Managing liminality: professional care during organizational change

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Eileen Mary Willis ◽  
Deidre D. Morgan ◽  
Kate Sweet
Keyword(s):  
Lived Experience ◽  
Health Professionals ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Occupational Therapists ◽  
Theoretical Construct ◽  
Content Type ◽  
Provide Quality Care ◽  
Dying At Home ◽  
Ritual Process

PurposeThe purpose of this study is to examine the way in which the theoretical construct of liminality contributes to understanding the process of dying of cancer from the perspective of patients, carers and professionals in a state-run organization undergoing privatization.Design/methodology/approachQualitative interviews were held with 13 patients and their carers and two focus groups with eight physiotherapists and occupational therapists. Data were analysed from the perspective of liminality for all three actors: patients, carers and health professionals.FindingsThe theoretical construct of liminality was useful for understanding the lived experience of patients and their carers. However, a major finding of this study reveals that health professionals operated in a dual space as both managers of the ritual process and individuals undergoing a liminal journey as their organization underwent transformation or restructure. Clients and carers had little knowledge of these tensions.Research limitations/implicationsThe findings are limited by the fact that the interviews did not directly ask questions about the restructure of the organization.Social implicationsIt would appear that professionals provide quality care despite their own struggles in moving from one organizational form to anotherOriginality/valueFew studies have explored the liminal rituals of dying at home that outline how professionals, as managers of the process, deal with their own liminal issues.

scholarly journals What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda

2018 ◽  
Vol 23 (1) ◽  
pp. 46-59 ◽  
Author(s):  
Louise Ackers ◽  
Hannah Webster ◽  
Richard Mugahi ◽  
Rachel Namiiro
Keyword(s):  
Public Health ◽  
Low Income ◽  
Quality Care ◽  
Qualitative Interviews ◽  
Health Facilities ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Private Care ◽  
Willingness To Disclose ◽  
Respectful Care

Purpose The purpose of this paper is to present the findings of research on mothers and midwives’ understanding of the concept of respectful care in the Ugandan public health settings. It focusses on one aspect of respect; namely communication that is perhaps least resource-dependent. The research found endemic levels of disrespect and tries to understand the reasons behind these organisational cultures and the role that governance could play in improving respect. Design/methodology/approach The study involved a combination of in-depth qualitative interviews with mothers and midwives together with focus groups with a cohort of midwives registered for a degree. Findings The findings highlight an alarming level of verbal abuse and poor communication that both deter women from attending public health facilities and, when they have to attend, reduces their willingness to disclose information about their health status. Respect is a major factor reducing the engagement of those women unable to afford private care, with health facilities in Uganda. Research limitations/implications Access to quality care provided by skilled birth attendants (midwives) is known to be the major factor preventing improvements in maternal mortality and morbidity in low income settings. Although communication lies at the agency end of the structure-agency continuum, important aspects of governance contribute to high levels of disrespect. Originality/value Whilst there is a lot of research on the concept of respectful care in high income settings applying this to the care environment in low resource settings is highly problematic. The findings presented here generate a more contextualised analysis generating important new insights which we hope will improve the quality of care in Uganda health facilities.

Proactive and reactive responses to pregnancies resulting from sexual exploitation and abuse: an ecological model based on Haitian survivors’ experiences

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Luissa Vahedi ◽  
Sabine Lee ◽  
Susan A. Bartels
Keyword(s):  
Lived Experience ◽  
Child Support ◽  
Ecological Model ◽  
Qualitative Interviews ◽  
Sexual Exploitation ◽  
Third Party ◽  
Content Type ◽  
Response Strategies ◽  
Micro Level ◽  
Women And Girls

Purpose This paper aims to analyze the lived experience of seeking justice and reparations related to conceiving a peacekeeper-fathered child. Design/methodology/approach Based on 18 semi-structured qualitative interviews conducted across Haiti in 2017, the authors mapped the experiences of Haitian mothers of peacekeeper-fathered children onto the ecological framework, proposing prevention/response strategies at the micro, meso and macro levels. Findings The findings mainly focus on reporting and access to support. Reporting was sometimes discouraged by the peacekeeper fathers due to the fear of being reprimanded. Among women who did report, some were told that nothing could be done, as the peacekeeper returned to his home country. Disclosure fatigue was common among participants who formally reported their pregnancies/peacekeeper-fathered children, particularly when promises of employment or child support failed to materialize. Overall, there was widespread distrust and disillusionment with the UN’s reporting and support system. Originality/value To improve the UN’s sexual abuse and exploitation prevention/response system at the micro level, the authors propose addressing personal knowledge/attitudes/beliefs through scenario-based and contextually relevant peacekeeper training and addressing the sexual/reproductive health needs of women and girls in proximity to peacekeeping bases. At the meso level, the UN should improve trust in reporting. Efforts to do so should include mandatory third-party deoxyribonucleic acid testing and banking, streamlined reporting mechanisms and removing the practice of automatically repatriating implicated peacekeepers. At the macro level, the authors recommend investments to improve educational and economic opportunities for women and girls, as well as revamping policies that contribute to impunity and absolve peacekeepers and troop-contributing countries of their responsibilities to provide child support.

scholarly journals The cultural non-participant: critical logics and discursive subject identities

2019 ◽  
Vol 9 (1) ◽  
pp. 50-64
Author(s):  
David Stevenson
Keyword(s):  
Lived Experience ◽  
Cultural Policy ◽  
Qualitative Interviews ◽  
Primary Data ◽  
Research Approach ◽  
Data Generation ◽  
Cultural Participation ◽  
Content Type ◽  
Policy Problem ◽  
The Uk

Purpose The existence of so-called non-participants is a cultural policy problem in the UK and beyond. Yet, the very notion of a cultural non-participant seems nonsensical against the palpable evidence of lived experience. The purpose of this paper is to understand “who” a cultural non-participant is by first comprehending “what” the cultural non-participant is and why it exists. Design/methodology/approach Drawing on primary data generated in the form of 40 in-depth qualitative interviews, this paper employs a discursive methodology to explore the critical logics (Howarth, 2010) that underlie the problem representation (Bacchi, 2009) of cultural non-participation and in particular the discursive subject identity of the cultural non-participant. Findings Beginning with a discussion about how cultural non-participants are represented as socially deprived and hard to reach, the paper moves on to highlight how they are also presumed to lack knowledge and understanding about what they are rejecting. Their supposed flawed subjectivity is then contrasted with the desirable model of agency claimed by the cultural professionals who seek to change the cultural participation patterns of others. The paper concludes with a consideration of how the existence of the cultural non-participant subject identity limits the extent to which those labelled as such can meaningfully contribute to the field of cultural policy and obscures the extent to which such individuals are culturally disenfranchised. Research limitations/implications Because of the chosen research approach and the geographical limitations to the data generation, the research makes no claim to generalisability. Therefore, researchers are encouraged to test the discursive logics identified at alternative discursive sites. Practical implications This paper proposes a change in the language used by cultural professionals accompanied by changes in practice that abandoning the identity of the cultural non-participant would demand. Originality/value This paper challenges a taken for granted assumption that cultural non-participants exist “in the real”.

Ethnically diverse workplaces in Irish hospitals

2017 ◽  
Vol 39 (7) ◽  
pp. 1015-1029 ◽  
Author(s):  
Alicja Bobek ◽  
Camilla Devitt
Keyword(s):  
Health Professionals ◽  
Design Methodology ◽  
Small Sample Size ◽  
Qualitative Interviews ◽  
Ethnically Diverse ◽  
Small Sample ◽  
Foreign Born ◽  
Content Type ◽  
Hospital Managers ◽  
Communication Problems

Purpose The purpose of this paper is to explore the ethnically diverse workplace in Irish hospitals by examining the perspectives of foreign- and Irish-born professionals and their managers. Design/methodology/approach Semi-structured qualitative interviews with 30 health professionals (foreign- and Irish-born) and with hospital managers (Irish-born). All interviews were transcribed and analysed using thematic analysis. Findings The managers and professionals interviewed mostly perceived ethnically diverse workplaces as an asset. Health professionals also identified a number of challenges, including internal divisions based on ethnicity, language and communication problems and cultural differences. However, in general, discrimination on the basis of ethnicity was not highlighted by interviewees. Research limitations/implications While the qualitative design of the study allowed for an in-depth exploration of experiences in ethnically diverse workplaces in selected Irish hospitals, the relatively small sample size poses some limitations. The study brings to light the need for larger-scale survey-based research on the ethnically diverse workplace in Irish hospitals, which includes Irish- and foreign-born health professionals in the sample. Originality/value The study includes a variety of perspectives on experiences in ethnically diverse workplaces in Irish hospitals, including foreign-born health professionals, their Irish-born colleagues and hospital managers.

scholarly journals Experiencia vivida del primer contacto con muerte en prácticas clínicas de estudiantes de enfermería

2022 ◽  
Vol 21 (1) ◽  
pp. 116-139
Author(s):  
Manuel de Jesús Hernández Ramírez ◽  
Erika Yovana González Martín ◽  
Ashlye Melannie Fuentes Rodríguez ◽  
Suleika Alelí Carranza López ◽  
Violeta Compeán Padilla ◽  
...  
Keyword(s):  
Nursing Students ◽  
Lived Experience ◽  
Quality Care ◽  
Phenomenological Approach ◽  
Clinical Practicum ◽  
Hermeneutic Phenomenological ◽  
Van Manen ◽  
Provide Quality Care ◽  
First Contact ◽  
Phenomenological Interview

Introduction: Death is a complex phenomenon, nurses in training may face the process of dying and death of people, which can generate diverse situations that represent their lived experiences. Objective: To understand the lived experience of the first contact with death during clinical practicum of nursing students at a public university.Methodology: Qualitative study with phenomenological approach. It was conducted from October 2020 to February 2021. Selection of participants by intentional sampling with information saturation with seven participants. Data collection through phenomenological interview; participants gave informed consent. The analysis was carried out through the three phases of Max Van Manen's hermeneutic phenomenological method (description, interpretation, description plus interpretation). Results: The students refer to having been faced with the phenomenon in a state of helplessness, blockage, uncertainty, and fear; as well as facing death in a professional and reflective manner in order to provide quality care. Discussion: Death is a natural process; however, the first experiences are diverse and can produce in the students a set of emotions that condition their capacity to act, the way of adapting and observing the needs that arise during this experience. Conclusion: The experiences of nursing students show that they have difficulties in facing death, but it was not an impediment to provide the necessary care; it is considered that a deeper preparation on the process of dying can be favorable for their performance as professionals. Introducción: La muerte es un fenómeno complejo, las enfermeras en formación pueden enfrentarse al proceso de morir y muerte de personas, lo que puede generar diversas situaciones que representan sus experiencias vividas. Objetivo: Comprender la experiencia vivida ante el primer contacto con la muerte durante prácticas clínicas de estudiantes de enfermería de una universidad pública.Metodología: Estudio cualitativo con enfoque fenomenológico. Se llevó a cabo de octubre del 2020 a febrero del 2021. Selección de participantes por muestreo intencional con saturación de información con siete participantes. Recolección de datos a través de entrevista fenomenológica; los participantes emitieron su consentimiento informado. El análisis se llevó a cabo por las tres fases del método fenomenológico hermenéutico de Max Van Manen (descripción, interpretación, descripción más interpretación). Resultados: Los estudiantes refieren haber estado frente al fenómeno en un estado de impotencia, bloqueo, incertidumbre y miedo; así como afrontaron la muerte de manera profesional y reflexiva para brindar cuidado de calidad. Discusión: La muerte es un proceso natural, sin embargo, las primeras experiencias son diversas y pueden producir en los estudiantes un conjunto de emociones que condicionan su capacidad de actuar, el modo de adaptarse y observar las necesidades surgidas durante esta experiencia. Conclusión: Las experiencias de los estudiantes de enfermería demuestran que tienen dificultades para afrontar la muerte, pero no fue un impedimento para brindar los cuidados necesarios; se considera que una preparación más profunda sobre el proceso de morir puede ser favorable para su actuar como profesional.

scholarly journals Perception regarding humanizing healthcare among the national healthcare service patients in Évora area - Portugal

2011 ◽  
Vol 5 (2) ◽  
pp. 321
Author(s):  
Ermelinda Do Carmo Valente Caldeira Batanete ◽  
Maria Vitória Glórias Almeida Casas-Nova
Keyword(s):  
Health Care ◽  
Health Professionals ◽  
Consumer Satisfaction ◽  
Healthcare Service ◽  
Quality Care ◽  
Healthcare Services ◽  
Human Beings ◽  
National Healthcare ◽  
Short Period ◽  
Provide Quality Care

ABSTRACTObjective: to ascertain the perception regarding humanizing healthcare among the National Healthcare Service (NHS) patients in the area of Évora - Portugal. Method: this is a descriptive study, exploratory, with a quantitative approach using a random sampling starting from the guiding question: What is the NHS patients’ perception on humanizing the care provided by the healthcare services? Data were collected with an informed consent questionnaire, administered between September and October 2010 to 62 individuals who were patients in the NHS, according to the approval of the Ethic Committee on Research Involving Human Beings, with the 203/2008 legal opinion. Results: concerning humanizing health care, the respondents of this study outlined as particularly important aspects the following: being attended by gracious professionals who facilitate the dialogue and provide quality care in a short period of time. The value placed on being able to select one’s doctor and nurse is explained by aspects that patients find important such as availability, confidentiality, competence as well as the continuity of care and trust for the health professionals. Conclusion: the results highlight the following aspects: communication; attitudes and competence of the health professionals; accessibility and exercise of autonomy. Descriptores: humanizing; health care; health systems; consumer satisfaction; perceptionRESUMOObjetivo: conhecer a percepção dos usuários do Serviço Nacional de Saúde (SNS) do conselho de Évora - Portugal acerca da humanização dos cuidados. Método: estudo descritivo, exploratório, de abordagem quantitativa com uma amostra acidental, a partir da questão norteadora: Como é que os usuários do SNS percepcionam a humanização dos cuidados prestados nos serviços de saúde? A colheita de dados foi realizada através de um questionário com consentimento livre e esclarecido, aplicado entre setembro e outubro de 2010 a 62 sujeitos usuários do SNS, conforme aprovação do Comité de Ética em Pesquisa Envolvendo Seres  Humanos. Resultados: acerca da humanização dos cuidados de saúde os informantes deste estudo evidenciaram como aspectos particularmente importantes, um atendimento por profissionais simpáticos, que facilitem o diálogo e prestem cuidados de qualidade num curto espaço de tempo. A importância da escolha do médico e do enfermeiro de familia, pelos usuários do SNS, é justificada pela disponibilidade, a confidencialidade, a competência, assim como a continuidade de cuidados e a confiança nos profissionais de saúde. Conclusão: os resultados remetem-nos para um acentuado destaque dos seguintes aspectos: a comunicação; atitudes e competência dos profisionais de saúde;  acessibilidade e exercício da autonomia. Descritores: humanização; cuidados; sistemas de saúde; satisfação dos consumidores; percepção.RESUMENObjetivo: conocer la opinión de los usuarios del servicio nacional de Saúde (SNS) del consejo de Évora- Portugal sobre la humanizácion de los cuidados. Método: estudio descriptivo, exploratório, de abordage cuantitativa con una muestra aleatoria, basando-se en la pregunta norteadora: ¿Cómo los usuarios del SNS percepcionan la humanizácion de los cuidados prestados por  los servicios de salud? La cosecha de datos fue hecha utilizando un cuestionario con consentimiento libre y clarificado, aplicado entre septiembre y octubre de 2010 a 62 usuarios del SNS, con aprobación del Comité de Ética en la Investigación en Seres Humanos, con el dictamen legal 203/2008. Resultados: referente a la humanizácion de los cuidados de salud, los informadores de este estudio habían evidenciado particularmente como aspectos importantes, la atención de profesionales agradables que facilitan el diálogo y dan cuidados de calidad en poco tiempo. La seleccion del doctor y de la enfermera es justificada por la importancia que asume para los usuarios la disponibilidad, la confidencialidad, la competencia, así como la continuidad de cuidados y la confianza en los profesionales de salud. Conclusión: los resultados nos apuntan para la importancia de los aspectos siguientes: la comunicación; actitudes y capacidad de los profisionales de la salud;  accesibilidad y ejercicio de la autonomía. Descriptores: humanizácion; cuidados; sistemas de salud; satisfacción de los consumidores; percepción.

Remarkable lives: Spencer Insley in conversation with Jerome Carson

2015 ◽  
Vol 19 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Spencer Insley ◽  
Jerome Carson
Keyword(s):  
Lived Experience ◽  
Design Methodology ◽  
Mental Distress ◽  
Occupational Therapists ◽  
Content Type ◽  
Mental Health Nurse ◽  
Major Mental Disorder ◽  
History Of ◽  
Biographical Account ◽  
Practical Implications

Purpose – The purpose of this paper is to provide a profile of Spencer Insley. Design/methodology/approach – Spencer gives a short biographical account and is then interviewed by Jerome. Areas covered in the narrative are the misery of mental illness, the prodromal signs of illness, hospital admission and discharge to supported accommodation. Findings – Apart from the losses resulting from a diagnosis of major mental disorder, Spencer also talks about the loss of friendships. His admission to hospital was especially traumatic, leaving him frightened and confused and feeling he was treated like an animal. Research limitations/implications – While Spencer's is only one story of many, his experiences have a sorry familiarity to them. Practical implications – Too long denied in the history of psychiatry, service user narratives help us understand the nature of mental suffering and the often inadequate nature of service responses to mental distress. Social implications – Involuntary admissions to hospital need to be handled in a more therapeutic manner. Originality/value – So often it is nurses and occupational therapists who have the most impact on the lives of those with lived experience. Psychiatrists were felt not to be interested in Spencer, whereas his community mental health nurse “Had a genuine interest in what I was doing and how I was getting along”.

Coaching Care Partners Who Support Loved Ones With MCI

2014 ◽  
Vol 19 (2) ◽  
pp. 50-56 ◽  
Author(s):  
Kerry Mills ◽  
Jennifer Brush
Keyword(s):  
Cognitive Functioning ◽  
Educational Program ◽  
Social Withdrawal ◽  
Quality Care ◽  
Critical Role ◽  
Family Care ◽  
Speech Language Pathologists ◽  
Care Partners ◽  
Provide Quality Care ◽  
Solution Focused

Speech-language pathologists can play a critical role in providing education and intervention to prevent social withdrawal, prevent premature disability, and maximize cognitive functioning in persons with MCI. The purpose of this article is to describe positive, solution-focused educational program that speech-language pathologists can implement with family care partners to improve relationships and provide quality care for someone living with MCI.

Now they’re listening: involvement in clinical psychology training

2019 ◽  
Vol 23 (1) ◽  
pp. 23-29
Author(s):  
Laura Lea ◽  
Sue Holttum ◽  
Victoria Butters ◽  
Diana Byrne ◽  
Helen Cable ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Clinical Psychology ◽  
Health Professionals ◽  
Service User ◽  
Health Workers ◽  
Psychology Training ◽  
Service Users ◽  
Clinical Psychology Training ◽  
Content Type

PurposeThe 2014/2015 UK requirement for involvement of service users and carers in training mental health professionals has prompted the authors to review the work of involvement in clinical psychology training in the university programme. Have the voices of service users and carers been heard? The paper aims to discuss this issue.Design/methodology/approachThe authors update the paper of 2011 in which the authors described the challenges of inclusion and the specific approaches the authors take to involvement. The authors do this in the context of the recent change to UK standards for service user and carer involvement, and recent developments in relation to partnership working and co-production in mental healthcare. The authors describe the work carried out by the authors – members of a service user involvement group at a UK university – to ensure the voices of people affected by mental health difficulties are included in all aspects of training.FindingsCareful work and the need for dedicated time is required to enable inclusive, effective and comprehensive participation in a mental health training programme. It is apparent that there is a group of service users whose voice is less heard: those who are training to be mental health workers.Social implicationsFor some people, involvement has increased. Trainee mental health professionals’ own experience of distress may need more recognition and valuing.Originality/valueThe authors are in a unique position to review a service-user-led project, which has run for 12 years, whose aim has been to embed involvement in training. The authors can identify both achievements and challenges.

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