Pregnancy loss in women with systemic lupus erythematosus: Grounded Theory

OBJECTIVE

to learn the meanings attributed to pregnancy loss by women with Lupus.

METHOD

qualitative research, based on Symbolic Interactionism and Grounded Theory. Data collection took place between January and August 2022 through in-depth interviews. Data analysis went through the stages of initial and focused coding.

RESULTS

seventeen women participated. The central phenomenon "The climb to motherhood: falls and overcoming" was constructed, consisting of three categories: "Falling to the ground during the climb: the experience of pregnancy loss"; "Getting up and following the path: new attempts to conceive"; and "Remembering the journey: meanings attributed to pregnancy losses".

FINAL CONSIDERATIONS

experiencing pregnancy is, analogously, like climbing a mountain, where obstacles need to be overcome to reach the summit. The experience of pregnancy loss is seen as complex, especially when there is fragility in healthcare and a lack of awareness regarding feelings of loss and grief.

Men's experience of caring for a family member with cancer: a theory based on data

OBJECTIVE

to understand the meaning attributed by men to the experience of caring for their family member with cancer and to develop a substantive theory that represents the experience of men caring for their family member with cancer.

METHOD

this is qualitative research guided by the methodological framework of Grounded Theory and the precepts of Symbolic Interactionism. A form with identification and interview data was used. The analysis followed the substantive and theoretical coding stages.

RESULTS

12 male caregivers of their family member with cancer participated. The constant comparative analysis of the data allowed the creation of a substantive theory "Experiencing the care of a family member with cancer: men as a caregivers" explaining the experience that has as its central category "The love that drives care", representing the symbolic actions and attitudes of men living in the context of illness due to cancer and care.

CONCLUSION

the theory allowed us to understand feelings, perceptions, ways of acting and facing the diagnosis, providing care, recognizing difficulties and learning from the situations that arise, making explicit the interactional processes and symbolic elements present and how these influence male caregivers in their actions and attitudes.

BACKGROUND

(1) For men, caring is a choice (2) Taking care symbolizes a way of expressing love and reciprocation. (3) Love in caring is strengthened by reciprocity, commitment, gratitude and zeal. (4) To provide care, man reorganizes himself and adjusts to the conditions that present themselves (5) Male caregivers need to be heard and included in the actions of health teams.

Syphilis in pregnancy and congenital syphilis: women's experiences from the perspective of symbolic interactionism

OBJECTIVES

to understand the meanings attributed by women to the diagnosis and treatment of syphilis and congenital syphilis, and to outpatient follow-up of their children.

METHODS

this is a qualitative study conducted with 30 mothers of children with congenital syphilis using audio-recorded semi-structured interviews, which were submitted to inductive thematic analysis. Symbolic interactionism was the theoretical framework considered in this study.

RESULTS

two themes were identified, showing the maternal diagnosis involved shock, guilt, and fear of social exclusion, in addition to frustration due to failure to prevent vertical transmission. Moreover, the painful clinical procedures for the child's treatment enhanced maternal guilt, and the symbolic process of re-signification of the disease/treatment took place with the child's healing.

FINAL CONSIDERATIONS

understanding the intersubjective aspects involved in this experience helps nurses rethink their care practice and contributes to their critical role in the context of syphilis.

"They're just, like, there": A constructivist grounded theory study of student experiences with school resource officers

School-based policing has become common practice, but there is limited qualitative research examining what meanings students make of police presence in their schools. This study sought to understand how students construct narratives of police presence in their schools based on their experiences with school resource officers (SROs). Drawing on constructivist grounded theory methodology with a sample of 17 students, this study found that students are continuously integrating multiple conflicting narratives about SROs: students experience SROs as an established yet ambiguous presence, which produces mixed feelings of reassurance, wariness, and intimidation. Students manage the conflicts between these narratives by positioning school-based police as a fixed structure with pitfalls and positives but no alternatives. Additionally, students experience SROs as being available to them in relational capacities. The primary recommendations from this study are for schools and communities to (1) reconsider the appropriateness of SRO programs with student perspectives at the center of dialogue, and (2) invest in non-law enforcement school-based professionals who students experience as available and relational.

Negotiating mental illness across the lay-professional divide: Role play in peer work consultations

Patient involvement is a prominent policy aim in modern health care. Today, mental health services employ peer workers (PWs) who have personal experiences with mental illness. Based on 22 interviews with PWs and 26 audio recordings of real-life consultations, we show how PWs talk about their personal experiences as professional qualifications. Furthermore, we demonstrate how in real-life encounters, PWs and patients convert personal experiences into a professional approach through an interactionist role play that balance PWs role as former patients and current professionals. Our analysis shows that PWs combine the personal pronoun 'I' (stressing that it is personal) with the indefinite pronoun 'one' (referring to generalised patient experiences) when they recount illness experiences. This convey that PWs engage with mental illness as both a personal and professional topic. In addition, the analysis shows that PWs (and patients) use professional clues to manifest PWs' positions as professionals. Overall, the article demonstrates that instead of focussing on authentic patient relationships, as previous research has done, it is beneficial to investigate peer work from a symbolic interactionist approach revealing how PWs and patients skilfully manoeuvre the contradictions embedded in the PWs' dual role as former patients and current professionals.

The COVID-19 Mask: Toward an Understanding of Social Meanings and Responses

The COVID-19 pandemic has imposed unprecedented restrictions on everyday life. Unlike lockdown or shelter-in-place measures, the facemask has emerged as an empowering response to the public spread of the virus, permitting some degree of return to prepandemic life-such as school or work-by disrupting transmission that would otherwise occur. And yet, this utilitarian tool has attracted considerable controversy and polarized opinions. This article uses Blumer's adaptation of symbolic interactionism as a theoretical roadmap to examine the various meanings ascribed to the facemask and its usage. We discuss how it is socially perceived and consider implications for health care providers within the Canadian social context.

The Symbolic Meaning of HIV: Understanding Lecturers' Ambivalence over Teaching HIV to Dietetic Students

Responding to the increasing reports of health students and professionals demonstrating stigmatized attitudes toward people living with HIV (PLHIV), this article examined the learning process that takes place during their academic training. Using symbolic interactionism as a theoretical framework, we studied the way lecturers in dietetic schools in Indonesia make meaning of their understanding and experience of HIV in relation to their teaching conduct. We found that the current curriculum does not provide adequate opportunities for students to learn and interact with PLHIV. Participants described HIV discussion is mainly limited to the clinical aspects and essential treatment as they were uncomfortable discussing HIV with the students. The ostensible symbolic meaning of HIV among dietetic lecturers in Indonesia was compounded with limitations and restrictions affecting their teaching practices and attitudes to PLHIV. Future intervention is required to help lecturers recognize their degree of awareness and personal values about HIV.

Supporting identity and relationships amongst people with dementia through the use of technology: a qualitative interview study

Meaningful activities in dementia care can promote the co-construction of narrative identity in caregiving relationships, helping to preserve the sense of self in people with dementia.

Purpose: Informed by symbolic interactionism and Deweyan transactionalism, the aim of this study was to develop a transactional model of how narrative identity and relationships are promoted through the use of a new technological solution, SENSE-GARDEN, that uses digital technologies and multisensory stimuli to facilitate individualized, meaningful activities.

Method: We conducted a qualitative interview study to explore the experiences of people with moderate to advanced dementia and their caregivers in Norway and Portugal. After using SENSE-GARDEN for 12–16 weeks, 20 participants (7 persons with dementia and 13 caregivers) were interviewed. The interviews were analysed using reflexive thematic analysis.

Results: Three themes were generated: openness, learning, and connection. Findings suggest that SENSE-GARDEN can stimulate emotional experiences, preserve narrative identity, and foster interpersonal relationships. These findings are illustrated through a transactional model.

Conclusion: This study highlights the complex multitude of factors affecting person-environment interactions in which narrative identity and relationships are constructed. To better understand these factors, future work should adopt a holistic approach to studying new methods of creating meaningful activities in dementia care.

A dimensional analysis of inner strength in people ageing with serious illness

Nursing models of care show promise in addressing the needs of older adults facing serious illness through supporting inner strength. However, previous conceptual and theoretical models of inner strength are limited. This concept analysis used dimensional analysis methods to explore inner strength in people ageing with serious illness to address limitations by defining a pragmatic, data-driven model. This study analyzed published literature of adults with serious illness that describes inner strength. Thirty articles were selected after review. The result was an explanatory matrix that describes inner strength from the perspective of where have I been, where am I going? within the context of being a person who is living and dies and you have a serious illness. The conditions spotlighting by actors around me and taking stock of others and ideas lead to processes of looking in/looking out and seeing me as I'm seen. The final consequence of this process is meeting me. This updated concept analysis of inner strength improves upon previous models by providing a clinically relevant situation-specific model of inner strength for people with serious illness. Implications for nursing scholarship and practice are described including exploration of person-centered care, relational practice, and health communication.

GPs' perspectives of the patient encounter - in the context of standardized cancer patient pathways

Objective: We aim to explore how GPs assign meanings and act upon patients' symptoms in primary care encounters in the context of standardized cancer patient pathways (CPPs).Design, setting and subjects: Thirteen individual interviews were conducted with GPs, at primary healthcare centers (n = 4) in one county in northern Sweden. Interviews were analyzed using grounded theory method. The results were then linked to symbolic interactionism.Main outcome measures: GPs' perspectives about assigning meanings to patients' presented symptoms and perception about CPPs.Results: In the encounter, GPs engaged in two simultaneous interactions, one with patients' symptoms - and the other with CPPs. The core category Disentangling patients' care trajectory consists of three categories, interpreted as GPs' strategies developed to assign meaning to symptoms. These strategies are carried out not in a straightforward manner but rather in a conflicting way, illuminating the complexity of GPs' daily work.Conclusions: Interacting with patients is vital for assigning meaning to presented symptoms. However, nowadays GPs are not only required to interact with patients, they are also required to interact with CPPs. These standardized routines might create pressure and demands on GPs, especially for those experiencing a lack of information about CPPs. Beside of carrying out the challenging patient/person-centered dialogues and interpreting presented symptoms, GPs also need to link the interpreted symptoms to CPPs. Therefore, it is essential that GPs are given opportunities at their workplaces to continuously be informed and be supported in order to practice CPPs and thereby optimize trajectories for patients undergoing cancer diagnostics.Key points Current awareness: • GPs deliberation about patients' trajectories is a complex process, often dealing with vague symptoms. How CPPs influence this process within the encounter has not been studied. Main statements:  • GPs in our study were involved in two simultaneous interactions, one with patients' symptoms in the encounter - and the other with CPPs within the healthcare organization. • Symbolic interactionism helped capture how GPs deliberated about conflicting and paradoxical aspects of the encounter, in terms of balancing two contradictory ways of action that GPs face when providing patient/person-centered care and linking to CPPs. • Based on our results, primary care needs support from healthcare organizations to build capacity about CPPs and how to use them.

She Left the Party: College Students' Meanings of Sexual Consent

At a moment when college sexual assault is described as an epidemic, it is important to understand college students' implicit meanings of consent. Through 83 interviews, we examine students' interpretations of a vignette in which neither character asked nor gave consent to sex. Gendered expectations significantly shaped whether students interpreted the male or female character as giving consent. When considering how students indicate interest in kissing or having sex, students interpreted acts such as leaving a party as indications of a man's sexual interest and a woman's willingness. That is, college students "expected" and employed implicit, gendered readings of actions that inform their understandings of implicit consent.

A Theoretical Exploration of Live Discharge from Hospice for Caregivers of Adults with Dementia

Patients with dementia may be discharged from hospice if their condition stabilizes. The loss of professional support and an already complex grief process needs careful attention. A live discharge presents a unique experience for each hospice patient, caregiver, and hospice team, which varies from traditional bereavement theories used to describe the grieving process. This article explores live discharge from hospice for caregivers of adults with dementia through a theoretical lens of Symbolic Interactionism (SI) and Attachment Theory (AT). The theories of SI and AT support and assist in understanding the experience of caregivers who lose hospice support due to ineligibility. In addition, caregivers watch the gradual deterioration and psychological loss of someone with dementia while they remain alive described as an ambiguous loss. Ambiguous loss as a subset of traditional bereavement theories provides a framework for this exploration and provides a relevant illustration of the complex needs. This article will conclude with implications for social work practice. It is important for hospice clinicians to be aware of current termination practices necessary to manage appropriate attachments, support the symbolic meaning of the hospice experience, validate the ambiguous losses, and maintain a sense of hope through a live discharge from hospice.

Evaluating sense of community in the residential environment from the perspectives of symbolic interactionism and architectural design

The paper fills the gap between the design and the actuality of how buildings, and its surroundings, urban design, and the built environment influence its occupants' behavior and interactions. We assess how the built environments can be influenced by humans and their control, both physical and symbolically, of the urban landscapes. In this regard, our paper merges symbolic interactionism, sense of community, and architectural design to aid our understanding of the man-environment relationship. Specifically, we assess qualitative data on Ekbatan Residential Complex in Tehran. We use Ekbatan as a case study to see how a sense of community among residents reflects both physical features of the complex and the symbolic meaning attached to these features by residents and those living outside the community. We conclude by suggesting that combining the interests of urban sociologist, community psychology, and architects via symbolic interactionist concepts may be a fruitful avenue for studying factors affecting sense of community and larger urban processes.

Elderly and forced displacement in Colombia

Objective

To describe the experiences of older adults around forced displacement due to the Colombian armed conflict.

Methods

Interpretive-comprehensive study, with a hermeneutical approach; several types of sampling were carried out. The participants were 12 people aged over 60 years, who reported having being displaced and who participated in the SABE Colombia Survey. The data were encoded using the Atlas.ti software. A process of condensation of central analytical, support and emerging categories was made.

Results

The displacement generated by the armed conflict has been decisive in the current life conditions of the participants. They know that they are survivors of someone else's violence; there is dislocation, loss of territory, de-anchoring, lack of protection and insecurity. To the stigma of old age, it is added being displaced and being strangers in a place where they don't belong. They live the violent uprooting of their lands and the confusion of their identity; they found themselves in a foreign scene where they were the unusual and the strangers; from receiving threats, they passed to be labeled as 'threatening'. This forced displacement stems from violence, but also from fear, and it marks the trajectory of life for older people who experience a prolonged struggle for survival in often hostile environments, living "permanently" displaced.

Conclusion

When there is displacement, older people are not only shed of their land and their home, but also from their cosmos and their vital referents; in addition, it changes their life trajectory and their place in the world. Interventions should be designed based on specific particular and contextual analyses.

K-12 School Employee Sexual Abuse and Misconduct: An Examination of Policy Effectiveness

Despite federal and state laws and policies aimed at preventing sexual misconduct by school employees, one in ten American students will experience sexual abuse or misconduct at the hands of a K-12 school employee. To explore why such sexual misconduct continues to occur, this study examined the effectiveness of education policies by investigating whether and how school employees understand these policies, how they are implemented, and how loopholes may undermine their intent. This qualitative case study was conducted in three Virginia school districts and included 46 semi-structured interviews with school district employees and county, state, and federal government employees associated with cases of school employee sexual misconduct, and extensive document analysis of school policies and procedures, laws, and court records. Analyses revealed an absence of policy implementation, demonstrated most seriously by a lack of awareness and understanding of policies among school employees, underreporting, and ineffective data collection. The study also identified a number of loopholes in the implementation of policies, resulting from a mismanaged intergovernmental system. The analysis suggests that understanding and implementation of policies meant to prevent sexual misconduct by school employees are fragmented; this fragmentation may be contributing to the continued prevalence of sexual misconduct by school employees.

Patients´ experiences and perspectives of challenges and needs related to nonmyeloablative stem cell transplantation: Involving patients in developing a targeted rehabilitation programme

AIMS AND OBJECTIVES

To explore patients' experiences and perspectives of their challenges and needs regarding their return to everyday life after allogeneic nonmyeloablative haematopoietic stem cell transplantation (NMA-HSCT).

BACKGROUND

NMA-HSCT can cure patients with malignant blood diseases, but during the following years, the majority of patients suffer from serious side effects and complications. Hence, it is a major challenge for patients treated with NMA-HSCT to rehabilitate, maintain physical and psychosocial functioning and return to a life in restored balance.

DESIGN

The design was qualitative using the interpretive description methodology, and the theoretical framework symbolic interactionism inspired the interview guide and analysis.

METHODS

Between April to May 2017, five focus group interviews were conducted with 15 outpatients in a haematological ward in Denmark. The patients were treated with NMA-HSCT 8-30 months prior to the interviews. The study adheres to the Consolidated Criteria for Reporting Qualitative Research guidelines.

RESULTS

The impaired functioning was the overarching theme and seemed to be the trigger entailing rehabilitation needs related to the following main themes: realising decline, adapting to changes, the meaning of motivation and reliance on relations. These findings seemed to affect and influence the patients' struggle for a return to an everyday life like before being diagnosed or just before undergoing NMA-HSCT.

CONCLUSION

This study adds to our understanding of important elements to consider when developing a targeted rehabilitation programme.

RELEVANCE TO CLINICAL PRACTICE

Based on our findings, the rehabilitation programme should encompass: extensive variation regarding how to address the impaired functioning through individualised approaches, multimodal interventions, interventions through several months with varying intensity, an interdisciplinary team approach supporting motivation and visualisation of every progress by tangible goal setting, communication regarding hope and support, extended supportive care for patients living alone and finally increased adherence through social sessions with relatives and fellow patients.

Improving Identification and Child-Focused Collaborative Care for Children of Parents With a Mental Illness in Tyrol, Austria

Background: Children of parents with a mental illness (COPMI) are more likely to experience negative long-term adversities. However, interventions to support their needs early can significantly enhance adjustment and reduce negative outcomes. Approximately one in four children currently lives with a parent with mental illness worldwide. The lifelong impact for individuals, governments, and broader society is likely to be substantial. There are significant workforce barriers to the early identification of COPMI and addressing their needs, particularly within the adult mental health care system. The current study aims to reduce such barriers and to improve identification of COPMI in the current health care systems. Objectives: The project "The Village" is a multidisciplinary health and social care policy intervention and seeks to improve child development and well-being outcomes for children of parents with a diagnosed mental illness. This will be achieved through the co-development, implementation, and evaluation of a practice approach to the early identification and collaborative care for COPMI, through establishing child-focused support networks. This will be done with open innovation science (OIS) approaches engaging the public in Tyrol, a geographical region of Austria, throughout 4 years. As part of the co-development process, we will work with stakeholders to co-develop the practice approaches based on evidence-based approaches and determine the most appropriate study design to evaluate those, as well as the implementation processes we will undertake. Methods: The project is underpinned by theories from different disciplines (i.e., public health, psychology, sociology, linguistics, economic sciences) as well as drawing on different approaches (i.e., co-development, implementation science, symbolic interactionism, and realist evaluation). It is based on the seven content work packages (WPs): 1) management, 2) focusing on children and methods to understand their "voice," 3) scoping, 4) co-development, 5) implementation, 6) evaluating the practice approaches, and 7) knowledge dissemination. "Scoping" will involve exploring the existing evidence, practice, and current state of identification and collaborative care in Tyrol, Austria. "Co-development" involves the co-design of practice approaches to identify and support children in partnership with key stakeholders and service providers working in Tyrol. The "implementation" of practice approaches will be based on the results of the co-development phase and will involve working with organizations to develop support strategies that draw on known organizational drivers from the field of implementation science to support the rollout of the practice approaches. In "Evaluation" we will follow principles of a realist approach; this includes developing program theories and logic models for the practice approaches. Those will set out the outcomes hypothesized to achieve and the processes that are expected to lead to those changes. This will refer to changes in children, parents, and practitioners. We expect that the main focus will be on measuring child quality of life and mental health outcomes, and outcomes that are on the path to those (such as social support needs, resilience, mental health literacy, stigma, and help-seeking behavior) as well as costs. The "child voice" WP focuses on children's perceptions and needs as the importance of "assent" and support of children to develop their own "voice" in health care is increasingly recognized within child health research. The "dissemination" step focuses on reaching a broad public audience of different stakeholders, researchers, and families involved. Discussion: The research project aims to directly improve identification and support of vulnerable children across selected regions in Tyrol, Austria, and by doing so, improve the health and well-being of future generations, through breaking the cycle of intergenerational transfer of adverse childhood experiences.

Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians

The aim of this study was to explore nurses’ and physicians’ perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care.

We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway.

The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities.

The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology.

Contextualizing Informal Labeling Effect on Adolescent Recidivism in South Korea

Symbolic interactionism argues that the effect of informal labeling by general others, such as family and friends, on behavior depends on the social context under which labeling takes place. Despite abundant research on informal labeling, little effort has been made to contextualize its impact on adolescent reoffending. Also, compared with other theories, only a few studies have been conducted among youths in Asian population. Using three consecutive waves of self-reported survey data from a nationally representative sample of 2,406 Korean adolescents, this study examined an interactional model for the informal labeling effect. Findings suggest that informal labeling, as well as school commitment and delinquent peer association, has an independent effect on delinquency. Also supported is the symbolic interactionist hypothesis that adolescents with greater involvement in delinquent subcultures were less susceptible to informal labeling. Implications of the findings are discussed.

Lessons learnt on the meaning of involvement and co-creation in developing community-based rehabilitation

Purpose: To describe and analyse social interactions among the users, partners and stakeholders involved in developing a rehabilitation park to determine a future approach to community-based rehabilitation.Materials and methods: The design was qualitative using the methodology interpretive description and symbolic interactionism as the theoretical framework. Data was generated through a two-year ethnographic fieldwork throughout the development of the SPARK (Sound Park Activities Rehabilitation and Climate) rehabilitation park. The participants were users, partners, and stakeholders of the park and data consisted of participant observations comprising observations, informal conversations, and field notes.Results: Three themes formed an understanding of the significance of involvement; A shared vision reflected the participants' joint overall idea for the rehabilitation park containing possibilities for health promotions for everyone. Perceived solidarity represented an experience of a project where everyone's opinion counted whilst Profound Acknowledgement signified a state of a deeper experience of being valued and heard.Conclusions: The findings suggest consistent and continuous involvement of users, partners, and stakeholders, creating possibilities for co-creation in rehabilitation in new settings. The development of rehabilitation parks like the SPARK park in a shared public arena may benefit people with disability, and everyone and further help reduce stigma around disability.Implications for RehabilitationThe rehabilitation definition forms the base for co-creation of rehabilitation initiatives among people in need of rehabilitation as such and professionals with different approaches and professions.Conducting rehabilitation practice in a shared outdoor arena may provide professional development and expansion towards interdisciplinary approaches across diagnoses and professions.Outdoor rehabilitation may (despite different target groups) function as a facilitator for professional and chance meetings in the park and thereby create a community for meeting across professional disciplines, founding, and enabling a practice that allows to reflect on and learn from different approaches within rehabilitation.Community-based rehabilitation in a public shared arena may generate possibilities for reducing stigma towards people with disability.

'Just because a doctor says something, doesn't mean that [it] will happen': self-perception as having a Fertility Problem among Infertility Patients

Only some individuals who have the medically defined condition 'infertility' adopt a self-definition as having a fertility problem, which has implications for social and behavioural responses, yet there is no clear consensus on why some people and not others adopt a medical label. We use interview data from 28 women and men who sought medical infertility treatment to understand variations in self-identification. Results highlight the importance of identity disruption for understanding the dialectical relationship between medical contact and self-identification, as well as how diagnosis acts both as a category and a process. Simultaneously integrating new medical knowledge from testing and treatment with previous fertility self-perceptions created difficulty for settling on an infertility self-perception. Four response categories emerged for adopting a self-perception of having a fertility problem: (i) the non-adopters - never adopting the self-perception pre- or post-medical contact; (ii) uncertain - not being fully committed to the self-perception pre- or post-medical contact; (iii) assuming the label - not having prior fertility concerns but adopting the self-perception post-medical contact; and (iv) solidifying a tentative identity - not being fully committed to a self-perception pre-medical contact, but fully committed post-medical contact. (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).

The Role of the Mental Health Worker in a Housing and Accommodation Support Initiative for Indigenous Australians

PURPOSE

To explore the experiences of mental health workers and perceptions of their role and the scope of their work.

DESIGN AND METHODS

Qualitative design. Twenty interviews were conducted with mental health workers. Interviews were analyzed using thematic analysis.

FINDINGS

Three overarching themes were identified. In this paper the overarching theme of "dimensions of my role" is discussed. Subthemes were (a) information and education, (b) person-centered care, and (c) networking and partnerships.

PRACTICE IMPLICATIONS

Professional development, networking, and partnerships underpin the provision of coordinated services and ultimately person-centered care. Enhancing staff capacity building may also enable sustainability of appropriate quality services.

Stigma of mental and physical illness and the use of mobile technology

Research has shown the stigma attached to mental disabilities, yet little research has directly compared the experiences of people with physical disabilities and those with mental disabilities. Not only are both conditions likely perceived as stigmatizing, but the pervasive use of mobile technology may be one means by which people with disabilities can manage and understand their disability. Four hundred and eighty-seven individuals with physical and/or psychological disabilities completed a survey examining whether they would be willing to use mobile technology to manage their disability and how stigmatizing they perceived their disability to be. Willingness to use mobile technology was related to the age of the sample as well as the type of disability. Individuals with psychological disabilities were more likely to use certain forms of mobile technology relative to those with physical disabilities. Observed differences between physical and psychological disabilities are discussed in terms of the symbolic interaction stigma model.

Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model

This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.

Essential methodological considerations when using grounded theory

AIM

To suggest important methodological considerations when using grounded theory.

BACKGROUND

A research method widely used in nursing research is grounded theory, at the centre of which is theory construction. However, researchers still struggle with some of its methodological issues.

DISCUSSION

Although grounded theory is widely used to study and explain issues in nursing practice, many researchers are still failing to adhere to its rigorous standards. Researchers should articulate the focus of their investigations - the substantive area of interest as well as the focal population. This should be followed by a succinct explanation of the strategies used to collect and analyse data, supported by clear coding processes. Finally, the resolution of the core issues, including the core category and related categories, should be explained to advance readers' understanding.

CONCLUSION

Researchers should endeavour to understand the tenets of grounded theory. This enables 'neophytes' in particular to make methodological decisions that will improve their studies' rigour and fit with grounded theory.

IMPLICATIONS FOR PRACTICE

This paper complements the current dialogue on improving the understanding of grounded theory methodology in nursing research. The paper also suggests important procedural decisions researchers need to make to preserve their studies' scientific merit and fit with grounded theory.

The Humanbecoming theory as a reinterpretation of the symbolic interactionism: a critique of its specific nature and scientific underpinnings

Discussions about real knowledge contained in grand theories and models seem to remain an active quest in the academic sphere. The most fervent of these defendants is Rosemarie Parse with her Humanbecoming School of Thought (1981, 1998). This article first highlights the similarities between Parse's theory and Blumer's symbolic interactionism (1969). This comparison will act as a counterargument to Parse's assertions that her theory is original 'nursing' material. Standing on the contemporary philosophy of science, the very possibility for discovering specific nursing knowledge will be questioned. Second, Parse's scientific assumptions will be thoroughly addressed and contrasted with Blumer's more moderate view of knowledge. It will lead to recognize that the valorization of the social nature of existence and reality does not necessarily induce requirements and methods such as those proposed by Parse. According to Blumer's point of view, her perspective may not even be desirable. Recommendations will be raised about the necessity for a distanced relationship to knowledge, being the key to the pursuit of its improvement, not its circular contemplation.

Improving Therapeutic Relationships: Joint Crisis Planning for Individuals With Psychotic Disorders

Outcomes for individuals with psychosis remain far from acceptable. Recently, prominent psychiatrists have called for an improved understanding of the impact of social contexts, and how social contexts might influence the development and maintenance of mental health problems. A key social context for individuals with psychosis is the therapeutic relationship. As part of a trial of joint crisis planning in England, this qualitative study aimed to determine the mechanism through which joint crisis planning might affect the therapeutic relationship. Results suggest that routine processes in mental health care are affected by policy and organizational requirements for risk mitigation-aspects that undermine person-centered approaches. In contrast, strong therapeutic relationships are characterized by individualized care and reliable and respectful treatment. The Joint Crisis Plan intervention partially succeeded in reducing contextual influences on routine role enactments, facilitating the demonstration of respect and improving the therapeutic relationship.

Parent-healthcare provider interaction during peripheral vein cannulation with resistive preschool children

AIM

The aim of this study was to increase understanding of parent-healthcare provider interaction in situations where newly admitted preschool children resist peripheral vein cannulation.

BACKGROUND

Parent-healthcare provider interaction represents an important context for understanding children's resistance to medical procedures. Knowledge about this interaction can provide a better understanding of how restraint is used and talked about. Symbolic interactionism informed the understanding of interaction.

DESIGN

An exploratory, qualitative study was chosen because little is known about these interactions.

METHODS

During 2012-2013, 14 naturalistic peripheral vein cannulation -attempts with six newly hospitalized preschool children were video recorded. Eight parents/relatives, seven physicians and eight nurses participated in this study. The analytical foci of turn-taking and participant structure were used.

RESULTS

The results comprised three patterns of interactions. The first pattern, 'parents supported the interaction initiated by healthcare providers', was a response to the children's expressed resistance and they performed firm restraint together. The second pattern, 'parents create distance in interaction with healthcare providers', appeared after failed attempts and had a short time span. Parents stopped following up on the healthcare providers' interaction and their restraint became less firm. In the third pattern, 'healthcare providers reorient in interaction', healthcare providers took over more of the restraint and either helped each other to continue the interaction or they stopped it.

CONCLUSION

Knowledge about the identified patterns of interactions can help healthcare providers to better understand and thereby prepare both parents and themselves for situations with potential use of restraint.

How Like Perceives Like: Gay People on "Gaydar"

When lacking explicit knowledge of someone's sexual orientation, gay people commonly assess the likelihood that another is gay using their "gaydar." The term gaydar is a playful mix of the word gay with radar, suggesting that one can sense, intuit, or perceive some set of characteristics in another that signal a shared minority status. While commonly mentioned, the exact criteria a gay person uses when employing their gaydar are little discussed. Drawing methodologically on a series of five focus groups of self-identified lesbians and gay men, this study explores the physical, visual, energetic, and conversational cues gay people consider when they employ the trope of gaydar. Specifically, interview subjects most often described their gaydar as triggered by the following elements: physical presentation, including mannerisms, dress, and voice; interactions, especially eye contact; a presence or absence of certain conversational social norms; and, intangibly, as a kind of energetic exchange.

[The Durkheim Test. Remarks on Susan Leigh Star's Boundary Objects]

The article reconstructs Susan Leigh Star's conceptual work on the notion of 'boundary objects'. It traces the emergence of the concept, beginning with her PhD thesis and its publication as Regions of the Mind in 1989. 'Boundary objects' attempt to represent the distributed, multifold nature of scientific work and its mediations between different 'social worlds'. Being addressed to several 'communities of practice', the term responded to questions from Distributed Artificial Intelligence in Computer Science, Workplace Studies and Computer Supported Cooperative Work (CSCW), and microhistorical approaches inside the growing Science and Technology Studies. Yet the interdisciplinary character and interpretive flexibility of Star’s invention has rarely been noticed as a conceptual tool for media theory. I therefore propose to reconsider Star's 'Durkheim test' for sociotechnical media practices.

COLLABORATING WITH THE COMMUNITY: THE EXTRA-TERRITORIAL TRANSLATIONAL RESEARCH TEAM

The purpose of the present study is to suggest a revision of the team science concept to the more inclusive extra-territorial research team (ETRT). Translational thinking is largely marked by the perception of the team as a thing-like structure at the center of the scientific activity. Collaboration accordingly involves bringing external others (e.g., scientists, community members, and clinicians) into the team through limited or dependent participation. We suggest that a promising and innovative way to see the team is as an idea: a schema for assembling and managing relationships among otherwise disparate individuals with vested interests in the problem at hand. Thus, the ETRT can be seen as a process as well as an object. We provide a case study derived from a qualitative analysis of the impact of the logic of translational science on a team assessment of environmental health following an off-coast oil disaster. The ETRT in question displayed the following principles of constructive relationship management: a high sense of adventure given the quick pace and timeliness given the relevance of the oil spill to all team members; regular meetings in the community to avoid the appearance of academic hegemony; open access by lay as well as institutional scientists; integration of emergency management coordinators into the group; and the languages of public health, environmental pharmacology/toxicology and coastal culture seamlessly interwoven in discussion. The ETRT model is an appropriate strategy for mobilizing and integrating the knowledge and skills needed for comprehensive science and service responses, especially during crisis.

Caregivers' management of schooling for their children with fetal alcohol spectrum disorder

In this article we describe a grounded theory study of how caregivers of school-aged children with fetal alcohol spectrum disorder (FASD) managed their children's schooling. We completed 30 interviews with 17 caregivers residing in a western Canadian province, as well as document analysis and 25 hours of participant observation. We used constant comparative analysis to construct our substantive theory: intertwining to fit in. The core variable is an iterative cycle caregivers used to resolve their main concerns: preventing their children from failing academically and in social interactions and preventing themselves from being regarded as unacceptable parents. To intertwine to fit in, caregivers used two strategies: orchestrating schooling and keeping up appearances. They also regulated their relationships with their children. "Intertwining to fit in" contributes to the literature on attachment and parenting and extends explanations about caregivers' advocacy for their children with FASD. The theory has implications for school personnel and practitioners, as well as researchers.

Analysis of a support group for children of parents with mental illnesses: managing stressful situations

We report an ethnographic analysis of a psycho-education and peer-support program for school-aged children of parents with mental illnesses. We conducted a critical discourse analysis of the program manual and observed group interactions to understand whether children shared program goals predetermined by adults, and how, or if, the intervention was responsive to their needs. Children were expected to learn mental illness information because "knowledge is power," and to express difficult feelings about being a child of a mentally ill parent that was risky. Participants used humor to manage group expectations, revealing how they made sense of their parents' problems, as well as their own. Suggestions are made for determining good mental health literacy based on children's preferences for explaining circumstances in ways they find relevant, and for supporting children's competencies to manage relationships that are important to them.

Parental advocacy styles for special education students during the transition to adulthood

In an ethnographic study of planning for the transition to adulthood, we explored parental advocacy styles in special education settings for youth and young adults with chronic health conditions and developmental disabilities. Of 61 parents, 43 were satisfied with outcomes in negotiations for school services for their children. We identified three parental advocacy styles for these parents: (a) high-profile parents, who insisted on specific, wide-ranging services for their children that often resulted in conflict with educators; (b) strategic parents, who negotiated for selected goals and were willing to compromise, and (c) grateful-gratifier parents, who formed close relationships with educators and trusted them to make appropriate decisions. Eighteen parents were overwhelmed, burned out, or unfocused, and generally dissatisfied with outcomes of educational planning meetings. Professional efforts to enhance parental advocacy can target development of skills and strategies that have worked for successful negotiators.

Thinking through every step: how people with spinal cord injuries relearn to walk

In this article we explore how people with incomplete spinal cord injury (iSCI) create meaning out of their changing bodies as they undergo a therapeutic intervention called locomotor training (LT). Therapeutic interventions like LT are used to promote the recovery of walking ability among individuals with iSCI. The chronological nature of this study--interviews at three points throughout the 12-week intervention--enhances understanding of the recovering self after spinal cord injury. Drawing on a constructivist theoretical framework, we organize data according to three narrative frames. Participants interpreted LT as (a) a physical change that was meaningful because of its social significance, (b) a coping strategy for dealing with the uncertainty of long-term recovery, and (c) a moral strategy to reconstitute the self. We offer findings that lay the conceptual groundwork for generating new knowledge about what is important to people with iSCI as they relearn how to walk.

The Culture of Translational Science Research: Participants' Stories

We apply a symbolic interactionist framework and a qualitative methodology to the examination of the everyday reality of translational science research (TSR). This is a growing scientific movement that aims to facilitate the efficient application of basic research to clinical service design and delivery. We describe the emerging culture of translational research at a mid-size medical center that received a Clinical and Translational Science Award from the National Institutes of Health. The stories related by scientists, clinicians, and students in interviews indicate that they make sense of the emerging inter- and cross-disciplinary, team-oriented culture of TSR through the refinement and redefinition of the significant symbols that inform their work while they attempt to master translational research by addressing the dilemmas it produces for them and their work. We see the strength, currency, adaptability, and energy of the core self-definition of "scientist" to be significant in shaping the emerging culture of translational research. We conclude by celebrating the value of interpretive ethnography for evaluation research.