A Phenomenological Investigation into the Use of Therapist Self-disclosure in Compassion-Focused Therapy With Forensic Clients

Existing research has demonstrated the benefits of therapist self-disclosure (TSD) in strengthening therapeutic alliance. However, little is known about its effectiveness in the forensic context. The current research sought to address this gap by interviewing six Compassion Focused (CFT) therapists who had experience of working across a range of forensic settings. Results of an Interpretative Phenomenological Analysis (IPA) indicated that all participants advocated using TSD as a powerful therapeutic tool when working with forensic clients. However, there was a tension between balancing risk with the rewards of TSD, and participants expressed how the secure forensic environment was not conducive to its use. There was a consensus that TSD was more strongly discouraged with clients who had sexual convictions. For some, this had an impact on their own disclosures. Training on the function of TSD is recommended in forensic practice to address some of the environmental barriers to its implementation.

Positioning of community pharmacists in interactions with general practitioners and patients regarding prescribing and using antibiotics

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is important for ensuring antibiotics are used correctly and combating antibiotic resistance. The study's main objective was to investigate how CPs, GPs and patients, respectively, position CPs in their interactions with patients on antibiotic-related matters in Norwegian pharmacies. Seven focus-group interviews were performed. Data were analyzed using systematic text condensation. Positioning theory was used to identify positions assigned to CPs by themselves, by GPs and by patients. CPs position themselves as helpful, accessible drug specialists responsible for advising on antibiotic use, but also consider themselves dependent on GP-supplied information to do so. GPs position CPs as helpful, responsible businesspeople who, however, lack clinical experience and are overzealous gatekeepers. Patients position CPs as helpful people who supply information in "everyday language" and as the GP's extended arm. Patients utter they are best served when GPs and CPs collaborate. This discrepancy is a barrier to optimal service to patients in general, and to proper antibiotic use in particular.

"A place without walls, only opportunities": personal accounts of attending Recovery Colleges in Norway

Introduction

Recovery colleges (RCs) are learning environments, first established in the UK, based on principles that support positive life changes and reduce stigma related to challenges with mental health and substance use problems. RCs offer courses based on co-production processes and are designed and delivered jointly by individuals with lived experience and professional experts. The courses are open to anyone, attracting people with a variety of life experiences. RCs are non-clinical environments that provide individuals with the identities of students and/or trainers as autonomous and independent agents. In this paper, we investigate experiences of being a part of a RC in Norway, either as a student and/or as a course trainer with lived experiences of mental health or substance use challenges. We ask the following research question: What kinds of personal and social processes are enabled by being part of a recovery college from the perspective of persons with experience-based competence?

Materials and methods

The study is qualitative and explorative based on 11 individual (N = 11) and two focus group interviews (N = 8). Participants were recruited from two of the first RCs in Norway between August 2021 and January 2022.

Results

Study participants describe how their involvement in a RC provided them with opportunities to assume new positions in their recovery process, both related to former institutional identities given in the course of treatment and related to the way they see themselves as people struggling with mental health and substances use challenges. Attending a RC represented significant transitions (1) from an institutional position as "sick" or as "what's on the paper" into a position as "a whole person"; (2) from being in in a position as a recipient of care to the position as actively responsible for life changes; (3) from seeing themselves as worthless to seeing themselves as persons with resources; (4) from being alone to being part of a fellowship. Participants describe being part of a RC as an invaluable addition to other kind of support or help.

Discussion

It is important to provide alternative arenas like RC for facilitating work with life changes, as an invaluable addition to regular services.

Exploring intersectoral collaboration in diabetes care: A positioning theoretical perspective

Intersectoral collaboration (IC) plays a significant role in the delivery of diabetes care and treatment of patients with type 2 diabetes (DM2), as the treatment and care of these patients take place in both primary care and specialist settings. The collaboration involves a large number of actors from primary and secondary healthcare sectors, who are expected to fulfil various roles when they engage in IC. We explored the actors' roles by applying the framework of positioning theory with the aim of revealing seemingly embedded understandings of such roles. The empirical data consisted of individual and focus group interviews. Our results indicate that naturalised understandings of the roles of actors interact with the way in which health professionals, patients, managers and relatives strive to develop IC that aims to help and guide patients who live with DM2.

Power dynamics and interprofessional collaboration: How do community pharmacists position general practitioners, and how do general practitioners position themselves?

Power differentials and medical dominance can negatively affect collaboration between physicians and pharmacists. Norway is recognized as having a relatively egalitarian work sector, which could affect power differentials. In this qualitative study, we used positioning theory as a framework to explore the aspect of power dynamics between Norwegian general practitioners (GPs) and community pharmacists. We used the concepts of reflexive and interactive positioning to identify how GPs positioned themselves and how they were positioned by pharmacists in six focus groups. Data were analyzed using systematic text condensation. We found positioning theory to be a useful lens through which to study power dynamics in relation to collaboration between community pharmacists and GPs. Our findings imply that the presence of medical dominance poses challenges even in an egalitarian Norwegian setting. However, although both GPs and pharmacists draw on a 'medical dominance' storyline, we have also identified how both pharmacists and GPs draw on alternative and promising storylines of collaboration between the two professions.

Experiences of female partners of prostate cancer survivors: A systematic review and thematic synthesis

The purpose of this systematic review and synthesis of studies reporting qualitative data was to understand the gendered experiences of female partners of prostate cancer survivors to inform psychosocial support for women. We searched Medline, PsycINFO, EMBASE, AMED, CINAHL, Cochrane Database of Systematic Reviews, and Sociological Abstracts for articles on 15 and 16 April 2019, and again on 30 November 2020. English language articles published in peer-reviewed journals were included if they reported solely on findings describing the perspectives of the female partners. Extracted data were analysed using line-by-line coding, organisation of codes into descriptive themes, and development of analytical themes. A theoretical framework was then selected to organise the relationships between issues that were found to be central to the experiences of female partners. Of 4839 articles screened, 14 met inclusion criteria, reporting 13 studies with a total sample of 359 female partners. Ussher and Sandoval's theory to describe the gendered positionings of cancer caregivers accommodated the thematic findings. The overarching theme reflected the substantive psychosocial impact of prostate cancer on female partners. Women's experiences were influenced by self-positioning (as part of a couple; provider of support to their male partner; resilient; and guided by faith and spirituality), being positioned by their partners' response (manager of male partner's psychological distress or strengthened by male partner's positive response) and by their broader contexts (family members and social networks; clinicians and the health system; and cultural values and customs). Findings highlight the need to avoid reductionist approaches to gender. Greater consideration of 'contextualised femininities', or conceptualising the influence of gender roles, relations, and identities within the wider life course contexts of female partners is required in the design and delivery of psychosocial support services.

Professional Self-Positioning of Indian Social Workers in Response to Domestic Violence

This article explores the self-positioning of Indian social workers who work with female survivors of domestic violence (DV). We know from previous research about the experiences of persons who have encountered DV, but more studies on the point of view of the professionals is needed. Relying on positioning theory and discursive analysis as a framework, we analyzed interviews (N = 18) concerning the practices, emotions, and attitudes of social workers. Positioning theory enables scholars to approach the situation of encountering a survivor as a social event, which consists of the meaning-making activities of social workers. Professionals self-position themselves as one or a combination of the following: (a) a challenger of gendered oppression, (b) an advocator of women's rights, (c) a facilitator of women's empowerment, and/or (d) a self-reflector of personal emotions and attitudes. The findings suggest that the event of DV intervention is a discursive and contextually situated moral practice in which the distribution of rights and duties to say and do things is of particular interest. The act of self-positioning is constructed in relation to sociocultural settings. Social workers may take several positions during the meetings with survivors. Positions build our understanding of how social workers in violence-specific units make sense of DV, illustrating how the act of self-positioning may also define to the position of the survivor. Social workers experienced boundaries, and possibilities in responding to DV were explored. The study reveals that barriers should be addressed at a wider level by funders and policy makers to enhance the continuity of work and the implementation of women rights legislation in India.

User involvement in the making: Positions and types of knowledge enacted in the interaction between service users and researchers in user panel meetings

BACKGROUND

Numerous studies of user involvement in research have been conducted. However, there is a lack of studies applying observational methods and addressing the concrete practice of involvement.

OBJECTIVE

To determine what knowledge types and competences users apply when involved in the research process through user panel meetings.

DESIGN

User panel meetings in a qualitative project in rehabilitation were sound-recorded and transcribed verbatim. Data analysis applied an abductive approach framed by positioning theory.

SETTING AND PARTICIPANTS

Six rehabilitation service users and a similar number of researchers met 20 times during a six-year project period. They discussed various issues in the research process such as interview guides, analysis and dissemination of results.

FINDINGS

The service users combined their respective knowledge and competence into six positions enacted in the panel interactions. They engaged as co-researchers, based their contributions on their respective personal histories, represented an NGO and peers, applied their respective professional and educational backgrounds and, finally, engaged as concerned citizens.

DISCUSSION AND CONCLUSION

The findings add to the discussion of professionalization of user involvement by introducing a wider array of positions enacted than do the findings of previous studies. Researchers recruiting user panel members, as well as NGOs appointing candidates for user panels, are advised to consider a wide competence profile for possible candidates. A panel is also considered as a resource in confirming and elaborating on a study's findings.

PATIENT AND PUBLIC CONTRIBUTION

A service user panel contributed to the study.

mHealth for image-based diagnostics of acute burns in resource-poor settings: studies on the role of experts and the accuracy of their assessments

Diagnostic assistance using mobile technology is instrumental to timely and adequate care in resource-scarce settings, particularly for acute burns. Little is known, however, as regards to how remote diagnostic consultation in burns affects the work process. This article reviews a doctoral thesis on this topic based on four studies conducted in the Western Cape, South Africa prior to and in a very early phase of the implementation of an app for burn remote diagnostic assistance. The aim was to increase knowledge on how remote diagnostic assistance for burn injuries can influence the role and work of medical experts in a resource-poor setting. The congruence model was used as a reference framework to study the ‘input’ (study 1), ‘tasks’ (studies 2 and 3) and ‘people’ (study 4) involved. The results show higher burn incidence in young children (75.4 per 10 000) and gender differences primarily among adults. The quality of images was considered by experts as better when viewed on smartphones and tablets than on computers. The accuracy of burn size assessments was high overall but low for burn depth (ICC = 0.82 and 0.53 respectively). Experts described four positions pertaining to remote consultations: clinical specialist, gatekeeper, mentor and educator. They perceived images as improving accuracy of consultation and stressed the need for verbal communication among clinicians during critical situations. In conclusion, experts are satisfied with the quality of images seen on handheld devices and can accurately assess burn size using these, yet burn depth assessment is more challenging without additional clinical information. mHealth for diagnostic assistance can benefit current image-based consultation by systematising information quality, introducing enhanced security and improved access to experts. Remaining challenges include the necessity of verbal communication in some instances and replacing existing informal organisational practices.

Users' and researchers' construction of equity in research collaboration

BACKGROUND

Equity is described as an ideal in user involvement in research and is mentioned in the health service literature and in several guidelines. However, equity is described as being difficult to obtain and the concept is rarely clarified or concretized. Equity can be socially constructed.

OBJECTIVE

This study explored users' and researchers' constructions of equity in research processes.

DESIGN AND METHOD

The study had a qualitative research design. Constructions of equity were analysed through the lens of positioning theory. Two focus group interviews consisting of both users and researchers were conducted.

FINDINGS

The thirteen users and four researchers considered 'equity' as an important part of user involvement in research. Storylines about norms, responsibility, language, knowledge and usefulness evolved in the discussions. These storylines elucidated unequal access to rights and duties.

DISCUSSION AND CONCLUSION

Users and researchers constructed equity in user involvement differently, but the difference was masked by an apparent agreement. Users and researchers drew on different storylines. The researchers emphasized the scientific discourse and although users acknowledged this discourse, they attempted to oppose this dominant discourse by drawing on a lay discourse. The identified constructions and negotiations of equity may contribute in new understandings of an equal collaboration in user involvement in research.

Coming from two different worlds-A qualitative, exploratory study of the collaboration between patient representatives and researchers

Background

Interest in user involvement in research has increased and user involvement is increasingly seen as a prerequisite. Still, challenges in the collaboration process have been documented from both researchers' and users' perspective.

Objective

By bringing together researchers and patient representatives, this study explores and describes both parties' experiences with user involvement in research as they appear through interactions in a focus group.

Design

We apply a qualitative design using positioning theory as a theoretical framework.

Setting and participants

Researchers and patient representatives were mixed within 2 focus groups. Positioning theory was used to guide the analysis.

Findings

The discussion evolved around knowledge, equity and partnership, all related to power through constant negotiations of positions. Researchers and users ascribed various positions while discussing these topics. Various positions are seen as the result of different rights and duties in the research process. Power differences in the form of different rights and duties stand out as barriers. Being positioned as a partner was an important aspect for users in our study. Researchers assumed passive positions within the focus group, whereas users assumed active positions by expressing their wishes and needs.

Discussion and conclusion

Our study indicates that positions relating to status and knowledge in the involvement process are important. The findings suggest that the positions that users and researchers assume and ascribe throughout the process are constantly changing; however, the researchers tend to have more power. More studies are needed to understand how equity is perceived in user involvement in health research.

The silver lining of greying: Ageing discourses and positioning of ageing persons in the field of social health insurance

Contemporary ageing discourses and policies perceive being active as the key to a good later life and thereby focus on individual responsibility and self-care. Drawing on website articles and press releases of Belgian sickness fund agencies, this study analyses the ageing discourses and positioning of ageing persons of these organisations. A discourse analysis was performed using positioning theory to analyse how sickness fund agencies discursively construct the ageing process and position ageing persons, and to investigate how these positioning acts are related to sickness fund agencies' roles as social insurer, social movement, social entrepreneur and private insurer. Our results reveal three storylines on ageing; ageing as a medical problem, ageing as a new stage in life and ageing as a natural life process. These storylines are applied to construct ageing and position ageing persons in different ways. Depending on their role, sickness fund agencies take on a different position drawing on these different storylines. We also show how these storylines reproduce the moral framework on how to age well and thereby disempower ageing persons. Our results underline the importance of multidimensional perspectives on ageing.

A virtual academy of polydrug use: Masters, novices and the art of combinations

Aims

Information technology has become an essential part of drug culture, providing a platform for lay knowledge concerning drug use. Due to the co-effects of different substances, making substance "combos" requires advanced skills to enhance pleasures and manage risks. In this study, we focussed on Finnish and Swedish online discussions as a context for learning and sharing experiences of combining substances.

Methods

Taking influences from positioning theory, we used qualitative methods to map what kinds of mutual interactive positions related to the expertise in polydrug use online discussants take and how these positions are negotiated and reformulated in the online setting. We reflect these results through Howard S. Becker's theory of social learning, according to which becoming a drug user is a process that occurs in interaction with other users, as the beginners need a model and advice from experienced users in order to claim their place in the users' community.

Results

In online forums, users discuss the risks and pleasures of combining drugs - on the one hand, in relation to different situations and, on the other hand, in relation to different competence positions. This occurs by asking for advice, presenting one's knowledge, challenging others, repositioning oneself, defending one's position or proving one's competence.

Conclusion

Online discussion forums constitute a kind of virtual academy where knowledge of the pleasures and risks of combining substances is produced and circulated, and where experienced masters mediate their expertise to less experienced novices.

"We're at a watershed": The positioning of PhD nurses in clinical practice

AIM

The aim of this study was to explore different perspectives on the positioning (i.e. the perceived rights and duties) of PhD nurses and how they contribute to clinical nursing practice.

BACKGROUND

The number of PhD nurses is growing worldwide, but we only have little knowledge of what is expected of PhD nurses and what their actual impact is in the clinic.

DESIGN

The findings of this article stem from a qualitative, explorative interview study.

METHODS

Semi-structured interviews were carried out with six PhD nurses, nine nurse colleagues and six clinical nurse leaders. Data collection took place from April - June 2016 in Central Denmark Region. Data were analysed using positioning theory.

FINDINGS

The PhD nurses were positioned as responsible for implementing evidence-based practice in the clinic and in nursing culture as such. Emphasis was put on the importance of PhD nurses staying close to the clinic to do practice-based research of immediate effect for patient care.

CONCLUSION

The study reveals several positive effects of PhD nurses in the clinic but also problematizes the many and diverse duties they are expected to carry out.

Understanding functional ability: Perspectives of nurses and older people living in long-term care

The functional ability of older people has come to play a significant role in their care. Policies and public debate promote active aging and the need to maintain functioning in old age, including among older people living in long-term care. This study explores the meanings given to functional ability in the interview talk of long-term care nurses (n=24) and older people living in long-term care (n=16). The study is based on discourse analysis and positioning theory. In this study, accounts of functioning differed between nurses and older residents. For the nurses, functional ability was about the basic functions of everyday life, and they often used formal and theoretical language, whereas for older long-term care residents, functional ability was a more versatile concept. Being active was promoted, particularly in the nurses' talk but also sometimes in residents' talk, thereby reflecting the public discourse about functioning. In their talk, the nurses positioned themselves in relation to functional ability as competent professionals and active caregivers. In residents' talk, we found three positions: an active individual taking care of him or herself, a recipient of help, and a burden to nurses. To move in a direction that promotes activity and rehabilitative care, a better understanding of older people's individual needs and their own views of functional ability is needed.

The social positioning of older people living with Alzheimer's disease who scream in long-term care homes

This article describes the social positioning of older people living with Alzheimer's disease who scream in a long-term care home. Few studies have focused on the social positions taken by older people, their family and formal caregivers during interaction and their effects on screams. A secondary data analysis was conducted using Harré and Van Langenhove's positioning theory. The results show that older people are capable of positioning and repositioning themselves in relational patterns. Family and formal caregivers position older people who scream according to their beliefs about their lived experience. They also react emotionally to older people and try to influence their behaviors. Understanding the social positioning of older people with Alzheimer's disease brought out their capacities and their caregivers' concerns for their well-being. Interventions should focus on these strengths and on promoting healthy relations in the triads to enhance quality of care in long-term care homes.