Living through unsuccessful conception attempts: a grounded theory of resilience among women undergoing fertility treatment.

OBJECTIVE: To provide a model of resilience among women undergoing fertility treatments, who experience repeated unsuccessful conception attempts. BACKGROUND: Assisted reproductive treatment is emotionally and physically challenging. Women undergoing such treatments report experiencing high levels of anxiety and depression. There continues to be a lack of understanding of the process women go through to adapt to the challenges associated with fertility treatment, in order to continue to pursue their goal of pregnancy. METHOD: The study employed a qualitative Grounded Theory design. Eleven women aged between 24 and 42 years took part in individual semi-structured interviews around their experiences of living through unsuccessful fertility treatment attempts. RESULTS: Three core categories were identified: 'Appraisal'; 'Stepping away from treatment'; and 'Building self up for the next attempt'. Following the failure of treatment, participants appraised their ability to carry on with further treatment attempts. Those who felt they had depleted their resources through the cycle of attempting pregnancy had taken a step back from the treatment cycle to reconnect with themselves and gather sufficient resources to attempt treatment again. During preparation for the next treatment, participants demonstrated their resilience by taking steps to build up their resources, such as nurturing their strength and taking control of their fertility experience. CONCLUSIONS: Women undergoing fertility treatment demonstrate their resilience through a variety of actions that enable them to continue to pursue their pregnancy goal. Clinical staff should be mindful of their clients' need to withdraw from the treatment cycle and offer support to enable them to do this.

Sexuality after stroke: an exploration of current professional approaches, barriers to providing support and future directions.

Purpose Sexual difficulties post-stroke are common, yet frequently neglected within rehabilitation. This study aimed to explore the process by which healthcare professionals approach and work with the topic of sexuality within stroke rehabilitation. Method Ten participants were recruited from 5 community and inpatient multi-disciplinary stroke rehabilitation teams. Semi-structured interviews were carried out and data were analysed using grounded theory methodology. Results The authors developed a theoretical model of how professionals engage with sexual concerns. Professionals' own personal level of comfort with the topic of sexuality interacted with a series of barriers to limit opportunities for engagement. These barriers included factors relating to the context and workplace environment of stroke rehabilitation, professionals' perceptions that they did not have adequate skills in this area and unhelpful attitudes towards stroke survivors and sexuality. Although the majority of participants rarely engaged with sexual issues, they adopted both direct and indirect strategies for engaging with their service users' sexual concerns. Concerns were usually addressed through the provision of information and supportive conversations. Conclusions The findings suggest that sexuality is not a legitimised topic within stroke rehabilitation, and current work practises limit professionals' abilities to address service-users' concerns. Implications for developing effective training and staff support are discussed. Implications for rehabilitation Professionals working within stroke rehabilitation rarely directly bring up sexuality with patients, but an indirect method of approaching the topic is more common. Addressing sexual concerns often does not require expertise. Training should show professionals how to use transferable knowledge to address sexual issues and also enhance communication skills. Sexuality should be incorporated within local stroke policy and procedures, to support professionals in addressing the concerns of their patients and motivate them to act.

How sickle cell disease patients experience, understand and explain their pain: An Interpretative Phenomenological Analysis study.

OBJECTIVES: Sickle cell disease (SCD) is the UK's most common blood disorder causing sickle shaped red blood cells to block small blood vessels inducing both acute and chronic pain. A crucial factor in determining quality of life for those with SCD is the severity, timing and number of painful sickling episodes. However, little research focuses on the nature of pain and so it is poorly understood. The aim of this study is to provide an in-depth and meaning led account of the experience of SCD pain. DESIGN: Qualitative research design. METHODS: Seven face-to-face semi-structured interviews were conducted. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis. RESULTS: Participants described experiencing unimaginable, agonising, continuous, inescapable and limitless pain which was almost impossible to describe; participants resorted to using analogy and personification as a way to overcome this difficulty. Participants spoke about a process where, ultimately, they felt obliged to accept their illness as it would never be cured; but were able to appreciate life and recognize positive life lessons as a result of living with SCD. CONCLUSIONS: This research indicates that therapeutic work around analogy can help individuals understand and express their pain and that current attempts to measure pain are unhelpful for SCD populations. Further research is needed across a wider SCD population to forward the findings of this qualitative study. STATEMENT OF CONTRIBUTION: What is already known on this subject? Sickle cell disease (SCD) has an impact on all aspects of a person's life (Edwards et al., 2005, International Journal of Behavioral Medicine, 12, 171). Strickland , Jackson, Gilead, McGuire, and Quarles (2001, Journal of the National Black Nurses' Association, 12, 36) suggest that one of the crucial factors in determining quality of life for those with SCD is the severity, timing and number of painful sickling episodes. Exacerbations of pain are also cited as explanation for the majority of medical contacts for people with SCD (McClish et al., 2009, Pain, 145, 246). The majority of research focuses on the consequences of pain in terms of handicap, and its impact on emotional well-being, relationships and the need for medication/hospital treatment (Booker et al., 2006, Chronic Illness, 2, 39; Weisberg et al., 2013, Journal of Hospital Medicine, 8, 42) rather than how SCD patients experience and understand their pain. However, the actual nature of pain experience in SCD is poorly understood and sub-optimally managed (Booker et al., 2006; Taylor et al., 2010, Journal of Pain and Symptom Management, 40, 416). What does this study add? The experience of SCD pain is indescribable without the use of analogy, as it is unbearable, agonising, constant, inescapable and without limit. Difficulty describing pain creates a perception of being misunderstood or minimized by professionals. Personification of pain is often employed by patients to attempt to form a relationship with pain. Current pain measures used in clinical practice are inadequate at capturing the acute and chronic SCD pain experience.

The lives of adults over 30 living with sickle cell disorder.

OBJECTIVES: The study investigated the lived experiences of adults over 30 years old living with sickle cell disorder (SCD) and sought to develop a model understanding participants' ability to function. DESIGN: Over a period of 10 months, in-depth individual interviews were held with nine participants and three focus groups were held with six further participants. METHODS: Grounded theory, a qualitative methodology, was chosen to explore functioning across domains of experience in order to build an explanatory model. RESULTS: Physical, psychological, and social functioning were adversely effected by SCD. Access to and quality of resources including friends, family, and finances formed the context in which participants attempted to manage the disorder. Management of SCD improved over time as participants moved to acceptance of the condition. This allowed participants to strengthen their resilience by creating meaning, developing their identity, and actively coping with the effects of SCD, thus improving their ability to function and to appreciate life. CONCLUSIONS: The study demonstrates the considerable resilience of people over 30 with SCD, providing a positive and hopeful model which can be utilized clinically to support the functioning of people with SCD.