troubles mentaux graves. Le devis de recherche était la théorisation ancrée constructiviste, auprès de 30 personnes vivant avec la schizophrénie. Les données étaient composées d’entrevues et de résultats de trois questionnaires qui ont contribué à décrire de façon plus détaillée le profil des participants. Les résultats sont une modélisation du processus d’adaptation nommée « les filtres dans le processus d’adaptation des personnes vivant avec la schizophrénie ». Cette modélisation met en lumière le fait que le potentiel d’adaptation des personnes vivant avec la schizophrénie est affecté à la fois par des éléments de l’environnement social et des éléments inhérents à la maladie elle-même. Ces éléments altèrent la possibilité et la capacité à utiliser des stratégies d’adaptation adéquates et efficaces. Ces résultats de recherche pourraient permettre d’améliorer l’évaluation des personnes atteintes de schizophrénie et de diminuer les « inconnues » dans l’effet des interventions, tout comme de favoriser les actions visant à lutter contre les conditions sociales qui nuisent à l’adaptation.

Failing to meet expectations:the meaning of intimate partner violence for Pakistanis

Background: Intimate Partner Violence (IPV) is a major social and public health problem affecting people across cultures, religions and societies. Much research has been undertaken to offer understanding and explanations of this phenomenon, its determinants, and its consequences in developed countries around the world. However, there is still a paucity of research on IPV in many areas of the developing world such as Pakistan. Although various studies have been conducted to demonstrate the prevalence of IPV in the country, none of the studies have tried to explore the meaning of IPV from the perspective of Pakistani people. Aim: This study aimed to explore understandings of Pakistani men and women of IPV. It aimed to develop a theory to explain the meaning of IPV and the process through which it occurs, from the perspective of Pakistani people. Methods: The study utilised a qualitative approach with constructivist grounded theory methods and analysis techniques. Data was collected from Karachi, Pakistan and Sheffield, UK. Forty one people (20 from Pakistan and 21 from UK) participated in the study. Findings: The participants identified IPV as a serious concern. Although verbal abuse is often included in definitions of IPV, the participants did not consider shouting, raising the voice or scolding as a type of violence. Hitting, beating, pushing, throwing objects, and pulling hair were identified as acts of physical violence, and non-consensual sex was identified as a form of sexual abuse. Participants identified failure to meet role expectations of a husband or wife as a key contributor to the development of conflict between partners which could lead to IPV. Examples of various expectations from a wife include completing household chores, looking after husband, looking after children, looking after in laws, respecting and adjusting to in-law's customs and traditions. Important expectation from a husband include provision of finances, acting as a bridge, maintaining a balance between his wife and other family members particularly his mother and sisters, and taking the responsibility for his wife and children. Failure to meet these expectations could contribute to conflict and subsequent violence. This appeared to be shaped by cultural issues such as common use of arranged marriages, the rarity of divorce and the centrality of the extended family to the intimate partnership. Implications: Any interventions aimed at reducing IPV in Pakistani people must consider the meaning and causes of IPV from the perspective of that group.

LEISURE CONNECTIONS AND HEALING FOLLOWING TRAUMA: CONSTRUCTIVIST AND EXISTENTIAL REFLECTIONS AND THEORIZING

Trauma can have lasting effects on health (CAMH, 2010; DSM-IV, 1994; Lazarus, 1966), negatively influencing meanings and experiences of leisure in relation to health (Griffin, 2002, 2005; Meister & Pedlar, 1996). This interpretive grounded theory explored understandings of leisure during Leisure Connections and how Leisure Connections provides a context for healing from trauma. Data included observations, interviews with six participants, and reflection cards. Nine themes emerged: responding to trauma in leisure, letting go of familiar coping patterns and opening to joy, being in the moment of small steps and simple things, changing understandings of self, reconnecting with the body, shifting to internal motivation, choosing, reconnecting with others in leisure, balancing life with leisure, and growth and connections. Leisure Connections supported participants to explore leisure and its benefits as issues arise, to understand and respond differently. Leisure Connections provides boundary situations critical for existential growth and opportunity to change coping patterns.

Knowledge transfer intervention theory : a model grounded in the strategies used by intermediate agents in the context of education

La présente thèse se base sur les principes de la théorisation ancrée (Strauss & Corbin, 1998) afin de répondre au manque de documentation concernant les stratégies adoptées par des « agents intermédiaires » pour promouvoir l’utilisation des connaissances issues de la recherche auprès des intervenants en éducation. Le terme « agent intermédiaire » réfère aux personnes qui sont positionnées à l’interface entre les producteurs et les utilisateurs des connaissances scientifiques et qui encouragent et soutiennent les intervenants scolaires dans l’application des connaissances scientifiques dans leur pratique. L’étude s’inscrit dans le cadre d’un projet du ministère de l’Éducation, du Loisir et du Sport du Québec visant à améliorer la réussite scolaire des élèves du secondaire provenant de milieux défavorisés. Des agents intermédiaires de différents niveaux du système éducatif ayant obtenu le mandat de transférer des connaissances issues de la recherche auprès des intervenants scolaires dans les écoles visées par le projet ont été sollicités pour participer à l’étude. Une stratégie d’échantillonnage de type « boule-de-neige » (Biernacki & Waldorf, 1981; Patton, 1990) a été employée afin d’identifier les personnes reconnues par leurs pairs pour la qualité du soutien offert aux intervenants scolaires quant à l’utilisation de la recherche dans leur pratique. Seize entrevues semi-structurées ont été réalisées. L’analyse des données permet de proposer un modèle d’intervention en transfert de connaissances composé de 32 stratégies d’influence, regroupées en 6 composantes d’intervention, soit : relationnelle, cognitive, politique, facilitatrice, évaluative, de même que de soutien et de suivi continu. Les résultats suggèrent que les stratégies d’ordre relationnelle, cognitive et politique sont interdépendantes et permettent d’établir un climat favorable dans lequel les agents peuvent exercer une plus grande influence sur l’appropriation du processus de l’utilisation des connaissances des intervenants scolaire. Ils montrent en outre que la composante de soutien et de suivi continu est importante pour maintenir les changements quant à l’utilisation de la recherche dans la pratique chez les intervenants scolaires. Les implications théoriques qui découlent du modèle, ainsi que les explications des mécanismes impliqués dans les différentes composantes, sont mises en perspective tant avec la documentation scientifique en transfert de connaissances dans les secteurs de la santé et de l’éducation, qu’avec les travaux provenant de disciplines connexes (notamment la psychologie). Enfin, des pistes d’action pour la pratique sont proposées.