Rethinking the moral in narrating trauma: Ethnographic insights on clinical reasoning

2021 ◽  
pp. 136346152110412
Author(s):  
Galia Plotkin Amrami
Keyword(s):  
Clinical Reasoning ◽  
Political Ideology ◽  
Complex Dynamics ◽  
A Priori ◽  
Explanatory Models ◽  
Care Providers ◽  
Trauma Narratives ◽  
Patient’S Experience ◽  
Moral Dimensions ◽  
Ethnographic Analysis

This article explores the moral dimensions of the clinical narration of suffering in a highly political context. Based on an ethnographic analysis of psychotherapists’ discussions of a clinical case related to the Israeli evacuation from Gaza, I illustrate how the care providers navigate competing moral logics while explaining the reasons for the patient's experience. Capturing moments of the simultaneous appearance of different explanatory models, informed by contradictory moral grammars, during the process of clinical reasoning allowed me to obtain a complex and nuanced picture of social reality in which the experience of the patient simultaneously appeared as both a success and a failure of communal education. The ethnographic observation and analysis of clinical reasoning challenge the assumed connection between practitioners’ ideological identifications and their narration of suffering, and allowed to move beyond the idea… moving beyond the idea of coherent moral subjects who act according to a priori moral values informed by political ideology. This perspective is particularly significant for the field of traumatic suffering because it questions the moral grammar of trauma narratives that imply unambiguous and idealized distinctions between victims, perpetrators, and witnesses, revealing the complex dynamics of suffering and caring.

Conceptualizing depression in Vietnam: Primary health care providers’ explanatory models of depression

2018 ◽  
Vol 55 (2) ◽  
pp. 219-241 ◽  
Author(s):  
Jill Murphy ◽  
Elliot Goldner* ◽  
Kitty K. Corbett ◽  
Marina Morrow ◽  
Vu Cong Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care Providers ◽  
Help Seeking ◽  
Healthcare Providers ◽  
Community Outreach ◽  
Health Service Delivery ◽  
Explanatory Models ◽  
Care Providers ◽  
Urban District ◽  
Mental Health Service Delivery

The purpose of this qualitative study was to elicit the explanatory models (EMs) of primary healthcare providers (PHPs) in Vietnam in order to (a) understand if and how the concept of depression is understood in Vietnam from the perspective of nonspecialist providers and community members, and (b) to inform the process of introducing services for depression in primary care in Vietnam. We conducted semistructured interviews with 30 PHPs in one rural and one urban district of Hanoi, Vietnam in 2014. We found that although PHPs possess low levels of formal knowledge about depression, they provide consistent accounts of its symptoms and aetiology among their patient population, suggesting that depression is a relevant concept in Vietnam. PHPs describe a predominantly psychosocial understanding of depression, with little mention of either affective symptoms or neurological aetiology. This implies that, with enhanced training, psychosocial approaches to depression care would be appropriate and acceptable in this context. Distinctions were identified between rural and urban populations in both understandings of depression and help-seeking, suggesting that enhanced services should account for the diversity of the Vietnamese context. Alcohol misuse among men emerged as a considerable concern, both in relation to depression and as stand-alone issue facing Vietnamese communities, indicating the need for further research in this area. Low help-seeking for depression in primary care implies the need for enhanced community outreach. The results of this study demonstrate the value of eliciting EMs to inform planning for enhanced mental health service delivery in a global context.

Are natural selection explanatory models a priori?

2015 ◽  
Vol 30 (6) ◽  
pp. 787-809 ◽  
Author(s):  
José Díez ◽  
Pablo Lorenzano
Keyword(s):  
Natural Selection ◽  
A Priori ◽  
Explanatory Models

scholarly journals Safety of Electronic Cigarette Use During Breastfeeding: Qualitative Study Using Online Forum Discussions

10.2196/11506 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e11506 ◽  
Author(s):  
Emily Jade Johnston ◽  
Katarzyna Campbell ◽  
Tim Coleman ◽  
Sarah Lewis ◽  
Sophie Orton ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Postpartum Period ◽  
Perceived Risk ◽  
Electronic Cigarettes ◽  
A Priori ◽  
Cigarette Use ◽  
Care Providers ◽  
Online Forum ◽  
Breastfeeding Rates ◽  
Google Search

Background Electronic cigarettes (e-cigs) are an increasingly popular alternative to smoking, helping to prevent relapse in those trying to quit and with the potential to reduce harm as they are likely to be safer than standard cigarettes. Many women return to smoking in the postpartum period having stopped during pregnancy, and while this can affect their decisions about breastfeeding, little is known about women’s opinions on using e-cigs during this period. Objective The aim of this study is to explore online forum users’ current attitudes, motivations, and barriers to postpartum e-cig use, particularly as a breastfeeding mother. Methods Data were collected via publicly accessible (identified by Google search) online forum discussions, and a priori codes identified. All transcripts were entered into NVivo for analysis, with a template approach to thematic analysis being used to code all transcripts from which themes were derived. Results Four themes were identified: use, perceived risk, social support and evidence, with a number of subthemes identified within these. Women were using e-cigs to prevent postpartum return to smoking, but opinions on their safety were conflicting. They were concerned about possible transfer of harmful products from e-cigs via breastmilk and secondhand exposure, so they were actively seeking and sharing information on e-cigs from a variety of sources. Although some women were supportive of e-cig use, others provided harsh judgement for mothers who used them. Conclusions E-cigs have the potential to reduce the number of women who return to smoking in the postpartum period and potentially improve breastfeeding rates, if breastfeeding mothers have access to relevant and reliable information. Health care providers should consider discussing e-cigs with mothers at risk of returning to smoking in the postpartum period.

scholarly journals What Do Patients Complain About Online: A Systematic Review and Taxonomy Framework Based on Patient Centeredness (Preprint)

2019 ◽  
Author(s):  
Jing Liu ◽  
Shengchao Hou ◽  
Richard Evans ◽  
Chenxi Xia ◽  
Weidong Xia ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
A Priori ◽  
Patient Experiences ◽  
Study Patient ◽  
Significant Heterogeneity ◽  
Care Providers ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Wide Range

BACKGROUND Complaints made online by patients about their health care experiences are becoming prevalent because of widespread worldwide internet connectivity. An a priori framework, based on patient centeredness, may be useful in identifying the types of issues patients complain about online across multiple settings. It may also assist in examining whether the determinants of patient-centered care (PCC) mirror the determinants of patient experiences. OBJECTIVE The objective of our study was to develop a taxonomy framework for patient complaints online based on patient centeredness and to examine whether the determinants of PCC mirror the determinants of patient experiences. METHODS First, the best fit framework synthesis technique was applied to develop the proposed a priori framework. Second, electronic databases, including Web of Science, Scopus, and PubMed, were searched for articles published between 2000 and June 2018. Studies were only included if they collected primary quantitative data on patients’ online complaints. Third, a deductive and inductive thematic analysis approach was adopted to code the themes of recognized complaints into the framework. RESULTS In total, 17 studies from 5 countries were included in this study. Patient complaint online taxonomies and theme terms varied. According to our framework, patients expressed most dissatisfaction with patient-centered processes (101,586/204,363, 49.71%), followed by prerequisites (appropriate skills and knowledge of physicians; 50,563, 24.74%) and the care environment (48,563/204,363, 23.76%). The least dissatisfied theme was expected outcomes (3651/204,363, 1.79%). People expressed little dissatisfaction with expanded PCC dimensions, such as involvement of family and friends (591/204,363, 0.29%). Variation in the concerns across different countries’ patients were also observed. CONCLUSIONS Online complaints made by patients are of major value to health care providers, regulatory bodies, and patients themselves. Our PCC framework can be applied to analyze them under a wide range of conditions, treatments, and countries. This review has shown significant heterogeneity of patients’ online complaints across different countries.

scholarly journals Introducing a nurse practitioner into an urban Canadian emergency department

CJEM ◽  
2008 ◽  
Vol 10 (04) ◽  
pp. 355-363 ◽  
Author(s):  
Ivan P. Steiner ◽  
Sandra Blitz ◽  
Darren N. Nichols ◽  
Dwight D. Harley ◽  
Leneela Sharma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Real Time ◽  
Nurse Practitioner ◽  
A Priori ◽  
Care Providers ◽  
Job Descriptions ◽  
Free Standing ◽  
Physician Care ◽  
Patient Presentation

ABSTRACTObjective:Our objective was to compare the emergency care provided by a nurse practitioner (NP) with that provided by emergency physicians (EPs), to identify emergency department (ED) patients appropriate for autonomous NP practice and to acquire data to facilitate the development of the clinical scope of practice recommendations for ED practice for NPs.Methods:Using a comprehensive 3-part process, we selected and hired the best NP from 12 applicants. The NP was oriented to the operations of our free-standing community ED and incorporated in the care team, working in real time with EP preceptors during a 6-month, prospective clinical assessment comparing NP care with EP care. ED preceptors reviewed every case in real time with the NP and completed an explicit evaluation form to determine whether NP assessment, investigation, treatment and disposition were “all equivalent to emergency physician care” (AEEPC) or whether they differed. The proportion of AEEPC interactions was determined for 23 patient presentation categories. Our a priori assumption was that a patient presentation category might be suitable for autonomous NP practice if 50% of NP encounters in that category were rated as AEEPC. Descriptive data were presented for patient case mix, teaching domains and time criteria.Results:Eighty-three NP shifts and 711 patient encounters were evaluated by 21 EP preceptors. The NP saw a median of 8 patients per shift. In 43% of encounters, NP care was AEEPC. Highest AEEPC rates were found in the patient follow-up categories general follow-up (55.4%), diagnostic imaging (91.7%) and microbiology laboratory results (87.6%). NP scores over 50% were also seen for lacerations (63.6%) and isolated sore throats (53%). With teaching, NP performance improved over time.Conclusion:With the exception of follow up–related complaints, simple lacerations and isolated sore throats, NP care differed substantially from EP care. Although NPs with extensive emergency experience and training might ultimately be able to function as autonomous ED care providers, Canadian EDs currently developing job descriptions for emergency NPs should focus on a model of collaborative practice with EPs.

scholarly journals Depth of Necrosis Using Different Ablation Techniques in Healthy Cervical Tissue

2017 ◽  
Vol 3 (2_suppl) ◽  
pp. 4s-5s
Author(s):  
Miriam Cremer ◽  
Karla Alfaro ◽  
Mauricio Maza ◽  
Philip E. Castle ◽  
Albert Zevallos ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Conflicts Of Interest ◽  
Low Cost ◽  
A Priori ◽  
Intraepithelial Neoplasia ◽  
Cost Effective ◽  
Care Providers ◽  
Cervical Tissue ◽  
Low Resource Settings ◽  
Low Resource

Abstract 22 Background: Screening followed by treatment has been a key contributor to the reduction of cervical cancer in industrialized countries and is critical to reduce its burden in low-resource countries. Screening technologies that are appropriate for low-resource settings have advanced considerably; however, treatment technologies have lagged. Treatment methods that are used in developing countries must be low cost, effective, and adaptable for areas with limited infrastructure and health care providers. This study was performed to determine the depth of necrosis in cervical tissue achieved with three treatment devices: conventional cryotherapy with CO2, the CryoPen (CryoPen, Corpus Christi, TX) adapted for low-resource settings, and the thermocoagulator. Methods: One hundred twenty-five women who were scheduled for hysterectomy for indications other than cervical pathology were randomly assigned to one of five treatment arms: single-freeze arms and double-freeze arms for both conventional cryotherapy and the adapted CryoPen, and a single application of thermoablation at 100° C for 40 seconds. Treatment was administered 12 to 24 hours before hysterectomy. Depth of necrosis in cervical specimens was measured by pathologists who were blinded to the treatment modality. Results: A total of 119 women have been enrolled to date, and 114 specimens have been reviewed. Mean depth of necrosis is 5.1 mm (0.9 to 8.5 mm) for single-freeze cryotherapy, 5.6 mm (3.8 to 10.5 mm) for double-freeze cryotherapy, 4.9 mm (3.5 to 8.5 mm) for single-freeze adapted CryoPen; 4.5 mm (3.0 to 7.3 mm) for double-freeze adapted CryoPen, and 3.7 mm (1.9 to 5.5 mm) for the thermoablation ( Table 1 ). Conclusion: The depths of necrosis achieved with the three different ablation modalities are competitive and surpass the targeted depth of 3.5 mm established a priori. Results thus far have demonstrated that devices that are optimized for use in low-resource settings can be as effective as conventional cryotherapy in treating cervical intraepithelial neoplasia. [Table: see text] AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Miriam Cremer Honoraria: Merck Speakers' Bureau: Merck Travel, Accommodations, Expenses: Merck Other Relationship: Basic Health International Karla Alfaro No relationship to disclose Mauricio Maza No relationship to disclose Philip E. Castle No relationship to disclose Albert Zevallos No relationship to disclose Ana Cecilia Diaz de Uriarte No relationship to disclose Manuel Alvarez No relationship to disclose Manuel Salinas No relationship to disclose Ana Sofia Ore No relationship to disclose Luis Taxa No relationship to disclose Juan Felix Expert Testimony: Johnson & Johnson, Philip Morris

Developing CAHPS for cancer care prototype: Progress and next steps.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 134-134 ◽  
Author(s):  
Steven Garfinkel ◽  
Elizabeth Frentzel ◽  
Christian Evensen ◽  
San Keller ◽  
Kathleen J. Yost ◽  
...  
Keyword(s):  
Field Test ◽  
Cancer Care ◽  
Structural Equation ◽  
Discriminant Validity ◽  
Quality Care ◽  
A Priori ◽  
Measurement Properties ◽  
Equation Modeling ◽  
Care Providers ◽  
Stakeholder Input

134 Background: The CAHPS Survey for Cancer Care Prototype (application for CAHPS trademark in process) represents a significant advancement towards helping cancer care providers understand patients’ experiences of care. Although a number of standard commercial surveys are in use, currently none are available that both (1) capture the aspects of care most important to patients and (2) allow comparisons of those aspects of care across treatment centers and modalities. Methods: We developed a survey instrument that incorporated patient, clinician, and other stakeholder input throughout the development process. The survey measures patients’ perceptions of observable provider behaviors that are indicative of high quality care. Field test data were collected from 1,367 of 2,826 eligible patients (48% response rate) treated with surgery, radiation, or medical oncology from 6 accredited cancer treatment centers across the US. Classical psychometric methods were used to evaluate the measurement properties of composite scales per standard CAHPS methodology. Results: Based on a priori conceptualization, patient and stakeholder input, and empirical analyses, we identified 5 composites measuring shared decision-making, exchanging information about treatment, affective communication, access to care, and patient self-management. A confirmatory factor analysis using structural equation modeling showed an excellent fit (CFI > 0.96; RMSEA < 0.05) between the observed data and the structure for these five composites. Cronbach’s alpha for these composites ranged from 0.71-0.88, discriminant validity was good for all scales, and correlations with overall ratings of cancer care providers were moderate (0.31) to high (0.69). Evaluation of the precision with which the composites distinguish among cancer centers indicated that the measures were reliable; however, a second field test with a greater number and variety of centers will be needed to establish a standard sampling approach and confirm these results. Conclusions: We anticipate wide-spread adoption of this measure by cancer care providers to direct quality improvement efforts due to great interest and involvement in this project on the part of stakeholders.

Diabetes at Home

2018 ◽  
pp. 110-128
Author(s):  
Mari Armstrong-Hough
Keyword(s):  
Type 2 Diabetes ◽  
Health Care Providers ◽  
Japanese Patients ◽  
Illness Narratives ◽  
Explanatory Models ◽  
Care Providers ◽  
Healthy Life ◽  
Regular Rhythm

This chapter uses interview data collected from Japanese patients, members of the general public, and health care providers to examine personal explanatory models and illness narratives surrounding type 2 diabetes. Participants articulated a model of health that revolves around the idea of an “ordered” life. In particular, order comes from careful adherence to a classification of time and relies on a clear division of domestic labor. Having a “rhythm” to one’s life, and observing regular, unchanging hours for core activities like waking, eating, and bathing were identified as key to a healthy life. But the responsibility for this temporal maintenance falls largely on women: women work to organize the time of loved ones into a healthy, regular rhythm. Men without mothers, wives, sisters, or daughters to take care of them are thus thought to be particularly at risk of illness.

Concepts of mental illness and medical pluralism in Harare

1995 ◽  
Vol 25 (3) ◽  
pp. 485-493 ◽  
Author(s):  
V. Patel ◽  
T. Musara ◽  
T. Butau ◽  
P. Maramba ◽  
S. Fuyane
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Traditional Healers ◽  
Explanatory Models ◽  
Psychiatric Nurses ◽  
Medical Pluralism ◽  
Care Providers ◽  
Illness Episode ◽  
Screening Criteria ◽  
Case Vignettes

SYNOPSISThe Focus Group Discussions (FGD) described in this paper are the first step of a study aiming to develop an ‘emic’ case-finding instrument. In keeping with the realities of primary care in Zimbabwe, nine FGD were held with 76 care providers including 30 village community workers, 22 traditional and faith healers (collectively referred to as traditional healers in this paper), 15 relatives of patients and 9 community psychiatric nurses. In addition to the general facets of concepts of mental illness, three ‘etic’ case vignettes were also presented.A change in behaviour or ability to care for oneself emerged as the central definition of mental illness. Both the head and the heart were regarded as playing an important role in the mediation of emotions. The types of mental illness described were intimately related to beliefs about spiritual causation. Angered ancestral spirits, evil spirits and witchcraft were seen as potent causes of mental illness. Families not only bore the burden of caring for the patient and all financial expenses involved, but were also ostracized and isolated. Both biomedical and traditional healers could help mentally ill persons by resolving different issues relating to the same illness episode. All case vignettes were recognized by the care providers in their communities though many felt that the descriptions did not reflect ‘illnesses’ but social problems and that accordingly, the treatment for these was social, rather than medical.The data enabled us to develop screening criteria for mental illness to be used by traditional healers and primary care nurses in the next stage of the study in which patients selected by these care providers on the grounds of suspicion of suffering from mental illness will be interviewed to elicit their explanatory models of illness and phenomenology.

Parents’ Experiences and Information Needs While Caring for a Child With Functional Constipation: A Systematic Review

2020 ◽  
pp. 000992282096445
Author(s):  
Alison P. Thompson ◽  
Eytan Wine ◽  
Shannon E. MacDonald ◽  
Alyson Campbell ◽  
Shannon D. Scott
Keyword(s):  
Health Care Providers ◽  
Information Needs ◽  
A Priori ◽  
Functional Constipation ◽  
Family Education ◽  
Current Evidence ◽  
Care Providers ◽  
Relationship Breakdown ◽  
Published Research ◽  
Parents Experiences

Pediatric functional constipation (FC) reportedly affects at least 1 in 10 children worldwide. Parent and family education is a key component for successful treatment, yet there is little research exploring what information families need and how to best support them. The aim of this review is to synthesize current evidence on the experiences and information needs of parents caring for a child with FC. We systematically searched published research and completed screening against a priori inclusion criteria. Thirteen studies (n = 10 quantitative, n = 3 qualitative) were included. We found 2 main themes, precarious footing and profound and pervasive effects. Heavy caregiving burdens fueled doubts, misinformation, relationship breakdown, and treatment deviation. In light of clinical recommendations, our findings reveal a potential mismatch between parents’ needs and care provision for FC. It is likely that both parents and health care providers would benefit from resources and interventions to improve care related to pediatric FC.

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