The change of intimate relationship between people with Alzheimer's disease and their adult child caregivers: An interpretative phenomenological analysis

This study aims to explore the change of intimate relationship between people with Alzheimer's disease and their adult child caregivers as the disease progresses. Twelve adult child caregivers were recruited through purposive sampling. Explanatory phenomenological analysis was conducted to analyse data collected by semi-structured in-depth interviews. This study found a dynamically changing relationship between adult child caregivers and their parents with Alzheimer's disease during care giving that evolved with the progress of the disease. The relationship was the most intimate in the middle stage of the disease for most caregivers and a new reciprocal relationship developed due to caregiving. Caregivers experienced different degrees of self-growth when providing care, though caregiver burdens were common. The positive experience and perception of caregivers were important for improving the quality of life for adult child caregivers of people with Alzheimer's disease.

White American transgender adults' retrospective reports on the social and contextual aspects of their gender identity development

A growing body of research has attended to the experiences of transgender and gender non-conforming (TGN) youth's gender identity development. However, practical and ethical concerns have impeded our ability to understand the experiences of TGN youth. Thus, the aim of this study was to utilize one-on-one semi-structured interviews to explore White American TGN adults' (N = 15) retrospective accounts of their gender identity development in childhood and adolescence. Findings demonstrate considerable heterogeneity in TGN adults' retrospective accounts of their gender identity development. However, TGN adults consistently highlighted the role of social (e.g. friends, family and teachers) and contextual (e.g. online, offline, educational and geographical) factors in their gender identity journeys. This study provides new insight into the role of social and contextual factors in TGN adults' retrospective accounts of their gender identity development, demonstrating the importance of continuing to examine these factors in gender diversity research.

Something Lost, Something Gained: Experiences of Psychological Therapists Bereaved of a Parent in Childhood

Situated in the context of existing literature on wounded healers and the use of self in therapy, the aim of this qualitative study was to examine the experiences of psychological therapists who experienced the death of a parent in childhood. Seven psychological therapists from a range of professions and therapeutic modalities participated in semi-structured interviews exploring how this experience impacted them personally and professionally, in their therapeutic work. Using interpretative phenomenological analysis, three master themes emerged: 'A loss beyond words'; 'Navigating in a strange landscape'; and 'Something lost, something gained'. Areas of convergence and divergence between these findings and previous theory and research are discussed, particularly with respect to literature on grieving and the self of the therapist. Implications for therapeutic practice, supervision and training are highlighted, including the importance of self-reflection and supervision in facilitating the use of self, and the value of therapeutic training incorporating self-of-the-therapist work.

"We Need to Go Back Home (to) the Philippines Healthy": An Interpretive Phenomenological Analysis of Migrant Domestic Workers' Experiences of Having Breast Cancer in Hong Kong

Diagnoses of breast cancer are continuing to increase in the Philippines, but little is known about incidence rates among the significant number of Filipino women working abroad as migrant domestic workers (MDWs). These women are often the main income providers for their families, and their ability to work depends upon their physical health and strength. In this article, we use interpretive phenomenological analysis to explore the experiences of 10 MDWs from the Philippines who were diagnosed with breast cancer during a period of employment in Hong Kong. Analysis of these narratives revealed numerous points at which their status as temporary, transnational migrant workers intersected with their experiences of breast cancer detection, diagnosis, and treatment. We argue that these women's experiences of breast cancer were shaped by the structures of migration that link the Philippines with host destinations like Hong Kong. These structures create a unique context in which these women had to constantly renegotiate their identities as migrants, financial providers, and breast cancer patients.

I'm a 45-year-old woman in the body of an 80-year-old: The multiple losses of living and aging in the shadow of prostitution

INTRODUCTION

Research on aging women who are involved in prostitution is currently limited, both in terms of the number of studies conducted and their scope. Nevertheless, the available research suggests that women who are aging while involved in prostitution may confront some unique challenges. Thus, the study aims to explore the experiences of aging as narrated by Arab women in prostitution, using Intersectionality as a theoretical framework.

METHOD

Interpretive phenomenological analysis was used, and semistructured interviews were performed with 12 participants.

FINDINGS

Four themes emerged: "I'm a 45-year-old woman in the body of an 80-year-old:" Loss of physical and mental health; "There is no retirement plan in prostitution: Economic and social losses; As they were taken, my soul went with them too: The loss of the parenting experience and motherhood"; and "I'm going to get older with the disgust clinging to me:" The loss of authentic identity and dignity.

CONCLUSION

The findings demonstrate how aging serves to exacerbate overlapping forms of discrimination and marginalization.

CLINICAL RELEVANCE

Healthcare professionals, including nurses caring for older women in prostitution, should be aware of their unique circumstances, considering the social, economic, and healthcare obstacles they face. By being cognizant of these factors, healthcare practitioners can provide meaningful assistance in their pursuit of improved quality of life.

Women's experience of post-traumatic growth following a traumatic birth: an interpretive phenomenological analysis

BACKGROUND

Approximately 3-5% of women experience post-traumatic stress disorder following birth; positive experiences that can follow traumatic birth are under-researched.

AIMS AND OBJECTIVES

To explore how women experience post-traumatic growth following a traumatic birth.

METHODS

Interpretative Phenomenological Analysis was used to explore experiences of women who self-identified as having found positive benefits through coping with a traumatic birth. Eight women who had birthed in the past five years in the UK were recruited online and interviewed face-to-face.

RESULTS

Three superordinate themes were developed: 'The total opposite to what I'd expected' (participants' struggle to understand and integrate their birth experience in the postnatal period); 'I see it a bit differently now' (processes experienced in coming to a place of growth); and 'A much better place' (experienced growth 'outcomes').

DISCUSSION

Faced with shattered assumptions whereby their birth experiences contrasted with their expectations, participants felt their identities as women and mothers were challenged. In overcoming these challenges, participants described actively striving to cope and make sense of their experience. Multiple factors facilitated this, notably partner support, telling their birth story, acknowledging the impact and developing a compassionate narrative. Although growth was experienced in ways commonly reported by survivors of challenging life events, some aspects appeared pertinent to birth trauma.

CONCLUSIONS

Widening our understanding of the range of experiences following traumatic birth and making these narratives public may offer hope for some women and families and inform health professionals' education and practice. Further research would be needed before advocating interventions to foster post-traumatic growth.

Financial Toxicity Experiences of Patients With Cancer in Indonesia: An Interpretive Phenomenological Analysis

OBJECTIVES

Financial toxicity (FT) is an important adverse effect of cancer. Recent systematic reviews have shown that FT may lead to treatment nonadherence and impaired health-related quality of life, both of which may adversely influence the survival rates of patients. However, less is known about how patients endure FT, particularly in low- and middle-income countries. The purpose of this study was to explore how patients with cancer experience and cope with FT in Indonesia.

METHODS

Semistructured in-depth interviews were conducted to explore the experiences of Indonesian patients with cancer. Qualitative data were analyzed using interpretive phenomenological analysis approach. We purposefully recruited 8 patients undergoing active treatment (aged 27-69 years) who had been diagnosed of cancer over 5 years before and possessed health insurance at the time of diagnosis.

RESULTS

We identified 2 main themes: (1) the experienced financial burden, with subthemes underinsurance, out-of-pocket nonhealthcare cancer-related costs, and negative income effect from employment disruption, and (2) the financial coping strategies, with subthemes reallocating household budget, seeking family support, rationalizing treatment decisions, and topping up insurance for family members.

CONCLUSIONS

This is the first interpretive phenomenological study on FT in the literature and the first qualitative FT study in Indonesia. Our findings provide insight into the occurrence of FT and coping strategies used by Indonesian patients with cancer. The subjective experiences of patients may be considered to further improve oncology care, support the need for measurement of FT, and provide mitigation programs for patients.

How Do Older Adults in a Sub-Saharan African Community Perceive and Cope With Their Disability? An Interpretive Phenomenological Analysis

Objective: The study explored the perceptions and coping strategies employed by older adults in a Sub-Saharan African community in relation to their disabilities. Methods: The research utilized an Interpretive Phenomenological Analysis methodology and conducted semi-structured interviews with a purposive sample of households. The study recruited a total of 36 older adults aged 65 years and above, aiming to capture a diverse range of insights and perspectives within the Sub-Saharan African community. Results: Three interrelated themes pertaining to the perception of disability emerged: the impact of old age, disabilities caused by diseases, and disabilities attributed to external factors such as witchcraft. In coping with disability, two interrelated themes emerged: pragmatic coping strategies and unpragmatic coping strategies. Conclusion: This study offers valuable insights into the nuanced perception of disability and coping mechanisms utilized by older adults within the Sub-Saharan African community. By exploring their lived experiences, the findings contribute to a better understanding of the challenges they face. These insights have important implications for policy development and public health initiatives.

'It breaks my heart': Healthcare practitioners' caring for families with epidermolysis bullosa

Background

Epidermolysis bullosa (EB) is a painful genodermatosis presenting with skin fragility and blisters. There is no cure; the prognosis is guarded and depends on the subtype of the disease. Managing these patients can be emotionally challenging for healthcare practitioners.

Aim

To determine the perceptions, impact, and needs of healthcare practitioners (HCP) caring for patients and their families with EB.

Setting

Nelson Mandela School of Medicine, Durban and Grey's Hospital, Pietermaritzburg, KwaZulu-Natal.

Methods

The study was guided by interpretative phenomenological analysis. Individual in-depth interviews were conducted with 10 healthcare practitioners. Guba's trustworthiness framework was used to ensure rigour.

Results

Six global themes were identified, each related primarily to the perceptions, impact, and needs of healthcare practitioners. The experiences and perceptions of healthcare practitioners were that caring for patients with an incurable disease such as EB could negatively impact healthcare practitioners. There were divergent views among the disciplines of HCPs regarding the extent of care in a resource-limited environment. This resulted in negative emotions, ethical concerns, and a need for continued medical education and the application of coping strategies. Healthcare practitioners observed that patients and their families were vulnerable, requiring comprehensive biopsychosocial care.

Conclusion

Healthcare practitioners should be aware of their emotional challenges, seek support where necessary, and use effective coping strategies and self-care.

Contribution

The concerns and needs of healthcare practitioners are highlighted and interventional strategies to assist healthcare practitioners are suggested which will ultimately improve patient care.

The Meaning of Physical Literacy for Instructors of Children Experiencing Disability, from an Ecological Systems Perspective

With the rapid and widespread uptake of physical literacy (PL), there is potential for instructors to devalue participation of children who experience disability. The aim of the investigation was to understand how instructors who facilitate physical activity for children experiencing disability make sense of PL, and more specifically, how these instructors bring meaning to PL. Using interpretive phenomenological analysis, six instructors engaged in individual, semi-structured interviews. The study rationale was underpinned by the conceptual framework of ecological systems theory, which provided a foundation for the research, guided the structure of the interview guide, and facilitated a reflexive interpretation of the findings. Four themes were generated: Recognizing unique embodiments, The importance of context, Beyond physical competence, and Navigating PL's dominant discourse. The instructors' meaning of PL, impacted by relational and environmental influences, reflected the importance of movement skill development, while also embracing diverse embodiment and pedagogical flexibility by giving value to exploratory play, partial participation, family involvement, and willingness to abandon rigid lessons plans.

The Experiences of Post-ICU COVID-19 Survivors: An Existential Perspective using Interpretative Phenomenological Analysis

COVID-19 has highlighted the vulnerability of intensive care unit (ICU) patients and the negative sequelae associated with ICU treatment. While the potentially traumatic impact of ICU is well documented, less is known about the ICU survivor's subjective experience and how it influences life post-discharge. Existential psychology addresses the universal concerns of existence, including death, isolation, and meaninglessness, and offers a holistic view of human experience beyond diagnostic categories. An existential psychological understanding of ICU COVID-19 survivorship may therefore provide a rich account of what it means to be among the worst affected by a global existential crisis. This study employed interpretive phenomenological analysis of qualitative interviews with 10 post-ICU COVID-19 survivors (aged 18-78). Interviews were structured on existential psychology's 'Four Worlds' model that explores the physical, social, personal, and spiritual dimensions of human experience. The essential meaning of ICU COVID-19 survival was conceptualised as 'Trying to Reconnect with a Changed Reality' and consisted of four themes. The first, Between Shifting Realities in ICU, described the liminal nature of ICU and the need to ground oneself. The second, What it Means to Care and Be Cared For, captured the emotive nature of personal interdependence and reciprocity. The third, The Self is Different, described survivors' struggle to reconcile old and new selves. The fourth, A New Relationship with Life, outlined how survivors' experiences shaped their new worldviews. Findings evidence the value of holistic, existentially informed psychological support for ICU survivors.

The Experience of Health Professionals With Misinformation and Its Impact on Their Job Practice: Qualitative Interview Study

Background

Misinformation is often disseminated through social media, where information is spread rapidly and easily. Misinformation affects many patients' decisions to follow a treatment prescribed by health professionals (HPs). For example, chronic patients (eg, those with diabetes) may not follow their prescribed treatment plans. During the recent pandemic, misinformed people rejected COVID-19 vaccines and public health measures, such as masking and physical distancing, and used unproven treatments.

Objective

This study investigated the impact of health-threatening misinformation on the practices of health care professionals in the United Kingdom, especially during the outbreaks of diseases where a great amount of health-threatening misinformation is produced and released. The study examined the misinformation surrounding the COVID-19 outbreak to determine how it may have impacted practitioners' perceptions of misinformation and how that may have influenced their practice. In particular, this study explored the answers to the following questions: How do HPs react when they learn that a patient has been misinformed? What misinformation do they believe has the greatest impact on medical practice? What aspects of change and intervention in HPs' practice are in response to misinformation?

Methods

This research followed a qualitative approach to collect rich data from a smaller subset of health care practitioners working in the United Kingdom. Data were collected through 1-to-1 online interviews with 13 health practitioners, including junior and senior physicians and nurses in the United Kingdom.

Results

Research findings indicated that HPs view misinformation in different ways according to the scenario in which it occurs. Some HPs consider it to be an acute incident exacerbated by the pandemic, while others see it as an ongoing phenomenon (always present) and address it as part of their daily work. HPs are developing pathways for dealing with misinformation. Two main pathways were identified: first, to educate the patient through coaching, advising, or patronizing and, second, to devote resources, such as time and effort, to facilitate 2-way communication between the patient and the health care provider through listening and talking to them.

Conclusions

HPs do not receive the confidence they deserve from patients. The lack of trust in health care practitioners has been attributed to several factors, including (1) trusting alternative sources of information (eg, social media) (2) patients' doubts about HPs' experience (eg, a junior doctor with limited experience), and (3) limited time and availability for patients, especially during the pandemic. There are 2 dimensions of trust: patient-HP trust and patient-information trust. There are 2 necessary actions to address the issue of lack of trust in these dimensions: (1) building trust and (2) maintaining trust. The main recommendations of the HPs are to listen to patients, give them more time, and seek evidence-based resources.

"Me and 'that' machine": the lived experiences of people with neuromuscular disorders using non-invasive ventilation

PURPOSE

Neuromuscular disorders (NMD) encompasses a wide range of conditions, with respiratory weakness a common feature. Respiratory care can involve non-invasive ventilation (NIV) resulting in fewer hospital admissions, a lower mortality rate and improved quality of life. The aim of this study was to explore the 'lived experience' of NIV by people with NMD.

METHODS

Interpretive Phenomenological Analysis (IPA) with semi-structured, face to face interviews with 11 people with NMD, using bi-level positive airway pressure for NIV for more than 12 months.

RESULTS

Three themes were interpreted: (i) Alive, with a life; (ii) Me and 'that' machine; and (iii) Precariousness of this life. NIV enabled hope, independence and the opportunity to explore previously perceived unattainable life experiences. Yet, participants felt dependent on the machine. Furthermore, practical considerations and fear of NIV failure created a sense of precariousness to life and a reframing of personal identity.

CONCLUSION

The findings highlight the broad ranging positive and negative effects that may occur for people with NMD when using this important therapy. Ongoing non-judgemental support and empathy are required from health professionals as the use of NIV challenged concepts such as 'living life well' for people with NMD. IMPLICATIONS FOR REHABILITATIONNeuromuscular disorders may result in respiratory weakness requiring non-invasive ventilation (NIV).When prescribed early, NIV can results in fewer hospital admissions, a lower mortality rate and improved quality of life.The relationship of people with NMD with their NIV machine is complex and impacts on and requires adjustment to their identity.NIV users acknowledged that NIV provided hope but simultaneously recognised the precariousness of NIV on their life.In order to better support people with NMD healthcare professionals need to better understand how the physical, psychological and social implications of NIV affect an individual's life.

The experiences of hospital social workers who care for homeless patients: an interpretive phenomenological analysis

Unique challenges exist for hospital social workers tasked with the care of patients experiencing homelessness. These challenges affect patient care, impact social work practice, and emphasize the need to better understand the experience of providing services to this vulnerable population. Research is limited and focuses upon the experiences of unhoused patients and of medical management, not upon the experiences of the social workers positioned to meaningfully impact care. To address this gap, the current study utilized Interpretive Phenomenological Analysis (IPA) to examine the lived experiences of hospital social workers providing services to homeless patients. Respondents identified fulfilling aspects of this work but also emphasized the deeply personal and professional challenges it engendered. Recommendations were offered for supporting hospital social workers' self-care, incorporating effective practice perspectives, and providing meaningful patient support. Alignment of respondent experiences with literature on compassion satisfaction, compassion fatigue, work life conditions, and burnout was considered.

Having permission not to remember: perspectives on interventions for post-traumatic stress disorder in the absence of trauma memory

BACKGROUND

It is possible for people to have post-traumatic stress disorder (PTSD) without memory of the trauma event, such as in drug-facilitated sexual assault. However, there is little evidence available on treatment provision for this population.

OBJECTIVE

This study aimed to address this gap by exploring the experiences of people who have had psychological intervention for PTSD without memories (PwM).

METHOD

Interpretative phenomenological analysis was used to explore the lived experience of nine women with PwM, who had sought psychological assessment/therapy. Participants were recruited via social media and completed semi-structured interviews online/via telephone.

RESULTS

Identified themes concerned two broad areas: (i) the challenges of having therapy whilst lacking memories and (ii) what was helpful in therapy. Challenges included: delayed help-seeking; having emotional/sensory reactions in the absence of recognisable triggers; experiencing therapy as more applicable to remembered trauma (vs. unremembered); and difficulty discussing and processing unremembered trauma. However, participants also described helpful aspects of therapy including: feeling safe and supported; working with emotional and sensory forms of experience; having scientific explanations for trauma and memory; and having 'permission' from therapists not to remember.

CONCLUSIONS

Recommendations for clinicians included: being aware that clients with PwM may have more difficulty accessing treatment and perceive it as less applicable to them; focussing on clients' emotions and sensations (not cognitive memories) in therapy; and supporting clients to develop a more self-compassionate understanding of their experiences and lack of memory, thus supporting them to accept that not remembering is 'permitted'.

HIGHLIGHTS

• Having therapy for unremembered trauma involves unique challenges, but aspects of therapy can still be helpful.• Suggested 'dos and don'ts' for therapists include recognising the additional barriers to treatment, focussing on emotions (not memories), and normalising memory loss.

Physical Literacy for Children Labeled With Autism Spectrum Disorder: Mothers' Experiences of Ableism, Exclusion, and Trauma

Countering the declining physical activity patterns of children labeled with autism spectrum disorder (ASD) has gained considerable research attention given its impact on health and quality of life. The purpose of this study was to explore how parents of children labeled with ASD understand the concept of physical literacy, based on their children's participation in community-based physical activity programs. Using interpretive phenomenological analysis, six mothers of children labeled with ASD participated in one-on-one semistructured interviews. The conceptual framework of ecological systems theory supported the rationale for the study purpose, provided structure for the interview guide, and offered a reflexive context for interpretation. Four themes were generated from the thematic analysis: From embodied movement to normative skill expectations, Be flexible, not rigid, Systematic exclusion, and Valuable? . . . Absolutely! Despite experiences of marginalization, exclusion, and trauma within physical activity programs, mothers valued physical literacy development for their children given the positive outcomes of increasing family connections, engagement with peers, and enhanced wellness.

Experiencing visions of Canadian church workers: Exploring the mentality fueling systems involved in poverty reduction

To better understand the preferred role of faith-based organizations in secular society, the Canadian Council of Churches partnered with researchers to explore current systems of poverty reduction. The nature of the systems involved in attending to the underlying collective subjectivities (i.e., group/communally-shaped psychological experiences such as shared motivations, values, and aspirations) often being overlooked was justification for the importance of the research. These collective subjectivities are the forces that often drive system functioning. We conducted exploratory qualitative work situated in a theoretical frame informed by bringing together systems theory along with cultural psychology (an approach that focuses on socio-communally shaped collective subjectivities). In turn, this theoretical frame-shaped how Interpretive Phenomenological Analysis was employed. A total of 33 participants' collective subjectivities undergirding systems surrounding poverty reduction reveals a missional faith foundation leading toward perceived essential processes of advocacy and congregational connections bridging communal divisions. They see themselves as distinctly striving to create opportunities that encourage poverty alleviation in a holistic and dignified manner reflected in a multidimensional understanding of poverty. Perceived procedural tension exists between giving (that has long-lasting change and resonates with colonial forms of charity) and forming relationships can help people more effectively.

An interpretive phenomenological analysis of hope in cancer patients: A qualitative study

BACKGROUND

In positive psychology, increased recognition of the phenomenon of hope among people suffering from cancer, along with alleviating their negative mental states like anxiety, depression, and fear of death is evident and promising. The aim of the study was to explore the lived experience of hope in cancer patients.

MATERIALS

Qualitative phenomenological research approach was used. A semi-structured in-depth interview with open-ended questions was administered to explore the patient's hope related experiences during the journey of cancer. A purposive sampling technique was used to select a total of 10 participants for the study. The size of the sample was decided on the basis of literature for the interpretive phenomenological study.

RESULTS

Results revealed five major common themes related to hope during illness: (1) survival expectation; (2) will to live; (3) prognostic clarification; (4) positivity of health providers; and (5) recovery of other patients: A source of hopefulness.

CONCLUSION

The lived experiences of cancer patients shows that hope is the positive expectation of survival, which is a source of motivation during their journey of illness. It also denotes goal setting behaviour. Thus, hope is the "will to live" which is related to social support, positive communication with healthcare providers, and recovery of fellow patients.

Exploring the transition from student to health professional by the first cohort of locally trained occupational therapists in Ghana

INTRODUCTION

The transition from student to occupational therapist for new graduates has been described as a period of extreme stress and anxiety; novice therapists enter a world that is new and complex upon starting clinical practice. The first locally-trained occupational therapists in Ghana worked autonomously and in a self-directed manner from their first year of practice in a country where occupational therapy had not been established. The study sought to explore the transition from student to clinician, made by the first cohort of locally trained occupational therapists in Ghana.

METHODS

An interpretive phenomenology approach was used to explore participants' experiences of their transition from occupational therapy students to clinicians in Ghana. Six participants were selected using purposive, maximum variation, sampling. Data were collected by means of in-depth interviews and analysed using an iterative, inductive approach.

RESULTS

Four themes emerged: Being 'new' in a new profession, introducing occupational therapy into a new environment, Personal and professional competence, and 'The future is bright'. New graduates found continued professional development activities, such as additional reading, seminars and conferences, essential for successful transition into practice.

CONCLUSION

The importance of supervision and mentorship was highlighted in the study. Explicit attention to factors that support assimilation of new graduates within health care facilities were highlighted. The importance of continued professional development in development of practice competencies was foregrounded. Strategies to facilitate multi-professional work were demonstrated.

Why learning space matters: a script approach to the phenomena of learning in the emergency remote learning scenario

The study focuses on how the notion of learning space is perceived and experienced by learners in the Emergency Remote Learning (ERL) scenario. In doing so, the lived experiences of remote learners who were abruptly shifted to a completely online learning space due to the pandemic COVID-19 in the Indian higher education system are documented. Online interviews were conducted with eight undergraduate and four postgraduate students of English and Cultural Studies, enrolled at a Southern Indian university, and their responses were explicated using the Interpretive Phenomenological Analysis (IPA) approach. The interviews revealed that the phenomenon of ERL is shaped by dissonance informed by the absence of a familiar learning space. Often the patterns of this dissonance were marked by (1) the perception of learning and learning space, (2) the lack of intimacy in learning and learning space, (3) the negotiations made for learning and the space of learning in ERL, and (4) the challenges to cope with the responsibilities of the ERL scenario. Further, the script approach was applied to analyse the data and the analysis revealed an expansion of the existing internal scripts that were based on previous learning experiences of the learners. The study thus establishes the centrality of space in the process of learning and points out how the lack of a familiar learning space is linked to the absence of internal scripts that considerably impact learning. The study concludes by discussing the possibilities of application of script approach to effectively incorporate the aspect of learning space in new pedagogies and learning models as Blended Learning (BL) and Online Learning (OL) become the new normal worldwide.

Life Experiences with Using Community Care among People with Severe Physical Disabilities: A Comparative Analysis between South Korea and Japan

This study identified the pathways chosen by people with severe physical disabilities (PWSPD) in South Korea and Japan in using community care throughout their life and compared their experiences while navigating these pathways from their perspective. A concurrent nested mixed-method design was adopted. Quantitative data analysis included pathway mapping of facilities and services used throughout their lives. For qualitative data, interpretative phenomenological analysis (IPA) was applied. Eleven South Korean (congenital 7, acquired 4) and nine Japanese (congenital 6, acquired 3) participants were surveyed and interviewed. Pathway mapping was conducted by classifying the participants into focus groups. South Korean participants took nine years more than the Japanese participants to reach independence and showed different pathway characteristics. Superordinate themes from the IPA provided insight into the differences in experiences between PWSPD of the two countries: (1) accessibility and continuity of medical services; (2) experience of vocational training; (3) way and degree of social support for independent living; (4) care planning for receiving comprehensive services. In developing a community care model for the PWSPD to accelerate their time to independence, the government should strive for accessibility and connectivity of medical services, strengthen vocational training, social support for independent living, and information provision for the PWSPD.

Predicting and understanding seasonal influenza vaccination behaviour among forensic mental health inpatients

OBJECTIVES

This study aimed to identify demographic and psychological predictors of seasonal influenza vaccination intentions and behaviour among a sample of inpatients in a secure forensic mental health service. It also sought to explore patient experiences about being offered the vaccine.

DESIGN

This study used a mixed-methods design. The quantitative element employed a prospective design using a questionnaire; both cross-sectional and prospective findings are reported. For the qualitative part of the study, semi-structured interviews were conducted and analysed using Interpretative Phenomenological Analysis (IPA).

MAIN OUTCOME MEASURES

Seasonal influenza vaccination intentions and behaviour.

RESULTS

Past behaviour, vaccine knowledge and cues to action were predictors of vaccination intention (N = 57). Cues to action remained as the only statistical predictor of vaccination behaviour (N = 55). Nine interviews were conducted with four vaccinated and five unvaccinated participants. Three main themes were formed in the IPA analysis; these were 'Managing Decisional Conflict', 'Interaction with Immune Function' and 'The Role of Others'.

CONCLUSIONS

The results highlighted the integral role of health professionals in shaping patient's vaccination behaviour within a secure mental health setting. Recommendations for vaccination promotion strategies were offered.

Self-care is Renouncement, Routine, and Control: The Experience of Adults with Type 2 Diabetes Mellitus

Type 2 Diabetes Mellitus can cause serious complications; it has a severe impact on the quality of life and high costs. One of the key strategies to manage diabetes is self-care, a complex multifactorial process influenced by personal, cultural, and systemic factors, that comprises self-care maintenance, self-care monitoring, and self-care management. Few patients perform adequate self-care. To deepen our understanding of patients' experiences of self-care maintenance, self-care monitoring, and self-care management, we conducted the first qualitative study on this topic. This study used Interpretive Phenomenological Analysis, informed by the Middle-range Theory of Self-care of Chronic Illness, to explore the experience and meaning of self-care maintenance, self-care monitoring, and self-care management in adults with T2DM (n = 10). Three themes were identified: self-care is renouncement, self-care is routine, and self-care is control. A cross-cutting moral pattern connects the three themes. Our findings corroborate the Middle-range Theory of Self-care of Chronic Illness in the field of diabetes self-care and could inform practitioners in understanding the experience of self-care as a complex phenomenon and in developing tailored interventions.

Experiences of Post Anaesthetic Unit Recovery Nurse facilitating Advanced Directives in the immediate postanaesthetic period: A phenomenological study

AIMS

The aims of this study were to develop an understanding of the lived experience of the Post Anaesthetic Unit Recovery Nurse facilitating Advanced Directives and implications for patient-centred care.

DESIGN

Interpretive phenomenological analysis.

METHODS

Homogenized purposive sampling of six Registered Nurses using in-depth semi-structured interviews. Interviews were conducted between June-July 2018. Analysis was performed using interpretive phenomenology analysis.

RESULTS

Post Anaesthetic Recovery Nurses experienced a 'Grey Zone' when facilitating Advanced Directives postanaesthetic. The 'Grey Zone' is defined through four themes; The 'Trigger' of the anaesthetic characterized by physiological instability; 'Confusion and Frustration' featuring balancing of roles as a clinician and advocate during patient decline; 'Consistent Paternalism' by medical staff in the consideration of Advanced Directives; and 'Disempowerment' where nurses faced issues of advocacy, personal distress, a lack of literature or protocols, and handover of information.

CONCLUSION

The lived experience of nurses facilitating Advanced Directives postanaesthetic may be distressing. Further research is required to understand the implications of Advanced Directives following an anaesthetic. Education and development of protocols are recommended to optimize patient-centred care.

IMPACT

Post Anaesthetic Unit Recovery Nurses experienced a 'Grey Zone' when facilitating Advanced Directives, defined through four themes. Advanced Directives may appear to be clear, however, the anaesthetic may trigger physiological instability leading to confusion and frustration in interpretation and application of Advanced Directives. Confusion and Frustration were experienced while the attitudes of Consistent Paternalism were encountered when advocating for patient wishes, resulting in Disempowerment. Post Anaesthetic Unit Recovery Nurses may become empowered through acknowledging and describing the 'Grey Zone'.

Identity, civic engagement, and altruism: a phenomenological exploration of activity engagement in older adults

BACKGROUND

Older adults' health and quality of life, proxies for aging well, are tied to activity engagement. Recent research indicates studying the perspective of older adults through their personal stories is key to understanding the phenomenon of occupational engagement as experienced day-to-day.

AIM

To uncover the lived experience of older adults within their natural settings to better understand the phenomenon of activity engagement. This new knowledge informs programming options suited to older adults' wants and needs.

MATERIALS/METHODS

Ten community-dwelling older adults (5 female, 5 male mean 79 years) were studied. Researchers performed phenomenological interpretive analysis (IPA) with multiple coders and member cheques to triangulate findings.

RESULTS

Daily activities revolved around three themes: 1) Perspectives of self-identity are viewed as consistent throughout the lifespan; 2) Civic engagement is beneficial for social support and self-efficacy; and 3) Philosophical outlook influences activity choices and outlooks centred on altruism are critical to continued activity engagement. Seven of the ten participants expressed an overall positive outlook on aging. Three participants described a negative outlook on aging, expressed more difficulty with activity engagement, but reported desire to help others.

CONCLUSIONS AND SIGNIFICANCE

These themes provide a basis for programming to increase activity engagement with older adults in the community.

How women with established obsessive compulsive disorder experience pregnancy and postpartum: an interpretative phenomenological analysis

Objective: To describe the lived experience of pregnancy and postpartum for women with established obsessive compulsive disorder (eOCD); clarify the nature of exacerbation when it occurs.Background: Little is known about the effects of pregnancy on women who have eOCD, except some women report symptom 'exacerbation'. Previous studies have failed to define 'exacerbation' beyond an 'increase in severity'.Methods: An interpretive phenomenological analysis (IPA) study of five women with eOCD, who had given birth within the past three years, using semi-structured interviews. The participants self-reported a clinical diagnosis of OCD. Dimensional Obsessive Compulsive Scale scores were used to triangulate this information.Results: Four superordinate themes emerged: exacerbation, responsibility, trust and control. Four women who experienced 'exacerbation' reported an increase in severity and distressing new symptoms or changes in symptoms. This related to a sudden increase in responsibility, feelings of loss of control and isolation. Lack of trust affected support networks and created barriers to accessing health care.Conclusion: Exacerbation involved an increase in symptom severity as well as distressing changes in symptoms. Strategies are required to identify and support women with eOCD prior to, during and after pregnancy to enable women who experience exacerbation of OCD symptoms to access healthcare.

Sibling Relationships Over the Life Course: Growing Up With a Disability

The research explores sibling relationships, and the ways in which they are shaped over the life course by family members, in families with a lifelong disability. In-depth, semistructured interviews were conducted with 15 family units including a parent, a sibling, and an adult sibling with a disability. The content analysis revealed five sibling relationship patterns: (a) "Not a child, but a parent caretaker"-the parent-surrogate sibling; (b) "We somehow grew apart"-the estranged sibling; (c) "It is important for me to maintain some kind of distance"-the bystander sibling; (d) "When there's something they want to tell him, they always send me"-the mediator sibling; and (e) "I love him to death"-the friend sibling. These patterns of adult sibling relationships are discussed in relation to family dynamics, values, and legacies; recommendations for practice and research are made.

When "a headache is not just a headache": A qualitative examination of parent and child experiences of pain after childhood cancer

OBJECTIVE

Today, more than 80% of children diagnosed with cancer are expected to survive. Despite the high prevalence of pain associated with the diagnosis and treatment of childhood cancer, there is a limited understanding of how having cancer shapes children's experience and meaning of pain after treatment has ended. This study addresses this gap by exploring childhood cancer survivors' (CCS') experiences of pain from their perspective and the perspective of their parents.

METHODS

Twenty semi-structured interviews were completed with CCS (50% female; mean age = 13.20 y, range = 8-17 y) and their parents (90% mothers). Data were analyzed using interpretive phenomenological analysis.

RESULTS

Analyses revealed three superordinate themes present in the data: (a) pain is a changed experience after childhood cancer; (b) new or ambiguous pains may be interpreted by CCS and parents as a threat of disease recurrence, late effects, or a secondary cancer; and (c) pain interpretation occurs within the broader context of how CCS and parents appraise their cancer experience. Parents generally appraised their child's cancer and pain as more threatening and were influential in guiding their child's interpretations.

CONCLUSIONS

The cancer experience played an important role in shaping CCS' and their parents' experience and interpretation of pain in survivorship. This study provides novel data to inform the development and refinement of new and existing conceptual models of pain and symptom perception after cancer. The results also point to key areas for future investigation and clinical intervention to address the issue of pain in cancer survivorship.

"It Could Have Been Me": An Interpretive Phenomenological Analysis of Health Care Providers' Experiences Caring for Adolescents and Young Adults with Terminal Cancer

Purpose: Adolescents and young adults (AYAs) with terminal cancer are a marginalized population with unique medical and psychosocial needs. AYAs commonly report challenges with their health care experiences, however, little is known about the experiences of the health care providers (HCPs) who deliver this specialized care. The purpose of the current study was to understand HCPs' experiences caring for AYAs with terminal cancer. Methods: Nine HCPs (four nurses and five physicians) took part in in-depth semistructured interviews. Participants were eligible if they were a nurse or physician in Atlantic Canada; cared for at least one AYA patient with terminal cancer in the past 3 years; and were able to speak and understand English. Data were analyzed using interpretive phenomenological analysis. Results: Analyses revealed four superordinate themes present in the data: (1) many unknowns and uncertainties associated with providing care for AYAs compounded by minimal or no training specifically concerning this population; (2) an intense emotional experience compared with caring for patients with terminal cancer of other ages; (3) personal identification with patients and their families; and (4) attempts to make sense of the circumstance thwarted by feelings of injustice and unfairness. Conclusions: HCPs experienced unique emotional and logistical challenges when caring for AYAs with terminal cancer, which can influence the care they provide. HCPs' experiences highlight the need for training to support clinicians in caring for AYAs with terminal cancer to optimize their own well-being and delivery of health care services to this population.

"Like I Have No Choice": A Qualitative Exploration of HIV Diagnosis and Medical Care Experiences While Incarcerated and Their Effects

It is estimated that one in six Black and Latino adult persons living with HIV (PLWH) spend time in correctional institutions each year. Yet after release, PLWH of color evidence poor HIV health outcomes across the HIV care continuum. This study, guided by an ecological approach and Critical Race Theory, sought to understand the lived experiences of socioeconomically disadvantaged PLWH of color who received an HIV diagnosis and/or medical care while incarcerated, and the ways in which those experiences influenced engagement in medical care after release. Drawn from a larger study in Brooklyn, NY, in 2013-2016, a subset of 28 participants who received in-depth qualitative interviews were purposively sampled for a secondary analysis of participants who received an HIV diagnosis and/or medical care while incarcerated. Using an Interpretive Phenomenological Analysis, we found participant's experiences were shaped by longstanding mistrust of the medical establishment. While incarcerated, lack of autonomy, substandard medical care, and poor social support exacerbated medical mistrust and avoidance of HIV medical care long after release. Engagement in HIV medical care and treatment were also impacted by a dynamic interplay of factors including substance use, prolonged periods of denial, poverty, and repeated bouts of incarceration. Given that experiences of HIV diagnosis and medical care while incarcerated have long-ranging, adverse effects, we argue that a better understanding of the ways in which PLWH of color experience HIV diagnosis and medical care while incarcerated may serve to inform intervention efforts within correctional institutions to improve HIV health outcomes.

Surviving moment to moment: The experience of living in a state of ambivalence for those with recurrent suicide attempts

OBJECTIVE

This qualitative study aimed to capture the experience of living in the ambivalent space between life and death for adults with recurrent suicide attempts (RSA). It sought to expand upon an earlier study that explored the processes involved in transitioning away from RSA among adults, which revealed that occupying this ambivalent space is a crucial part of this process.

DESIGN

Interpretive phenomenological analysis (IPA) was used. This methodology was designed to explore the lived experiences and meaning making and enabled interpretation of the multidimensional subjective experiences of RSA participants.

METHODS

In-depth semi-structured interviews were conducted with eight adult women with a history of RSA who had participated in a therapeutic intervention at the research site (Skills for Safer Living: A Psychosocial/Psychoeducational Intervention for People with Recurrent Suicide Attempts [SfSL/PISA]). The six stages of IPA were followed to analyse the interview data.

RESULTS

Analysis revealed the superordinate theme, 'surviving moment to moment', which refers to a precarious state of making decisions about one's life and destiny on a moment-to-moment basis without clear commitment to either life or death. Two subordinate themes were identified: 'deciding not to die in the moment' when the participants were more invested in dying than living and 'deciding to live in the moment' when they were more invested in living than dying.

CONCLUSION

The study illuminated the complex process of making decisions about ones' destiny on a moment-to-moment basis. It revealed the torment experienced when occupying this state, while paradoxically, also revealing how indecision about life and death provided a lifeline opportunity for those with RSA. Clinicians who recognize the subtle distinctions associated with this in-between state can tailor their interventions accordingly.

PRACTITIONER POINTS

Surviving moment to moment is characterized by a state of emotional flux and uncertainty about one's destiny, where the person has not fully committed to either life or death. Within this state, there are two interlinked subprocesses, whereby the person is leaning more towards death or life. A critical feature in working with this client group is to recognize their ambiguity and the fragility and temporality of their decisions about their destiny. The practitioner has an opportunity to be a catalyst in the momentum towards life by demonstrating understanding of this survival struggle and tailoring intervention to fit with the nuanced processes within this state.

Hearing the voices of young people who self-harm: implications for service providers

The incidence of adolescent self-harm and suicidal behaviour has increased globally, with many adolescents repeating the behaviour. While studies indicate that large numbers of adolescents who self-harm do not seek professional help, research focusing on barriers to help seeking from an adolescent perspective is limited. Locally, a rise in reported and unreported rates of self-harm and a number of suspected child suicides prompted the commissioning of a research project to ascertain young people's experiences of help and support for self-harm and how their future needs could be best met. Qualitative research, adopting an interpretive phenomenological analysis, was used to elicit narratives of adolescents engaging in self-harm. Data were collected via 1:1 interviews with seven participants and analysed in two stages: an analysis of each individual narrative, and thematic analysis across the group. Three themes were identified: (i) cutting out the stress; (ii) stepping onto the path of help; and (iii) cutting to the chase. In conclusion, mental health nurses have a vital role in providing knowledge and support to those likely to have initial contact with this vulnerable group and to the wider population, ensuring we more effectively address the increasing use of this risky behaviour among young people.

Couples constructing their experiences of dementia: A relational perspective

Many people with dementia are cared for by their spouse or partner, therefore there is a need to understand the ways in which dementia and couple relationships impact upon each other. This study aimed to contribute to our understanding of the experience of dementia from a relational perspective. Seven couples, in which one person had a diagnosis of dementia, were interviewed about their experience of being in a couple where one partner had a diagnosis of dementia. Using interpretative phenomenological analysis, five master themes were identified, which illustrated how couples constructed their experience of dementia in order to make sense of it, and describe the processes that they adopt in order to adjust to dementia. Findings were supported by existing empirical and theoretical literature and suggest that services and interventions could be enhanced if a relational understanding of dementia were more fully considered.

The experience of pregnancy in women with a history of anorexia nervosa: An interpretive phenomenological analysis

BACKGROUND AND AIMS

To explore the experience of pregnancy for women who have a history of anorexia nervosa (AN), in relation to the impact of AN on pregnancy, and pregnancy on AN.

METHODS

Semi-structured interviews were conducted with six women with a history of AN. Data were analysed using Interpretive Phenomenological Analysis.

RESULTS

Four super-ordinate themes emerged: 'Effortful resistance of AN'; 'The unvalued self, valued other dialectic'; 'In new territory'; and 'Feeling distanced'.

CONCLUSIONS

Various factors motivated the women to try and change their AN behaviours. This was achieved with varying degrees of success. Attempts to manage AN cognitions and emotions were less successful, and this aspect of their illness persisted. Whilst the baby was viewed as worthy of nurturance, the self was not. Pregnancy represented an unfamiliar experience, and was a time of relative isolation and lack of psychological support. Findings are discussed in the context of theory, research and practice.

Learning to change a way of being: an interpretative phenomenological perspective on cognitive therapy for social phobia

Social phobia (SP) is a common and disabling condition for which cognitive-behavioral treatments (CBT) have demonstrated efficacy. However, there remains room for improvement. Hence, further exploration of the means by which CBT helps patients with SP is warranted. Studies examining patients' perspectives on which aspects of treatment were most or least helpful may augment other established methodologies for identifying the more or less effective components and thus help to increase the efficacy and cost-effectiveness of CBT for SP. The current study used interpretive phenomenological analysis to analyze the transcripts of interviews with eight patients who had completed cognitive therapy (CT) for SP. Four related themes were identified: (i) social phobia as a way of being; (ii) learning to challenge social phobia as a way of being: transformative mechanisms of therapy; (iii) challenges faced in the pursuit of change; (iv) a whole new world: new ways of being. This analysis of patients' experiences of CT for SP confirmed that the factors hypothesized to be important in maintaining SP in cognitive-behavioral models of the disorder are evident in patients' descriptions of the processes of change in CT for SP (e.g., reducing internal focus of attention and reducing safety behaviors and avoidance). Helpful components of CT for SP were identified as areas where the protocol could be enhanced. Recommendations for the way in which CT for SP is implemented are made.