The postmodern heart: war veterans' experiences of invasive cardiac technology

Parental liminality: a way of understanding the early experiences of parents who have a very preterm infant

AIM

The aim of this study was to explore the early experiences of parents who have a very preterm infant.

BACKGROUND

Very preterm infants are physiologically ill-prepared for extra-uterine life, but a greater number now survive birth and the postnatal period. The complex needs of the very preterm infant are met in the technological environment of the neonatal intensive care area, separating parents, physically and psychologically from their very preterm infant. Studies exploring the parental experience have identified parental stress; lowly parental status and attachment issues as areas of concern. However, there is little understanding about the early parental experience.

DESIGN

This study used a phenomenological interpretive design.

METHODS

Ethical approval to conduct this study using two study centres was obtained. An interpretive interactionist approach guided this study. Data were collected from three sources: 20 parents of very preterm infants, five senior neonatal nurses and seven neonatal intensive care nurses. Purposive sampling was used for the first and second sources, and data were collected through semi-structured interviews. The third source of data occurred opportunistically through one focus group.

ANALYSIS

Analysis involved constant comparative analysis.

RESULTS

Crisis, uncertainty and powerlessness, properties of liminality framed this early complex parental transition. It is argued that the overarching theme of parental liminality best framed the parental physical, psychological and social experiences.

CONCLUSION

This qualitative interpretive study identified that parents of very preterm infants experienced many crises, uncertainty and powerlessness in their transition to parenthood, making them liminal people.

RELEVANCE TO CLINICAL PRACTICE

Parental liminality provides a means of conceptualising the early experiences of parents of very preterm infants, providing practitioners, at strategic and operational levels, with the means of developing supporting interventions in the early stages of transition for parents of very preterm infants. Such support could mediate parent-infant relationships.

Work-arounds in health care settings: Literature review and research agenda

BACKGROUND

As health care professionals seek to balance technological and regulatory demands with the need to provide patient-centered care, all in an efficient and cost-effective manner, they may see a greater need to improvise or work around intended work practices. Health care professionals acknowledge widespread use of work-arounds, and the literature documents their prevalence and influence on performance. Despite their importance, few studies have focused exclusively on work-arounds. This suggests a key area of need in the research, particularly because work-arounds are frequently cited in the context of serious patient safety consequences.

PURPOSE

The purpose of this article is to review the existing literature concerning work-arounds to elucidate the definition and nature of work-arounds, how work-arounds can be differentiated from similar constructs (e.g., errors, mistakes, and deviance), and the potential causes of work-arounds and to explore potential consequences of work-arounds in health care settings.

APPROACH

We conducted a systematic review of the literature concerning work-arounds to develop themes concerning the nature of work-arounds and ideas for future research on the topic.

IMPLICATIONS FOR PRACTICE

In this article, we develop links between work-arounds and potential outcomes, particularly safety outcomes. Moreover, we discuss the manner in which open discussion can allow work-arounds to facilitate work process improvement and the role that climate and culture play in reducing work-arounds.

The body electric: a review of literature on implantable cardioverter defibrillators

The number of scientific research studies expounding the efficacy and effectiveness of the implantable cardioverter defibrillator (ICD) in the treatment of cardiac arrhythmias and the prevention of sudden cardiac death (SCD) is prolific. The results from clinical trials that have led to the acceptance of implanting the human heart with an ICD are not as convincing as medical science would have health-care consumers believe. There are many other scientific studies that deal with the hazards involved in heart implantation with an ICD. It is argued in this paper that the impact of heart implantation with an ICD is hazardous to a person's being in significant ways. Heart implantation with an ICD is hazardous to physiological wellbeing, to psychosocial wellbeing, and to quality-of-life wellbeing. It is also argued that although humanistic studies are beginning to filter through the maze of scientific studies, many gaps remain in ICD research. Scientific researchers agree that there remains much needed knowledge for cardiac patients, their family members, and for health professionals.