Embedding Researcher’s Reflexive Accounts within the Analysis of a Semi-Structured Qualitative Interview

This manuscript aims to embed a researcher’s reflexive account within a qualitative interview in an iterative process whereby a self-analytic reflexive exercise was conducted prior to, during the interview, and within the analysis of the interview. This interview was conducted between an overseas PhD student as an interviewer and a native PhD student as interviewee. The researcher’s (interviewer) demonstration of learning about herself is of particular importance in this piece of work. Having the chance to conduct this interview between an overseas PhD student and a native student provided insights about the stereotypes implanted within the researcher which meant that she assumed that a PhD is more stressful for overseas than for home students

Love, Fear and Disgust: Deconstructing Masculinities and Affective Embodiment in Pregnancy Guides for Men

© The Author(s) 2021. Employing a material discursive approach, this article deconstructs advice within published guides to pregnancy and birth written by men for men. We deconstruct the representation of feelings and emotions in men during this period rejecting essentialist and social constructionist views of gendered emotionality. We find the texts are saturated with emotional advice, which is ambivalent and resorts to forms of essentialism that obscure male vulnerabilities and leave male forms of power intact. While men can expect to feel love, fear, and disgust, the case for male calm and stoicism is reconstructed, threatening dire consequences if he fails. Our study makes a unique contribution to our understanding of the affective assemblage that accompanies men who are now expected to care during pregnancy, labor, and birth. Men are constructed as having an embodied experience that cannot be admitted to, ensuring that hegemonic masculine understandings reinforce gendered constructions of care, caring and emotions during pregnancy, labor and birth

“I don’t have any emotions”: An ethnography of emotional labour and feeling rules in the emergency department

Aims: This study aims to apply Hochschild's theory of emotional labour to emergency care, and uncover the 'specialty-specific' feeling rules driving this labour. Despite the importance of positive nurse wellbeing, the emotional labour of nursing (a great influencer in wellbeing) remains neglected. Design and Methods: Ethnography enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nursing team. We undertook first-hand observations at one major trauma center ED and one district general ED including semi-structured interviews (18). A reflexive and interpretive approach towards thematic analysis was utilised. Results: We unearthed and conceptulaised four feeling rules born from this context and offer extensive insights into the emotional labour of emergency nurses. Conclusion: Understanding the emotional labour and feeling rules of various nursing specialties offers critical insight into the challenges facing staff-fundamental for nursing wellbeing and associated retention programs. Impact: What problem did the study address? A lack of (theoretical and empirical) knowledge relating to emotional labour, and associated feeling rules, in the ED. What were the main findings? The distinctive context has significant implications for the emotional labour undertaken. This labour was driven by four, enculturated feeling rules which we conceptualised. Where and on whom will the research have impact? Academically, this research expands our understanding-we know little of nurses' feeling rules and how specialties influence them. Clinically, (including service managers and policy makers) there are practical implications for nurse wellbeing

‘Socialised care futility’ in the care of older people in hospital who call out repetitively: an ethnographic study

BackgroundPeople living with dementia may call out repetitively, sometimes called disruptive vocalisation, or verbal agitation. In literature and policy, patients who call out repetitively are assumed to be expressing an unmet need, which should be met. Yet there has been little systematic study of this patient group in an acute hospital setting.ObjectivesTo better understand patients who call out repetitively and to identify what care looks like in an acute hospital setting.DesignEthnography.SettingsTen acute geriatric medical wards in two hospitals.Participants30 cognitively impaired patients who were calling out repetitively, and 15 members of hospital staff.MethodsSemi-structured interviews with hospital staff, 150 hours of ward observations and informal conversations with staff, scrutiny of medical and nursing documentation, and measures of patient health status.ResultsPatients who called out were moderately or severely cognitively impaired, often had delirium, were very physically disabled, and many were approaching the end of life. Most hospital staff were found to hold contradictory views: that calling out represents distress or unmet need, but that nothing can be done to alleviate the calling out. During informal conversations, most staff also tended to say that they intuitively recognised when intervening was likely to alleviate calling out. During observations, many staff appeared to and spoke of the ability to ‘block’ calling out. As a result we argue that social, emotional and physical needs may get overlooked. We argue that some calling out of a need, represents a need that is unmeetable. We also found that while staff would talk about strategies for identifying need, observations and hospital documentation did not support evidence of systematic attempts to identify potential need.ConclusionCalling out repetitively within a hospital setting is difficult for staff to understand and to respond to. This is because many of these patients are severely cognitively impaired, while also bed-bound and dependent on their professional carers. We argue that a form of socialised care futility gets communicated between staff and is used to rationalise becoming unresponsive to calling-out. We explain this phenomenon as resulting from two protective mechanisms: defence of staff's professional identity as competent practitioners; and defence of staff as having personal morality. Socialised care futility risks good quality care, therefore systematic strategies to assess and manage possible need should be developed, even if calling out remains irresolvable in some cases

‘Maybe I Shouldn’t Talk’: The Role of Power in the Telling of Mental Health Recovery Stories

Mental health ‘recovery narratives’ are increasingly used within teaching, learning and practice environments. The mainstreaming of their use has been critiqued by scholars and activists as a co-option of lived experience for organisational purposes. But how people report their experiences of telling their stories has not been investigated at scale. We present accounts from 71 people with lived experience of multiple inequalities of telling their stories in formal and informal settings. A reflexive thematic analysis was conducted within a critical constructivist approach. Our overarching finding was that questions of power were central to all accounts. Four themes were identified: (1) Challenging the status quo; (2) Risky consequences; (3) Producing ‘acceptable’ stories; (4) Untellable stories. We discuss how the concept of narrative power foregrounds inequalities in settings within which recovery stories are invited and co-constructed, and conclude that power imbalances complicate the seemingly benign act of telling stories of lived experience

Multi-centre parallel arm randomised controlled trial to assess the effectiveness and cost-effectiveness of a group-based cognitive behavioural approach to managing fatigue in people with multiple sclerosis

Abstract (provisional) Background Fatigue is one of the most commonly reported and debilitating symptoms of multiple sclerosis (MS); approximately two-thirds of people with MS consider it to be one of their three most troubling symptoms. It may limit or prevent participation in everyday activities, work, leisure, and social pursuits, reduce psychological well-being and is one of the key precipitants of early retirement. Energy effectiveness approaches have been shown to be effective in reducing MS-fatigue, increasing self-efficacy and improving quality of life. Cognitive behavioural approaches have been found to be effective for managing fatigue in other conditions, such as chronic fatigue syndrome, and more recently, in MS. The aim of this pragmatic trial is to evaluate the clinical and cost-effectiveness of a recently developed group-based fatigue management intervention (that blends cognitive behavioural and energy effectiveness approaches) compared with current local practice. Methods This is a multi-centre parallel arm block-randomised controlled trial (RCT) of a six session group-based fatigue management intervention, delivered by health professionals, compared with current local practice. 180 consenting adults with a confirmed diagnosis of MS and significant fatigue levels, recruited via secondary/primary care or newsletters/websites, will be randomised to receive the fatigue management intervention or current local practice. An economic evaluation will be undertaken alongside the trial. Primary outcomes are fatigue severity, self-efficacy and disease-specific quality of life. Secondary outcomes include fatigue impact, general quality of life, mood, activity patterns, and cost-effectiveness. Outcomes in those receiving the fatigue management intervention will be measured 1 week prior to, and 1, 4, and 12 months after the intervention (and at equivalent times in those receiving current local practice). A qualitative component will examine what aspects of the fatigue management intervention participants found helpful/unhelpful and barriers to change. Discussion This trial is the fourth stage of a research programme that has followed the Medical Research Council guidance for developing and evaluating complex interventions. What makes the intervention unique is that it blends cognitive behavioural and energy effectiveness approaches. A potential strength of the intervention is that it could be integrated into existing service delivery models as it has been designed to be delivered by staff already working with people with MS. Service users will be involved throughout this research. Trial registration: Current Controlled Trials ISRCTN7651747

MRSA care in the community: why patient education matters

In primary care, patients are prescribed decolonisation treatment to eradicate meticillin-resistant Staphylococcus aureus (MRSA). This complex treatment process requires the patient to apply a topical antimicrobial treatment as well as adhering to rigorous cleaning regimens to ensure the environment is effectively managed. A pilot study was carried out that involved developing an enhanced, nurse-delivered education tool, training a community nurse to use it, then testing its use with a patient. Three interviews were carried out: one with a patient who received usual care, one with a patient who received the enhanced education and one with the community nurse who delivered the enhanced education tool. The patient who received the enhanced education reported better knowledge and understanding of the application of treatment than the patient who did not. These results are interesting and point the way forward for larger research studies to build on the learning from this limited exploration and develop more effective management of MRSA in primary care

The attitudes of neonatal nurses towards extremely preterm infants

Aim. The paper is a report of a study of the attitudes of neonatal nurses towards extremely preterm infants. Background. Alongside advancing survival at extremely preterm gestational ages, ethical debates concerning the provision of invasive care have proliferated in light of the high morbidity. Despite nurses being the healthcare professionals who work closest with the infant and their family, their potential influence is usually ignored when determining how parents come to decisions about future care for their extremely premature infant. Methods. A Q methodology was employed to explore the attitudes of neonatal nurses towards caring for extremely preterm infants. Data were collected between 2007 and 2008 and analysed using PQMethod and Card Content Analysis. Results. Thirty-six nurses from six neonatal units in the United Kingdom participated. Although there was consensus around the professional role of the nurse, when faced with the complexities of neonatal nursing three distinguishing factors emerged: the importance of parental choice in decision-making, the belief that technology should be used to assess response to treatment, and the belief that healthcare professionals should undertake difficult decisions. Conclusion. Neonatal nurses report unexpected difficulties in upholding their professionally defined role through highly complex and ever varied decision-making processes. Recognition of individual attitudes to the care of extremely preterm infants and the role of the family in the face of difficult decisions should facilitate more open communication between the nurse and the parents and improve the experience of both the nurse and the family during these emotional situations. © 2011 Blackwell Publishing Ltd