Communicative Rationality in the Clinic? Exploring the Parental Role in the Management of Gastro-Oesophageal Reflux in Children

Exploring parents' experiences, attitudes and understanding of gastro-oesophageal reflux in infants

BACKGROUND

Gastro-oesophageal reflux (GOR) affects nearly half of infants. Parents play a crucial role in management but more understanding of their attitudes and experiences is needed to inform future education, support and research. This study aims to explore parental experiences, attitudes and understanding of the symptoms, diagnosis and management of infant GOR.

METHODS

Qualitative semi-structured interviews with 9 parents of infants with GOR in the UK, analysed by thematic analysis.

RESULTS

8 participants were mothers and median age was 34 years. Over half identified as White ethnicity. Parents described that GOR can affect all aspects of life, including mental wellbeing and bonding with their baby. Medications are time-consuming to prepare and can cause challenging side effects such as constipation. It is crucial that health professionals manage parental expectations in that treatments are not curative and symptoms do not last forever. Attitudes about healthcare professionals varied: some were perceived as dismissive, whilst some showed understanding. There were differences depending on whether the child was a first or second born child, with more understanding shown where the child was not the parents' first born. Parents felt more education could be beneficial for parents and clinicians.

CONCLUSIONS

Infant GOR can affect infants and parents in a variety of ways, impacting both physical and mental health. Parents play a vital role in the management of infant reflux, but there is lack of consistency of information and levels of knowledge among healthcare professionals vary. More education could be beneficial, and further research is needed into health professionals' perceptions and fathers' experiences.

The Patient’s Lifeworld: Building meaningful clinical encounters between patients, physicians and interpreters

In this paper, our objectives are first to explore the different ways physicians and interpreters interact with patients’ Lifeworld, and second, to describe and compare communication patterns in consultations with professional and those with family interpreters. We used a qualitative design and conducted analyses of transcriptions of 16 family practice consultations in Montréal in the presence of interpreters. Patterns of communication are delineated grounded in Habermas’ Communicative Action Theory and Mishler’s operational concepts of Voice of Medicine and Voice of Lifeworld. Four communication patterns emerged: (1) strategically using Lifeworld data to achieve biomedical goals, (2) having an interest in the Lifeworld for itself, (3) integrating the Lifeworld with biomedicine and (4) referring to another professional. Our results suggest physicians engage with patients’ Lifeworld and may benefit from both types of interpreters’ understanding of the patient’s specific situations. A professional interpreter is likely to transmit the patient’s Lifeworld utterances to the physician. A family member, on the other hand, may provide extra biomedical and Lifeworld information, but also prevent the patient’s Lifeworld accounts from reaching the physician. Physicians’ training should include advice on how to work with all type of interpreters and interpreters’ training should include mediation competencies in order to enhance their ability to promote the processes of co-construction of meaning.

Bringing values back into evidence-based nursing: the role of patients in resisting empiricism

We examine problems resulting from the narrow empirical focus associated with evidence-based nursing, including the deleterious influence of vested interests, disattention to patients' experiences, underestimation of the importance of social processes, lack of an individualized research perspective, marginalization of other forms of knowledge, and the undermining of patients' autonomy. Addressing each problem in turn, we argue that inclusion of patients at all stages of evidence-based practice can counter or ameliorate these problems. While we concede that patient involvement is not a complete solution to the problem of empiricism, it is the most effective means available to defend nursing values.