Barbara's story : a thematic analysis of a relative's reflection of being in the intensive care unit

Aim The aim of this reflective account is to provide a view of the intensive care unit (ICU) relative’s experiences of supporting and being supported in the ICU. Background Understanding the relatives’ experiences of ICU is important especially because a recent work has identified the potential for this group to develop post-traumatic stress disorder, a condition that is normally equated with the ICU survivor. Design A thematic analysis was used in identifying emerging themes that would be significant in an ICU nursing context. Setting The incident took place in two 8-bedded ICUs (Private and National Health Service) in October. Results Two emergent themes were identified from the reflective story – fear of the technological environment and feeling hopeless and helpless. Conclusion The use of relative stories as an insight into the live experiences of ICU relatives may give a deeper understanding of their life-world. The loneliness, anguish and pain of the ICU relative extends beyond the walls of the ICU, and this is often negated as the focus of the ICU team is the patient. Relevance to clinical practice: Developing strategies to support relatives might include the use of relative diaries used concurrently with patient diaries to support this groups recovery or at the very least a gaining a sense of understanding for their ICU experience. Relative follow-up clinics designed specifically to meet their needs where support and advice can be given by the ICU team, in addition to making timely and appropriate referrals to counselling services and perhaps involving spiritual leaders where appropriate.

A qualitative investigation into the different health experiences of people living with type II diabetes, in the rural environments

Study Rationale The objective of the study was to explore if and how rural culture influences type II diabetes management and to better understand the social processes that rural people construct in coping with diabetes and its complications. In particular, the study aimed to analyse the interface and interactions between rural people with type II diabetes and the Australian health care system. Theoretical framework and methods The research applied constructivist grounded theory methods within an interpretive interactionist framework. Data from 39 semi-structured interviews with rural and urban people with type II diabetes plus a mix of rural health care providers were analysed to develop a theoretical understanding of the social processes that define diabetes management in that context. Results The analysis suggests that although type II diabetes imposes limitations that require adjustment and adaptation these processes are actively negotiated by rural people within the environmental context to fit the salient social understandings of autonomy and self-reliance. Thus people normalised self-reliant diabetes management behaviours because this was congruent with the rural culture. Factors that informed the actions of normalisation were the relationships between participants and health care professions, support and access to individual resources. Conclusions The findings point to ways in which rural self-reliance is conceived as the primary strategy of diabetic management. People face the paradox of engaging with a health care system that at the same time maximises individual responsibility for health and minimises the social support by which individuals manage the condition. The emphasis on self-reliance gives some legitimacy to a lack of prevention and chronic care services. Success of diabetic management behaviours is contingent on relative resources. Where there is good primary care there develop a number of downstream effects including a sense of empowerment to manage difficult rural environmental circumstances. This has particular bearing on health outcomes for people with fewer resources.

Rural self-reliance: the impact on health experiences of people living with type II diabetes in rural Queensland, Australia

Objective: The objective of the study was to explore whether and how rural culture influences type II diabetes management and to better understand the social processes that rural people construct in coping with diabetes and its complications. In particular, the study aimed to analyse the interface and interactions between rural people with type II diabetes and the Australian health care system, and to develop a theoretical understanding that reflects constructs that may be more broadly applicable. Methods: The study applied constructivist grounded theory methods within an interpretive interactionist framework. Data from 39 semi-structured interviews with rural and urban type II diabetes patients and a mix of rural health care providers were analysed to develop a theoretical understanding of the social processes that define diabetes management in that context. Results: The analysis suggests that although type II diabetes imposes limitations that require adjustment and adaptation, these processes are actively negotiated by rural people within the environmental context to fit the salient social understandings of autonomy and self-reliance. Thus, people normalized self-reliant diabetes management behaviours because this was congruent with the rural culture. Factors that informed the actions of normalization were relationships between participants and health care professionals, support, and access to individual resources. Conclusions: The findings point to ways in which rural self-reliance is conceived as the primary strategy of diabetes management. People face the paradox of engaging with a health care system that at the same time maximizes individual responsibility for health and minimizes the social support by which individuals manage the condition. The emphasis on self-reliance gives some legitimacy to a lack of prevention and chronic care services. Success of diabetes management behaviours is, however, contingent on relative resources. Where there is good primary care, there develops a number of downstream effects including a sense of empowerment to manage difficult rural environmental circumstances. This has particular bearing on health outcomes for people with fewer resources.

Looking back : students' perceptions of the relative enjoyment of primary and secondary school science

This paper reports and discusses a contentious result from an Australia-wide study of the influences on students' decisions about taking senior science subjects. As part of the Choosing Science study (Lyons and Quinn 2010) 3759 Year 10 students were asked to indicate which stage of their schooling (lower primary, upper primary, lower secondary, middle secondary) they had most enjoyed learning science. Crosstabulations of responses revealed that around 78% of students indicated that they had enjoyed learning science more in secondary than in primary school, and 55% enjoyed it the most during Years 9 and 10. The perception that school science was more enjoyable in high school was also found among students who did not intend taking science in Year 11, though to a lesser extent. These findings are unexpected and significant, challenging the prevailing view that enjoyment of school science steadily declines after primary school. The paper elaborates on the findings and suggests that the different conclusions arrived at by studies in this field may be due to the different methodologies employed.

The effects of parental illness and other ill family members on youth caregiving experiences

Informed by a model of family role-redistribution derived from the Family Ecology Framework (Pedersen & Revenson, 2005), this study examined differences in two proposed psychological components of role-redistribution (youth caregiving experiences and responsibilities) between youth of a parent with illness and their peers from ‘healthy’ families controlling for the effects of whether a parent is ill or some other family member, illness type, and demographics. Based on self-report questionnaire data, four groups of Australian children were derived from a community sample of 2474youth (‘healthy’ family, n=1768; parental illness, n=336; other family member illness, n=254; both parental and other family member illness, n=116). The presence of any family member with a serious illness is associated with an intensification of youth caregiving experiences relative to peers from healthy families. This risk is elevated if the ill family member is a parent, if more illnesses are present, and by certain youth and family demographics, and especially by higher caregiving responsibilities. The presence of a family member, particularly a parent, with a serious medical condition has pervasive increased effects on youth caregiving compared to healthy families, and these effects are not fully accounted for by illness type, demographics or caregiving responsibilities.

Subtypes of psychotic-like experiences are differentially associated with suicidal ideation, plans and attempts in young adults

Psychotic-like experiences (PLEs) have been associated with increased risk of suicidality, but it is unclear whether the level of risk varies with different types of PLE. A cross-sectional online survey was completed by 1610 university students. Respondents completed the Community Assessment of Psychic Experiences-15 (CAPE-P15) assessing PLEs on three subscales: Perceptual Abnormalities (PA), Persecutory Ideation (PI) and Bizarre Experiences (BE). Lifetime suicidal ideation, plans and attempts, cannabis, ecstasy and methamphetamine use and family history of mental disorder were also assessed. Multinomal logistic regression was used to examine unique determinants of lifetime suicidality, defined as any history of (i) suicidal ideation or plans and (ii) any attempt, relative to no lifetime history of suicidality. A lifetime history of PA and PI provided significant unique contributions to the prediction of suicide risk, after control for other significant predictors. BE were not associated with any suicide variable demonstrating the variation in risk of suicidality with different types of PLEs. Perceptual abnormalities and persecutory ideation as measured by the CAPE-P15 are the PLEs associated with a higher risk of lifetime suicidality.

Ethnic variations in the experiences of mental health service users in England: results of a national patient survey programme

Background: Minority ethnic groups in the UK are reported to have a poor experience of mental health services, but comparative information is scarce. Aims: To examine ethnic differences in patients’ experience of community mental health services. Method: Trusts providing mental health services in England conducted surveys in 2004 and 2005 of users of community mental health services. Multiple regression was used to examine ethnic differences in responses. Results: About 27 000 patients responded to each of the surveys, of whom 10% were of minority ethnic origin. In the 2004 survey, age, living alone, the 2004 survey, age, living alone, detention and hospital admissions were stronger predictors of patient experience than ethnicity. Self-reported mental health status had the strongest explanatory effect. In the 2005 survey, the main negative differences relative to the White British were for Asians. Conclusions: Ethnicity had a smaller effect on patient experience than other variables. Relative to the White British, the Black group did not report negative experiences whereas the Asian group were most likely to respond negatively. However, there is a need for improvements in services for minority ethnic groups, including access to talking therapies and better recording of ethnicity.

Experiences during three generations of web based learning. Six years of web based communication

This paper tells the story of how a set of university lectures developed during the last six years. The idea is to show how (1) content, (2) communication and (3) assessment have evolved in steps which are named “generations of web learning”. The reader is offered a stepwise description of both didactic foundations of university lectures and practical implementation on a widely available web platform. The relative weight of directive elements has gradually decreased through the “three generations”, whereas characteristics of self-responsibility and self-guided learning have gained in importance. -Content was in early times presented and expected to be learned but in later phases expected to be constructed for examples of case studies. -Communication meant in early phases to deliver assignments to the lecturer but later on to form teams, exchange standpoints and review mutually. -Assessment initially consisted in marks invented and added up by the lecturer but was later enriched by peer review, mutual grading and voting procedures. How much “added value” can the web provide for teaching, training and learning? Six years of experience suggest: mainly insofar as new (collaborative and selfdirected) didactic scenarios are implemented! (DIPF/Orig.)

Interaction Rituals and Jumbled Emotions Among “Relative Strangers”: Simulated Patient Work on a Trainee Complementary Therapy Practitioner Program

Learning games such as role-play (which we refer to as “simulated interaction rituals”) are commonly used as social tools to develop trainee health practitioners. However, the effect of such rituals on individual and group participant emotions has not been carefully studied. Using a heuristic approach, we explore the experiences of complementary therapy practitioner trainees (and their trainers) participating in a personal development course. Ten trainees and two tutors were interviewed, observational notes taken, and a secondary qualitative analysis undertaken. Participants and tutors described a medley of disparate emotional and moral responses to group rituals, conceptualized in this article as “jumbled emotions.” Such emotions required disentangling, and both trainees and staff perceived participating in unfamiliar rituals “with relative strangers” as challenging. Front of stage effects are frequently processed “backstage,” as rituals threaten social embarrassment and confusion. Concerns around emotional triggers, authenticity, and outcomes of rituals arise at the time, yet trainees can find ways to work through these issues in time.

Understanding the Integration of Living Skills Through the Context of Health and Physical Education: A Case Study of Educators’ Experiences

The research presented is a qualitative case study of educators’ experiences in integrating living skills in the context of health and physical education (HPE). In using semi-structured interviews the study investigated HPE educators’ experiences and revealed their insights relative to three major themes; professional practice, challenges and support systems. Professional practice experiences detailed the use of progressive lesson planning, reflective and engaging activities, explicit student centered pedagogy as well as holistic teaching philosophies. Even further, the limited knowledge and awareness of living skills, conflicting teaching philosophies, competitive environments between subject areas and lack of time and accessibility were four major challenges that emerged throughout the data. Major supportive roles for HPE educators in the integration process included other educators, consultants, school administration, public health, parents, community programs and professional organizations. The study provides valuable discussion and suggestions for improvement of pedagogical practices in teaching living skills in the HPE setting.

Automatically linking live experiences captured with a ubiquitous infrastructure

Ubiquitous computing aims at providing services to users in everyday environments such as the home. One research theme in this area is that of building capture and access applications which support information to be recorded ( captured) during a live experience toward automatically producing documents for review (accessed). The recording demands instrumented environments with devices such as microphones, cameras, sensors and electronic whiteboards. Since each experience is usually related to many others ( e. g. several meetings of a project), there is a demand for mechanisms supporting the automatic linking among documents relative to different experiences. In this paper we present original results relative to the integration of our previous efforts in the Infrastructure for Capturing, Accessing, Linking, Storing and Presenting information (CALiSP). Ubiquitous computing aims at providing services to users in everyday environments such as the home. One research theme in this area is that of building capture and access applications which support information to be recorded (captured) during a live experience toward automatically producing documents for review (accessed). The recording demands instrumented environments with devices such as microphones, cameras, sensors and electronic whiteboards. Since each experience is usually related to many others (e.g. several meetings of a project), there is a demand for mechanisms supporting the automatic linking among documents relative to different experiences. In this paper we present original results relative to the integration of our previous efforts in the Infrastructure for Capturing, Accessing, Linking, Storing and Presenting information (CALiSP).

Information society and public ICT policies in the Caribbean: a review of advances and challenges, policy instruments and country experiences

Includes bibliography

From hard-peg to hard landing?: recent experiences of Argentina and Ecuador

Includes bibliography

Tecniche investigative ed aspetti criminologici nelle indagini giudiziarie relative ai suicidi ed alle morti equivoche. L'autopsia psicologica

La ricerca è strutturata in due sezioni: nella prima, dopo una premessa storica sul suicidio ed una lettura dei relativi dati statistici italiani integrata dall’analisi delle principali teorie sociologiche e dei principali aspetti psicopatologici e di psicologia clinica, vengono esaminati i risultati forniti da numerosi studi scientifici sul tema complementare delle morti equivoche, con particolare riferimento alle categorie a rischio rappresentate da anziani, carcerati, piloti di aerei, soggetti dediti a pratiche di asfissia autoerotica o roulette russa, istigatori delle forze di polizia e suicida stradali. Successivamente sono esaminati gli aspetti investigativi e medico-legali in tema di suicidi e morti equivoche con particolare riferimento alla tecnica dell’autopsia psicologica analizzandone le origini ed evoluzioni, il suo ambito di utilizzo ed i relativi aspetti metodologici. Nella seconda sezione del lavoro il tema dei suicidi e delle morti equivoche viene approfondito grazie all’apporto di professionisti di discipline diverse esperti in materia di autopsia psicologica ed indagini giudiziarie. A questi è stata presentata, con l’utilizzo della tecnica qualitativa “Dephi, una iniziale ipotesi di protocollo di autopsia psicologica, con le relative modalità applicative, al fine di procedere ad una sua revisione ed adattamento alle esigenze operative italiane grazie alle specifiche esperienze professionali e multidisciplinari maturate dagli esperti. I dati raccolti hanno permesso di giungere alla formulazione di un protocollo di autopsia psicologica, basato sulla elaborazione di domande generali, specifiche e conclusive, a risposta aperta, che possono esser formulate, secondo le modalità previste, alle persone affettivamente significative per la vittima nei confronti della quale si intende procedere con tale strumento investigativo.

The illness experiences of African Americans residing in an inner city community, Houston, Texas

This dissertation documents health and illness in the context of daily life circumstances and structural conditions faced by African American families living in Clover Heights (pseudonym), an inner city public housing project in the Third Ward, Houston, Texas. Drawing from Kleinman's (1980) model of culturally defined health care systems and using the holistic-content approach to narrative analysis (Lieblich, Tuval- Mashiach, & Zilber, 1998) the purpose of this research was to explore the ways in which social and health policy, economic mobility, the inner city environment, and cultural beliefs intertwined with African American families' health related ideas, behaviors, and practices. I recruited six families using a convenience sampling method (Schensul, Schensul, & LeCompte, 1999) and followed them for fourteen months (2010–2011). Family was defined as a household unit, or those living in the same residence, short or long-term. Single, African American women ranging in age from 29–80 years headed all families. All but one family included children or grandchildren 18 years of age and younger, or children or other relative 18 years of age and older. I also recruited six residents with who I became acquainted over the course of the project. I collected data using traditional ethnographic methods including participant-observation, archive review, field notes, mapping, free-listing, in-depth interviews, and life history interviews. ^ Doing ethnography afforded the families who participated in this project the freedom to construct their own experiences of health and illness. My role centered on listening to, learning from, and interpreting participants' narratives, exploring similarities and differences within and across families' experiences. As the research progressed, a pattern concerning diagnosis and pharmacotherapy for children's behavioral and emotional problems, particularly attention-deficit hyperactivity disorder (ADHD) and pediatric bipolar disorder (PBD), emerged from my formal interactions with participants and my informal interactions with residents. The findings presented in this dissertation document this pattern, focusing on how mothers and families interpreted, organized, and ascribed meaning to their experiences of ADHD and PBD. ^ In the first manuscript presented here, I documented three mothers' narrative constructions of a child's diagnosis with and pharmacotherapy for ADHD or PBD. Using Gergen's (1997) relational perspective I argued that mothers' knowledge and experiences of ADHD and PBD were not individually constructed, but were linguistically and discursively constituted through various social interactions and relationships, including family, spirituality and faith, community norms, and expert systems of knowledge. Mothers' narratives revealed the complexity of children's behavioral and emotional problems, the daily trials of living through these problems, how they coped with adversity and developed survival strategies, and how they interacted with various institutional authorities involved in evaluating, diagnosing, and encouraging pharmaceutical intervention for children's behavior. The findings highlight the ways in which mothers' social interactions and relationships introduced a scientific language and discourse for explaining children's behavior as mental illness, the discordances between expert systems of knowledge and mothers' understandings, and how discordances reflected mothers' ‘microsources of power’ for producing their own stories and experiences. ^ In the second manuscript presented here, I documented the ways in which structural factors, including gender, race/ethnicity, and socioeconomic status, coupled with a unique cultural and social standpoint (Collins, 1990/2009) influenced the strategies this group of African American mothers employed to understand and respond to ADHD or PBD. The most salient themes related to mother-child relationships coalesced around mothers' beliefs about the etiology of ADHD and PBD, ‘conceptualizing responsibility,’ and ‘protection-survival.’ The findings suggest that even though mothers' strategies varied, they were in pursuit of a common goal. Mothers' challenged the status quo, addressing children's behavioral and emotional problems in the ways that made the most sense to them, specifically protecting their children from further marginalization in society more so than believing these were the best options for their children.^