Writing place: a comparison of nursing research and health geography

Psychosocial well-being after stroke in Aotearoa New Zealand: a qualitative metasynthesis

PURPOSE

Psychosocial well-being is key to living well after stroke, but often significantly affected by stroke. Existing understandings consider well-being comes from positive mood, social relationships, self-identity and engagement in meaningful activities. However, these understandings are socioculturally located and not necessarily universally applicable. This qualitative metasynthesis examined how people experience well-being after a stroke in Aotearoa New Zealand.

MATERIAL AND METHODS

This metasynthesis was underpinned by He Awa Whiria (Braided Rivers), a model which prompts researchers to uniquely engage with Māori and non-Māori knowledges. A systematic search identified 18 articles exploring experiences of people with stroke in Aotearoa. Articles were analysed using reflexive thematic analysis.

RESULTS

We constructed three themes which reflect experiences of well-being: connection within a constellation of relationships, being grounded in one's enduring and evolving identities, and being at-home in the present whilst (re)visioning the future.

CONCLUSION

Well-being is multi-faceted. In Aotearoa, it is inherently collective while also deeply personal. Well-being is collectively achieved through connections with self, others, community and culture, and embedded within personal and collective temporal worlds. These rich understandings of well-being can open up different considerations of how well-being is supported by and within stroke services.

The right place? Users and professionals' constructions of the place's influence on personal recovery in community mental health services

Background

Current mental health policy emphasizes the importance of community-based service delivery for people with mental health problems to encompass personal recovery. The aim of this study is to explore how users and professionals construct the place’s influence on personal recovery in community mental health services.

Methods

This is a qualitative, interpretive study based on ten individual, semi-structured interviews with users and professionals, respectively. A discourse analysis inspired by the work of Foucault was used to analyze the interviews.

Results

The findings show how place can be constructed as a potential for and as a barrier against recovery. Constructions of the aim of the services matter when choosing a place for the services. Further, constructions of user–professional relationships and flexibility are important in the constructions of an appropriate place for the services.

Conclusions

The aim of the service, the user–professional relationship, and flexibility in choosing place were essential in the participants’ constructions. To find “the right place” for mental health services was constructed as context-sensitive and complex processes of assessment and co-determination.

Trial registration The study is approved by the Regional Committee for Medical Research Ethics, Norway (REK-Midt 2011/2057)

Transfusing our lifeblood: Reframing research impact through inter-disciplinary collaboration between health geography and nurse education

Geographers have long grappled with how their research can positively impact individuals, communities and society. Demonstrating research impact is an increasingly important aspect of academic life internationally. In this paper we argue that agendas for encouraging 'impact' would be well-served if impact through teaching was identified and stimulated more explicitly, and if academics better recognised and seized the opportunities that already exist for such impact. We take engagement between health geography and nurse education as an example of how social scientists could demonstrate research impact through inter-disciplinary involvement in the education of health care professionals, and specifically student nurses. We begin by showing how the UK's Research Excellence Framework (widely regarded as the key reference point for research performance management regimes internationally) has tended to produce an undervaluation of impact via education in many disciplines. A comprehensive overview of international scholarship at the intersection between geography and nursing is then presented. Here we trace three 'waves of enquiry' that have focused on research interactions before calling for a fourth focused on critical pedagogy. To illustrate the possibilities of this fourth wave, we sketch a case study that outlines how engagement with research around blood donation could help provide a foundation for critical pedagogy that challenges student nurses to practice reflexively, think geographically and act justly. Finally, we call for closer engagement between health geography and nurse education, by encouraging educators to translate, teach, and transfuse ideas and people between health geography and nurse education. In so doing, we argue that work at this interface can be mutually beneficial and demonstrate impact both within and beyond research assessment rubrics. Hence, our ideas are relevant beyond nurse education and geography insofar as this paper serves as an example of how reframing research impact can recover the importance of impact through education.

A shared respite--The meaning of place for family well-being in families living with chronic illness

Living with chronic illness is a family affair that involves ongoing changes and challenges in everyday life. When life changes, the environment is important for family health and well-being. The relation between a place and a family is rarely described, and therefore the aim of this study was to explore the meaning of place for family well-being in families living with chronic illness. A qualitative design was chosen. Data were collected by photovoice combined with narrative family research interviews with 10 families living with chronic illness. A phenomenological hermeneutic analysis was used to interpret the data. The results showed that the meaning of place for family well-being in families living with chronic illness can be described as "a shared respite." This main theme included three subthemes: "a place for relief," "a place for reflection," and "a place for re-creation." These results were further understood by means of the concept place security. Feeling well means having place security in these families. Through knowledge about the meaning of place for family well-being, health care personnel can stimulate families living with chronic illness to find respite in places that contribute to well-being, both in familiar and new places.

Neighborhood: A Conceptual Analysis

Researchers interested in measuring neighborhood-level effects should understand how "neighborhood" is defined within nursing sciences and other sciences, and the inherent strengths and weaknesses of current research methodologies. This concept analysis provides clarity around the concept of neighborhood within the context of health, analyzes the current state of development of the neighborhood concept, and proposes areas for future nursing research. Using the Rodger's Method of analysis, the concept of neighborhood within nursing and public health research is described based on existing literature. The concept's attributes, related concepts, antecedents, and consequences are given from the literature. Comparisons of the use of neighborhood are made between nursing, public health, sociology, and other sciences. The evolution of the concept of neighborhood throughout history is described, and important implications for future research are discussed.

Locating the qualitative interview: reflecting on space and place in nursing research

Interview location has been widely overlooked in the nursing literature. This paper presents a discussion of interview location in the context of nursing research with particular emphasis on the concepts of space and place. It draws on six research projects that were conducted between 2008 and 2013 in Canada, and is informed by key texts on the concepts of space and place. We argue that thinking about space and place in the context of interviewing is one way to engage in reflexivity. The reflexive accounts featured in this paper support the need for nursing researchers to engage in explicit analysis of their own interview locations and to discuss the significance of space and place in their own work. These accounts suggest that location is a fundamental aspect of the interview process.

Motivation, justification, normalization: talk strategies used by Canadian medical tourists regarding their choices to go abroad for hip and knee surgeries

Contributing to health geography scholarship on the topic, the objective of this paper is to reveal Canadian medical tourists' perspectives regarding their choices to seek knee replacement or hip replacement or resurfacing (KRHRR) at medical tourism facilities abroad rather than domestically. We address this objective by examining the 'talk strategies' used by these patients in discussing their choices and the ways in which such talk is co-constructed by others. Fourteen interviews were conducted with Canadians aged 42-77 who had gone abroad for KRHRR. Three types of talk strategies emerged through thematic analysis of their narratives: motivation, justification, and normalization talk. Motivation talk referenced participants' desires to maintain or resume physical activity, employment, and participation in daily life. Justification talk emerged when participants described how limitations in the domestic system drove them abroad. Finally, being a medical tourist was talked about as being normal on several bases. Among other findings, the use of these three talk strategies in patients' narratives surrounding medical tourism for KRHRR offers new insight into the language-health-place interconnection. Specifically, they reveal the complex ways in which medical tourists use talk strategies to assert the soundness of their choice to shift the site of their own medical care on a global scale while also anticipating, if not even guarding against, criticism of what ultimately is their own patient mobility. These talk strategies provide valuable insight into why international patients are opting to engage in the spatially explicit practice of medical tourism and who and what are informing their choices.

Community health promotion with people who are experiencing homelessness

Homelessness is an experience of being displaced. Once removed from their personal places, homeless people are barred access to healthy places in which to be. Health clinics for people who are experiencing homelessness offer an opportunity to create health-promoting places. In this study, we explore how place is experienced within a community health clinic for people who are experiencing homelessness. A critical ethnographic methodology was used. Results illustrate how clients and providers contested the space of the clinic. Discourses of safety, health promotion, and privacy were enacted, altered, and resisted in a constant practice of culture-making. Physical components of the space became conceptual components of how place and power in place were understood by clients and providers. Results point to the importance of conceptualizing service users as the key stakeholders in their care, considering how places may be more or less health promoting, and rethinking how safety is conceptualized.

Patient centered, nurse averse? Nurses' care experiences in a 21st-century hospital

Implementations of patient centeredness can vary tremendously across settings, yet we know little about how clinicians experience local interpretations of patient centeredness. In this article, we investigate nurses' experiences in a hospital designed to be patient centered in its emphasis on patient amenities and customer service. This environment altered nurses' articulation work by shifting the visibility of a number of nursing tasks; customer service tasks became more visible whereas many medical and caring tasks were obscured. We found that these changes in nursing work challenged nurses' professional roles, and the informants reported that the changes disrupted their relationships with patients and with one another. This implementation of patient centeredness resulted in a view of nursing that conflicted with many nurses' implicit and explicit understanding of their work. Our findings suggest that the adoption of some versions of patient centeredness might obscure substantial and substantive nursing work and might undermine nurses' concepts of caregiving.

Examining the language-place-healthcare intersection in the context of Canadian homecare nursing

Currently, much of the western world is experiencing a shift in the places where care is provided, namely from institutional settings like hospitals to diverse community settings such as the home. However, little is known about how language and the physical and social aspects of place interact to influence how health-care is delivered and experienced in the home environment. Drawing on ethnographic participant observations of homecare nursing visits and semi-structured interviews with Canadian family caregivers, care recipients and nurses, the intersection of language, place and health-care was explored in this secondary analysis. Our findings reveal four themes: homecare nurses view themselves as 'guests'; home environments facilitate the development of nurse-client relationships; nurses adapt healthcare language to each home environment; and storytelling and illness narratives largely prevail during medical interactions in the home. These findings demonstrate the spatiality of language and how the home environment informs decisions regarding language use. Furthermore, these findings exemplify how language and place mutually influence the experiences and delivery of home health-care. We conclude by discussing the importance of considering the language-place-healthcare intersection in order to gain a better understanding of medical exchanges in places and the associated implications for optimizing best nursing practice.

Updating and normalization of the Nursing Management Minimum Data Set element 6: patient/client accessibility

Patient/client accessibility is one of 18 Nursing Management Minimum Data Set data elements developed to evaluate contextual factors at the nursing unit or service level of care. The Nursing Management Minimum Data Set 06 patient/client accessibility was developed to capture variability in time and distance required to access patients. Variability in access to patients, needed supplies, equipment, and information for patient care has an impact on the amount of time available for direct patient care. Limitations in time available to provide safe and quality care may negatively affect patient outcomes, nurse retention, and, as a result, a healthcare organization's accreditation and finances. Since 2005, the first five Nursing Management Minimum Data Set data elements have been incorporated into the publicly accessible healthcare data set Logical Observation Identifier Names and Codes, thereby making results derived from these nursing management data elements available for empirical use. A critical review of the literature and other healthcare resources was conducted to update patient/client accessibility. A consensus approach was used by an interdisciplinary panel of experts to finalize recommendations for revisions. The name, conceptual and operational definitions, and measures were updated. The revised data element is titled "client accessibility." The conceptual and operational definitions were expanded and measures changed to increase validity and reliability of data collection. The updated conceptual definition is "the time, distance, and method to connect the nurse/provider and client for an encounter and includes the information, supplies, equipment, and personnel required for the encounter." The Nursing Management Minimum Data Set can provide individuals responsible for managing and financing nursing resources with quantifiable data regarding the context of nursing care. At present, healthcare costs are rising at an unsustainable rate, and many national healthcare outcomes are worsening. More information is needed to identify potential areas of improvement in the management and funding of nursing care. The update and use of Nursing Management Minimum Data Set 06 data element client accessibility may help to identify problem areas associated with nursing time, distance traveled, and methods used to provide patient care. Such empirical evidence may support better informed decisions on caseloads in diverse settings, hospital designs, methods used to provide care, and fiscal requirements.

Institutional geographies in dying: nurses' actions and observations on dying spaces inside and outside intensive care units

This paper articulates the geographies associated with intensive care nursing work with dying patients and their families. Six focus groups were conducted with 27 registered critical care nurses who practice in hospitals in a mid-western city in the United States. The analysis is structured by three emerging themes (i) the importance of a 'good' and 'sacred' place, (ii) the body as mapped by medical specialties, and (iii) problems with procedurally driven suspension of 'do not resuscitate' orders beyond intensive care units (ICUs). Recommendations describe the need for institutional recognition of the moral importance of strong relationships between nurses, clients, and their families, and nurses' wide-ranging roles in bridging the various spatial domains of intensive care.

The geography of patient safety: a topical analysis of sterility

Many studies on patient safety are geared towards prevention of adverse events by eliminating causes of error. In this article, I argue that patient safety research needs to widen its analytical scope and include causes of strength as well. This change of focus enables me to ask other questions, like why don't things go wrong more often? Or, what is the significance of time and space for patient safety? The focal point of this article is on the spatial dimension of patient safety. To gain insight into the 'geography' of patient safety and perform a topical analysis, I will focus on one specific kind of space (sterile space), one specific medical procedure (insertion of an intravenous line) and one specific medical ward (neonatology). Based on ethnographic data from research in the Netherlands, I demonstrate how spatial arrangements produce sterility and how sterility work produces spatial orders at the same time. Detailed analysis shows how a sterile line insertion involves the convergence of spatially distributed resources, relocations of the field of activity, an assemblage of an infrastructure of attention, a specific compositional order of materials, and the scaling down of one's degree of mobility. Sterility, I will argue, turns out to be a product of spatial orderings. Simultaneously, sterility work generates particular spatial orders, like open and restricted areas, by producing buffers and boundaries. However, the spatial order of sterility intersects with the spatial order of other lines of activity. Insight into the normative structure of these co-existing spatial orders turns out to be crucial for patient safety. By analyzing processes of spatial fine-tuning in everyday practice, it becomes possible to identify spatial competences and circumstances that enable staff members to provide safe health care. As such, a topical analysis offers an alternative perspective of patient safety, one that takes into account its spatial dimension.

Living on the threshold: The spatial experience of living alone with dementia

The purpose of this qualitative study was to understand the meaning of living alone for older people with dementia. Fourteen audio-taped open-ended interviews were conducted with eight such older women in Ontario, Canada. The data were analyzed using an adaptation of van Manen's method. Heidegger's philosophy informed interpretation of the findings through the theme living on the threshold. The study findings deepen understanding of `space' and `place' in the experience of living alone with dementia. Participants sought the middle-ground of dialectical tensions within the threshold space and shared insights about their spatial experience of: (a) being here, (b) being there, (c) being out, and (d) keeping out. These older women risked losing their threshold space when admitting to mistakes as their illness progressed. The authors conclude with examples of how this spatial interpretation may inform and improve communication with and care of older people in similar circumstances.

Patients as `Safeguard' and Nurses as `Substitute' in Home Health Care

One aim of this study was to explore the role, or subject position, patients take in the care they receive from nurses in their own home. Another was to examine the subject position that patients say the nurses take when giving care to them in their own home. Ten interviews were analysed and interpreted according to a discourse analytical method. The findings show that patients constructed their subject position as `safeguard', and the nurses' subject position as `substitute' for themselves. These subject positions provided the opportunities, and the obstacles, for the patients' possibilities to receive care in their home. The subject positions described have ethical repercussions and illuminate that the patients put great demands on tailored care.

Nurses as guests or professionals in home health care

The aim of this study was to explore and interpret the diverse subject of positions, or roles, that nurses construct when caring for patients in their own home. Ten interviews were analysed and interpreted using discourse analysis. The findings show that these nurses working in home care constructed two positions: ;guest' and ;professional'. They had to make a choice between these positions because it was impossible to be both at the same time. An ethics of care and an ethics of justice were present in these positions, both of which create diverse ethical appeals, that is, implicit demands to perform according to a guest or to a professional norm.

Clinical geography: nursing practice and the (re)making of institutional space

AIM

To present a geographical study that highlights the wide ranging spatial features of nursing agency. In turn, illustrate the further potential for geographical research to describe, support, challenge and guide clinical practice - particularly with regard to those 'everyday' activities and actions undertaken on a frequent basis.

BACKGROUND

To provide a focus, and to anchor the study in existing clinical knowledge and debates, the role of nursing in the (re)making of institutional experiences and life is specifically explored.

METHODS

In-depth semi-structured interviews were conducted with 15 nurses working in Buckinghamshire and West London, UK. The following specialties were represented: acute care including emergency (n = 3), midwifery (n = 3), children's nursing (n = 2), elderly care (n = 1), rehabilitation (n = 2), mental health (n = 3) and palliative care (n = 1).

RESULTS

Nurses claimed to actively manipulate, normalize and recreate clinical spaces as part of their everyday therapeutic practice. Specifically, the range of agency employed by them falls under the following six categories: adjusting social composition; introducing 'normal' activities; providing private spaces; seeking private spaces; explaining clinical spaces; spaces for personal escape and wellbeing.

IMPLICATIONS FOR NURSING MANAGEMENT

It is recommended that nurse leaders - including researchers, managers and clinical educators - explore geography as a source of social scientific evidence that sheds light on the complex nature of everyday professional practice. In this regard, some important disciplinary and structural issues are noted.

Home as place for healing

Although environment is a core concept in nursing, it has had little theoretical or empirical attention, especially related to healing. This article explores the following aspects of the meaning of healing as they relate to environment as place: (a) healing is grounded in suffering; (b) healing is active and requires presence of the patient and the nurse; and (c) healing is private, spiritual, and profound. Home is explored as a place for healing. The article explores implications for the study of meaning of home, when home is not a place for healing, and future directions for theory and research.

Promoting the sense of self, place, and belonging in displaced persons: the example of homelessness

This article discusses the psychosocial impact of displacement using homelessness as an illustrative example of displacement. This article draws on the geography literature concerning the sense of space and place and on social theories of self-identity and belonging, notably Anthony Giddens' structuration theory. The impact of displacement is an important dimension of homelessness because it influences social and functional abilities that are relevant to reentry into homes and society. This article explains the relevance of these considerations in the care of displaced persons and emphasizes the role of place in determining identity and self-efficacy.

Geography: research and teaching in nurse education

This paper outlines how geography might be integrated into nurse education. At one level, researching nurse education geographically could add to the current academic understanding of the many transitional places that make educational experiences and influence outcomes. At another level, as part of a nursing curriculum, teaching geographical concepts and issues to students might provide them with unique insights into core subjects.