"We are not the person we will be when these things happen:" Reflections on personhood from an ethnography of neuropalliative care.

Neuropalliative care developed to address the needs of patients living with life-limiting neurologic disease. One critical consideration is that disease-related changes to cognition, communication, and function challenge illness experiences and care practices. We conducted an ethnography to understand neuropalliative care as a phenomenon; how it was experienced, provided, conceptualized. Personhood served as our conceptual framework; with its long philosophical history and important place in nursing theory, we examined the extent to which it captured neuropalliative experiences and concerns. Personhood contextualized complex losses, aligning the impact of functional and relational changes. Cognition, communication, and functional alterations stretched conceptions of personhood, insinuating it can be relational, fluid, adaptive. Although normative conceptions of personhood guided research and decision-making, ethical considerations suggested personhood could be transformed, remade. We consider the implications of our findings through three themes. First, we examine how literature on illness experience fails to integrate the realities of people living with and dying from neurologic disease; we counter this by interrogating the concept of experience. Second, we turn to Ricoeur's work on recognition to illuminate relational conceptions of personhood to inform care practices. Finally, we reflect on how personhood can bridge the gap left by functional changes, enhance relational engagement, and promote dignity at the end of life.

Enhancing children's participation in dental research: A commentary.

The concept of childhood has evolved over the years, inspired by the United Nations Convention on the Rights of the Child in 1989, shifting from developmental models to a conception of childhood that recognizes children as moral agents. This evolution highlights the importance of respecting children's agency and their right to be heard in matters that are related to them. In conventional health research, however, children's voices are often inadequately accessed. In this commentary, we discuss the imperative to recognize children's agency in dental research and a shift from research on children to research with and by children. Moreover, we underscore the importance of actively seeking and listening to children's voices and recognizing their agency in shaping research and healthcare practices in the field of dentistry. Further, we explore the application of participatory research approaches in dental research and provide examples of studies that have involved children in various capacities. We conclude this commentary by emphasizing the potential benefits of participatory research in both qualitative and quantitative dental studies to promote deeper understanding, clearer communication, and stronger advocacy regarding children's interests. Primarily, we call for greater recognition of children's agency in dental research and advocate for more inclusive and child-centred research methodologies.

Learning Through Teaching: How Physicians Learn Medicine in Authentic Clinical Contexts.

PURPOSE: Little is known about the clinical knowledge and skills that are acquired by physicians through teaching, how such learning occurs, or the factors that influence this process. This study explored how physicians acquire clinical knowledge and skills through clinical teaching and examined the contextual elements that influence this learning. METHOD: Two theoretical frameworks informed this interpretive description study: situated learning and cognitive apprenticeship. From March to November 2021, semistructured interviews and follow-up discussions were conducted at McGill University with clinician-teachers who regularly supervise internal medicine residents. Participants were asked to describe how they learned clinical medicine through spontaneous clinical teaching, guided by questions relating to what they learned, memorable teaching moments, and factors influencing this learning. Data were analyzed iteratively, using both a deductive and inductive approach. RESULTS: Of the 87 contacted physicians, 45 responded, expressing interest (n = 22) or declining participation (n = 23), and 42 did not respond. All 22 clinicians who responded positively were interviewed, with 7 follow-up discussions. Results suggested that clinician-teachers encountered myriad opportunities to learn clinical medicine during spontaneous interactions with trainees. These interactions, embedded in authentic patient care, were influenced by clinician-teacher characteristics, trainee characteristics, and contextual affordances. Clinician-teachers were stimulated to learn by trainee presence and through discrete interactions with trainees. These stimuli often led to feelings of "performative pressure" to role model and teach effectively or "slowing down" in thinking, prompting clinician-teachers to engage in learning processes (e.g., reflection, collaboration, and articulation), which resulted in knowledge acquisition, reinforcement, and refinement. CONCLUSIONS: Learning through teaching is an underappreciated strategy that can help clinician-teachers improve their clinical knowledge and skills. This study uncovered some of the processes through which clinicians learn during spontaneous clinical teaching and the factors that modulate this learning.

Integration of an evidence-based caries management approach in dental education: The perspectives of dental instructors.

PURPOSE/OBJECTIVES: Evidence-based caries management (EBCM) has developed into an internationally recognized tool for integration of comprehensive non-surgical caries treatment in dental education. However, uptake of the EBCM approach remains uneven across Canadian dental schools. Our project sought to understand how dental instructors perceive the challenges and solutions to the integration of the EBCM approach in undergraduate clinical education. METHODS: Using a qualitative descriptive design, we recruited a purposeful sample of clinical instructors supervising undergraduate dental students in caries-related dental care. Semi-structured, online interviews focused on the main characteristics of EBCM. Interviews were analyzed using the awareness, desire, knowledge, ability, and reinforcement (ADKAR) change management model to understand challenges with EBCM implementation in undergraduate education. The analysis process started with verbatim transcription; then, transcripts were coded deductively based on the interview guide and the ADKAR model domains, and inductively to generate emergent codes. Finally, thematic analysis was used to develop themes and subthemes. RESULTS: We interviewed 11 dental instructors with a wide range of clinical experience. Our results show that participants had sufficient awareness regarding the need for the EBCM approach and portrayed a strong desire to participate in bringing curricular changes. Knowledge and ability of participants depended on their training, experience, and involvement in continuing education courses. A lack of standardized caries management practices, less chairside time, and poor remuneration for instructors were major barriers in EBCM clinical implementation. Potential solutions suggested included providing continuing education courses, credits for students for non-surgical caries management, and remunerating instructors for implementation. CONCLUSIONS: In conclusion, most participants were aware of the need for a substantive change toward EBCM and demonstrated the desire to participate and improve its implementation. Our analysis showed that to facilitate full integration of the EBCM approach into the undergraduate dental clinics, organizational focus needs to be placed on the individual's knowledge and ability, with tailored efforts toward reinforcement.

What are the impacts of oral complications from cancer therapy on the quality of life of children? A protocol to update a scoping review.

INTRODUCTION: Cancer treatments can damage healthy tissues and organs, and leave harmful impacts on cancer survivors, especially on children and adolescents. The oral effects of cancer treatment can occur during or soon after treatment, or months-even years-later. Cancer treatments can also affect the child, psychologically and socially by hindering their speech, eating, sleeping, and social interactions. These effects can have profound impacts on children's quality of life. Building on a previous review published in 2012, this scoping review aims to identify and map the current evidence base underpinning the oral health-related impacts of cancer treatment on the quality of life of children with cancer. METHODOLOGY AND METHODS: Our methodology is guided by Arksey and O'Malley's methodological framework for scoping reviews, Levac's additions to the framework, and follows the Joanna Briggs Institute Reviewer's Manual. Five electronic databases and grey literature will be systematically searched using a predefined search strategy. Two reviewers will independently screen the retrieved articles using Rayyan software and chart data from included articles. One of the team's senior research members will act as a third reviewer and make the final decision on disputed documents. We will include literature with a focus on oral health-related quality of life of children undergoing cancer treatments. Following the selection of studies, data will be extracted, synthesized, and reported thematically and the relevant stakeholder's insight will be added to our results.

Introducing SAMMSA, a Five-Step Method for Producing 'Quality' Qualitative Analysis.

Qualitative health research is ever growing in sophistication and complexity. While much has been written about many components (e.g. sampling and methods) of qualitative design, qualitative analysis remains an area still needing advanced reflection. Qualitative analysis often is the most daunting and intimidating component of the qualitative research endeavor for both teachers and learners alike. Working collaboratively with research trainees, our team has developed SAMMSA (Summary & Analysis coding, Micro themes, Meso themes, Syntheses, and Analysis), a 5-step analytic process committed to both clarity of process and rich 'quality' qualitative analysis. With roots in hermeneutics and ethnography, SAMMSA is attentive to data holism and guards against the data fragmentation common in some versions of thematic analysis. This article walks the reader through SAMMSA's 5 steps using research data from a variety of studies to demonstrate our process. We have used SAMMSA with multiple qualitative methodologies. We invite readers to tailor SAMMSA to their own work and let us know about their processes and results.

How to use mixed methods in oral health research.

Wicked problems exist in the realm of oral health research. Due to their inherent complexity, using qualitative or quantitative methods alone may not be adequate for resolving them. Mixed methods approaches combine qualitative and quantitative methods, and thus, can provide a powerful tool for understanding and solving complex problems in dental public health. However, using mixed methods does not come without its challenges. This commentary outlines four main tips for researchers to consider when applying mixed methods to their research projects.

The Necessity of qualitative research for advancing oral health.

Researchers are engaged with producing knowledge. Through this knowledge production, they make claims about the world. For applied health researchers, our knowledge production is both a scientific as well as a moral activity. Increasingly, oral health researchers are turning to qualitative research, a research approach that takes science and morality seriously. Qualitative research pushes researchers to think about the different worlds in which people live and work, and endeavours to generate data that reflect those worlds. This paper argues that humans are complex, and that qualitative approaches are necessary for understanding how we are all deeply embedded in historical, social, cultural and political contexts, and why this matters when thinking about oral health. This paper also dispels myths about the limitations of qualitative research and proposes future directions to improve the sophistication of qualitative oral health sciences.

No time to grieve: Inuit loss experiences and grief practices in Nunavik, Quebec.

This article presents an overview of past and current grief rituals and practices and existing grassroots and institutional initiatives seeking to address the complex, prolonged, and traumatic grief experienced by many Inuit living in Quebec. While conducting a study seeking to identify the strengths, resources, and challenges for Nunavik's Inuit communities related to end-of-life care, results emerged concerning how family caregivers' grief related to the dying process was compounded by the sequelae of historic loss experiences (e.g., losses related to Canada's federal policies, including residential schools, forced relocations, and dog slaughters) and by present loss experiences (e.g., tragic and sudden deaths in local communities). To better support caregivers, an understanding of these grief experiences and a vision of bereavement care inclusive of community mobilization efforts to develop bereavement training and support is needed. We conclude with a discussion of a community capacity approach to bereavement care.

Moral experiences of children with medical complexity: A participatory hermeneutic ethnography in Brazil.

Children with medical complexity have been defined within the literature as chronically ill and medically fragile children with complex care needs. Care for these children raises significant ethical and moral considerations. Therefore, this participatory ethnographic study conducted with eight children and their families aimed to better understand the moral experiences of children with medical complexity, based on views of children as moral agents and capable of understanding and expressing interpretations about their lived experiences. Through our participatory hermeneutical ethnographic research, we were able to shed light on how children with medical complexity express their moral experiences within a complex sociopolitical context, perpetuating dominant outlooks on what is considered a "normal" child. Children with medical complexity described their resistance to these dominant views as they strive to be included in discussions about matters that affect them, reacting to painful medical procedures and treatments, and expressing their concerns about their future aspirations. The knowledge advanced by this study about moral experiences of children with medical complexity can inform understandings of children's interests based on their own interpretations within complex sociopolitical contexts that value their lives differently.

Engaging Retired Physicians as Educators: Motivations and Experiences of Participants in a Novel Educational Program.

PURPOSE: Physician retirement has important impacts on medical learners as well as retiring physicians themselves. Retiring physicians take with them a wealth of knowledge, wisdom, and expertise and can feel a loss of identity, lack of fulfillment, and reduced social connectedness after leaving the institution. To address this, a novel educational program providing retired physicians with renewed educational roles was implemented in 2018 within a university-associated pediatric department. This study sought to explore the retired physicians' experiences in this new intergenerational program, including their motivations to reengage as educators after retirement. METHOD: The authors designed this study using qualitative description. Semistructured interviews were conducted in the Department of Pediatrics of McGill University in 2019 with retired physicians who participated in the educational program's inaugural year. Role theory and psychosocial development theory were used to design the interview guide and inform the thematic analysis. Iterative analysis of the interview transcripts was deductive and inductive. RESULTS: Of the 8 retired physicians who participated in the program's first cohort, 7 participated in this study. Analysis of the data yielded 4 main themes: a challenging shift to retirement, a desire for reengagement after retirement, role dissonance, and gaining by giving. The retired physicians were motivated to engage as educators. Although they experienced some discomfort in their new nonclinical roles, they described their experiences as fulfilling, with benefits such as intellectual stimulation, social connectedness, and a sense of purpose. CONCLUSIONS: Retired physicians' motivations to reengage academically and their experiences contributing to educational activities in this program highlight the importance of supporting physicians during the transition to retirement and establishing formal programs to engage retired physicians as educators.

Perceptions of Inuit Women and Non-Inuit Healthcare Providers on the Implementation of Human Papillomavirus Self-Sampling as an Alternative Cervical Cancer Screening Method in Nunavik, Northern Quebec.

Human papillomavirus (HPV) self-sampling offers a cervical cancer (CC) screening alternative that can address certain barriers to the Papanicolaou test. As part of a larger community-based participatory project in Nunavik, Northern Québec, we travelled to two communities to gather perspectives from Inuit women and healthcare professionals (HCPs) on CC screening services and the possible implementation of HPV self-sampling. We held 10 group discussions with 28 Inuit women and 10 semi-structured interviews with 20 HCPs. The thematic analysis extracted themes reflecting one barrier and seven facilitators to accessing CC screening and the implementation of HPV self-sampling in Nunavik. Themes included, though not limited to, language and communication in health settings, access to culturally responsive educational resources on CC, and the noninvasive nature of HPV self-sampling. This study may serve to contribute to the co-development of a strategy for implementation that is designed according to the needs and priorities of the communities.

Advancing a programme theory for community-level oral health promotion programmes for humanitarian migrants: a realist review protocol.

INTRODUCTION: Humanitarian migrants often suffer from poor health, including oral health. Reasons for their oral health conditions include difficult migration trajectories, poor nutrition and limited financial resources. Oral health promotion is crucial for improving oral health-related quality of life of humanitarian migrants. While community-level oral health promotion programmes for humanitarian migrants have been implemented (eg, in host countries and refugee camps), there is scant literature evaluating their transferability or effectiveness. Given that these programmes yield unique context-specific outcomes, the purpose of this study is to understand how community-level oral health promotion programmes for humanitarian migrants work, in which contexts and why. METHODS AND ANALYSIS: Realist review, a theory-driven literature review methodology, incorporates a causal heuristic called context-mechanism-outcome configurations to explain how programmes work, for whom, and under which conditions. Using Pawson's five steps of realist review (clarifying scope and drafting an initial programme theory; identifying relevant studies; quality appraisal and data extraction; data synthesis; and dissemination of findings), we begin by developing an initial programme theory using the references of a scoping review on the oral health of refugees and asylum seekers and through hand searching in Google Scholar. Following stakeholder validation of our initial programme theory, we will locate additional evidence by searching in four databases (Ovid Medline, Ovid Embase, Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) to test and refine our initial programme theory into a middle-range realist programme theory. The resultant theory will explain how community-level oral health promotion programmes for humanitarian migrants work, for whom, in which contexts and why. ETHICS AND DISSEMINATION: Since this study is a review and no primary data collection will be involved, institutional ethics approval is not required. The findings of this study will be disseminated in peer-reviewed journals, local and international conferences, and via social media. TRIAL REGISTRATION NUMBER: CRD42021226085.

Medical assistance in dying in hospice: A qualitative study.

OBJECTIVES: The modern hospice movement has historically opposed assisted dying. The 2016 legalisation of medical assistance in dying (MAID) in Canada has created a new reality for Canadian hospices. There have been few studies examining how the legalisation of MAID has affected Canadian hospices. Our objective was to identify the challenges and opportunities hospice workers think MAID brings to a hospice. METHODS: This qualitative descriptive study included four focus groups and four semistructured interviews with Canadian hospice workers at two hospices, one which allowed MAID on site, and one which did not. Thematic analysis was used to understand and report these challenges and opportunities. RESULTS: We constructed five themes. These themes detailed participants' beliefs in the abilities of hospice care, and how they felt MAID challenged these abilities. Further, participants felt that MAID itself created challenging situations for patients and families, and that local policies and practices led to additional institutional challenges. Some participants also felt that allowing MAID in hospice provided opportunities for more extensive end-of-life options. CONCLUSIONS: The legalisation of MAID in Canada has created both challenges and opportunities for Canadian hospices. A balancing of these challenges and opportunities may provide a path for Canadian hospices to navigate their new reality. Increasing demand for MAID means that hospices are likely to continue to encounter requests for MAID, and should enact supports to ensure staff are able to manage these challenges and make best use of the opportunities.

Grief literacy: A call to action for compassionate communities.

The compassionate communities movement challenges the notion that death and dying should be housed within clinical and institutional contexts, and works to normalize conversations about death and dying by promoting death literacy and dialogue in public spaces. Community-based practices and conversations about grief remain marginal in this agenda. We aimed to theorize how grief could be better conceptualized and operationalized within the compassionate communities movement. We develop the concept of Grief Literacy and present vignettes to illustrate a grief literate society. Grief literacy augments the concept of death literacy, thereby further enhancing the potential of the compassionate communities approach.

Memorial tattoos: Advancing continuing bonds theory.

A memorial tattoo is a tattoo that honors a person who has died. We aimed to understand how memorial tattoos could be an expression of a bereaved person's continuing relationship with the deceased person that the tattoo memorializes. We interviewed 41 people and used qualitative description grounded in a symbolic interactionist framework to analyze the transcripts. This research expands on continuing bonds theory by showing that memorial tattoos are an expression of the bond with the deceased as well as a way to communicate with others about their ongoing connection and to challenge stigma.

Critically engaging vulnerability: Rethinking oral health with vulnerabilized populations.

This paper is the third in a series of narrative reviews challenging core concepts in oral health research and practice. Our series started with a framework for Inclusion Oral Health. Our second review explored one component of this framework, looking at how intersectionality adds important complexity to oral public health. This current manuscript drills into a second component of Inclusion Oral Health, exploring how labels can lead to 'othering' thereby misrepresenting populations and (re)producing harms. Specifically, we address a common oral public health label: vulnerable populations. This term is commonly used descriptively: an adjective (vulnerable) is used to modify a noun (population). What this descriptor conceals is the 'how,' 'why,' and 'therefore' that leads to and from vulnerability: How and why is a population made vulnerable; to what are they vulnerable; what makes them 'at risk,' and to what are they 'at risk'? In concealing these questions, we argue our conventional approach unwittingly does harm. Vulnerability is a term that implies a population has inherent characteristics that make them vulnerable; further, it casts populations as discrete, homogenous entities, thereby misrepresenting the complexities that people live. In so doing, this label can eclipse the strengths, agency and power of individuals and populations to care for themselves and each other. Regarding oral public health, the convention of vulnerability averts our research gaze away from social processes that produce vulnerability to instead focus on the downstream product, the vulnerable population. This paper theorizes vulnerability for oral public health, critically engaging its production and reproduction. Drawing from critical public health literature and disability studies, we advance a critique of vulnerability to make explicit hidden assumptions and their harmful outcomes. We propose solutions for research and practice, including co-engagement and co-production with peoples who have been vulnerabilized. In so doing, this paper moves forward the potential for oral public health to advance research and practice that engages complexity in our work with vulnerabilized populations.

"Reflection and soul searching": Negotiating nursing identity at the fault lines of palliative care and medical assistance in dying.

Authorities within the field of palliative care frequently espouse that assisted death is - and must remain - separate from palliative care. This fault line, between palliative care and assisted death, has important implications for how we enact end-of-life care, particularly in jurisdictions where assisted death is legal. And yet little is known about how direct-care clinicians providing palliative care navigate this demarcation in everyday practice. This qualitative study reports on semi-structured interviews with 22 palliative care nurses from across Canada, where assisted death was legalized in 2016. Although a minority of participants did express categorical opinions around the (non) legitimacy of assisted death as an ethical end-of-life care option, most engaged in an ongoing and sometimes painful process of questioning and self-examination. Their ethical reflections were more nuanced than simply dismissing MAiD as incompatible with palliative care philosophy; yet this idea of incompatibility weighed heavily as they reasoned through their experiences and questioned their own perspectives. Nurses described grappling with the finality of assisted death, which contradicts their belief in the telos of palliative care; when adequately resourced, palliative care should be available to support people to live well before death. At the same time, commitment to important palliative care values such as the non-abandonment of dying people and respecting peoples' individual end-of-life choices reveal the possibility of overlap between the ethos of assisted death and that of palliative care nursing. Drawing on scholarship in feminist ethics, our study sheds light on the moral identity work that assisted dying catalyzes amongst palliative care nurses. We highlight what is at stake for them as they navigate a delicate tension in responding ethically to patients whose suffering motivates an interest in assisted death, from within a wider professional collective that upholds a master narrative about the incompatibility of assisted death and palliative care.