"Unable to Feed My Hungry Child": Experiences of Mothers Caring for Children With Prader-Willi Syndrome.

Mothers' experiences of caring for children with Prader-Willi Syndrome (PWS) is largely unknown. With no treatment for PWS, parents undertake (extra)ordinary care practices to keep children safe from overeating and self harm. Knowledge of these care practices could lead to effective interventions. Narrative inquiry was used to study everyday experience with Canadian mothers. Participants cared for a child 3 to 17 years old who had hyperphagia. Participants were interviewed 8 to 12 times each over the course of a year. Narrative accounts were co-composed through a collaborative process of analysis. Engaging with participants' everyday experiences amplified complex care needs for families and gaps in health and social care systems. Narrative threads focused on engaging in (extra)ordinary care practices, rigid care work to keep children healthy and safe, tension from others while enacting these care practices, and difficulty conforming to social expectations with childrearing and care work. Recommendations for practice and policy include (a) shifting from untenable care practices, (b) reconceptualizing care work, and (c) alternative care models.

Nursing Students' Perceptions Regarding Teaching and Learning Practices That Promote Safe Medication Administration.

ABSTRACT: This article reports on a study conducted to explore what helps and what complicates learning safe medication administration. In this study, nurse educators explored students' perspectives on effective teaching practices, what influences medication errors and near misses, and strategies for improving students' learning about medication administration. Students ranked nursing instructors, peers, and staff nurses as having the greatest positive impact on both their learning and patient safety. Good relationships, an appropriate pace of learning, and practice were also beneficial. Noise, time constraints, and interruptions were negatively associated with learning and patient safety.

Mothering a Child With Complexity and Rarity: A Narrative Inquiry Exploring Prader-Willi Syndrome.

Daily experiences of mothers caring for children with Prader-Willi syndrome (PWS) are largely unknown and unvoiced. Knowledge of PWS has generally focused on pathology of the disorder. This emphasis overlooks the challenging moments of everyday life caring for children with PWS. Storied accounts of mothers caring for children with PWS offer expanded narratives to medicalized descriptions of experience. An understanding of everyday challenges in managing physical and mental health issues of PWS including hyperphagia and anxiety may create shifts in social and clinical perspectives. This understanding could improve practices in health and social care for families with PWS. This narrative inquiry studied everyday experience using storied accounts. Participants were mothers caring for children aged 3-17 years with genetically confirmed PWS who were experiencing hyperphagia. Four participants were recruited, and each interviewed 8-12 times over 12 months. Field texts and narrative accounts were co-composed through a collaborative process of analysis. Engaging with participants' day-to-day experiences offered insights into their work of nurturing, caring, and contributing to the care of a child with PWS. Narrative threads focused on complexity and rarity and include the desire to be normal, how ordinary becomes extraordinary, isolation, behaviors and normative standards, and alternative stories of mothering. Recommendations for practice and policy include (a) challenges of mothering a child with complexity, (b) moving beyond functionality and impairment to participation and quality of life, (c) re-storying narratives and supports for families, and (d) engaging with mothers to determine care priorities.

The experiences of international students in a Canadian faculty of nursing: A narrative inquiry study.

BACKGROUND: In response to the global need for nursing faculty, and nurses in leadership and advanced clinical practice roles, students from different countries come to Canada for their graduate nursing education. The positive reputation and the perceived advantages of the education system are particularly compelling to applicants from the countries located in the Global South. However, these students come from different social, historical, political, cultural, and educational backgrounds that deeply influence their learning experiences in Canada. OBJECTIVE AND METHODOLOGY: The aim of this narrative inquiry study was to understand the experiences of international graduate nursing students. The focus was to unravel two puzzles of this inquiry: What stories across social, historical, political, cultural, and educational borders shaped students' identities and ways of knowing? How did the experience in Canada impact their identities? SETTING AND PARTICIPANTS: Participants were invited from a Master of Nursing program at a research-intensive University in Western Canada. METHODS: Participants engaged in series of conversations over a period of one year. RESULTS: Multiplicity of borders and identity making, border making, and border crossing, were the threads that resonated across the narrative accounts. CONCLUSION: These narrative threads provided insights into the lived experiences of tensions, the shifting of identities, and the day-to-day challenges that international students face while learning in Canada. Being aware of these experiences and acknowledging them could be a significant stride towards addressing the issues of racism, inequity, and exclusion for international students within Canadian graduate nursing education.

The Relationship Between Critical Social Theory and Interpretive Description in Nursing Research.

This paper is an examination of the methodological and theoretical perspectives of a study with an inquiry focus on the experiences and perspectives of staff who worked at an injectable opiate assisted (iOAT) clinic. Twenty-two staff members, including nurses, social workers, and peer support workers, were interviewed. The goal of the study was to uncover how the clinic staff provided care to the clients who attend the clinic, their perspectives on how the clinic program impacted both them and their clients, and their experiences with the program itself. This interpretive descriptive study was underpinned by critical social theory. Thematic analysis was undertaken to identify recurring, converging, and contradictory patterns of interaction, key concepts and emerging themes. In this paper we examine and discuss how the relationship between critical social theory and interpretive description enhanced the study. Examples from the study are presented to provide insight into the relationship.

The enigma of weight: Figures, flux, and fitting in.

Purpose: In Western society, the measurement of weight is prioritized over a person's bodily experience. Hermeneutic philosopher Gadamer warned against the emphasis on measurement, rather than experience, in the medical sciences. An examination of the complexity of the experience of weight provides the opportunity to shift focus from quantifying the connection between health and weight to the experience of the person being weighed. Methods: This qualitative hermeneutic study aims to understand people's experiences of weight from the interviews of professionals (n = 7) and lay experts (n = 10). Interviews were analyzed using an interpretive hermeneutic method. Results: The interviews revealed that weight was experienced as a number imbued with meaning and bias, as a number that could be manipulated, and as a constant and anticipated bodily change. Weight change was expected and often unwelcomed, despite weight being a quality of the body that is always in flux. External measures of weight meant to monitor wellness and health inadvertently became an unhealthy fixation that prevented some participants from fully participating in life events and appreciating the stages their bodies were in. Conclusion: Weight change is a necessary condition of being human, and bodies are and will be constantly changing. To achieve health and harmony, one must fit together the acceptance of change and their bodily experience of weight. It is often the preoccupation with weight, not weight itself, that gets in the way of living.

The optics of weight: expert perspectives from the panopticon and synopticon.

Objective: That we all weigh something is a fact of life, yet the material reality of weight is refracted through multiple layers of surveillance revealing contradictions in experience and understanding, depending on one's vantage point. We explored the complexities of weight with the specific aim of furthering understanding of this multifaceted surveillance.Methods and Measures: We used hermeneutics, the philosophy and practice of interpretation, as the method of inquiry. Ten experts by experience and seven professional experts participated in interviews, which were audio- recorded, transcribed, and analyzed. Interpretations were developed through group discussions among the eight authors and reiterative writing.Results: Using the metaphor of optics, we demonstrate how the interplay of the panopticon (the few watching the many) and synopticon (the many watching the few) help us gain a deeper understanding of weight through "fitting in," being "captured by numbers," "dieting: the tyrannic tower," and "the male gaze."Conclusion: Monitoring and judging body weight have become so normative in Western society that "weight watching" practices are synonymous with good citizenship and moral character. This study offers insight about how weight is conceptualized in personal and professional contexts, with implications for body image, dieting, eating disorders, public health, and weight bias.

Being Uncertain: Rural-Living Cardiac Patients' Experience of Seeking Health Care.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Secondary prevention strategies reduce disease progression to heart failure. Rural cardiac patients typically have less access to health care resources to support them in managing secondary prevention, and services to improve quality of life tend to be lacking in rural settings. The study aim was to examine the process that rural cardiac patients go through to access health care and cardiac rehabilitation (CR) following myocardial infarction (MI). In-depth interviews with 11 post-MI participants using Straussian grounded theory were undertaken. Analysis revealed a linear process from hospital discharge to maintaining health. There were five elements: comfort with health information, relationship with health care providers, social support, taking ownership, and availability of/for CR. The core category was "being uncertain." Findings can be used to identify ways to improve access and address uncertainty stemming from a lack of perceived information and supports following discharge.

Undergraduate nursing simulation facilitators lived experience of facilitating reflection-in-action during high-fidelity simulation: A phenomenological study.

BACKGROUND: Reflective practice is an essential step to learning in high-fidelity simulation, yet, reflection-in-action is an often overlooked yet important opportunity to support student learning. OBJECTIVES: To explore and describe the lived experience of undergraduate nursing simulation facilitators use of reflection-in-action during high-fidelity simulation. DESIGN: A descriptive phenomenological study. SETTING: A western Canadian province. PARTICIPANTS: Undergraduate nursing simulation facilitators with experience in nursing education and simulation facilitation. METHODS: We conducted 11 semi-structured interviews and utilized Colaizzi's seven step process of analysis to discover the essence of undergraduate nursing simulation facilitators use of reflection-in-action during high-fidelity simulation. RESULTS: Simulation facilitators were able to identify reflection-in-action during high-fidelity simulation when students paused, collaborated, shared their thinking aloud, and changed their course of action. Barriers to reflection-in-action included learner fear and anxiety, poor simulation design, and inadequately prepared students and facilitators. Simulation facilitators supported reflection-in-action through prebriefing, facilitator curiosity, and providing cue, prompts, and facilitated paused. Some of the noted benefits to reflection-in-action include promoting collaborative learning, building confidence and critical thinking, and embedding reflection into practice. CONCLUSIONS: The insights from this research can be used to guide reflection-in-action strategy development and future research in high-fidelity simulation.

The impact of horizontal violence on the individual nurse: A qualitative research study.

AIM: Horizontal violence (HV) is a familiar term used in nursing. Certain populations of nurses are more susceptible to HV than others. Graduate nurses (nurses within their first 12 months of practice) are widely considered a vulnerable population in the profession and thus more at risk for HV. The purpose of this qualitative study was to explore how HV affects graduate nurses (GNs). DESIGN: Inductive thematic analysis was used in the design of this study. METHODS: Participants included eight Canadian GNs or Registered Nurses (RNs), all of whom had experience with HV in their first 12 months of practice. Data collection was done via one-on-one interviews. RESULTS: Two main themes were revealed from the data collected - Toxic Nursing Culture and Fear. Several subthemes were also identified - cycle of violence, nurses eating their young, shame, drowning, isolation and vulnerability. The findings indicate that HV is prevalent in the first year of practice and is destructive to the mental health of the individual nurse. Horizontal violence poses a serious challenge for GNs entering nursing and is often touted as the reason new nurses leave the profession altogether. CONCLUSION: This study highlighted the personal and professional challenges that are heightened for a GN when they experience HV in their first year of practice. These experiences emphasize the impact that HV can have on the mental health of nurses and their ability to deliver safe patient care.

Waiting as Performative and Relational: A Narrative Inquiry Study Into the Experiences of Women Who Use Substances.

BACKGROUND AND PURPOSE: The act of waiting in health care is becoming increasingly prevalent worldwide. Waiting in health care is not a neutral activity; it is filled with expectations marked by cultural and social norms. In this article, we consider the performative nature of waiting by reflecting on the experiences of two participants in a narrative inquiry study. METHODS: Drawing on a narrative inquiry study focused on the experiences of three women who disclosed illegal substance use during their pregnancy or early postnatal period, we inquired into two participants' experiences of waiting. The study which took place in a large urban center in Western Canada, where the researcher connected with participants who faced numerous challenges due to poverty, stigma, and discrimination. RESULTS: Sharing the narratives of Georgia Dewart, and participants Renate, and Marilynn, we explore the performative act of waiting in their interactions with health care. We consider the political and social implications of the act in order to explore the subtleties and overlooked consequences of waiting. This work encourages the nursing profession to address overlooked aspects of care, such as the act of waiting. IMPLICATIONS FOR PRACTICE: Our findings draw attention to the normative expectations within participants' experiences of waiting. This work offers methodological considerations for those engaging with Butler's concept of performativity when considering everyday acts. We also challenge care providers to reflect on their experiences working with clients, families, and communities to consider both the relational and performative nature of these interactions.

Beyond the Buzzword: A Concept Analysis of Harm Reduction.

BACKGROUND AND PURPOSE: Harm reduction is a concept that is increasingly applied in health and social care, as well as law and policy development around the world. Despite being used in a variety of contexts for decades, there is no universal understanding of harm reduction, and this may interfere with its implementation in various settings. Using Rodgers' (1989) evolutionary approach to concept analysis, this article defines the key attributes of harm reduction, along with surrogate terms, relevant uses, antecedents, consequences, related concepts, a model case, and implications for practice. METHODS: Following Rodgers' (1989) method, a literature sample from a variety of disciplines was selected using keywords. The review included 25 key publications of international origin, as well as several web-based resources, with a focus on illegal psychoactive drug use and healthcare outcomes. RESULTS: Seven key attributes of harm reduction were identified: a focus on harms, the participation of people who use drugs, the promotion of human rights, a public health approach, value neutrality and nonjudgment, practicality and pragmatism, and innovation and adaptability. IMPLICATIONS FOR PRACTICE: The harms associated with illegal drugs are a global health problem, and advocacy is needed to promote harm reduction policy at health provision, community, and government levels. Without a concerted understanding of harm reduction, the concept is at risk of being relegated to a buzzword that lacks meaning. This concept analysis provides health and social care providers with a point of reference for meaningful harm reduction initiatives and strategies within their practice.

Composing Sexuality in the Midst of Adolescent Cancer.

A cancer diagnosis heralds the onset of significant life changes. The various experiences of diagnosis, treatment, and recovery from cancer during adolescence and young adulthood are complex and disruptive. Emphasis on treatment and recovery often overshadows other social and developmental imperatives for adolescents and young adults. Acknowledging, exploring, and crafting one's own sexual identity is a significant milestone achieved during this time, and it is one that is interrupted by the arrival and treatment of cancer. There is value in understanding how adolescents and young adults compose sexuality amid cancer experiences, and how this composition contributes to their ongoing stream of life experiences after recovery. As part of a larger study of sexuality and adolescent cancer, we undertook a narrative inquiry with Anna and Mark, two young adults who experienced cancer during adolescence. Over 14 months, we met with Anna and Mark, drawing on different narrative inquiry approaches to explore their past and ongoing experiences and to build negotiated stories of those experiences. We explored resonant threads between the stories, which help show the depth and complexity of sexuality as it is experienced in the midst of and after cancer. Two resonant threads are discussed: inward and outward looking, and sexuality and survival. The inquiry reveals the richness of self-composition amid competing stories of cancer treatment, disruptions to family and socialization, survivorship, what it means to be a young man or woman in the world, and the sense of a developing sexual self.

Digital Storytelling as a Psychosocial Tool for Adult Cancer Survivors.

PURPOSE: To understand the meaning and impact for adult patients with cancer (past or present) of creating a digital story related to their cancer experience. PARTICIPANTS & SETTING: 10 participants made digital stories with the help of a research assistant trained in digital storytelling. This research took place in a large, urban center in Calgary, Alberta, Canada. METHODOLOGIC APPROACH: This research was done in the tradition of philosophical hermeneutics. Ten one-on-one interviews were conducted, and data were analyzed using an interpretive qualitative methodology. FINDINGS: Findings revealed that digital stories were cathartic; reconnected individuals with family, friends, and parts of their lives that had been interrupted from cancer therapy; helped participants reflect in a way that was often described as therapeutic; and bridged communication with others about their cancer experiences. IMPLICATIONS FOR NURSING: Digital stories can be used to highlight the immense psychosocial impact of cancer and point healthcare professionals and other researchers toward creative and nontraditional ways to address this issue.

Selecting a Grounded Theory Approach for Nursing Research.

Grounded theory is a commonly used research methodology. There are three primary approaches to grounded theory in nursing research: those espoused by Glaser, Strauss and Corbin, and Charmaz. All three approaches use similar procedures, yet there are important differences among them, which implies that researchers need to make careful choices when using grounded theory. Researchers new to grounded theory need to find the most appropriate approach that fits their research field, topic, and researcher position. In this article, we compare the three grounded theory approaches. Choices of a grounded theory approach will depend on the researcher's understanding of the philosophical underpinnings of all three approaches. Practical aspects of grounded theory approaches should match the information processing styles and analytical abilities of the researcher and the intended use of the theory. We illustrate key aspects of decision making about which method to select by drawing upon the first author's experiences in his doctoral research.

"Family Is Who They Say They Are"a: Examining the Effects of Cancer on the Romantic Partners of Adolescents and Young Adults.

In this article, we discuss a study we conducted to examine the effects of cancer on romantic partners (i.e., boyfriends and girlfriends, social/romantic/intimate partners) of adolescents and young adults experiencing, or who have experienced, cancer. In this hermeneutic study, we interviewed partners who were involved with an adolescent/young adult with cancer, a cancer survivor who was in a relationship during his treatment, and two healthcare professionals who have worked with these couples and witnessed many other situations of impact, effect, and repercussion. Out of this study, we suggest that partners are affected in many ways that can vary from estrangement, to termination of the relationship, to premature decisions about remaining in the relationship, to family disregard of the partner, and to disregard of the family due to influence of, or relationship with, the partner. We discuss these findings within the context of the larger picture of the psychosocial relational impact of cancer on members beyond those in the immediate and biological family.

Mothers' Experiences of Supporting Adolescent Children Through Long-Term Treatment for Substance Use Disorder.

Substance use disorder is a complex phenomenon that affects people in many different contexts. Adolescent substance abuse within families is a particular problem that merits ongoing study. In particular, the experiences of mothers in this context are not fully explored. In this narrative inquiry study, we explored the experiences of four mothers parenting children through long-term substance abuse treatment. Participants were recruited from a family-orientated long-term adolescent treatment center in Alberta, Canada. The mothers' experiences were explored within a three-dimensional narrative inquiry space of temporal, social, and situated experience. Four narrative accounts were co-composed, revealing personal, familial, social, and substance abuse-related complexities in mothers' experiences. Four narrative threads were also theorized: navigating complexities; loud silences; places, spaces, and the in-between; and living within one another's stories. These narrative threads are discussed in relation to health and social care practices. Recommendations for practice and research are made.

"A Tribe Apart": Sexuality and Cancer in Adolescence.

This qualitative study employed hermeneutic phenomenology and narrative inquiry to examine the topic of sexuality and adolescents with cancer from the perspectives of survivors who had experienced cancer as adolescents. This investigation examined the potentially sensitive, disquieting, and often taboo issue of sexuality in the interest of optimizing wellness in young people, and, ultimately, in the health of adults. Understanding the adolescent body as a sensitive, sexual, and developing self can enrich our understanding of adolescent cancer and promote best health care and practices, examining ways that we might mitigate the long-term effects of arrested or delayed development of sexual identity. In this article, we discuss phase 1 of the study, which used hermeneutics as the method of inquiry. Findings included a general experience of adolescents having a sense of "losing themselves" while at the same time finding themselves in a new light. Other findings include the connection between sexuality, self, and identity; the unique "tribe" of adolescents with cancer; the necessity for sexuality to take a backseat to cancer; the changing mirror images from self and others; sexuality and fertility; and, ultimately, that sexuality is a relational experience.

Stories That Heal: Understanding the Effects of Creating Digital Stories With Pediatric and Adolescent/Young Adult Oncology Patients.

The purpose of this philosophical hermeneutic study was to determine if, and understand how, digital stories might be effective therapeutic tools to use with children and adolescents/young adults (AYA) with cancer, thus helping mitigate suffering. Sixteen participants made digital stories with the help of a research assistant trained in digital storytelling and were interviewed following the completion of their stories. Findings from this research revealed that digital stories were a way to have others understand their experiences of cancer, allowed for further healing from their sometimes traumatic experiences, had unexpected therapeutic effects, and were a way to reconcile past experiences with current life. Digital stories, we conclude, show great promise with the pediatric and AYA oncology community and we believe are a way in which the psychosocial effects of cancer treatment may be addressed. Recommendations for incorporating digital stories into clinical practice and follow-up programs are offered.

"Stories Take Your Role Away From You": Understanding the Impact on Health Care Professionals of Viewing Digital Stories of Pediatric and Adolescent/Young Adult Oncology Patients.

The purpose of this philosophical hermeneutic study was to understand the effects on health care providers (HCPs) of watching digital stories made by (past and present) pediatric and adolescent/young adult (AYA) oncology patients. Twelve HCPs participated in a focus group where they watched digital stories made by pediatric/AYA oncology patients and participated in a discussion related to the impact the stories had on them personally and professionally. Findings from this research revealed that HCPs found digital stories to be powerful, therapeutic, and educational tools. Health care providers described uses for digital stories ranging from education of newly diagnosed families to training of new staff. Digital stories, we conclude, can be an efficient and effective way through which to understand the patient experience, implications from which can range from more efficient patient care delivery to decision making. Recommendations for incorporating digital storytelling into healthcare delivery are offered.