"It Is a Full-time Job to Be Ill": Patient Work Involved in Attending Formal Diabetes Care Among Socially Vulnerable Danish Type 2 Diabetes Patients

Ergonomics of an In-Patient Hospitalization

This article documents inpatient work, including activities, number of nurses, shift changes and other staff encounters for the first time. In 2022, the researcher (patient) had a traumatic limb injury and began three 6-8 day stays in three different hospitals. Nursing care was provided by 37 different nurses and 23 certified nursing assistants in 50 different shifts over 21 days. There were 35 other unique encounters by other medical care staff. As an experienced qualitative researcher, the patient relied on field observation skills. Thirty-eight distinct inpatient activities were grouped into five general categories: Logistics, Arrangements, Self-care, Healing and Social Management. This article reveals that patients inside the hospital actively engage in various tasks to navigate and manage their health-related goals. These responsibilities may be overwhelming for the patient, who is without resources to solve their own problems. PATIENT CONTRIBUTION: This paper is 100% from the patient's perspective and their original contribution.

"You do need each member of the team to bring that next piece of the puzzle": Allied health professionals' experience of interprofessional complex care in hospital settings

This study explores the experiences of allied health professionals who work in interprofessional hospital complex care teams. The aim of the study was to identify factors influential to meaningful clinician experiences in these contexts. Increase in interprofessional complex care in hospital settings reflects rising population health complexity. Furthermore, growth in these models coincides with a heightened focus on health system efficiency due to rising healthcare costs, resource constraints, and health workforce shortfalls. Combined, these issues constitute a 'wicked problem'. However, research exploring the experiences of clinicians working under these conditions is limited, exposing the knowledge gap of interest to this study. Using a qualitative approach, in-depth interviews were conducted with allied health professionals engaged in hospital-based interprofessional complex care, and their narratives were analysed according to the conceptual framework of complex adaptive phenomenology. The study identified four interconnected themes: workplace culture and leadership, interprofessional practice, healthcare ethics, and the ambiguity of complex care. Furthermore, the notion of 'empowerment of self and others' was a continuous thread throughout, which appeared essential to effective interprofessional practice. The study showed how the clinician experience provides a window to the functioning of a healthcare system and the bearing of experience on healthcare efficiency and sustainability. Recommendations include developing a more balanced approach to 'efficiency' in policy settings, implementing structured leadership development programs within the allied health workforce, empowering under-graduate practitioners through education to work effectively with uncertainty, and increasing research into the clinician experience of interdisciplinary complex care practice.

Home self-management of type 2 diabetes with diabetes technologies in northern France: a focused ethnographic study protocol

INTRODUCTION

Type 2 diabetes is a chronic condition associated with impaired glucose tolerance and a high prevalence of comorbidity, polypharmacy and medication safety incidents. Little is known about the patient work associated with using diabetes management technologies by patients and their informal caregivers at home. This study aims to apply a systems engineering approach to better understand this work.

METHODS AND ANALYSIS

This is a qualitative focused ethnographic study using interview and photography. Adults, living independently at home, with type 2 diabetes who have been using insulin as part of their treatment regimen for a minimum of 6 months and who are using at least one diabetes management technology without support of a professional at home are eligible for inclusion. Participants will be recruited through advertisements on social media, in diabetes clinics and by contacting associations of persons living with diabetes and diabetes specialists. Participant consent will be taken, interviews will be undertaken in the participant's home, audio-recorded and photographs securely saved. The Systems Engineering Initiative for Patient Safety (SEIPS) model will frame the data coding and we will develop new codes to accommodate data outside the SEIPS model. Results will be interpreted to produce a description of work processes, work system elements and interactions that support or jeopardise the achievement of safety. This protocol will follow the consolidated criteria for reporting qualitative research checklist for the reporting of qualitative research interviews.

ETHICAL CONSIDERATIONS AND DISSEMINATION

This protocol was approved by the University of Lille's Behavioural Sciences Ethics Committee. The study will comply with data protection legislation: the protocol has been declared by the Data Protection Officer of the University of Lille to the National Commission on Informatics and Liberty. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and publish in a peer-reviewed journal.

Financial struggles and coping with the aftermath of breast cancer care: An ethnographic study in Vietnam

Breast cancer, the most common cancer diagnosed among women, disproportionately affects low- and middle-income countries (LMICs). Based on an ethnographic study conducted in Central Vietnam in 2019, including observation and interviews with 33 women patients, we investigate how women and their families managed the financial burden of breast cancer care. Our findings suggest that in a context where health-related risk protection is poorly organised and out-of-pocket expenses are burdensome, despite the presence of universal health coverage, patients must rely heavily on informal arrangements to finance their treatment. They proactively researched available information and undertook extensive and ramified work to prove their deservingness for some types of assistance, including strategically disclosing their cancer status or using tactics to accelerate the process of applying for state welfare. Affected families must make hard calculations to prioritise the pressing health need of a member diagnosed with cancer and in many circumstances, forfeited the education of their young children. We offer theoretical understanding of 'patient work' beyond the routine management of the biological aspects of an illness. In addition, we demonstrate how engaging in those various coping practices can reinforce one's vulnerability to a vicious cycle of illness and poverty and amplify socio-economic inequalities among the affected community and the larger society. We argue this situation, if not tackled urgently and appropriately, can impede the progress towards achieving Sustainable Development Goal 3 (Good Health and Wellbeing) and Goal 10 (Reduced Inequalities) in LMICs amidst the non-communicable disease epidemic.

Making it Work: Everyday Life and Healthcare with Multiple Chronic Illnesses in Denmark

A growing concern in clinical literature with the "treatment burden" of living with multimorbidity raises questions about how we can study and produce knowledge on the impact of health care. In this article, we draw on ethnographic material from fieldwork among people with multimorbidity in Denmark and recent theorization on "values" in health care, to show how an ongoing "trying out" and ways of "just getting on with it" are enacted in illness trajectories marked by multimorbidity. Our findings point to the importance of attending to the subject positions that particular healthcare relations and encounters make possible.

Finding meaning in complex care nursing in a hospital setting

This study explores the experiences of nurses that provide 'complex', generalist healthcare in hospital settings. Complex care is described as care for patients experiencing acute issues additional to multimorbidity, ageing or psychosocial complexity. Nurses are the largest professional group of frontline healthcare workers and patients experiencing chronic conditions are overrepresented in acute care settings. Research exploring nurses' experiences of hospital-based complex care is limited, however. This study aims to add to what is known currently. Four 'complex care' nurses undertook in-depth semistructured interviews and their narratives were analysed using the conceptual framework of complex adaptive phenomenology. Two overarching themes constituting the 'essence' of complex care nursing were identified: Contextual factors and attribute/value-based elements. Creating meaningful patient outcomes and feeling part of a team were experienced as fulfilling, whereas time constraints, institutional settings and systemic barriers to comprehensive caregiving diminished the experience of providing complex care. Overall, work meaning presented as a dynamic phenomenon, shaped by personal and professional values, local settings and systemic factors. It is recommended that more expansive research be undertaken to explore the experience of complex care for nurses. Such knowledge can contribute to initiatives that draw a skilled, effective and engaged hospital-based complex care nursing workforce.

Schizophrenia and type 2 diabetes: Perceptions and understandings of illness management in everyday life

People with schizophrenia and type 2 diabetes face complex challenges in daily life and the management of both illnesses is burdensome. This qualitative interview study aimed to explore perceptions and understandings of the day-to-day management of schizophrenia and type 2 diabetes. Fourteen semi-structured interviews were conducted between January 2020 and October 2021 in the participants' respective mental health clinics, in their homes or by phone. Thematic analysis led to four themes representing participants' self-management strategies and perceived challenges. The first theme showed that participants use self-learned strategies for managing schizophrenia. In contrast, they perceived type 2 diabetes self-management as governed by a set of rules and guidelines given by health professionals. The second theme showed that both psychotic and negative symptoms present challenges to diabetes management. Theme 3 illustrated that participants consider their type 2 diabetes to be a very serious illness. They worried about potential long-term consequences and expressed wishes and motivation to improve their lifestyle. The final theme showed that participants discuss challenges related to their schizophrenia with family and friends but not type 2 diabetes. In conclusion, this study highlights the importance of considering individual challenges and everyday routines when supporting this population. It underlines the need for future research to further explore the complexity of managing the illnesses and to understand the needs for treatment and support.