Qualitative Research in Medicine and Healthcare最新文献

{"title":"Editor's Introduction","authors":"M. Bartesaghi","doi":"10.4081/qrmh.2018.7817","DOIUrl":"https://doi.org/10.4081/qrmh.2018.7817","url":null,"abstract":"Not available.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115161275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stress and burnout in anesthesia residency: an exploratory case study of peer support groups","authors":"J. Spence, David Smith, Anne K. Wong","doi":"10.4081/QRMH.2018.7417","DOIUrl":"https://doi.org/10.4081/QRMH.2018.7417","url":null,"abstract":"Stress and burnout are alarmingly prevalent in anesthesiologists, with the highest risk occurring during anesthesia residency training. To better understand this phenomenon, we conducted a mixed methods case study of our anesthesia training program to explore the residents’ accounts of stress and burnout and the potential value of peer support groups. Eight out of thirty eight residents participated in nine monthly peer support group (PSG) meetings followed by a focus group interview about stress and burnout in training and the value of PSG. We compared the participants’ mean pre-and post-PSG Maslach Burnout Inventory® (MBI) and Perceived Stress Scale® (PSS) and analysed the focus group interview for recurring themes. We captured the perspectives of twenty seven out of thirty residents who did not participate in support groups (non-participants) through an online survey on stress and burnout. We found evidence of a high prevalence of stress and burnout from the MBI and PSS scores and survey responses. Analysis of the focus group interview showed that the specific stressors of anesthesia training included: an individually-based model of training that predisposes to isolation from peers, an over-reliance on the quality of the faculty-resident relationship and the critical, high stakes nature of the profession. Residents strongly endorsed the value of PSG in decreasing isolation, enhancing validation, and support through the sharing of experiences. Lack of dedicated time and integration into the training program were major barriers to PSG participation. These barriers need to be overcome in order to fully realize its role in mitigating stress and burnout.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129297860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of meaningful work in a high-burnout academic medical center: a discourse analysis","authors":"Timothy N. Atkinson, Molly M Gathright, J. Clardy, C. Thrush, E. Messias","doi":"10.4081/QRMH.2018.7572","DOIUrl":"https://doi.org/10.4081/QRMH.2018.7572","url":null,"abstract":"We conducted a discourse analysis of meaningful work from the perspective of healthcare workers in an academic medical center where we previously observed relatively high levels of personal burnout (52.7%) and work-related burnout (47.5%), all based on the Copenhagen Burnout Inventory survey. Burnout is often studied as psychological condition characterized by exhaustion, depersonalization, and feelings of inefficacy or lack of career achievement, but as demonstrated in this analysis, burnout loses its meaning because healthcare professionals provide a robust account of what makes work meaningful to them despite their prevalence of burnout. Healthcare professionals exhibit a higher level of burnout compared to workforce members in other organizations. Physicians specifically are at high risk for exhibiting symptoms of burnout and work-life imbalances. In addition, burnout manifests itself early in the physician’s career compared other occupations, and in our sample was prevalent among nurses, too. In this discourse analysis of written answers to the survey question, In ten words or less describe what makes your work meaningful? healthcare professionals provide an account of meaningful work that maintains its value in this environment despite the level of burnout, especially when healthcare professionals can use their hard-earned knowledge to make a difference in the lives of people, and observe the results of their work, which is beyond just taking care of patients. Nurses accounted for meaningful work in terms of close connections with patients, while being closely focused on ability to provide professional care and experiencing the outcomes associated with that care, and knowing that they have done a good job. Physicians were patient focused, and they expressed meaningful work in terms of making a difference, and using their abilities to help patients. Basic scientists accounted for meaningful work in terms of their training and abilities to use science for the betterment of others in society.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"80 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117218606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study of illness identity: schizophrenia and depression","authors":"Namino Ottewell","doi":"10.4081/QRMH.2018.7420","DOIUrl":"https://doi.org/10.4081/QRMH.2018.7420","url":null,"abstract":"Illness identity refers to the interpretation of having mental illness in persons who regard themselves as mentally ill. Illness identity can impact people diagnosed with mental illness negatively. However, little is known about the background of illness identity. This study aimed to investigate the process whereby mental health service users accept their diagnosis and develop an illness identity and to compare the processes between schizophrenia and depression. Twenty persons with schizophrenia and depression were interviewed, and the data were analysed using grounded theory approach. The major findings were as follows: i) while those with schizophrenia were shocked by their diagnosis and took time to accept it, this was not true for those with depression; ii) for participants with depression, it was relatively easy to accept their diagnosis, as they thought that depression was a normal illness; participants with schizophrenia needed to learn about their illness, know the efficacy of psychiatric medication and reduce their prejudice against mental illness to accept their diagnosis; and iii) participants’ illness identity encompassed sickness and normality with sickness being related to taking psychiatric medication and normality being associated with having regular work, acting as other people do or living in the community. These findings suggest the influence of social attitudes to each illness on illness identity and the complex nature of illness identity.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122730318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The introduction of the medicinal partner in direct-to-consumer advertising: Viagra’s contribution to pharmaceutical fetishism and patient-as-consumer discourse in healthcare","authors":"J. Applequist","doi":"10.4081/QRMH.2018.7646","DOIUrl":"https://doi.org/10.4081/QRMH.2018.7646","url":null,"abstract":"Pfizer, manufacturer of the erectile dysfunction prescription treatment Viagra, has been a staple in the pharmaceutical advertising arena since broadcast versions of such ads became legally permissible in the United States in 1997. Given that the patent for Viagra is soon set to expire, it is important that research take a look back in an attempt to contextualize the brand’s place in shaping medicinal marketing culture. Of particular interest is the period beginning in 2014, when Viagra’s most unconventional campaign yet began using a tactic that was the first of its kind for the pharmaceutical industry. By removing the actual consumer of the medication from these ads (males), Viagra has paved the way for pharmaceutical advertising to target the medicinal partner. This manuscript reviews the first use of the medicinal partner in the pharmaceutical advertising sector, conducting a textual analysis of Viagra’s use of this mediated relationship. The medicinal partner is the pharmaceutical industry’s attempt to target a patient’s social circle in an effort to promote a discourse that suggests a medicinal remedy for a problem. This analysis describes how social meaning and relationships underlie the market transaction of obtaining a prescription, as has been previously established through the processes of medicalization and pharmaceutical fetishism. These advertisements create belief in the larger sense, meaning Pfizer is infiltrating upon the patient’s process of choice and consumption of medicinal remedies. Viagra is simultaneously encouraging male consumers to celebrate the brand while using female ambassadors to influence the decision to request medicinal intervention.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128107361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study of urban hospital transitional care","authors":"J. Feinglass, Samuel Wein, C. Teter, C. Schaeffer, A. Rogers","doi":"10.4081/QRMH.2018.7216","DOIUrl":"https://doi.org/10.4081/QRMH.2018.7216","url":null,"abstract":"This study is part of a mixed methods evaluation of a large urban medical center transitional care practice (NMG-TC). The NMG-TC provides integrated physical and behavioral health care for high need patients referred from the hospital emergency department or inpatient units and who lack a usual source of primary care. The study was designed for internal quality improvement and sought to evaluate staff perceptions of successful transitions for their medically and socially complex patients, and alternatively, the obstacles most likely to negatively impact patient outcomes. All 16 NMG-TC patient care staff were interviewed in a collaborative effort to produce empowered testimony that might go beyond expected clinical narratives. The interview schedule included questions on risk stratification, integrated mental health care, provider to provider handoffs, and how staff deal with key social determinates of patients’ health. The constant comparative method was used to deductively derive themes reflecting key domains of transitional care practice. Seven themes emerged: i) the need to quickly assess patient complexity; ii) emphasizing caring for major mental health and substance use issues; iii) obstacles to care for uninsured, often undocumented patients; iv) the intractability of homelessness; v) expertise in advancing patients’ health literacy, engagement and activation; vi) fragmented handoffs from hospital care and vii) to primary care in the community. Respondent stories emphasized methods of nurturing patients’ self-efficacy in a very challenging urban health environment. Findings will be used to conceptualize pragmatic, potentially high-impact transitional care quality improvement initiatives capable of better addressing frequent hospital use.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116357064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De-romanticising dialogue in collaborative health care research: a critical, reflexive approach to tensions in an action research project's initial phase","authors":"L. Phillips, Birgitte Ravn Olesen, Michael Scheffmann-Petersen, Helle Merete Nordentoft","doi":"10.4081/QRMH.2018.7178","DOIUrl":"https://doi.org/10.4081/QRMH.2018.7178","url":null,"abstract":"In the current socio-political conjuncture, collaborative, dialogic forms of knowledge production abound and are idealised as democratic and inclusive. The aim of the article is to contribute to the body of critical, reflexive analyses of collaborative research by analysing how complex dynamics of exclusion as well as inclusion create tensions in researchers’ attempts to establish collaborative relations in the initial phase of an action research project. The analysis applies a framework combining Bakhtinian dialogic communication theory and Foucauldian theory to explore inclusion and exclusion in the tensional interplay of multiple voices whereby certain voices dominate. Finally, the article offers a typology of ideal types of collaborative research relations that can be used in the initial research phase as a platform for reflexive discussion between researchers and potential collaborative partners about their respective understandings of collaboration and dialogue and corresponding expectations about the research process and results.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123205775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Our family portrait: the church as a model of social support","authors":"Liza Ngenye","doi":"10.4081/QRMH.2018.6996","DOIUrl":"https://doi.org/10.4081/QRMH.2018.6996","url":null,"abstract":"The church means many things to many people. Some would describe it as a culture, network, organization, or family. The purpose of this study is to understand of the role of the church in providing social support to individual church members and to uncover meanings prescribed by individuals about the nature of social support in the church. I analyze the context in which church practices are embedded, the processes of creating social support, and the meanings of church-related activities and gatherings that contribute to social support. The study examines how the health-related needs of church members are not only physiological but also accounted for in emotional, psychological and social terms. By using metaphor as a framework for interpretation of members’ meanings, my analysis of social support is broadened to include religious contexts. This study adds to growing literature on the connection between religion, communication and health.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121642595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Waiting for the doctor to ask: influencers of lesbian, gay, and bisexual identity disclosure to healthcare providers","authors":"Nicole C. Hudak, H. Carmack","doi":"10.4081/QRMH.2018.7157","DOIUrl":"https://doi.org/10.4081/QRMH.2018.7157","url":null,"abstract":"Lesbian, gay, and bisexual (LGB) individuals encounter multiple barriers in healthcare, resulting in problematic care. Many LGB patients wrestle with whether to disclose their sexuality to healthcare providers. This article explored what influences LGB patients’ decision to disclose their sexuality to healthcare providers. Guided by Communication Privacy Management theory, the authors conducted in-depth interviews with 20 LGB patients. LGB patients heavily relied on boundary management when negotiating the disclosure of their sexuality. The findings suggest several factors influence LGB patients’ disclosure of sexuality: i) experience with family; ii) fear of gossip and connections; iii) concern for provider care refusal; iv) religion; v) age; and vi) level of trust with providers. Boundary turbulence can be created between patient and provider when there is uncertainty about if and when sexuality is considered private information. Additionally, a site of tension for LGB patients was their concern about providers sharing private information outside the clinic setting.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130187596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"College students' communication about complementary and alternative medicine practices","authors":"H. Carmack, J. A. Serafin","doi":"10.4081/qrmh.2018.7161","DOIUrl":"https://doi.org/10.4081/qrmh.2018.7161","url":null,"abstract":"While the use of Complementary/Alternative Medicine (CAM) has increased over the last two decades, how patients communicate about their decisions to use CAM has yet to be fully explored. The purpose of this study is to examine college students’ decision-making and communication about CAM. Fourteen college students participated in semi-structured focus group interviews about their CAM use and communication about CAM with family, friends, and health care providers. Participants use CAM to improve their physical and mental health. However, they have difficulties justifying their decision to practice CAM to others. They relied on CAM not only for physical and mental stability, but also as a sounding board for larger spiritual issues. Participants use passive communication strategies to communicate about their CAM use and often do not disclose CAM use to their providers because of the stigmas related to CAM. There is potential danger for CAM users who do not disclose CAM use to providers, family, and friends. More efforts are needed to encourage open and honest communication about CAM use.","PeriodicalId":375726,"journal":{"name":"Qualitative Research in Medicine and Healthcare","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125212742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}