scholarly journals Orientation of medical trainees to a new clinical environment (the ready-steady-go model): a constructivist grounded theory study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Anél Wiese ◽  
Deirdre Bennett

Abstract Background High-quality orientation of trainees entering a new clinical workplace is essential to support education and patient safety. However, few consultants receive extensive formal training to support new trainees and must create their own ways of integrating newcomers into their clinical team and work environment. We aim to conceptualise the strategies consultants use in the early stages of working with new trainees that will be useful for future faculty development in this area. Methods We used constructivist grounded theory (CGT) methodology by interviewing fifteen consultants in three medical specialties, to explore how trainees are integrated into a new clinical environment. We used CGT principles and procedures (iteration, constant comparison, and theoretical sampling) to analyse and construct a conceptual interpretation of the empirical data. Results Consultants’ central concern when introduced to a new cohort of trainees was that they had the required knowledge and skills (ready), were adapted and integrated into the new workplace and clinical team (steady), and safely participating in practice (go). Consultants used two broad strategies: formal orientation and informal orientation. Both these approaches had the common goal of intensifying interaction between consultants and trainees to get trainees to a position where they were ready, adapted, integrated, and participating safely and efficiently in practice. Several disruptors were identified by participants that delayed and sometimes completely inhibited the orientation process. Conclusions The model of orientation constructed through this research could be a valuable tool to support faculty development initiatives, the reflective learning practice of clinical supervisors, and curriculum design. The disruptors were identified as valid priorities for improving trainee orientation in postgraduate medical education. Future research should involve a longitudinal approach to explore trainee engagement with orientation upon entering a new clinical workplace.

2021 ◽  
pp. 016235322110235
Author(s):  
Claudia A. Cornejo-Araya ◽  
Leonie Kronborg

Adopting a constructivist grounded theory approach, 91 students from Years 9 to 11, in gifted educational programs from three schools in Melbourne, nominated their inspiring teachers. Eleven teachers, who received the highest number of nominations, were invited to an interview and an observation of their teaching. The emerged theoretical construct was identified as “Opening new possibilities: Inspiring teachers of gifted and highly able students,” which is further explained through three main categories: Being a knowledgeable and passionate teacher, creating an academically safe learning environment, and teaching beyond and above the regular curriculum. In addition, the theoretical process was explained through three phases: Expanding knowledge and understanding, Fostering positive attitudes, and Encouraging students to take action. Contextual determinants were considered to analyze and report the findings: students’ developmental characteristics, school culture, curriculum, and gifted educational provisions. Findings are discussed in the light of existing literature, as well as study limitations and ideas for future research.


Sexual Abuse ◽  
2018 ◽  
Vol 31 (8) ◽  
pp. 908-929
Author(s):  
Miriam Ryan ◽  
Mathew McCauley ◽  
Davina Walsh

Sexual offenses evoke strong emotional responses and frequently elicit demands from society that offenders be indefinitely incarcerated or treated until they are deemed safe, which may impact the provision of therapeutic treatment for offenders. However, in recent years, there has been a proposal to move toward a positive, strengths-based treatment approach, namely the Good Lives Model (GLM). The present study used semi-structured interviews and a constructivist grounded theory approach to examine the experience of 13 men who were voluntarily engaging in or had completed a GLM community-based treatment program. A conceptual model emerged which outlines the process the men underwent, the factors they identified as crucial for change, and the perceived gains. The model extends previous work by exploring the process from the clients’ perspective. Implications for future research, prevention, and treatment are discussed.


2020 ◽  
Vol 30 (10) ◽  
pp. 1546-1560
Author(s):  
Emily C. Wacker ◽  
Megan L. Dolbin-MacNab

Despite knowledge that the larger sociocultural context contributes to the development of eating disorders, few studies have examined protective factors for women with subthreshold eating disorders. Using feminist-informed constructivist grounded theory methodology, 15 women (ages 18–25 years) with subthreshold eating disorders were interviewed. Results suggest that participants spoke of their subthreshold eating disorders in an externalized way and used protective factors to guide decision making toward their preferred values. A grounded theory model was developed to illustrate this process. Protective factors included (a) people who provide emotional and tangible support, (b) support people who challenge the eating disorder, (c) personal sense of agency, and (d) community activism and involvement. Participants experiencing subthreshold eating disorders demonstrated a capacity to distinguish their own thoughts and values from those of the “eating disorder voice,” and protective factors facilitated this process. Implications for future research and practice are discussed.


2021 ◽  
Author(s):  
◽  
Suzanne Hodgson

Fathers who are involved with their infants have the potential to make significant positive contributions to their children’s future health, wellbeing, and development. Transitions to fatherhood and the factors that shape those experiences, for some men, are poorly understood. There is a need for an improved awareness of the experiences of first-time fathers to inform policy and practice and improve support and outcomes for these men and their families. The primary aim of this work was to explore contemporary transitions to fatherhood. To this end, a constructivist grounded theory study (CGTM) was undertaken. Twelve new fathers were recruited in the North of England and data were gathered from semi-structured interviews where participants shared their experiences and perspectives of becoming fathers for the first time. Concepts relating to becoming and being fathers were explored in addition to fatherhood identity development. Following analysis of the data via processes fundamental to CGTM, the core category of reconciling father identities was constructed consisting of three theoretical categories: anticipating fatherhood, tensions in fathering and the fluidity of fathering. All participants had strong aspirations for involved fathering performances and took steps to prepare for their new roles. However, they faced various tensions in the workplace, in healthcare and in the normative, often traditional, expectations influenced by social and structural gendered norms. The father roles that they were ascribed by others frequently did not fit with their aspirations during pregnancy and the early months as fathers. They therefore found themselves working through periods of identity reconciliation which impacted upon their self-concept as fathers, their parenting confidence, and their parenting autonomy. Broader consideration of the needs of fathers is required across the arenas in which they perform fatherhood to support the development of positive father identities. This has the potential to benefit the wellbeing of the men themselves, their partners, and their infants. The implications for workplace, healthcare policy and practice are offered including suggestions for future research.


Dementia ◽  
2017 ◽  
Vol 18 (6) ◽  
pp. 2158-2172 ◽  
Author(s):  
Anna Colquhoun ◽  
Jennifer Moses ◽  
Rosslyn Offord

Couples living with dementia face multiple losses in their relationship, and may experience changes in their overall sense of relationship quality. These topics have predominantly been researched from the caring partner’s perspective therefore, this study aimed to explore how couples adapt to relational losses to maintain quality in their relationship from the perspective of both partners. Using a constructivist grounded theory approach 10 spousal dyads, where one partner has a diagnosis of dementia, engaged in a joint interview. The results revealed three master themes: consolidating us, contextual positioning, and living well together, as well as an overarching theme of ‘turning to and away’. The findings are discussed in relation to theories of loss and family adaptation, and implications for clinical practice and future research are proposed.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21560-e21560 ◽  
Author(s):  
Catherine Mary Oakley ◽  
Cath Taylor ◽  
Emma Ream ◽  
Alison Metcalfe

e21560 Background:Internationally the mortality rate for neutropenic sepsis (NS) is 2-21% (in patients who develop it). Within the United Kingdom NS causes around 700 deaths annually. Clinicians are concerned about patient delayed reporting of NS which may increase healthcare costs, mortality and chemotherapy delays, which can affect prognosis. Methods: Constructivist grounded theory was used to gain insight into the reasons for patient delays. Observations (n = 13 hours) of women with breast cancer being provided with information about NS by oncology doctors and nurses and 31 in-depth interviews. Analysis (and development of categories and supporting properties) commenced with the earliest data gathered and a rich theoretical picture was built through comparing perspectives, pursuing areas of inquiry and recruiting participants who became of interest. Data were collected until saturation. A coding framework was applied to examine and explain connections between categories. Results: 35 participants. 13 women with breast cancer (median age, 56 years, 8 Caucasian, 9 adjuvant, 4 metastatic), 9 carers (partners, family or friends, 50% lived with patients) and 13 clinicians (4 oncologists, 7 chemotherapy nurses, 2 emergency department clinicians, most doctors were male, most nurses were female). The majority of patients and carers were highly educated ( > degree level). All patients except 1, delayed reporting NS symptoms (2.5 hours - 8 days), sometimes repeatedly. The final grounded theory suggests patient delays are due to an interplay of behaviours between clinicians, patients and carers where they subconsciously collude to underplay the seriousness and possibility of NS occurring.Moderators of delay included metastatic disease, bereavement, fatalism, religious beliefs and quality of relationships with clinicians. Conclusions: Relationships with clinicians directly impacted on delayed patient reporting of NS.Findings have implications for health risk communication, development of holistic service models and the design of future research to develop interventions, to promote earlier recognition and treatment for this important chemotherapy complication.


2021 ◽  
pp. 238008442110144
Author(s):  
N.R. Paul ◽  
S.R. Baker ◽  
B.J. Gibson

Introduction: Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision. Objectives: The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment. Methods: This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding. Results: The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face. Conclusion: The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies. Knowledge Transfer Statement: The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.


Author(s):  
Sarah Lawson ◽  
Helen Griffiths

AbstractDespite the global impact of substance misuse, there are inadequate levels of specialist service provision and continued difficulties with treatment engagement. Within policy and research, there is substantial consideration of the importance of these factors. However, there is little empirical evidence of the views of non-treatment-seeking substance users, who make up the majority of the substance using population. The aim of this study was to understand how these individuals make sense of their behaviour and their reasons for not accessing treatment. A constructivist grounded theory approach was used to interview eight individuals who were currently using substances and not seeking help to stop. The analysis highlighted the importance of attachment to an identity associated with substance use, and relational variables such as connectedness to others, for treatment decisions for individuals who use substances. Understanding these influences, through trauma- and attachment-informed service provision, may reduce barriers to help-seeking and improve treatment uptake.


2021 ◽  
pp. 1-7
Author(s):  
Flerida Imperial-Perez ◽  
MarySue V. Heilemann ◽  
Lynn V. Doering ◽  
Jo-Ann Eastwood ◽  
Nancy A. Pike

Abstract Background: Caring for infants after the first-stage palliative surgery for single-ventricle heart disease bring challenges beyond the usual parenting responsibilities. Current studies fail to capture the nuances of caregivers’ experiences during the most critical “interstage” period between the first and second surgery. Objectives: To explore the perceptions of caregivers about their experiences while transitioning to caregiver roles, including the successes and challenges associated with caregiving during the interstage period. Methods: Constructivist Grounded Theory methodology guided the collection and analysis of data from in person or telephonic interviews with caregivers after their infants underwent the first-stage palliative surgery for single-ventricle heart disease, and were sent to home for 2–4 months before returning for their second surgery. Symbolic interactionism informed data analyses and interpretation. Results: Our sample included 14 parents, who were interviewed 1–2 times between November, 2019 and July, 2020. Most patients were mothers (71%), Latinx (64%), with household incomes <$30K (42%). Data analysis led to the development of a Grounded Theory called Developing a Sense of Self-Reliance with three categories: (1) Owning caregiving responsibilities despite grave fears, (2) Figuring out how “to make it work” in the interstage period, and (3) Gaining a sense of self-reliance. Conclusions: Parents transitioned to caregiver roles by developing a sense of self-reliance and, in the process, gained self-confidence and decision-making skills. Our study responded to the key research priority from the AHA Scientific Statement to address the knowledge gap in home monitoring for interstage infants through qualitative research design.


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