Development of a Digital Storytelling Intervention to Increase Breast, Cervical, and Colorectal Cancer Screening in the Hispanic/Latino Community: a Qualitative Evaluation

Digital storytelling (DST) interventions may be one way to address disparities in cancer screening experienced by the Hispanic/Latino population. Digital stories are short, first-person narratives that include voice-over narration and images. With storytellers' permission, researchers can screen digital stories as a health intervention. Digital stories can inspire viewers to adopt or change their behavior, such as completing cancer screening. Rochester Healthy Community Partnership (a 20-year community-based participatory research partnership) together with eight Hispanic/Latino, Spanish speaking cancer survivors, co-survivors, or recently screened individuals, developed digital stories about breast, cervical, and colorectal cancer screening. Here, we describe our qualitative evaluation of the DST workshop. To understand what the storytellers thought viewers would find relatable in their digital stories, we applied Narrative Theory. We also assessed workshop successes and opportunities for improvement. We used the constant comparative method for data analysis. We learned that the storytellers anticipated their stories would be engaging and that viewers would connect with Hispanic/Latino cultural values. During the workshop, the storytellers felt like they were making an important contribution. The storytellers highlighted specific opportunities for improvement including sharing the stories more quickly after the workshop. Future research is needed to test whether this intervention follows the Narrative Theory causal pathway by persuading viewers to complete recommended cancer screenings.

Learning to teach with patients and caregivers: a focused ethnography

BACKGROUND

Little is known about what happens when patients and caregivers are involved in an academic setting as co-teachers and how healthcare professionals approach a new model of partnership-based teaching. This study aimed to explore the learning and behavioural patterns of a group of healthcare professionals who were learning to teach with patients and caregivers as co-teachers in a post-graduate course.

METHODS

A focused ethnographic study involving 11 health professionals was conducted. Data were collected through participatory observation during the course, individual semi-structured interviews, and a follow-up focus group. Taxonomic analysis was performed.

RESULTS

Three categories were identified: 'group', 'role of narration' and 'applying co-teaching with patients and caregivers '. Specifically, heterogeneity, absence of hierarchies, and balanced relationships characterised the group dynamic and promoted partnership. Narration played a key role both in learning and in healthcare professionals' relationship with patients and caregivers and promoted emotional skills and self-awareness. Project planning and lessons simulations were essential aspects of the implementation process.

CONCLUSIONS

This focused ethnography helped further understanding of the context of a specific project involving patients and caregivers as co-teachers in healthcare professional education. The development of emotional skills and self-awareness are the main learning patterns of co-teaching, and interprofessionalism and balanced relationships are the basis of the behavioural patterns. These patterns facilitated the involvement of patients and caregivers in health education.

Narrative Understanding as a Means of Understanding the Other: A Review of Andrea Smorti's Book Telling to Understand

In this review I propose to discuss the contribution that Smorti's book makes to the study of autobiographical memory, since it examines the benefits that narratives provide to understanding human experience and the ability they offer in discovering and representing uncertainty. Andrea Smorti has long been engaged in the study of memory, autobiography, storytelling and psychology, as evidenced by his numerous studies mentioned in the book. Furthermore, in exploring the more purely psychological aspects of narratives, Smorti investigates the benefits that narratives offer to individual psychological well-being. Firstly published in Italian in 2018, Andrea Smorti's (2021) "Telling to Understand" is now available for the first time to the English-speaking public.

The intensive care unit diary as a valuable care tool: A qualitative study of patients' experiences

OBJECTIVES

The aim is to learn about patients' experience of reading the diary, assess attributed meaning and explore patients' experience and memories during their stay in the intensive care unit.

SETTING

Eleven patients who received the diary after a stay in a nine-bed cardiac intensive care unit in Southern Switzerland, from November 2019 to October 2021.

MAIN OUTCOME MEASURES

Descriptive qualitative research was performed using semi-structured interviews, followed by thematic analysis. Three research nurses conducted individual telephone or face-to-face interviews.

FINDINGS

Fifteen sub-themes emerged from the data interviews and were grouped into five main categories: a) the experience in the intensive care unit; b) Post Intensive Care Syndrome symptoms; c) the patient diary; d) new meaning of life; and e) sharing. Patients showed difficulties in remembering and understanding what happened during the hospitalization period. Reading the diary enabled them to understand the impact that the illness had on their daily experience. For some of them, reading the diary was helpful in reacting positively during moments of discouragement.

CONCLUSION

Qualitative approach allowed us to assess how patients perceive the diary in the intensive care unit in a cultural context of Central and Southern Europe, which is still poorly investigated. The diary responded to the person's need to know what happened during a period that they had no memory of. Its use demonstrated important benefits, allowing people to understand the impact that the illness had on everyday life. It allowed them to relate to the difficulties encountered during the healing process. Thus, the diary played an important role during the healing process.

IMPLICATIONS FOR CLINICAL PRACTICE

The diary was appreciated by patients during all stages of recovery from severe and acute illness. Gaps within the narration were avoided, in order to provide patients with a better timeline of the events occurred during the time they were unconscious.

Manifestation of speech disfluencies in preschool Cantonese-English speaking bilingual children

Stuttering is characterised by disruptions in speech fluency that normally emerges between the ages of 2 to 5 when children start to formulate sentences. Current stuttering identification in children is largely based on speech disfluency criteria (>3% stuttering-like disfluencies, SLDs) developed for monolingual English-speaking children. Research in a Western language context shows that application of the criteria for monolingual to bilingual children may result in false positive diagnosis of stuttering. The applicability of these criteria to children speaking languages typologically distinct from English remains unclear. This preliminary study focused on bilingual Cantonese-English-speaking children, aiming to explore the manifestations of the speech disfluencies in Cantonese (a syllable-timed language) and English (a stress-timed language) while accounting for language dominance/proficiency and speaking task. Nineteen typically fluent Cantonese-English bilingual preschoolers were recruited for this study and their speech samples were collected across different speaking tasks (i.e. conversation and narration), and languages (i.e. Cantonese and English). The types and frequency of speech disfluencies were compared across both languages and the speaking tasks. The results showed that between 21-68% of children showed higher than 3% SLDs across different languages and speaking tasks. Linear mixed-effect analysis revealed that the prevalence of SLDs is higher in English (less dominant language) than Cantonese (more dominant language), and the prevalence is also higher in narration than conversation. These findings suggest the need for tailored stuttering identification criteria for bilingual children speaking diverse languages and emphasise the importance of considering language dominance/proficiency and speaking task when assessing stuttering in bilingual populations.

Narrative Microstructure and Macrostructure Skills of Persian-Speaking Children with Autism Spectrum Disorder

Background

Studies examining narrative production skills in children with autism spectrum disorder (ASD) have demonstrated variable and inconsistent results. This study aimed to investigate to what extent narrative difficulties in children with ASD reflect difficulties with language.

Methods

Accordingly, the spoken narrative skills of 16 children with ASD were compared with those of their 16 chronological age-matched (CAM) and 16 language-matched (LM) peers. A Kruskal-Wallis non-parametric test was then used to examine the differences between groups in regard to NTC, NSG and SI variables .For other studied variables (NTW, number of T-units, ATL and total score), one-way analysis of variances (ANOVA) was also used.

Results

At the level of microstructure, the results showed that productivity (number of total words, total clauses, and T-unites) and syntactic complexity (average of T-unit length and subordination index) were predominantly similar in ASD and LM children. However, children with ASD scored lower than their CAM counterparts (P < 0.001). At the macrostructure level, we found that the total score of story grammar elements and the number of story grammars in the narrative production of children with ASD were lower than those in both CAM and LM children (P < 0.001).

Conclusion

The present study, thus, showed that creating a coherent narrative could be more demanding for children with ASD than productivity and syntactic complexity.

The feasibility and preliminary efficacy of narrative exposure therapy on post-traumatic stress disorder among Syrian refugees in Jordan

Objectives

Post-traumatic stress disorder (PTSD), anxiety, and depression are common mental health disorders among refugees, and all require immediate mental health support to prevent short- and long-term detrimental health outcomes. The purpose of this study was to evaluate the feasibility and preliminary efficacy of narrative exposure therapy (NET) in reducing symptoms of PTSD, depression, and anxiety among Syrian refugees residing in Jordan.

Methods

A two-arm randomized control trial was utilized. A total of 40 Syrian refugees aged 18 to 64 diagnosed with PTSD were randomly allocated to either the NET intervention group (n = 20) or the waitlist control group (n = 20) using a computer-generated allocation list with 1:1 allocation. PTSD symptoms were evaluated using the Arabic rendition of the Harvard Trauma Questionnaire, while depression and anxiety symptoms were appraised using the Arabic adaptation of the Hopkins Symptoms Checklist-25. Descriptive statistics were employed to characterize the sample and survey data. Independent t-tests were conducted to assess mean score differences in PTSD, anxiety, and depression between the intervention and control groups.

Results

Post NET intervention, significant reductions in PTSD (t = -10.00, P < 0.001), anxiety (t = -9.46, P < 0.001), and depression (t = -6.00, P < 0.001) scores were observed in the intervention group compared to the control group. Effect sizes were moderate for the trauma (Cohen's d = 0.73) and depression (Cohen's d = 0.79) symptoms and notably large for anxiety symptoms (Cohen's d = 0.97). There were no adverse events related to study participation. The intervention achieved a 100% participant retention rate.

Conclusions

The results pertaining to retention rate, adherence to the study protocol, data completeness, cultural congruence, and participants' satisfaction provided strong support for the future implementation of the full-scale RCT. NET may be a feasible and helpful approach for refugees and other patients with PTSD, anxiety, and depression.

Effects of a coach-guided video-conferencing expressive writing program on facilitating grief resolution in adults with SCI

OBJECTIVE

To examine effects of a videoconferencing coach-guided expressive writing program on facilitating grief resolution in adults with spinal cord injury (SCI).

DESIGN

One group pretest - posttest design with a 1-month follow-up.

SETTING

Home-based videoconferencing.

PARTICIPANTS

Twenty-four adults with SCI.

INTERVENTIONS

10 weekly 1-hour videoconferencing sessions in which participants engaged in expressive writing guided by writing coaches, either individually or in small groups.

OUTCOME MEASURES

Self-report questionnaires on measures of grief, emotional distress, depression, stress, trouble falling asleep, meaning and purpose, self-efficacy for managing chronic conditions, ability to participate in social roles and activities, and satisfaction with social roles and activities.

RESULTS

Immediately after completing the program, participants showed significant reductions in measures of severity of grief, trouble falling asleep, and trouble participating in social roles and activities and significant increases in self-efficacy for managing chronic conditions and satisfaction with social roles and activities. Participants maintained benefits at 1-month follow-up, showing significant reductions in measures of severity of grief, trouble falling asleep, and distress related to different difficulties and significant increases in feelings of meaning and purpose in life compared to their scores at pre-program. Post-hoc analysis showed that participants whose injury was sustained within 5 years of study enrollment had significant reductions in change scores of distress and trouble participating in social roles and activities compared to those whose injuries were sustained more than 5 years before the study began.

CONCLUSION

The videoconferencing coach-guided expressive writing program helps adults with SCI reduce grief intensity and trouble falling asleep and produces a sustained effect. People who sustained a more recent injury seemed to gain more benefits from the program than those whose injuries occurred less recently.Trial Registration: NCT04721717.

Discourse abilities in euthymic elderly patients with bipolar disorder: a preliminary study

Cognitive impairment has been well described in euthymic patients with bipolar disorder (BD), as well as in elderly patients. Language disturbances are less studied, and several inconsistencies are reported in the literature. Most language studies focus on verbal fluency and semantic alterations, with a lack of studies addressing discursive abilities in BD.

Objective

The aim of this study was to evaluate discourse abilities in euthymic elderly individuals with BD.

Methods

We studied 19 euthymic elderly patients with BD and a control group of non-BD, which performed a cognitive assessment of attention, memory, executive functions, and visual abilities. All participants produced a description from the Cookie Theft Picture in oral and written modalities that was analyzed according to micro- and macrolinguistic aspects. Generalized linear models were performed to compare intergroup linguistic performance and to determine whether any cognitive domain was associated with linguistic outcomes.

Results

The BD group produced more cohesion errors in the oral and written modalities (p=0.016 and p=0.011, respectively) and fewer thematic units in the oral modality (p=0.027) than the control group.

Conclusions

BD patients presented minimal changes in the descriptive discourse task. The BD group produced more cohesion errors than the control group in the oral (p=0.016) and written discourse (p=0.011); also, the BD group produced fewer thematic units than controls in the oral discourse (p=0.027).

[Thematic Apperception Test for Adolescents (TAT-A) - an Explorative Study]

Projective methods have lost significance in child and adolescent psychiatric diagnostics. These methods allow access to important emotional and conflictual topics that can only be determined to a limited extent via diagnostic discussions and questionnaires. The Thematic Apperception Test (TAT-A) has been updated for use in adolescents. For this purpose, special image templates with new motifs were developed, which were redrawn photorealistically in color to increase ambiguity and stimulate imagination. To check the thematic valences, the panels were presented to 184 schoolgirls in Seoul, South Korea, for assessment. The practical suitability and acceptance of the image templates were evaluated on a small clinical German sample (N = 13), and the valences in terms of content were determined by two raters. The results clarify that photorealistic color representation is an appropriate method for this new concept of TAT. In particular, "empty" panels with landscape views initiate meaningful narratives, thereby enabling access to personal topics.

Narrative Diaries in Pediatrics: A Scoping Review

PROBLEM

Health diaries with both clinical and narrative elements have been widely used in pediatrics to study children's and families' experiences of illness and coping strategies. The objective of this study is to obtain a synthesis of the literature about narrative health diaries using the PRISMA extension for scoping reviews.

ELIGIBILITY CRITERIA

Sources were limited to: English language; narrative diaries; children/adolescents and/or parents/caregivers.

SAMPLE

The following databases were searched: PubMed, Embase and CINAHL with no time limits.

RESULTS

Among 36 articles included the most common context where a diary was implemented was the home (61%), the hospital (17%) and the school (14%). The most common diarist is the child or adolescent (50%). Paper diary was the most common type (53%), followed by the video diary (19%), the e-diary (8%) or the audio diary (8%). None of the studies explored the impact of the use of diaries on patient outcomes.

CONCLUSIONS

The narrative health diary is used to report patient experiences of illness or common life from the point of view of the child, adolescent or other family members. The diversity of the diaries found shows how the narrative diary may be 'adapted' to different settings and pediatric populations.

IMPLICATIONS

The narrative diary is a relevant tool for the exploration of children's and adolescents' experiences of illness and common life. Studies are still needed to describe the impact of narrative diaries keeping on children's health outcomes.

[»I have been home in quarantine since Monday«: Relating Storytelling and Argumentation in Social Media Comments on Political Speeches]

This article examines narrative practices in the context of political speeches on the corona crisis. The qualitative analysis is based on a corpus of 650 social media comments posted in response to the so-called lockdown speeches by Sebastian Kurz and Angela Merkel in March 2020. The comments feature forms of fragmentary narration that are used by the participants both as resources of credibility and descriptiveness and as a means of positioning themselves in the context of the lockdown measures being announced.

[Sound Bites in TV News Between Narration and Argumentation]

Against the background of the re-constructive character of media reporting (section 1), this article explains the concept of ›news narratives‹ (2). Then the role and previous research of sound bites and their narrative integration are discussed (3). Explanations of the research question, corpus and method (4) are followed by quantitative and then more detailed exemplary qualitative analyses (5). Here, contributions from the Swiss »Tagesschau« and the American »CBS Evening News« since the 1960s are analyzed. It becomes apparent that the coverage is increasingly narrative in a narrower sense, that this development took place earlier in the USA, and that the argumentative functionalization of original sound clips can be reconstructed but remains implicit.

Promoting community reintegration using narratives and skills building for young adults with stroke: a protocol for a randomised controlled trial

BACKGROUND

Stroke in adults aged between 18 and 64 years old is increasing significantly worldwide. Studies have reported that this group of young stroke survivors encounters enormous difficulties reintegrating into their social roles. Individualised discussions with healthcare professionals and learning from other survivors are imperative for them to reconstruct their identities after stroke. There is also great demand for community support during their chronic stage of recovery to help them rebuild life skills to promote reintegration.

METHODS/DESIGN

This is a randomised controlled trial to investigate the effects of a 24-week Narrative and Skills-building Intervention (NSI) on young stroke survivors' community reintegration and psychosocial outcomes. A total of 208 adults aged 18-64 years old with a first-ever or recurrent ischaemic or haemorrhagic stroke and have been discharged home will be recruited and randomly assigned to receive usual care or usual care with NSI. The NSI is grounded in Narrative Theory and Bandura's principles of Self-efficacy and Outcome Expectation, consisting of successive eight individual sessions over six months delivered by a trained facilitator (a registered nurse). Participants will be facilitated to narrate their survival experiences and rebuild core life skills. Videos of peer young stroke survivors' experiences of recovery will be provided. Outcomes including community reintegration, depressive symptoms, health-related quality of life, self-efficacy, outcome expectation and satisfaction with performance of self-management behaviours will be measured before (T0) and immediately after NSI (T1), then six (T2) and 12 months after NSI (T3). Generalised estimating equations models will be used to compare the differential changes in outcomes across time between the two groups. Focus group interviews will be conducted with the facilitator at T1 and with the participants in the intervention group at T1 and T3.

DISCUSSION

This study will evaluate the short and long-term effects of a theory-based NSI on young stroke survivors' community reintegration and establish a new model of community reintegration after stroke to inform future research. The results will also provide valuable evidence to develop clinical guidelines for young stroke survivors' community reintegration.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04560140 , registered on 23 September, 2020.

Expressive language development in adolescents with Down syndrome and fragile X syndrome: change over time and the role of family-related factors

BACKGROUND

It is well known that individuals with Down syndrome (DS) or fragile X syndrome (FXS) demonstrate expressive language difficulties beginning early in childhood. It is less clear, however, whether expressive language skills change during the adolescent period in these individuals, and if any of these changes are syndrome specific. Studying this, as well as the role of maternal and family-related factors in expressive language development, may provide the foundation for efficacious interventions for adolescents with DS or FXS.

METHODS

In this study, we examined expressive language trajectories, assessed through conversation and narration, in 57 adolescent males with intellectual disability (ID) (20 DS and 37 FXS) in relation to the diagnostic group (DS vs. FXS) and family-related factors (maternal IQ, maternal psychological distress, closeness in the mother-child relationship, family income, and maternal and paternal education) after adjusting for chronological age (CA) and nonverbal cognition.

RESULTS

Changes over repeated annual assessments for males with DS or FXS were observed only during conversation, such as an increase in talkativeness, but a decrease in syntax complexity and lexical diversity. We found a diagnosis-related effect in the change over time in conversational talkativeness favoring those with FXS. Finally, a closer mother-child relationship predicted less decrease over time in lexical diversity during conversation, and participants of mothers who graduated college showed a greater increase in conversational talkativeness over time compared to those of mothers with a high school education.

CONCLUSIONS

Our results suggest that, during the adolescent period for males with DS or FXS, there is an increase in the amount of talk produced in conversational contexts, but also a decrease in the quality of the language produced. In addition, our results indicate syndrome-specificity for aspects of expressive language development and reinforce the protective role of family-related factors.

[Narratives help disseminate medical technologies: the case of coronary interventions]

Medical technologies are often disseminated and used although evidence demonstrating their effectiveness and safety is missing. Percutaneous intervention (PCI) in stable coronary artery disease (CAD) is an example. This raises the question of how these technologies get disseminated and on which basis they are accepted by clinicians, patients, and the wider public.Studies investigating the communication between clinicians and patients show that simple narratives play a decisive role here. In this paper I discuss how narratives contribute to the dissemination of medical technologies. Communication within the profession, which includes medical education, also relies on narratives to a large degree. They have the following characteristics in common: 1) extreme simplification, 2) reduction to biological processes, 3) deterministic logic, and 4) strong moral message. These narratives are always biased; narratives dealing with interventions paint an overoptimistic picture of their effectiveness and safety. Although they represent "modern" technologies, their logic and purpose are akin to archaic myths.Presumably education and persuasion cannot eschew narratives completely. But health professionals, patients and the public should be aware of the inevitable bias that comes with narratives and their potential for manipulation.

A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models

BACKGROUND AND OBJECTIVES

Compared with hemodialysis, home peritoneal dialysis alleviates the burden of travel, facilitates independence, and is less costly. Physical, cognitive, or psychosocial factors may preclude peritoneal dialysis in otherwise eligible patients. Assisted peritoneal dialysis, where trained personnel assist with home peritoneal dialysis, may be an option, but the optimal model is unknown. The objective of this work is to characterize existing assisted peritoneal dialysis models and synthesize clinical outcomes.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

A systematic review of MEDLINE, Cochrane Central Register of Controlled Trails, Cochrane Database of Systematic Reviews, Embase, PsycINFO, and CINAHL was conducted (search dates: January 1995-September 2018). A focused gray literature search was also completed, limited to developed nations. Included studies focused on home-based assisted peritoneal dialysis; studies with the assist provided exclusively by unpaid family caregivers were excluded. All outcomes were narratively synthesized; quantitative outcomes were graphically depicted.

RESULTS

We included 34 studies, totaling 46,597 patients, with assisted peritoneal dialysis programs identified in 20 jurisdictions. Two categories emerged for models of assisted peritoneal dialysis on the basis of type of assistance: health care and non-health care professional assistance. Reported outcomes were heterogeneous, ranging from patient-level outcomes of survival, to resource use and transfer to hemodialysis; however, the comparative effect of assisted peritoneal dialysis was unclear. In two qualitative studies examining the patient experience, the maintenance of independence was identified as an important theme.

CONCLUSIONS

Reported outcomes and quality were heterogeneous, and relative efficacy of assisted peritoneal dialysis could not be determined from included studies. Although the patient voice was under-represented, suggestions to improve assisted peritoneal dialysis included using a person-centered model of care, ensuring continuity of nurses providing the peritoneal dialysis assist, and measures to support patient independence. Although attractive elements of assisted peritoneal dialysis are identified, further evidence is needed to connect assisted peritoneal dialysis outcomes with programmatic features and their associated funding models.

[Disclosure and silence, protecting the baby from trauma transmission?]

The differences in how parents communicate their traumatic experience, through silence or by disclosure, play a fundamental role in the transgenerational transmission of trauma. Research into the transmission of trauma from mother to baby, in a humanitarian context, shows the importance of adapting the disclosure of the narrative of the mother's traumatic experience, which appears to be the most appropriate solution for protecting babies.

The Effect of Reflection on Nurse-Patient Communication Skills in Emergency Medical Centers

Introduction: Reflection is formed through deep reflection on the event or a certain clinical position. The aim of this study was to determine the effect of reflection on nurse-patient communication skills of nurses working in emergency departments.

Methods: This interventional study was conducted on intervention and control groups and with a pretest-posttest design. 142 nurses working in the emergency departments of hospitals affiliated to Golestan University of Medical Sciences were enrolled in the study in 2015, and randomly divided into two groups. During eight weeks of the study, the intervention group was asked to write their clinical experiences with regard to communication issues with their patients. Before the intervention, the communication skills of both groups were compared using a questionnaire. Data analysis was performed, using independent t-test, paired t-test, Mann-Whitney and Wilcoxon tests.

Results: Of the 142 nurses, 122 nurses had full participation. In the intervention group the mean scores of verbal communication skills, non-verbal communication skills, general communication skills and communication skills based on patient safety were statistically significant, but there was no significant difference in the control group.

Conclusion: The results showed that eight weeks of reflection by nurses is an effective intervention in dimensions of communication skills. We therefore suggest that a reflective writing be encouraged as a vital tool for improving communication competency among emergency department nurses.

Collaborative Remembering in Conversational Narration

This chapter introduces an epistemic perspective on narration and illustrates, based on data from storytelling in free natural conversation, how collaborative remembering can instantiate distributed cognition: first, when tellers deploy expressions of forgetfulness or explicitly enlist the aid of other participants; second, during various forms of collaborative turn sequencing with rapid speaker shift and a high degree of overlap; third, when conversational participants cooperate to produce a mosaic-like narrative consisting of their partially separate perspectives and contributions; and fourth, when they weave their voices into a single narrative thread in a Goffmanian team performance.

Spoken and Written Narrative in Persian-Speaking Students Who Received Cochlear Implant and/or Hearing Aid

OBJECTIVES

To compare narrative skills between fourth and fifth grades of Persian-speaking students with hearing impairments and typical hearing students of the same grade and also to evaluate the effects of group, sex, hearing age, and educational grade of the students on their spoken/written narrative performance.

METHODS

The subjects were 174 students aged 10-13 years, 54 of whom wore cochlear implants, 60 suffered from moderate to severe hearing losses and wore hearing aids, with the remaining 60 students being typical hearing in terms of the sense of hearing. The micro- and macrostructure components of spoken and written narrative were elicited from a pictorial story (The Playful Little Elephant) and then scored by raters.

RESULTS

Compared to the typical hearing, the students with hearing impairments had significantly lower scores in all of the microstructure components of narratives. However, the findings showed no significant difference among different groups in macrostructure components of narratives. It was also revealed that the students had equal performance in spoken and written narrative. Finally, factor analysis manifested that group, sex, hearing age, and educational level of children might alter the outcome measures in various interactions.

CONCLUSION

Although cochlear implantation was more effective than hearing aid on spoken and written narrative skills, the Persian-speaking students with hearing impairments were seen to need additional trainings on microstructure components of spoken/written narrative.

Analysis of macrolinguistic aspects of narratives from individuals with Alzheimer's disease, mild cognitive impairment, and no cognitive impairment

Introduction

The depiction of features in discourse production promotes accurate diagnosis and helps to establish the therapeutic intervention in cognitive impairment and dementia. We aimed to identify alterations in the macrolinguistic aspects of discourse using a new computational tool.

Methods

Sixty individuals, aged 60 years and older, were distributed in three different groups: mild Alzheimer's disease (mAD), amnestic mild cognitive impairment, and healthy controls. A narrative created by individuals was analyzed through the Coh-Metrix-Dementia program, extracting the features of interest automatically.

Results

mAD showed worse overall performance compared to the other groups: less informative discourse, greater impairment in global coherence, greater modalization, and inferior narrative structure. It was not possible to discriminate between amnestic mild cognitive impairment and healthy controls.

Discussion

Our results are in line with the literature, verifying a pathological change in the macrostructure of discourse in mAD.

Thank you letters from patients in an intensive care unit: From the expression of gratitude to an applied ethic of care

INTRODUCTION

Patients' perception of an intensive care unit stay can lead to a better understanding of the expectations and needs of patients hospitalised in intensive care so that care for critically ill patients can be adapted and improved. Thank you letters are sources of original information which come directly and spontaneously from patients.

OBJECTIVE

The objective of this study was to analyse the thank you letters from patients who required intensive care treatment and to identify messages that could be intended for the intensive care unit team.

DESIGN

We conducted a qualitative study according to a thematic analysis. The body of research consisted of 17 letters from patients hospitalised in intensive care unit.

SETTING

The study took place in the medical-surgical intensive care unit of a French general hospital. The intensive care unit is made up of 16 resuscitation beds and four continuous monitoring beds.

FINDINGS

Two main themes emerged: (i) expression of gratitude through a description of the caregivers' behaviour (humanity and professionalism) and recognition for surviving (ii) the narrative of the intensive care unit experience.

CONCLUSION

Thank you letters give a rich insight into how the patients perceived their stay in intensive care unit. Letters from patients give direct feedback on the quality of care provided, contribute to give meaning to work and raise the question of what the core values of care should be for all concerned in the healthcare providers-patients relationship.

Photoelicitation: a useful tool to investigate management of the vulnerability of homeless women

AIMS

The proposal of the manuscript is to provide a methodological reflection on the use of photo-elicitation as a data gathering strategy to explore vulnerability management among homeless women.

METHODS

A grounded theory study was carried out. Photo elicitation was one of the data gathering techniques used between February 2015 and February 2017. Five women were selected through intentional sampling. All of them were over 18 years old and residents in 4 shelters within the Madrid Care for the Homeless network. Participants used disposable cameras or mobile phones to record their experiences living in the shelters or on the street through photographs. An interview was conducted with each participant in order to explore the meaning of the photos after they were developed. Data analysis comprised, firstly, describing the obvious content of the photos and, secondly, comparing it with the latent content provided by participants during the interviews.

RESULTS

Only 3 women finished the task. Through data analysis some theoretical proposals were discovered, which contributed to a deeper knowledge of some previously established categories and subcategories such as: "The good professionals", "The safe places in the street" and "The threats in the street".

CONCLUSIONS

Photo-elicitation enabled an approach to participants' experiences with minimal imposition, allowing them much of the control over the data production. However, it is a demanding technique that requires deep reflection before its implementation, on the part of both participants and researchers.

The usual suspects: why techno-fixing dementia is flawed

Dementia is highly prevalent and up until now, still incurable. If we may believe the narrative that is currently dominant in dementia research, in the future we will not have to suffer from dementia anymore, as there will be a simple techno-fix solution. It is just a matter of time before we can solve the growing public health problem of dementia. In this paper we take a critical stance towards overly positive narratives of techno-fixes by placing our empirical analysis of dementia research protocols and political statements in a framework of technology assessment. From this perspective, it becomes obvious that a techno-fix is just one of many ways to approach societal problems and more importantly that technologies are way less perfect than they are presented. We will argue that this narrow scope, which focusses on the usual suspects for solving illnesses, reduces dementia to organismic aspects, and may be counterproductive in finding a cure for dementia. We conclude with outlining how the narrow scope can be balanced with other narratives and why we should have a reasonable scepticism towards the usual suspects.

Designing and delivering facilitated storytelling interventions for chronic disease self-management: a scoping review

Background

Little is known about how to develop and deliver storytelling as an intervention to support those managing chronic illnesses. This scoping review aims to describe the core elements of storytelling interventions in order to help facilitate its implementation.

Methods

A scoping review was conducted in seven databases for articles published up to May 2014 to identify interventions that describe in detail how storytelling was used to support people in disease self-management interventions.

Results

Ten articles met all inclusion criteria. Core elements consistently observed across the storytelling interventions were: reflection and interactive meaning-making of experiences; principles of informality and spontaneity; non-directional and non-hierarchical facilitation; development of group norms and conduct to create a community among participants; and both an individual and collective role for participants. Differences were also observed across interventions, such as: the conceptual frameworks that directed the design of the intervention; the type and training of facilitators; intervention duration; and how session topics were selected and stories delivered. Furthermore, evaluation of the intervention and outcome assessment varied greatly across studies.

Conclusion

The use of storytelling can be a novel intervention to enhance chronic disease self-management. The core elements identified in the review inform the development of the intervention to be more patient-centred by guiding participants to take ownership of and lead the intervention, which differs significantly from traditional support groups. Storytelling has the potential to provide patients with a more active role in their health care by identifying their specific needs as well as gaps in knowledge and skills, while allowing them to form strong bonds with peers who share similar disease-related experiences. However, measures of impact differed across interventions given the variation in chronic conditions. Our findings can guide future development and implementations of storytelling interventions.

[Technique-based game for daycare visitors with and without dementia : Effects, heuristics and correlates]

BACKGROUND

Playing of old people with or without dementia have not yet been substantially investigated.

OBJECTIVE

This study deals with the acceptance and impact of a tablet-based memory game, which was played on a weekly or semiweekly basis by visitors in two daycare units.

MATERIAL AND METHODS

Within the framework of focus groups the technical system was adapted for elderly users. The video-assisted data at the level of the game and the dynamics were investigated with respect to interaction and communication.

RESULTS

The analysis of psychological observation forms and game protocols, which were conducted over a period of 3 months, indicated different effects of the game on psychosocial and cognitive activation. The individual memory cards in particular served as an intensification of communication and a stimulation of episodic memory. Finally, with video analysis during the whole game setting three theoretical relationship patterns of the spheres playing and speech could be depicted.

CONCLUSION

Coherence, separation and incoherence of playing and speech are different forms of interaction in which individual and collaborative competences of people with and without dementia can be visualized. Furthermore, the study provides evidence for the cultural theory of playing by Huizinga.

A multicenter, non-interventional study to evaluate patient-reported experiences of living with psoriasis

Background: Moderate to severe plaque psoriasis (with or without psoriatic arthritis) places significant burden on patients’ lives. Objective: Explore and document patients’ experiences of living with psoriasis, including symptoms, treatments, impact on daily lives and patient-reported functioning. Methods: In a US-based, non-interventional study, narrative interviews were conducted at baseline and again within 16 weeks. In interviews, patients with moderate to severe psoriasis indicated symptoms, ranked symptoms according to level of bother and indicated areas of their lives affected by psoriasis. Transcripts of interviews were coded for themes. Measurements of psoriasis severity including BSA, PGA and PASI were recorded. Results: Symptoms reported most frequently included flaking/scaling (non-scalp areas), itching/scratching and rash, while the most bothersome symptoms were itching/scratching, flaking/scaling (non-scalp areas) and skin pain. Frequently reported impact areas were social and emotional. Conclusion: Broad-reaching interviews with patients with psoriasis show that these patients suffer in many aspects of their lives and in ways not indicated by typical psoriasis severity measures. Patients with psoriatic arthritis reported symptoms and disease-related complications at higher rates than those without arthritis. Physicians’ explorations of the effect of psoriasis on patients’ life events could aid in managing these patients.

Using narrative in nursing research

Narrative is a term used in everyday life. While it refers to a spoken or written account or story, it is also an increasingly popular research method. This article explores the role of narrative in nursing research and practice, and evaluates the use of narrative as a research method. Narrative is the study of how humans experience the world and how they interpret this experience. It can be an excellent research method to expand understanding of healthcare provision and individual patient experience.

Evidence-based medicine and the anecdote: Uneasy bedfellows or ideal couple?

Over the past 30 years, there has been a resurgence in the use of storytelling and narrative in medicine. At first glance, the trend to incorporate art forms into medicine appears to run counter to the rise of the more objective and positivist evidence-based medicine movement. In the present article, the authors provide examples of the use of storytelling and narrative in medicine, describe their origins, and contrast this approach with evidence-based medicine. The authors suggest that storytelling and narrative offer a complement to the science of evidence-based medicine. Finally, the authors describe a program of research to develop and evaluate the use of storytelling as a communication tool between physicians and parents/caregivers of children presenting to the emergency department.