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1.
Ergonomics ; 67(6): 717-731, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38351886

ABSTRACT

Assistive robots have the potential to support independence, enhance safety, and lower healthcare costs for older adults, as well as alleviate the demands of their care partners. However, ensuring that these robots will effectively and reliably address end-user needs in the long term requires user-specific design factors to be considered during the robot development process. To identify these design factors, we embedded Stretch, a mobile manipulator created by Hello Robot Inc., in the home of an older adult with motor impairments and his care partner for four weeks to support them with everyday activities. An occupational therapist and a robotics engineer lived with them during this period, employing an immersive participatory design approach to co-design and customise the robot with them. We highlight the benefits of this immersive participatory design experience and provide insights into robot design that can be applied broadly to other assistive technologies.


Subject(s)
Equipment Design , Robotics , Self-Help Devices , Humans , Aged , Male , User-Centered Design , Activities of Daily Living , Female
2.
Healthcare (Basel) ; 11(23)2023 Dec 02.
Article in English | MEDLINE | ID: mdl-38063656

ABSTRACT

Coronavirus disease 2019 (COVID-19) affected not only individuals but also families. The purpose of this study was to clarify the temporal changes in the impact of the COVID-19 pandemic on entire families with older adults susceptible to infection living on small islands in Japan over the duration of the pandemic. Family ethnographic research was conducted from 2021 to 2023, using the Concentric Sphere Family Environment Theory as the theoretical framework. Formal interviews were conducted with 20 families. In addition, data from informal interviews, participant observation and other sources were compiled into field notes. All data on the impact on the entire family were extracted and content analysis was conducted. Six categories (family internal environmental system, family system unit, micro system, macro system, supra system, and family chrono-environment system) and a total of 85 subcategories were extracted. The results show that COVID-19 exerted not only negative but also positive impacts on the entire family, and their temporal changes are clarified. The impact on families is believed to have been influenced by the family external environment, such as increases and decreases of infection cases or events that occurred outside the family. The knowledge acquired from these studies will help healthcare professionals in providing appropriate family support.

3.
Med Anthropol ; 42(8): 707-719, 2023 11 17.
Article in English | MEDLINE | ID: mdl-37972251

ABSTRACT

"Hanging out" with one's interlocutors generates ethnographic ways to creatively involve people in health care research. This special issue focusses on people who are difficult to engage in conventional research because they are not verbally fluent, such as people with dementia or learning disabilities, or who speak a language that the researcher does not understand. In this introduction I discuss how "Hanging out" shifts the goal-orientation of research practices toward relationships and settings. Hierarchies may be shifted to provide attractive possibilities for interlocutors to participate by doing things together with the researcher. The research practice itself becomes the object of analysis.


Subject(s)
Anthropology, Cultural , Language , Humans , Anthropology, Medical
4.
BMC Health Serv Res ; 23(1): 1282, 2023 Nov 22.
Article in English | MEDLINE | ID: mdl-37993840

ABSTRACT

BACKGROUND: Shared Decision-Making to discuss how the benefits and harms of lung cancer screening align with patient values is required by the US Centers for Medicare and Medicaid and recommended by multiple organizations. Barriers at organizational, clinician, clinical encounter, and patient levels prevent SDM from meeting quality standards in routine practice. We developed an implementation plan, using the socio-ecological model, for Shared Decision-Making for lung cancer screening for the Department of Veterans Affairs (VA) New England Healthcare System. Because understanding the local context is critical to implementation success, we sought to proactively tailor our original implementation plan, to address barriers to achieving guideline-concordant lung cancer screening. METHODS: We conducted a formative evaluation using an ethnographic approach to proactively identify barriers to Shared Decision-Making and tailor our implementation plan. Data consisted of qualitative interviews with leadership and clinicians from seven VA New England medical centers, regional meeting notes, and Shared Decision-Making scripts and documents used by providers. Tailoring was guided by the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). RESULTS: We tailored the original implementation plan to address barriers we identified at the organizational, clinician, clinical encounter, and patient levels. Overall, we removed two implementation strategies, added five strategies, and modified the content of two strategies. For example, at the clinician level, we learned that past personal and clinical experiences predisposed clinicians to focus on the benefits of lung cancer screening. To address this barrier, we modified the content of our original implementation strategy Make Training Dynamic to prompt providers to self-reflect about their screening beliefs and values, encouraging them to discuss both the benefits and potential harms of lung cancer screening. CONCLUSIONS: Formative evaluations can be used to proactively tailor implementation strategies to fit local contexts. We tailored our implementation plan to address unique barriers we identified, with the goal of improving implementation success. The FRAME-IS aided our team in thoughtfully addressing and modifying our original implementation plan. Others seeking to maximize the effectiveness of complex interventions may consider using a similar approach.


Subject(s)
Early Detection of Cancer , Lung Neoplasms , Aged , Humans , United States , Lung Neoplasms/diagnosis , Medicare , Delivery of Health Care , New England , Decision Making
5.
Heliyon ; 9(9): e20375, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37810144

ABSTRACT

Background: Japan has experienced a rapid decline in birth rate and an aging population, coupled with women choosing to delay having children. Family carers are therefore increasingly expected to accept simultaneous responsibilities for both children and parents. This responsibility often falls on women in Japan, but little is known about their views. This study aimed to understand how Japanese women who are simultaneously responsible for caring for children and older people perceive their experiences. Methods: This was an ethnographic study conducted in central Japan. Over a period of 3 years and 5 months, we observed 19 people active in a peer support group for people with both childcare and caregiving responsibilities. We also carried out individual interviews with 14 Japanese women who were raising children and caring for parents or parents-in-law. Results: Five key themes emerged. These were "Accepting both childcare and caregiving as my role," "Inability to fulfill the role of mother," "Being supported by children and grandparents," "Unable to talk to anyone about the pressures of caregiving," and "Realizing that caregiving is not the only way to live." Conclusions: Japanese women who provided care to both children and older people were influenced by traditional Japanese values. However, they had a sense of mission and accepted the role of providing for their families. They felt guilty about not being able to fulfill their role as mothers, and were lonely, with no one to understand or advise them. If the burden of caregiving is concentrated on women, there is an increased risk that their children will become involved in providing some of the care for older people. It may therefore be necessary to develop a support system for female carers, and to increase understanding of the potential harm of placing caregiving responsibility solely on women.

6.
Article in English | MEDLINE | ID: mdl-36767312

ABSTRACT

The ageing population, increasingly frail and chronically ill, and COVID-19 pandemic challenges have highlighted national health systems' vulnerability and, more strongly/to a greater extent, the pivotal role of the family and community nurse (FCN). However, the recent introduction of FCNs in primary care settings has yet to be explored in Italy. This study aimed to identify the FCNs' cultural model and its implementation during the COVID-19 outbreak. A focused ethnographic study was performed in a primary care community service in northern Italy. Participants were FCNs (N = 5), patients and caregivers (N = 12). Qualitative data were collected through semi-structured interviews, field notes, observation of FCNs' activities and access to documents. Qualitative analysis identified themes concerned with crucial aspects of FCNs' activities, role implementation, and their relationship with patients and families. This study illuminated how the FCN strategically takes care of and identifies patients' and community needs. Although the COVID-19 outbreak hindered effective FCN project implementation, this study highlighted that the pandemic provided a chance to better identify cultural, organisational and educational weaknesses that need to be addressed to support the full accomplishment of FCNs' scope of practice.


Subject(s)
COVID-19 , Nurses , Humans , Pandemics , COVID-19/epidemiology , Anthropology, Cultural , Caregivers , Qualitative Research
7.
Public Health Nurs ; 40(1): 36-43, 2023 01.
Article in English | MEDLINE | ID: mdl-36372948

ABSTRACT

OBJECTIVES: This paper presents findings from our collaborative research on the perceptions and preferences of people experiencing homelessness regarding outreach nursing services. METHOD: We conducted qualitative research using a critical ethnography approach. SAMPLE: A total of 15 participants were interviewed individually (n = 12 people experiencing homelessness) and in focus groups (n = 3 care providers). We also conducted direct observation. RESULTS: This paper focuses on one of the core categories that emerged from the data analysis "Perception of Health Care." This category emerged from the following three subcategories, which we will present in this paper: (1) Conflicting Relationships with Institutional Health Services; (2) Perception of Outreach Services; (3) Recommendations from Mobile Clinic Users. CONCLUSION: There are a range of perceptions of health services among people experiencing homelessness. Some are satisfied with the care received in the public health system, while many have experienced dehumanizing practices. Overall, outreach services are a promising strategy to reach people who are not served by the traditional modes of care delivery. Based on our findings, we suggest several key practices to personalize and adapt healthcare services and foster inclusive environments to better serve people experiencing homelessness.


Subject(s)
Ill-Housed Persons , Humans , Health Services , Delivery of Health Care , Qualitative Research , Focus Groups
8.
Front Sociol ; 7: 991183, 2022.
Article in English | MEDLINE | ID: mdl-36530449

ABSTRACT

Introduction: In middle and low resource countries worldwide, up to 70% of breast cancer cases are diagnosed as locally advanced (stages IIB-IIIC). Delays in referral from primary to specialty care have been shown to prolong routes to diagnosis and may be associated with higher burdens of advanced disease, but specific clinical and organizational barriers are not well understood. Methods: This article reports on the use of rapid ethnographic research (RER) within a largescale clinical trial for locally advanced breast cancer (LABC) in India, Mexico, South Africa, and the US. Our purpose is twofold. First, we demonstrate the value of ethnography as a mode of evaluative listening: appraising the perspectives of diverse patients and clinicians regarding prolonged routes to LABC diagnosis and treatment. Second, we show the value of ethnography as a compass for navigating among discrepant clinical research styles, IRB protocols, and institutional norms and practices. We discuss advantages and limits involved in each use of RER. Results: On the one hand, ethnographic interviews carried out before and during the clinical trial enabled more regular communication among investigators and research sites. On the other hand, the logistics of doing the trial placed limits on the extent and duration of inductive, immersive inquiry characteristic of traditional fieldwork. As a partial solution to this problem, we developed a multimodal ethnographic research (MER) approach, an augmentation of video-chat, phone, text, and email carried out with, and built upon the initial connections established in, the in-person fieldwork. This style has its limits; but it did allow us to materially improve the ways in which the medical research proceeded. Discussion: In conclusion, we highlight the value of not deferring to a presumed incommensurability of ethnographic fieldwork and clinical trialwork while still being appropriately responsive to moments when the two approaches should be kept apart.

9.
Cult. cuid ; 26(64): 1-13, 3º Cuatrimestre 2022.
Article in Spanish | IBECS | ID: ibc-213753

ABSTRACT

Introduction: There are ancestral care during the puerperium that remain in force, butthey are opposed to those indicated by the health personnel. Objective: Understand the culturalmeaning of the body, feeling and traditional care in the puerperium from the Nahua worldview.Methods: Qualitative ethnographic research carried out in the Axtla de Terrazas indigenous community in San Luis de Potosí, Mexico, from March to July 2019. The sample was non-probabilisticfor convenience, 14 postpartum women from the community participated. To collect the data, thefield diary, the participant observation and the ethnographic interview with prior informed consentwere used, which were then manually processed according to the thematic analysis. Results: Threecultural themes emerged: a) Affections that the "hot" body of the puerperal woman can cause, b)The feeling of the woman in the puerperium: Between pain and joy, c) Traditional care to avoidcomplications during the puerperium. Conclusions: There are meanings about the body, feelingsand traditional care during the puerperium in the Nahua worldview. For this reason, health caremust be intercultural, considering the customs of postpartum women, to avoid care that may beconsidered intrusive, causing a culture shock, and that they never attend their check-ups again. (AU)


Introducción: Existen cuidados ancestrales durante el puerperio que se mantienen vigentes, pero se contraponen con los indicados por el personal de salud. Objetivo. Comprender el significado cultural del cuerpo, el sentir y los cuidados tradicionales en el puerperio desde la cosmovisión nahua. Métodos: Investigación etnográfica cualitativa realizada en la comunidad indígenaAxtla de Terrazas en San Luis de Potosí, México, de marzo a julio de 2019. La muestra fue no probabilística por conveniencia, participaron 14 puérperas de la comunidad. Para recolectar los datos,se utilizaron el diario de campo, la observación participante y la entrevista etnográfica con consentimiento informado previo, que luego fueron procesadas manualmente según el análisis temático.Resultados: Emergieron tres temas culturales a) Afecciones que puede ocasionar el cuerpo “caliente” de la puérpera, b) El sentir de la mujer en el puerperio: Entre el dolor y la alegría, c) Cuidadostradicionales para evitar las complicaciones durante el puerperio. Conclusiones: Existen significados sobre el cuerpo, sentimientos y cuidados tradicionales durante el puerperio en la cosmovisiónnahua. Por ello, la asistencia sanitaria debe ser intercultural considerando las costumbres de laspuérperas, para evitar cuidados que puedan considerarse intrusivos provocando un choque cultural, y que nunca más asistan a sus controles. (AU)


Introdução: Existem cuidados ancestrais durante o puerpério que permanecem em vigor,mas são contrários aos indicados pelos profissionais de saúde. Objectivo: Compreender o significado cultural do corpo, sentimento e cuidado tradicional no puerpério a partir da cosmovisão nahua. Métodos: Pesquisa etnográfica qualitativa realizada na comunidade indígena Axtla de Terrazas em San Luis de Potosí, México, de março a julho de 2019. A amostra foi não probabilística porconveniência, participaram 14 puérperas da comunidade. Para a coleta dos dados foram utilizadoso diário de campo, a observação participante e a entrevista etnográfica com consentimento prévioinformado, os quais foram processados manualmente de acordo com a análise temática. Resultados:Emergiram três temáticas culturais: a) Afetos que o corpo "quente" da puérpera pode causar, b) Osentimento da mulher no puerpério: Entre a dor e a alegria, c) Cuidados tradicionais para evitarcomplicações durante o puerpério. Conclusões: Há significados sobre o corpo, sentimentos e cuidados tradicionais durante o puerpério na visão de mundo nahua. Por isso, a atenção à saúde deve serintercultural, considerando os costumes das puérperas, para evitar cuidados que possam ser considerados intrusivos, causando choque cultural, e que nunca mais compareçam ao seu check-up. (AU)


Subject(s)
Humans , Anthropology, Cultural , Nursing , 50227 , Postpartum Period/ethnology , Postpartum Period/psychology , Qualitative Research , Mexico
10.
Front Psychol ; 13: 957831, 2022.
Article in English | MEDLINE | ID: mdl-36164405

ABSTRACT

There is currently enough systematic literature presents about socioeconomic inequalities across different disciplines. However, this study relates socioeconomic inequality (SEI) to rural students educational management information systems (EMIS) in different schools in China. The dynamic force of information technology could not be constrained in the modern techno-based world. Similarly, the study was qualitative and ethnographic. Data were collected through an interview guide and analyzed with thematic scientific analysis. Ten male and ten female students were interviewed based on data saturation point. The purposive sampling technique was used for the rural school and students' selection. This study summarizes the findings and brings together in-depth emic and etic findings based on new Marxist conflict theory, exploitation, and domination power lens. The study found that SEI creates disparities among EMIS. Household income inequality has influenced on educational achievements of rural areas' students. Gender-based SEI was not present among students. Family wealth and SES-based exploitation are present regarding EMIS among male and female students. Household wealth is significant for the EMIS. The study put forward a recommendation to the policymakers that exploitation could be overcome among students if the government provides equal opportunities for access to the EMIS.

11.
Appetite ; 178: 106265, 2022 11 01.
Article in English | MEDLINE | ID: mdl-35932969

ABSTRACT

Foodborne disease is intimately connected to nutrition and causes considerable harm to health and economic wellbeing. Consumers play a key role in food safety, making it essential to understand the motivations, beliefs, and practices that shape their decisions. Ethnographic research methods are well suited to understanding such topics but have rarely been applied to food safety. This paper presents an evidence synthesis of ethnographic studies, with an emphasis on food safety beliefs, values, and related socio-cultural information, and a focus on consumers' purchasing behaviors. Vendor perspectives are also briefly considered. Key findings include the importance of trust, strategies to reduce risk, the effects of economic status and gender, and broader cultural concepts about foods that influence food purchasing. The synthesis demonstrates that there are numerous social and cultural factors that influence decision making related to food safety, offering insights for the design of interventions to reduce exposure to foodborne disease and improve nutrition.


Subject(s)
Developing Countries , Foodborne Diseases , Consumer Behavior , Food Safety , Foodborne Diseases/prevention & control , Health Knowledge, Attitudes, Practice , Humans , Income
12.
Front Psychol ; 13: 789404, 2022.
Article in English | MEDLINE | ID: mdl-35602750

ABSTRACT

New work is used as a general term to summarize professional developments in contemporary work style, structure and modus of organizations and society-this means collaborative work and flexible working hours on individual levels, and flat hierarchies and participatory decision-making on organizational levels. Contemporary corporations strive to orient toward the concept of new work to keep up with stakeholder demands, for instance in their branding strategies as an employer. However, studies on organizational practices indicate that alongside explicit values and agendas, organizations tend to slyly exert power to secure their (economic) interests. Constructive dismissal is one such instance where contractually protected employees are made to resign their positions because the work environment is altered to become increasingly unbearable. This research analyzes two case studies to explicate routine dismissal procedures at the managerial level in two internationally operating German corporations. Both corporations explicitly profile as new work environments and are structured according to democratic principles including flat hierarchies, feature institutionalized diversity management including control committees for equal opportunities, and emphasize values such as workplace dignity, employee agency, and equality. The data contain long-term participatory observation collected over a 6-month period from two managers of 5 and 8 years of experience in managerial duties. The content analysis of data reveals characteristics of everyday processes in these organizations especially in terminating managers. The findings are presented as the 'model of the silent dismissal,' containing seven types of managerial termination carried out by implicit power and symbolic conventions that circumvent subject participation and litigation in an effortless manner. After exposing the model's mechanisms, we turn to discuss its meaning for both terminated and surviving subjects against a critical theoretical framework of neoliberalism, democracy, and power.

13.
Foods ; 11(2)2022 Jan 12.
Article in English | MEDLINE | ID: mdl-35053935

ABSTRACT

This paper uses detailed data from in-depth interviews with consumers (n = 47) and vendors (n = 37) in three traditional markets in Birnin Kebbi, Nigeria. We used observations from those markets to examine how consumers and vendors identify and avoid or manage food safety risks and whom they hold responsible and trust when it comes to ensuring food safety. At the level of the vendor, consumers mentioned seeking "clean" or "neat" vendors or stalls. Cleanliness was primarily related to the appearance of the vendor, stall, and surroundings; reliance on trusted, known vendors was also noted. Food products themselves were largely evaluated based on visual cues: insects, holes, and colors-with some reliance on smell, also. Similarly, vendors assessed safety of food from suppliers based on a visual assessment or reliance on trusted relationships. On the second research question, both consumers and vendors largely placed responsibility for ensuring food safety on government; when asked specifically, consumers also named specific steps that vendors could take to ensure food safety. Consumers and vendors also generally felt that they could limit many food safety risks through identifying the "good" products in the market or from suppliers. The paper discusses the implications of these results for behavior change interventions.

14.
Foods ; 11(2)2022 Jan 14.
Article in English | MEDLINE | ID: mdl-35053957

ABSTRACT

This study examines the food safety beliefs of vendors and consumers in a mid-sized Nigerian city using data from in-depth interviews and cognitive mapping techniques drawn from ethnography. We examine vendors' and consumers' perspectives on which foods are safe, which are not, and why; the place of foodborne illness among other health concerns and motivators of food choice; and how salient food safety is as a concern for vendors. The main perceived causes of unsafe food were found to be chemicals and insects; while bacterial illnesses were widely mentioned as a cause of gastrointestinal symptoms, these were not necessarily linked to food in consumers' minds. Respondents agreed strongly that certain foods (e.g., cowpea, beef, green leafy vegetables, and local rice) were less safe than others. The importance of food safety as a choice motivator among consumers varies depending on framing: when asked directly, it was prominent and closely related to visible cleanliness, but concerns about food safety competed in consumers' minds against other salient motivators of food and vendor choice, such as price. Most vendors did not see food safety, cleanliness, or hygiene as a key trait of a successful vendor, and just over half of vendors had any concern about the safety of their food. In conclusion, we note the implications for intervention designs, particularly the need to build upon consumers' and vendors' current beliefs and practices related to food safety in order to make foodborne disease prevention a more salient concern in food choice.

15.
Arts Health ; 14(2): 204-216, 2022 06.
Article in English | MEDLINE | ID: mdl-34137671

ABSTRACT

BACKGROUND: Research concerning art initiatives within palliative care mainly addresses the artist's perspective. Our study brings in the end users' voices. METHOD: We conducted ethnographic research in the framework of a program that invited professional artists to work at a Belgian palliative and supportive day care center. We examined how the so-called guests (i.e. end users) valued and experienced the artists' presence and activities. RESULTS: Guests mentioned a positive influence on their personal and social well-being. They also indicated a cultural and artistic value. Art activities offered them something new and unexpected and took them to a different place. Guests felt challenged by activities when their well-being was negatively provoked, when they experienced activities as incomprehensible or in case of logistic hassle. CONCLUSIONS: Art activities in palliative care settings must be adapted to the interests and abilities of the end users and supported by an educational and logistic framework.


Subject(s)
Art Therapy , Art , Hospice and Palliative Care Nursing , Humans , Palliative Care
16.
Front Sociol ; 7: 1092181, 2022.
Article in English | MEDLINE | ID: mdl-36687011

ABSTRACT

Introduction: This work aims at transposing ethnographic research into digital contexts to probe its potential and limitations in a specific field of study: that of sexuality, particularly suited to ethnographic exploration. We chose as our case study a web community of Italian asexual people. As we shall see, this allowed us to simultaneously explore both the various techniques called into play in digital ethnography and the digital as a specific sphere within which sexuality takes on a very peculiar meaning. Digital sociality is paramount for the definition of imaginaries, meanings, and practices that could not be explored elsewhere. This is due to the implicit characteristics of the population studied, which does not find corresponding physical spaces of aggregation. Methods: The paper will present the research design using this specific case study to address some of the typical dilemmas that researchers face when following the digital ethnographic approach and will explore the research results as an example of the kind of analysis available with the information and data collected through this method. Results and discussion: The conclusions will attempt to briefly outline the shortfalls and advantages of this method, considering its application to this specific field of study.

17.
Nurs Health Sci ; 23(3): 586-610, 2021 Sep.
Article in English | MEDLINE | ID: mdl-33817939

ABSTRACT

This meta-ethnography had the objectives of identifying, evaluating, and summarizing the findings of qualitative studies regarding the suffering experiences of people undergoing chemotherapy, as well as developing an explanatory conceptual structure regarding what affects these experiences. A systematic literature review was carried out, covering the past 10 years, in the following databases: CINAHL, Embase, Medline, LILACS and Scopus. By using meta-ethnographic synthesis methods, the following themes were found: the pain of loss; evaluating, measuring, and neutralizing the threat; and social contours of suffering. The experience of living with cancer and undergoing chemotherapy was synthesized into a theoretical-explanatory model with a structure that resembles barbed-wire loops. The model expresses people's suffering experiences as marked by the feeling of loss, restraint of emotions, and resilience. While transcendent movements broke the cycle of suffering, resilience emerged as a learning experience that made patients more resistant to the pain of loss. The results indicated a complex and diverse set of factors that influence suffering, which confirmed that experiences are individual, comprehensive, and continuously reinterpreted.


Subject(s)
Anthropology, Cultural , Antineoplastic Agents/therapeutic use , Neoplasms/drug therapy , Neoplasms/ethnology , Neoplasms/psychology , Pain , Emotions , Humans , Qualitative Research
18.
Article in English | MEDLINE | ID: mdl-33918632

ABSTRACT

Little progress has been made to advance U.S. federal policy responses to growing scientific findings about cumulative environmental health impacts and risks, which also show that many low income and racial and ethnic minority populations bear a disproportionate share of multiple environmental burdens. Recent scholarship points to a "standard narrative" by which policy makers rationalize their slow efforts on environmental justice because of perceived lack of data and analytical tools. Using a social constructivist approach, ethnographic research methods, and content analysis, we examined the social context of policy challenges related to cumulative risks and impacts in the state of Maryland between 2014 and 2016. We identified three frames about cumulative impacts as a health issue through which conflicts over such policy reforms materialize and are sustained: (a) perceptions of evidence, (b) interpretations of social justice, and (c) expectations of authoritative bodies. Our findings illustrate that policy impasse over cumulative impacts is highly dependent on how policy-relevant actors come to frame issues around legislating cumulative impacts, rather than the "standard narrative" of external constraints. Frame analysis may provide us with more robust understandings of policy processes to address cumulative risks and impacts and the social forces that create health policy change.


Subject(s)
Ethnicity , Minority Groups , Environmental Health , Health Policy , Humans , Maryland , Social Justice
19.
Scand J Caring Sci ; 35(3): 761-768, 2021 Sep.
Article in English | MEDLINE | ID: mdl-32666524

ABSTRACT

RATIONALE AND AIM: Home nurses work largely alone, and consequently, 'difficult patients' can be challenging for them. Understanding of this phenomenon can have a major impact on the quality of care. The aim is to explore how nurses characterise, relate to and interact with these patients. Why do nurses perceive some patients as difficult and what are the consequences for the patient? What are these patients´ expectations of the nurses and their perceptions of illness? METHODS: An ethnographic study with 30 participant observations of 12 nurses visiting 146 patients was conducted. A total of 6 interviews were made with 4 'difficult patients' and 11 interviews with 5 nurses. FINDINGS: In the nurses' view, the 'difficult patients' had little insight into their illnesses, denied they were ill and were noncompliant. Some nurses had negative feelings about a patient, regarded the patient as too demanding or found the patient´s personal characteristics repulsive. The difficulty lies in the relationship between nurse and patient. Important health problems of some patients remained unrecognised. The nurses regarded the patients' illnesses as self-inflicted. The patients had low expectations of nurses, lacked knowledge about what to expect of them, and their views on their illnesses differed from those of the nurses. Contributing causes of patients becoming difficult for nurses seemed to be different norms and values and the nurses' work situation. CONCLUSION: It is important that nurses communicate their knowledge about the connection between illness and pathogenic social conditions and discuss 'self-inflicted' illness and their role in relation to this. Supervision is suggested. Improved working conditions could lead to fewer 'difficult patients'. STUDY LIMITATIONS: The perspectives of patients should be studied in greater detail.


Subject(s)
Nurses, Community Health , Anthropology, Cultural , Home Nursing , Humans , Nurse-Patient Relations
20.
Int J Qual Stud Health Well-being ; 15(1): 1815484, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32924864

ABSTRACT

PURPOSE: The purpose of this study was to explore how everyday life was organized in a Danish nursing home for people living with advanced dementia and how relatives experienced their family members' everyday lives. METHODS: Field notes from participant observations (approximately 160 hours) and transcripts from ethnographic interviews with relatives (9) were analysed thematically in accordance with ethnographic principles. RESULTS: The analysis revealed one main theme, 'Enabling a meaningful everyday life in the nursing home' with two corresponding sub-themes: (1) Structures of daily life: Balancing collective and individual activities and (2) Physical togetherness: Balancing being together and being alone. CONCLUSIONS: The findings showed that everyday life in the nursing home was organized to support a meaningful life for the residents by providing activities and togetherness on a daily basis. While relatives generally appreciated the everyday life experienced in the nursing home, challenges were encountered in connection with the provision of an appropriate balance between levels and types of activities and togetherness for all residents.


Subject(s)
Dementia/epidemiology , Family/psychology , Homes for the Aged/organization & administration , Nursing Homes/organization & administration , Anthropology, Cultural , Denmark/epidemiology , Humans , Qualitative Research , Severity of Illness Index
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