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1.
Qual Res Med Healthc ; 8(1): 11797, 2024 Mar 13.
Article in English | MEDLINE | ID: mdl-38784526

ABSTRACT

The coronavirus pandemic provoked worldwide changes to the workplace, leading to rapid changes in lifestyles and working conditions. While organizations and governments struggled to develop regulations and policies, individuals were forced to find ways to manage work and life. During the pandemic and quarantine, a group of knowledge workers from around the world convened virtually and agreed to use qualitative autoethnographic methods to study how the quarantine disrupted their conventional patterns of work and care. In this article, we apply two communication perspectives-uncertainty reduction theory and re-silience-to participant diaries to understand how participants represent internal and external stressors, the efforts diarists employed to overcome those stressors, and their varying success in doing so. Post-hoc application of these communication concepts suggests that the diarists, though privileged in some ways, were not exempt from the social, professional, and emotional consequences of the pandemic and that their efforts to enact resilience were unevenly successful, especially in relation to their use of communications technology. Diarists reported struggling with uncertainty at numerous levels and that uncertainty contributed to individual emotional and cultural distress. Disruptions to work, home, and communities significantly affected wellbeing and ability to cope with challenges. Added to this were the complex and competing roles that diarists felt as they struggled to work from home, parent, and remain engaged.

2.
Res Involv Engagem ; 9(1): 55, 2023 Jul 20.
Article in English | MEDLINE | ID: mdl-37474967

ABSTRACT

There is an increased interest from both researchers and knowledge users to partner in research to generate meaningful research ideas, implement research projects, and disseminate research findings. There is accumulating research evidence to suggest the benefits of engaging children/youth with disabilities and their parents/families in research partnerships; however, less is known about the benefits of, and challenges to, engaging organizations as partners in research. The purpose of this commentary is to reflect on successful organizational partnership experiences from the perspectives of researchers at an internationally-recognized childhood disability research centre (CanChild), and to identify and share key ingredients for developing partnerships between organizations and academic institutions. A companion study is underway to examine partnership experiences with CanChild from the partners' perspective. Four CanChild researchers and two co-facilitators participated in a collaborative auto-ethnography approach to share experiences with organizational research partnerships and to reflect, interpret, and synthesize common themes and lessons learned. The researchers and facilitators met virtually via Zoom for 105 min. Researchers were asked to discuss the following: the formation of their organizational partnerships; if/how partnerships evolved over time; if/how partnerships were sustained; and lessons learned about benefits and challenges to building research partnerships with organizations. The meeting was recorded, transcribed verbatim, and analyzed by the facilitators to identify and synthesize common experiences and reflections. Multiple rounds of asynchronous reflection and feedback supported refinement of the final set of analytic themes. Researchers agreed that partnerships with organizations should be formed through a mutual interest, and that partnerships evolved by branching to include new organizations and researchers, while also involving trainees. Researchers identified the importance of defining roles and responsibilities of key individuals within each partnering group to sustain the partnership. Lessons learned from organizational partnerships included reciprocity between the partnering organization and academic institution, leveraging small pockets of funds to sustain a partnership over time, and building a strong rapport with individuals in a partnership. This commentary summarized lessons-learned and provided recommendations for researchers and organizations to consider when forming, growing, and sustaining research partnerships over time.


Researchers and people who use research findings are partnering to create research projects and share results. There are examples of children with disabilities and their families participating in research partnerships, but less is known about the involvement of healthcare organizations and community organizations as research partners. The purpose of this article is to share successful examples of partnership between organizations and a childhood disability research centre from the perspective of researchers. Four researchers and two facilitators met to reflect on their experiences with organizational research partnerships. They met online for 105 min using Zoom software. The researchers were asked to talk about how their partnerships with organizations were formed, how they grew over time, and how they were maintained. The meeting was recorded, and the facilitators took the researchers' experiences and summarized them into common messages. Everyone then read the summary on their own and added their ideas. This happened three different times until everyone agreed on one set of ideas. The researchers agreed that partnerships with organizations should be formed through common goals, that they should grow to include new partners and junior researchers, and that clear roles and responsibilities were needed to keep the partnership going. The experiences shared in this article are valuable to other researchers and organizations that are interested in forming research partnerships.

3.
Pers Ubiquitous Comput ; : 1-11, 2023 Apr 15.
Article in English | MEDLINE | ID: mdl-37363426

ABSTRACT

Smart home technology is expected to be widespread in the future and to accommodate a green transition to reduce and time-shift energy consumption. However, smart technologies also have social consequences, which are important to understand. At a basic level, we need to know more about learning to live with these technologies and how they influence our everyday practices and routines. Providing in-depth longitudinal insights into these processes, this paper presents an auto-ethnography of living with smart home technology: a 20-month diary kept by one of the authors. The paper uses theories of practice to investigate details of learning processes when interacting with three selected technologies: smart alarm and lighting management, smart control of heating, and a smart electric vehicle (EV). Theories of learning have a well-established tradition within theories of practice, and the concept of "knowing how to go on" and the concept of practical intelligibility are central in this work. This paper investigates the adoption of new smart technologies and how they interact with learning processes in different material and social contexts. Such an approach can lay the groundwork for further empirical research with a broader set of materials. It can also provide knowledge to assist in the design of better technologies and in developing policies and regulations to promote this.

4.
Ann Sci ; 80(1): 62-76, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36695508

ABSTRACT

During the IAEA's Mobile Radioisotope Exhibition (1960-1965) through the eventful roads of five Latin American countries (Mexico, Uruguay, Argentina, Brazil, and Bolivia), a variety of photographs were taken by an unknown Mexican official photographer, and by Josef Obermayer, a staff driver from Vienna. The exhibition carried not only bits of nuclear sciences and technologies, but also the political symbolism of the 'friendly atom' as a token of modernization. The photographs embarked on different trajectories, though all of them ended up at the training and exchange official's desk in charge of the exhibition, Argentinian physicist Arturo Cairo. The ones taken in Mexico also had a local circulation as propaganda intended to promote radioisotope applications. The two sets of images were intended to show the contrast between modernity and traditional society, but they did it from different gazes. Our paper argues that, in the case of Mexico, the photographer reinforced representations of the country which were already popularized by Hollywood for foreign and local audiences. On the other hand, the Viennese photographer's gaze delivers an autoethnography of his dutiful journey. We also argue that Obermayer's projection is one of what Roger Bartra has conceptualized as the 'salvage on the mirror'.


Subject(s)
Photography , Physics , Humans , History, 20th Century , Latin America , Photography/history , Physics/history , Radioisotopes , Exhibitions as Topic
5.
Implement Sci Commun ; 4(1): 12, 2023 Jan 27.
Article in English | MEDLINE | ID: mdl-36707871

ABSTRACT

BACKGROUND: Despite growing enthusiasm for co-production in healthcare services and research, research on co-production practices is lacking. Multiple frameworks, guidelines and principles are available but little empirical research is conducted on 'how to do' co-production of research to improve healthcare services. This paper brings together insights from UK-based collaborative research partnerships on leading co-production. Its aim is to inform practical guidance for new partnerships planning to facilitate the co-production of applied health research in the future. METHODS: Using an auto-ethnographic approach, experiential evidence was elicited through collective sense making from recorded conversations between the research team and senior leaders of five UK-based collaborative research partnerships. This approach applies a cultural analysis and interpretation of the leaders' behaviours, thoughts and experiences of co-production taking place in 2008-2018 and involving academics, health practitioners, policy makers and representatives of third sector organisations. RESULTS: The findings highlight a variety of practices across CLAHRCs, whereby the intersection between the senior leaders' vision and local organisational context in which co-production occurs largely determines the nature of co-production process and outcomes. We identified four tensions in doing co-production: (1) idealistic, tokenistic vs realistic narratives, (2) power differences and (lack of) reciprocity, (3) excluding vs including language and communication, (4) individual motivation vs structural issues. CONCLUSIONS: The tensions were productive in helping collaborative research partnerships to tailor co-production practices to their local needs and opportunities. Resulting variation in co-production practices across partnerships can therefore be seen as highly advantageous creative adaptation, which makes us question the utility of seeking a unified 'gold standard' of co-production. Strategic leadership is an important starting point for finding context-tailored solutions; however, development of more distributed forms of leadership over time is needed to facilitate co-production practices between partners. Facilitating structures for co-production can enable power sharing and boost capacity and capability building, resulting in more inclusive language and communication and, ultimately, more credible practices of co-production in research. We provide recommendations for creating more realistic narratives around co-production and facilitating power sharing between partners.

6.
Front Psychol ; 14: 1287209, 2023.
Article in English | MEDLINE | ID: mdl-38222846

ABSTRACT

We are now at a transition point in autism conceptualisation, science, and clinical practise, where phenomenology could play a key role. This paper takes a broad view of the history of phenomenological perspectives on the autism concept and how this has evolved over time, including contemporaneous theory and methods. Early inquiry from a clinical perspective within the tradition of classical continental phenomenology, linked closely to the consideration of schizophrenia, is contrasted with emerging observations of child development and a period in the second half of the twentieth century of scientific inquiry into a behavioural autistic phenotype where there was little or no phenomenological aspect; a phenotype that has determined the recent scientific and clinical conceptualisation of autism within current nosology. We then mark a more recent reawakening of interdisciplinary interest in subjective experience and phenomenological inquiry, which itself coincides with the increasing prominence and salience of the neurodiversity movement, autistic advocacy, and critical autism studies. We review this emerging phenomenological work alongside a contemporaneous clinical phenomenology perspective and representations of autistic experience from within the extensive literature (including life writing) from autistic people themselves; all perspectives that we argue need now be brought into juxtaposition and dialogue as the field moves forward. We argue from this for a future which could build on such accounts at a greater scale, working toward a more co-constructed, systematic, representative, and empirical autistic phenomenology, which would include citizen and participatory science approaches. Success in this would not only mean that autistic experience and subjectivity would be re-integrated back into a shared understanding of the autism concept, but we also argue that there could be the eventual goal of an enhanced descriptive nosology, in which key subjective and phenomenological experiences, discriminating for autism, could be identified alongside current behavioural and developmental descriptors. Such progress could have major benefits, including increased mutual empathy and common language between professionals and the autistic community, the provision of crucial new foci for research through aspects of autistic experience previously neglected, and potential new supportive innovations for healthcare and education. We outline a programme and methodological considerations to this end.

7.
Front Vet Sci ; 9: 795628, 2022.
Article in English | MEDLINE | ID: mdl-35372559

ABSTRACT

I can still see the dog's face as its eyes connected with mine, framed by the black bin bag it had been carried in. I can still hear the clicking sound, louder than the animal's shrill cries, made by a mass of maggots moving against one another beneath the dogs matted fur, moistened by fluids leaking from its damaged flesh. My hands were shaking with panic and rage and I could hardly draw up the euthatal into the syringe quickly enough. I wanted to put an end to this, immediately. As the lethal fluid flowed into the tiny vein the dog's body finally relaxed. At my hand, like so many others, she had ceased to exist. Through the window I could see her owners waiting outside in the sunshine to pay me and I thought about the silky feel of the fur which covered an expensively shaped head. I knew this dog was loved once. This paper develops two neglected areas of veterinary thought; anthropological studies of the veterinary profession and feminist care approaches in veterinary ethics. I argue that the development of veterinary anthropology is crucial to advancing our understanding of veterinary lived experiences, through highlighting the previously under acknowledged emotional, relational and contextual realities of veterinary practice. I further propose that an ethic of care for the veterinary profession, which meaningfully connects with veterinary lived experiences, may provide a valuable approach through which to further develop veterinary ethical thinking. I share an autoethnographic account of a difficult veterinary encounter, which I then analyse using a novel feminist care approach. Through analyses centered on both emotional and relational aspects of veterinary care, I challenge the boundaries of traditional veterinary ethical approaches in terms of the scope, scale and complexity of veterinary ethical decision making. I describe the concept of emotional sponge work in veterinary practice and outline its potential impact for advancing understanding of both veterinary well-being and the profession's societal role. Finally, I propose that a feminist ethic of care might provide a framework for redefining the focus of veterinary professional responsibility, beyond animal health and toward the maintenance of healthy relationships between humans and animals.

8.
Integr Psychol Behav Sci ; 56(1): 75-83, 2022 Mar.
Article in English | MEDLINE | ID: mdl-33900544

ABSTRACT

Departing from meanings of experiences and experiencing, of memory and poetics, the aim of this article was to describe and analysis the experience of the encounter of two sisters by means of a common ground represented by family narratives. It was based on collaborative auto ethnography. The study involved two sisters that lost their parents and home. The older sister - I-conserved memories of her parents and house; the little one, did not. The main conclusion was that my sister and I constructed narratives that signal something common to both: pointing to the origin in family history.


Subject(s)
Family , Siblings , Female , Humans
9.
Res Involv Engagem ; 7(1): 78, 2021 Nov 06.
Article in English | MEDLINE | ID: mdl-34742354

ABSTRACT

BACKGROUND: Engaging patients and family members as partners in research studies has become a widespread practice in healthcare. However, relatively little has been documented about what happens after the research study ends. For example, is patient and family engagement embedded in the wider infrastructure of organizations, and if so how? What are the long-term effects of engaging parents on research teams on the culture of how research is conducted? This study seeks to address these two gaps by examining how a culture of family engagement has been built over time at CanChild Centre for Childhood Disability Research at McMaster University in Ontario, Canada. METHODS: This study is based on ethnographic research methodology and combines elements of organizational ethnography, interviews, and collaborative auto-ethnography with parent partners, researchers, staff, and trainees. RESULTS: Since the inception of CanChild Centre for Childhood Disability Research at McMaster University in 1989, parents have been involved in research studies. Over time, this involvement evolved from being consulted on research studies to undertaking decision-making roles as partners and most recently as co-principal investigators. A growing infrastructure fosters a community of engagement that goes beyond the individual research study, and often beyond CanChild. This infrastructure consists of training, knowledge mobilization and social networking. In addition, the "softer" building blocks of CanChild's culture of engagement are an openness to learning from others, a commitment to relationship building, and a drive to grow and improve. These values are espoused by the leadership and are instilled in the next generation of researchers to inform both research and clinical work. While some challenges should be acknowledged when researchers and family partners work together on research studies, we identify a number of strategies that we have used in our studies to foster authentic and meaningful family-researcher partnerships. CONCLUSION: Engaging patients and families as partners in research constitutes a culture shift in health research, whereby studies about patients and families are carried out with them. Developing a community of engagement that transcends an individual research study is a step towards creating a culture of research that is truly shaped by the people about whom the research is being done.


More and more patients and family members are getting involved in health research studies as partners. However we do not know much about what happens after the research study ends. This article looks at how parents have been involved in research studies at CanChild Centre for Childhood Disability Research at McMaster University in Ontario, Canada. CanChild researchers, staff, students and parents were asked about their experiences of working together on research studies. One of the researchers then pooled together all of these stories, shared them with everyone to get their feedback, and wrote the initial draft of this article. All the people interviewed were invited to read the article and to add their thoughts and opinions until everyone was satisfied with the final product. Our shared stories show that a lot has changed since CanChild was established in 1989. At first, researchers consulted with parents when they were doing a study. Now, many parents are partners and co-principal investigators on research studies. CanChild has also developed opportunities for parents and researchers to get training in patient-family engagement and to network with each other outside of research studies. Researchers, staff, students and parents talked about what makes research partnerships successful, including: being open to learning from each other; taking the time to get to know each other as people; and always trying to do better. They also shared some of the challenges that come up on research studies and suggested strategies for working through them.

10.
Qual Soc Work ; 20(1-2): 632-638, 2021 Mar.
Article in English | MEDLINE | ID: mdl-34254001

ABSTRACT

This reflexive essay examines the adoption of an intentional 'ethic of care' by social work administrators in a large social work school located in the Pacific Northwest. An ethic of care foregrounds networks of human interdependence that collapse the public/private divide. Moreover, rooted in the political theory of recognition, a care ethic responds to crisis by attending to individuals' uniqueness and 'whole particularity.' Foremost, it rejects indifference. Through the personal recollections of one academic administrator, the impact of rejecting indifference in spring term 2020 is described. The essay concludes by linking the rejection of indifference to the national political landscape.

11.
Anthropol Med ; 27(3): 347-362, 2020 Sep.
Article in English | MEDLINE | ID: mdl-31876166

ABSTRACT

The author presents an interpersonal experience between the author and her son during childhood cancer treatment and care, illustrating the complex relationship between childhood cancer and the term 'resilience'. During treatment and care, nurses used the term 'resilience' in an apparent attempt to reassure her. However, the author found that the concept distanced her from her and her son's experience, creating emotional distress for him. She discovered that the everyday use of resilience, devoid of its research connotations, has the potential to create barriers in understanding these experiences for the patient and the caregiver. For example, this everyday use did not account for the relationship that resilience has with growth. It is not just important in terms of diagnosing a tumour, it is also important for supporting the agency of a child and the cultivation of trustworthiness. A focus on growth supports the notion of an "active resilience," a process informed by research literature to help medical staff and families develop the child patient's capability for growing into resilience throughout the survivorship experience. By neglecting this relationship with growth, resilience was found to silence the agency and voice of the author's child which added to the difficulty that she had in providing care. As more children survive cancer, a meaningful use of the term resilience can support their recovery from the adversities of treatment and a life of adverse outcomes. The ethnographic detail provides the context necessary for contributing to and unpacking the normative use of the term resilience in paediatric oncology.


Subject(s)
Family/psychology , Neoplasms , Resilience, Psychological , Stress, Psychological/psychology , Anthropology, Medical , Child, Preschool , Female , Humans , Male , Neoplasms/ethnology , Neoplasms/psychology , Neoplasms/therapy , Nurse-Patient Relations , Oncology Service, Hospital
12.
Health Res Policy Syst ; 17(1): 49, 2019 May 08.
Article in English | MEDLINE | ID: mdl-31068186

ABSTRACT

BACKGROUND: To increase the uptake of research evidence in practice, responsive research services have been developed within universities that broker access to academic expertise for practitioners and decision-makers. However, there has been little examination of the process of knowledge brokering within these services. This paper reflects on this process within the AskFuse service, which was launched in June 2013 by Fuse, the Centre for Translational Research in Public Health, in North East England. The paper outlines the challenges and opportunities faced by both academics and health practitioners collaborating through the service. METHODS: The authors reflected on conversations between the AskFuse Research Manager and policy and practice partners accessing the service between June 2013 and March 2017. Summary notes of these conversations, including emails and documents relating to over 240 enquiries, have been analysed using an auto-ethnographic approach. FINDINGS: We identified five challenges to knowledge brokering in an institutional service, namely length of brokerage time required, limits to collaboration, lack of resources, brokering research in a changing system, and multiple types of knowledge. CONCLUSIONS: To understand and overcome some of the identified challenges, we employ Goffman's dramaturgical perspective and argue for making better use of the distinction between front and back stages in the knowledge brokering process. We emphasise the importance of back stages for defusing destructive information that could discredit collaborative performances.


Subject(s)
Academies and Institutes , Biomedical Research , Communication , Cooperative Behavior , Delivery of Health Care , Knowledge , Universities , Administrative Personnel , Anthropology, Cultural , Decision Making , England , Health Personnel , Health Policy , Health Resources , Humans , Public Health , Research Personnel , Translational Research, Biomedical
13.
J Intellect Disabil ; 23(2): 190-202, 2019 Jun.
Article in English | MEDLINE | ID: mdl-29172897

ABSTRACT

Parent narratives have contributed to ethnographic accounts of the lives of children with autism, but there are fewer examples of parents producing their own autoethnographies. This article explores the affordances of an online blog for enabling a parent of a child with autism to produce a written record of practice which may be considered 'autoethnographic'. Richardson's framework for ethnography as Creative Analytic Process (CAP) is applied to extracts from a blog post in order to consider its contribution, reflexivity, aesthetic merit and impact. The article addresses the methodological and ethical implications of reconceptualizing parents as researchers and the potential contribution of new writing platforms to the development of auto/ethnography.


Subject(s)
Autism Spectrum Disorder , Blogging , Parents , Personal Narratives as Topic , Adult , Anthropology, Cultural , Child , Female , Humans , Male , Writing
14.
Midwifery ; 68: 23-29, 2019 Jan.
Article in English | MEDLINE | ID: mdl-30342305

ABSTRACT

OBJECTIVE: To discuss the concept of 'transcendent birth', an as yet poorly articulated and under recognised psychosocial wellness phenomenon of childbirth. DESIGN: an auto-ethnographical examination of the primary authors' journaled experiences as a student midwife and childbearing woman. SETTING: three maternity care units in South Eastern Australia as well as the home of the primary author. FINDINGS: The phenomenon of transcendent birth is linked with physiologic birth. Maternity care can hinder or facilitate physiologic birth, and therefore transcendent birth. KEY CONCLUSIONS: Transcendent birth is more likely in maternity care models which value the childbearing woman and physiologic birth. IMPLICATIONS FOR PRACTICE: Women's access to transcendent birth is demarcated by women's position in society, cultural knowledge of transcendent birth and the valuing of transcendent birth as a maternity care outcome.


Subject(s)
Mothers/psychology , Parturition/psychology , Adult , Anthropology, Cultural/methods , Female , Humans , Labor, Obstetric/psychology , Pregnancy , Surveys and Questionnaires
15.
Trab. educ. saúde ; 16(2): 659-682, maio-ago. 2018.
Article in Portuguese | LILACS | ID: biblio-963004

ABSTRACT

Resumo Este estudo teve como objetivo compreender os elementos essenciais do processo de sistematização da prática clínica de uma farmacêutica da atenção primária à saúde com base no referencial teórico-metodológico da atenção farmacêutica, que subsidia o serviço clínico de gerenciamento da terapia medicamentosa. Tratou-se de pesquisa qualitativa autoetnográfica, construída de forma colaborativa entre os autores, de outubro de 2014 a outubro de 2015, nos Centros de Saúde da Prefeitura Municipal de Belo Horizonte, onde uma das autoras trabalha. Os dados foram produzidos por meio de observação participante, diários de campo, reflexões e entrevistas semiestruturadas com farmacêuticos que desenvolviam prática clínica na atenção primária à saúde. Os resultados evidenciaram que os principais elementos para sistematização da prática clínica passam pela 'construção de uma nova identidade profissional na equipe multiprofissional' e pela 'incorporação de novas atividades na rotina de trabalho' que, combinadas, resultam em uma 'proposta de integração de um serviço de gerenciamento da terapia medicamentosa nos fluxos das unidades de saúde'. Dessa forma, para que o farmacêutico possa legitimar o seu papel no cuidado do paciente, é preciso mudar, transformar, reorganizar e reconstruir a sua prática.


Abstract The aim of this study was to understand the essential elements of the systematization process of the clinical practice of a pharmacist in primary health care. This systematization was based on the framework of pharmaceutical care practice, which provides the foundation for comprehensive medication management services. The methodology utilized was autoetnography, built collaboratively between the authors. The data have been produced through participant observation, field journals, reflections and semi structured interviews with pharmacists who are building clinical practices in primary health care. The results have demonstrated that the main elements associated with the systematization of clinical practices are 'the construction of a new professional identity in a multiprofessional team' as well as 'the incorporation of new activities in the work routine', that, combined, result in 'Integration of comprehensive medication management services in the flow of the health unit'. In this way, in order for the pharmacist to legitimize his role in patient care, it is necessary to change, to transform, to reorganize and to rebuild his practice.


Resumen Este estudio tuvo como objetivo comprender los elementos esenciales del proceso de sistematización de la práctica clínica del farmacéutico en la atención primaria de salud a partir del marco teórico de la atención farmacéutica, que subvenciona los servicios de gestión integral de la farmacoterapia. Auto etnografía fue la metodología cualitativa utilizada, construida en colaboración entre los autores. Los datos fueron producidos a través de observación participante, diarios de campo, reflexiones y entrevistas semiestructuradas con los farmacéuticos que desarrollan la práctica clínica en atención primaria de salud. Los resultados mostraron que los principales elementos para la sistematización de la práctica clínica son la 'Construcción de una nueva identidad profesional en equipo multiprofesional' y la 'Incorporación de nuevas actividades en el trabajo de rutina' que, combinados, dan lugar a una 'propuesta de integración del servicio de gestión integral de la farmacoterapia en los flujos de las unidades de salud'. Por lo tanto, para que el farmacéutico pueda legitimar su papel en la atención al paciente, es necesario cambiar, transformar, reorganizar y reconstruir su práctica.


Subject(s)
Humans , Pharmaceutical Services , Primary Health Care , Drug Therapy , Anthropology, Cultural
16.
J Eval Clin Pract ; 24(5): 1132-1138, 2018 10.
Article in English | MEDLINE | ID: mdl-29656532

ABSTRACT

BACKGROUND: Evidence-based medicine is the application of research findings to inform individual clinical decisions. There is a tension-both philosophical and practical-between the average result from a population study and the circumstances and needs of an individual patient. This personal account of "evidence-based" trauma care illustrates and explores this tension. THE CASE: The author, a keen athlete, describes her experience of a high-impact cycle accident that led to limb fractures (which were diagnosed and treated according to evidence-based guidelines) and also an occult injury to the cervical spine (which was not diagnosed at the time). Some evidence-based guidelines are reviewed and applied to the case. The clinical record described the cycle accident as a "fall." Initial assessment directed the clinicians' gaze to the obvious injuries, whose treatment was straightforward. On admission, the patient (aged 55 years at the time) was offered "falls prevention" via a guideline-based checklist. Several months later, neurological sequelae indicated possible damage to the cervical spine. But the NICE Guideline recommending cervical spine imaging in cases of high-impact trauma had not been considered-perhaps because the clinical narrative had been prematurely assigned to the script of "older person with fall." Furthermore, the author, who was (appropriately) treated with neurosurgery, was surprised at the response of clinical colleagues, based on application of an irrelevant section of a guideline, that her cervical discectomy was "nonevidence based." Nonsteroidal anti-inflammatory drugs for postoperative pain were indicated in this patient even though they were not recommended for the average patient. CONCLUSION: As Sir John Grimley Evans' warned, we should avoid using evidence-based guidelines in the manner of the fabled drunkard who searched under the lamp post for his key because that was where the light was, even though he knew he had lost his key somewhere else.


Subject(s)
Accidental Falls , Patients/classification , Practice Guidelines as Topic , Checklist , Diagnostic Errors , Evidence-Based Medicine , Female , Fractures, Closed , Humans , Middle Aged , Narrative Medicine , Spinal Fractures/surgery
17.
Implement Sci ; 12(1): 112, 2017 09 08.
Article in English | MEDLINE | ID: mdl-28886709

ABSTRACT

BACKGROUND: Knowledge produced through applied health research is often of a form not readily accessible to or actionable by policymakers and practitioners, which hinders its implementation. Our aim was to identify research activities that can support the production of knowledge tailored to inform policy and practice. To do this, we studied an operational research approach to improving the production of applied health research findings. METHODS: A 2-year qualitative study was conducted of the operational research contribution to a multidisciplinary applied health research project that was successful in rapidly informing national policy. Semi-structured interviews (n = 20) were conducted with all members of the project's research team and advisory group (patient and health professional representatives and academics). These were augmented by participant (> 150 h) and non-participant (> 15 h) observations focusing on the process and experience of attempting to support knowledge production. Data were analysed thematically using QSR NVivo software. RESULTS: Operational research performed a knowledge mediation role shaped by a problem-focused approach and an intent to perform those tasks necessary to producing readily implementable knowledge but outwith the remit of other disciplinary strands of the project. Three characteristics of the role were found to support this: engaging and incorporating different perspectives to improve services by capturing a range of health professional and patient views alongside quantitative and qualitative research evidence; rendering data meaningful by creating and presenting evidence in forms that are accessible to and engage different audiences, enabling them to make sense of it for practical use; and maintaining perceived objectivity and rigour by establishing credibility, perceived neutrality and confidence in the robustness of the research in order to unite diverse professionals in thinking creatively about system-wide service improvement. CONCLUSIONS: Our study contributes useful empirical insights about knowledge mediation activities within multidisciplinary applied health research projects that support the generation of accessible, practice-relevant and actionable knowledge. Incorporating such activities, or a dedicated role, for mediating knowledge production within such projects could help to enhance the uptake of research findings into routine healthcare and warrants further consideration.


Subject(s)
Health Services Research/methods , Operations Research , Research Design , Humans , Interviews as Topic , Qualitative Research , United Kingdom
18.
Stud Health Technol Inform ; 241: 128-133, 2017.
Article in English | MEDLINE | ID: mdl-28809195

ABSTRACT

Stimulating widespread interests of the population to participate in behavioural changes through information and technology has been an aim of much health informatics research. The recent widespread participation of the augmented reality game Pokémon Go which encourages exercises, provides significant insights into the potential of information technology to improve healthcare intervention on obesity-related disease. Does Pokémon Go point to another way of achieving health benefits using mobile devices? This paper analyses the features of Pokémon Go in relation to potential health benefits. This paper suggests from the perspective of a user on changes to the game that potentially could help with obesity, mental health cardiovascular health and vitamin D deficiencies. While the impact of augmented reality games on improving exercises might be substantial, the question of sustainability and likely long-term health outcomes remain debatable. The rapid uptake of Pokémon Go by the population around the world, however, should serve as a useful lesson for information and technological design to improve outcomes obesity-related diseases in the future.


Subject(s)
Cardiovascular Diseases/prevention & control , Delivery of Health Care , Mental Health , Obesity/complications , Problem Solving , User-Computer Interface , Exercise , Health Status , Humans
19.
Nurs Outlook ; 65(4): 372-379, 2017.
Article in English | MEDLINE | ID: mdl-28185682

ABSTRACT

BACKGROUND: It is important for nurses to serve on hospital boards, largely to give voice to matters of quality and patient safety. PURPOSE: Describe what one nurse was able to accomplish on a statewide board over time as chair of the board's Quality and Patient Safety Committee. METHODS: The experience was analyzed using auto-ethnography and narrative analysis. DISCUSSION: After describing the organization, the paper summarizes the key issues on which the nurse took the lead, measures of success in the role, and learning acquired along the way. CONCLUSION: The "system" orientation of nurses is an asset in getting hospital boards to view themselves as institutional champions of quality.


Subject(s)
Governing Board/organization & administration , Hospital Administration , Leadership , Nurse's Role , Patient Safety , Quality of Health Care , Adult , Female , Humans , Indiana , Male , Middle Aged , Organizational Case Studies
20.
J Lesbian Stud ; 21(4): 432-442, 2017 Oct 02.
Article in English | MEDLINE | ID: mdl-27723437

ABSTRACT

What are the hesitations, dangers, and potentialities to inviting students to peruse my body? What possibilities arise from centering and leading with the body in the teaching/learning process? What risks and possibilities does this enactment pose to a Black lesbian educator? This auto/ethnography journeys through and reflects upon my experience enacting what I have coined "embodied vulnerability" as a pedagogical practice. Within this essay, I explore the interrelationship of race, gender, and embodiment (or, the performance of self). In addition, I reflect upon the pedagogical exercise-enacted over the last seven years-of asking students to see me and name what they see to illumine how social identities are read alongside context/location, as well as in relation to other assumed identities. Due to the historical and contemporary framing of Blackness and femininity-as paradoxical in popular culture and popular constructions of Blackness and queerness as antithesis-my queerness is undetectable in predominantly White classroom spaces. This essay documents my experience working through this contentious reality and offers the practice "embodied vulnerability" as a feminist practice and educative tool for mediating how the body is understood in the classroom, invoking identity and mobilizing the body in teaching/learning processes.


Subject(s)
Black or African American/psychology , Faculty/psychology , Self Disclosure , Sexual and Gender Minorities/psychology , Humans , Social Identification , Students/psychology , Teaching
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