Developing connections for engagement in stroke rehabilitation

Background and Aims: Engagement is increasingly recognised as important for maximising rehabilitation outcome following stroke. However, engagement can be challenging when neurological impairment impacts a persons’ ability to activate the regulatory processes necessary for engagement and in the context of a changed self. We explored engagement in stroke rehabilitation from the perspective of people with stroke with a primary focus on identifying key processes that appeared important to engagement in stroke rehabilitation. Design and Methods: This study drew on Interpretive Description methodology. Maximum variation and theoretical sampling were used to capture diversity in the sample and access a depth and breadth of perspectives. Data collection included semi-structured interviews with people with stroke (n = 19). Data were analysed through a collaborative and iterative process drawing on range of analytical tools including coding, memoing, diagramming and group discussions. Findings: Our findings highlight that engagement is a complex, nuanced, responsive, flexible and inherently two-way process. Developing connections appeared central to engagement with connections taking various forms. The most fundamental was the therapeutic connection between the person with stroke and their practitioner as it provided the foundation on which to build other connections. Connection was made possible through five collaborative processes: Knowing, Entrusting, Adapting, Investing and Reciprocating. Conclusions: Engagement is a social and relational process enabled through an inherently person-centred approach and active and ongoing reflexivity – highlighting the importance of a humanising approach to care where aspects of self, care and emotion are evident, for both the person with stroke and their practitioner.

Paramedic-delivered teleconsultations: a grounded theory study

Objective Progression in Anglo-American models of out-of-hospital care has resulted in the development of alternative roles for paramedics, including advanced paramedics providing teleconsultations to frontline paramedics. Traditionally provided by physicians, little is known about how paramedics perceive peer-to-peer teleconsultations. This research aimed to explore paramedic perceptions of paramedic-delivered teleconsultations. Methods This investigation employed a constructivist grounded theory methodology. Six focus groups were conducted with purposive and theoretical sampling and data analyzed using open coding and continual comparative analysis. Results 33 paramedics from across British Columbia, Canada, participated in the focus groups. Seven key themes emerged during the focus groups; the perceived roles and status of paramedic specialists and physicians in healthcare, the influence of relationships and culture on clinical consultations, practicalities of out-of-hospital care and the importance of lived experience, provision of appropriate clinical advice, professional trust and respect, mentorship in out-of-hospital care and clinical governance and education requirements. This led to the development of the grounded theory paramedics increasing ownership of their profession. Conclusion Paramedics reported a number of areas in which paramedic-delivered teleconsultations provided benefits not seen with traditional physician-delivered teleconsultation model. Emergency health systems delivering an Anglo-American model of care should consider the possible benefits of paramedic-delivered teleconsultations.

A model to foster and facilitate trust and trusting relationships in the nursing education context

Background: In the nursing education context, the fostering of trust and establishing trusting relationships are important facets of teaching and learning.Aim: The purpose of the study was to understand trust and trusting relationships in teaching and learning, and to develop a model to foster and facilitate trust and trusting relationships in the nursing education context.Setting: Two nursing education institutions were purposively sampled that offered a comprehensive programme in nursing.Methods: A grounded theory study was conducted with the aim to develop a model for trust and trusting relationships in teaching and learning. Purposive, convenience and theoretical sampling of participants were applied. The sample size consisted of 5 educators and 23 students at a university and 9 educators and 37 students at a public nursing education institution. Charmaz’s methods were used for the data analysis. Collection and analysis of data were conducted concurrently.Results: Data of views from the educators and students on trust were synthesised. Themes identified were: professional relations, expectations of the role players in nursing education, creating a conducive teaching and learning context, and outcomes of lack of trust. From the findings, a substantive model to foster and facilitate trust and trusting relationships in nursing education was developed.Conclusion: The study contributed to understanding trust in nursing education. Recommendations focus on fostering and facilitating self-trust and trusting relationships and also on how the model could be implemented in nursing education.Contribution: Fostering and facilitating trust and trusting relationships in the nursing education context will enhance a trusting culture and contribute to the quality of teaching and learning.

Insight into the Feasibility and Acceptability of a Multi-lifestyle Dementia Risk Intervention

Lifestyle interventions based on behaviour change principles may provide a useful mechanism in reducing dementia risk amongst older adults, however intervention acceptability remains relatively unexplored. We assessed the feasibility and acceptability of BRAIN BOOTCAMP, an Australian initiative aiming to improve dementia literary and reduce dementia risk by delivering a brain health box addressing multiple lifestyle factors through education, physical prompts and an individualised brain health profile. Semi-structured phone interviews were conducted with participants (N=94) at completion of the program (3-months) using a theoretical sampling approach to select a range of participants with varying brain health scores, age, gender, education and locality. Interview topics included participants’ overall experience and suggestions for program improvement. Interviews were transcribed and analysed using thematic analysis. Participants were mostly female (79%), with a mean age of 72.6 years (SD=5.4), from an English-speaking background (89.4%) and resided in metropolitan areas (76.6%). Participants positively perceived the program, resulting in high usability and acceptability. Valuable aspects included building dementia awareness in an innovative way, and having re-assessments which identified areas for personal improvement. Participants further discussed how the program prompted lifestyle change, including setting goals (e.g., physical activity) and facilitated a general awareness of their brain health. Suggested improvements included shorter surveys, regular check-ins, and specific tailoring of the program to be more inclusive for older adults with varying levels of health. Our study demonstrated that a simple, innovative program could be a promising medium for delivering comprehensive educational resources and induce lifestyle change for older adults.

Sampling Theoretically for Comparison

Sampling has historically been one of the major challenges of the comparative research approach. These sampling challenges primarily result from the way researchers select the cases/samples for the study. In this regard, researchers have to a large extent tended to employ non-probability convenience and purposive sampling techniques. Even though it may be argued that these sampling approaches need not be theory driven as samples tend to evolve in the process of research, more often than not, these sampling methods, especially in comparative research designs, while skewing research attention towards over-researched countries and cases, wealthy nations and incomparable cases, also introduce an element of bias into sampling and therefore into research findings. Thus, this paper argues for a move away from the simplicity of purposive and convenience sampling, to one of the more robust forms of theoretical sampling, in order to improve the research rigour associated with the comparative methodological approach. This paper accordingly postulates this may be achieved by engaging in some form of theoretical sampling. In this regard, this paper describes a two-phase method for generating comparative samples from theories, involving six distinct steps.

Adapting despite “walls coming down”: Healthcare providers’ experiences of Covid-19 as an implosive adaptation

Background The Covid-19 pandemic has been a daunting exercise in adaptation for healthcare providers. While we are beginning to learn about the challenges faced by teams during the Covid-19 pandemic, what remains underexplored are the ways team members identified and adapted to these challenges. This is the goal of this study. Methods We interviewed 20 healthcare workers at various hospitals in Ontario, who provided care as part of clinical teams during the Covid-19 pandemic. Data was collected and analyzed following Constructivist Grounded Theory principles including iteration, constant comparison and theoretical sampling. Results Participants’ accounts of their experiences revealed the process of ‘implosive adaptation’. The ‘reality check’, the ‘scramble’, and the ‘pivot’ comprised this process. The reality check described the triggers, the scramble detailed the challenges they went through, and the pivot prescribed the shifting of mindset as they responded to challenges. These stages were iterative, rather than linear, with blurred boundaries. Conclusion That not all adaptations have to be successful during a crisis was the major insight gained by our participants. The language of Reality Check, Scramble, and Pivot provides a framework for teams to talk about and make sense of their approaches to crisis, even beyond the Covid-19 pandemic.

Humane Organizing in a Post-COVID-19 World: Learning from Buurtzorg’s Trust-Based Decentralization

This paper examines the enablers and consequences of less hierarchical organizing in which humane values are in focus as a path toward spirituality in the workplace. It describes Buurtzorg Nederland, a revolutionary case in home health care due to its radically decentralized structure and integrative, autonomous system of organizing. Data were collected by studying the responses of directors and nurses to the COVID-19 pandemic. A formative grounded theory methodology based on theoretical sampling using two additional qualitative data sets is used. The paper demonstrates that the simplification of organizational structures through integrative self-management helps to put the organization’s purpose at the center. Even in times of COVID-19 pandemic, this decentralized organizational architecture is empowering. The core concept of integrating simplification is elaborated using the enablers of serving, attuning, and trusting, wherein the concept of trust emerges as foundational.

Leveraging grounded theory in supply chain research: A researcher and reviewer guide

PurposeThe purpose of this article is to identify and explain most frequently misunderstood steps in the use of grounded theory (GT) as a methodology and provide guidance on proper execution of these elements.Design/methodology/approachThis research provides meaningful guidance to both reviewers and authors interested in applying GT. This research is expected to advance the pursuit of formal theory development.FindingsThere are four most frequently misunderstood steps in the use of GT as a methodology. These are related to the use of literature, theoretical sampling, core category and formal theory development. Proper execution of these elements is important for convincing reviewers and readers that the findings of the research are meaningful and trustworthy.Originality/valueThis paper should be of significant value to researchers who are interested in GT as a methodology. It adds to the few journal articles that address the proper ways to conduct GT.

ANALYSIS OF PEPEE AND MASHA AND THE BEAR, PREPARED FOR PRESCHOOL PERIOD, IN TERMS OF VALUES

In the first two parts of the study, the literature review and in the third part, the cartoon Pepee and Masha and the Bear was examined by using the embedded theory method, one of the qualitative research methods. The theoretical sampling method, one of the purposive sampling methods, was used in the selection of the sample. The sample of the research consists of ten episodes of Pepee cartoon and ten episodes of Masha and the Bear cartoon. The document analysis method was used in the analysis of the cartoon Masha and the Bear, which was watched on the Turkish youtube channel, Pepee and Masha and the Bear. As a result of the analyzes, when the verbal expression and behavioral expression dimensions of the values in the Pepee cartoon were compared, it was determined that they were presented to the audience as verbal expression categories rather than behavioral expression value categories. Of the total value expressions (n= 457), 372 were in the "verbal expression dimension" and 55 were in the "behavioral expression dimension". When the verbal expression and behavioral expression dimensions of the values in the cartoon Masha and the Bear were compared, it was determined that they were presented to the audience as behavioral expression categories rather than verbal expression value categories. Of the total value expressions (n= 168), 112 were in the "behavioral expression dimension" and 56 in the "verbal expression dimension".

Exploring the barriers to Pap smear test in Iranian women: a qualitative study

Background Cervical cancer is one of the most frequent types of cancer in females. The Pap smear is one of the most essential ways of diagnosing and screening for this malignancy, and any failure can be caused by a number of causes. The current study sought to investigate barriers to Pap smear in Iranian women. Method This qualitative content analysis study was conducted in Iran in 2019. Data was gathered through focus groups and individual semi-structured interviews with 32 women and health professionals. The interviewees were chosen using a combination of purposive and theoretical sampling. The data was then analyzed using the content analysis approach developed by Graneheim and Lundman. Guba and Lincoln's criteria for establishing trustworthiness were explored. Results Data analysis resulted in the identification of four primary categories, seventeen subcategories, and 186 original concepts. The main categories include weakness of health system, difficult accessibility, low health literacy, and socio-cultural factors. Conclusion By informing women about the necessity and importance of Pap smear, providing the conditions, facilities, and equipment to facilitate the testing process, and paying more attention to cultural and social factors in cervical cancer and Pap smear planning, interventions, and policies, barriers to Pap testing can be eliminated.