More than putting on a performance in commercial homes: merging family practices and critical hospitality studies

Critical hospitality studies and family studies have shown a developing theoretical convergence predicated by the ‘social turn’ in the study of hospitality. Recent hospitality research on ‘Commercial Homes’ has drawn strongly on Goffman's concept of performance to examine both guest and host behaviours. In contrast, this article introduces the family studies concept of ‘displaying families’. This concept emphasises the family practices of host families as well as the commercial practices privileged in studies of hospitality. It also widens the often individualised focus on the (adult) host(s) to one that incorporates the host family. Drawing on empirical evidence, it appears that, for the hosts, displaying families in Commercial Homes is a complex and, apparently paradoxical, mix of presentation and reticence – the family has to be highly visible but not publicly privileged over guests. The inclusion of the concept of display will serve to illuminate further the arenas where family, commercial and hospitality practices intersect

A thematic synthesis of the experiences of adults living with hemodialysis

Background and objectives In-center dialysis patients spend significant amounts of time on the dialysis unit; additionally managing ESKD affects many aspects of life outside the dialysis unit. To improve the care provided to patients requiring hemodialysis their experiences and beliefs regarding treatment must be understood. This systematic review aimed to synthesise the experiences of patients receiving in-center hemodialysis. Design, setting, participants, and measurements Embase, MEDLINE, CINAHL and PsychINFO, Google scholar and reference lists were searched for primary qualitative studies exploring the experiences of adult patients receiving treatment with in-center hemodialysis. A thematic synthesis was conducted. Results 17 studies involving 576 patients were included in the synthesis. 4 analytical themes were developed. The first theme “a new dialysis dependent self” describes the changes in identity and perceptions of self that could result from dialysis dependence. The second theme, “a restricted life”, describes the physical and emotional constraints patients described as a consequence of their dependence. Some patients reported strategies that allowed them to regain a sense of optimism and influence over the future and these contributed to the third theme, “regaining control”. The first three themes describe a potential for change through acceptance, adaption and re-gaining a sense of control. The final theme, “relationships with health professionals” describes the importance of these relationships for in-center patients and their influence on perceptions of power and support. These relationships are seen to influence the other three themes through information sharing, continuity and personalized support. Conclusions This synthesis has resulted in a framework that can be utilized to consider interventions to improve patients’ experiences of in-center hemodialysis care. Focusing on interventions that are incorporated into the established relationships patients have with their health care professionals may enable patients’ to progress towards a sense of control and improve satisfaction with care

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Other Girls: a qualitative exploration of teenage mothers views on teen pregnancy in contemporaries

Perspectives that consider teenage mothers as a ‘social problem’ are well described in the literature. However, the attitudes towards teenage mothers held by other teenage mothers are not well understood. Given the growing use of peer support in the reproductive health of teenagers, the attitudes of teenage mothers towards their contemporaries is worthy of exploration. We aimed to examine the discourse around teenage pregnancy in teenage mothers who have recently experienced teenage pregnancy and motherhood for themselves. Fourty mothers aged 16 -19, who had recently given birth and used a homebased sexual health service took part in semi structured interviews to explore their views on pregnancy in other teenagers. The analytical framework of ‘othering’ and resistance are used to examine their discourse around teenage pregnancy in teenage mothers. Findings indicate that teenage pregnancy and parenting in teenage mother contemporaries is not always viewed positively. Some teenage mothers in this study used strategies to distance themselves from perceived negativity. Two overarching themes emerged from the data: Constructions of moral judgement and Maintenance of positive self-representations. The negative portrayal of teenage pregnancy within wider society impacts the ongoing stigma attached to teenage pregnancy within the teenage population. Approaches such as peer education and peer support used in reproductive health should not be considered neutral, taken for granted processes, but may be complex and more nuanced. Health and social care professionals supporting young parents should be aware of the potential for stigma, discrimination, isolation and exclusion within teenage peer groups. Policy makers need to ensure young mothers have access to a broad range of support opportunities and this should include formal, professional support

Cancer patients’ experiences of living with venous thromboembolism: A systematic review and qualitative thematic synthesis

Background: Cancer-Associated thrombosis is common. Recommended treatment is daily injected low-molecular-weight heparin for 6months. Most studies focus on prophylaxis and treatment; few have explored patients’ experience. Aims To identify and synthesise the available literature concerning patients’ experience of cancer associated thrombosis. Design Systematic literature review and qualitative thematic synthesis. MethodsMEDLINE, Embase, CINAHL, PsychINFO (until 10/2016; limited to English) were searched. Eligible papers were qualitative studies of adult patients’ experience of cancer-associated thrombosis. Two researchers screened titles/abstracts/papers against inclusion criteria with recourse to a third for disagreements. Critical Appraisal Skills Programme qualitative checklist tool was used for quality appraisal. Results1397 articles were identified. Five qualitative studies (total n=92; age range 32 to 84 years) met the inclusion criteria. Participants had various cancer types. Most had advanced disease and were receiving palliative care. Four major themes emerged from the data: knowledge deficit (patients and clinicians); effects of cancer associated thrombosis (physical and psychological); effects of anticoagulation; coping strategies. ConclusionThe cancer journey is difficult in itself, but thrombosis was an additional, frightening and unexpected burden. Although the association between cancer and thromboembolism is well known, cancer patients are not educated routinely about the risk or warning symptoms/signs of thromboembolism which may otherwise be misattributed to the cancer by patient and clinician alike. This systematic review highlights the impact of cancer-associated thrombosis on the lives of cancer patients, and calls for education for patients and clinicians to be part of routine care, and further work to address this patient priority

Julie Phillips-Seymour: Prints, Constructions, Drawings Show Card

Show Card featuring alumni Julie Phillips-Seymour: Prints, Constructions, Drawings.https://digitalcommons.udallas.edu/alumni_89-90/1000/thumbnail.jp

What do the healthcare experiences of people with long-term conditions tell us about person-centred care? A systematic review.

IntroductionGrowing numbers of people now live with long term conditions. For each person, the challenges are multiple and unique to that individual. In recognition of this, health policy places greater emphasis on the delivery of person-centred care (PCC). However, patients report declining levels of such care. One reason for this may be a mismatch between patient and professional/policy understanding of PCC.AimTo understand PCC from the perspectives of people with long-term conditions.MethodsA systematic review of qualitative literature was conducted. Databases searched included ASSIA, BNI, CINAHL, the Cochrane Library, Embase, Medline, PsycINFO, PubMed, Scopus, Web of Science, and grey literature databases. Two reviewers independently screened and selected the studies, assessed their quality, and extracted data. Fifty-four records were analysed through meta-ethnography.ResultsFour themes emerged: the healthcare system as a battlefield, the healthcare system as a maze, patients’ accounts of personhood, and the centrality of patient enablement. A person-centred healthcare system is described by this review as one that values personhood and enables patients to build knowledge with their clinician in order to manage their illness in a safe, caring, and accessible environment.ConclusionPCC does not depend on the efforts of the clinician alone, but results from a collaboration with the patient and needs to be enabled by the wider organisational and educational systems. Efforts directed at the implementation of PCC might be bound to fail if the healthcare policy agenda does not address the role of the patient’s personhood in clinical practice, and its integration in educational settings

Emergency admissions and subsequent inpatient care through an emergency oncology service at a tertiary cancer centre: service users’ experiences and views

Purpose Avoiding unnecessary emergency admissions and managing those that are admitted more effectively is a major concern for both patients and health services. To generate evidence useful for improving services for direct patient benefit, this study explores service users’ views and experiences of emergency admissions and subsequent inpatient care.Methods Participants were recruited during a cancer-related emergency admission from a tertiary cancer centre with an emergency oncology service and emergency department. Semi-structured interviews were conducted with fifteen patients and twelve carers post hospital discharge. Interview transcripts were analyzed using framework analysis.Results Twenty patients experienced 43 emergency admissions over six months. Most admissions (35/43) followed patients presenting acutely or as emergencies with cancer treatment side-effects. Most admissions (35/43) were directly to an oncology ward following specialist advice, review and triage and thus unavoidable. Participants experienced outstanding inpatient care because of: prompt and effective symptom control and stabilization of acute conditions; continuity of cancer care and coordination between acute and long-term treatment; satisfactory professional-patient communication and information sharing; responsive, motivated and competent staff; and less restrictive visiting times. Gaps in care were identified. Conclusions Many emergency admissions are necessary for people with cancer. Future work should focus on: improving easy access to specialist advice and triage, and the process of admission; providing rapid palliation of symptoms and prompt stabilization of acute conditions, and satisfactory inpatient care; closing the circle of care for patients by actively involving primary care and palliative/end-of-life care services to address the complex needs of patients and carers

An integrated understanding of the complex drivers of emergency presentations and admissions in cancer patients: qualitative modelling of secondary-care health professionals’ experiences and views

The number of cancer-related emergency presentations and admissions has been steadily increasing in the UK. Drivers of this phenomenon are complex, multifactorial and interlinked. The main objective of this study was to understand the complexity of emergency hospital use in cancer patients. We conducted semi-structured interviews with 42 senior clinicians (20 doctors, 22 nurses) with diverse expertise and experience in caring for acutely ill cancer patients in the secondary care setting. Data analysis included thematic analysis and purposive text analysis to develop Causal Loop Diagrams. Our Causal Loop Diagrams represent an integrated understanding of the complex factors (13) influencing emergency hospital use in cancer patients. Eight factors formed five reinforcing feedback loops and therefore were high-leverage influences: Ability of patients and carers to self-care and cope; Effective and timely management of ambulatory care sensitive conditions by primary and community care; Sufficient and effective social care for patients and carers; Avoidable emergency hospital use; Bed capacity; Patients accessing timely appropriate specialist inpatient or ambulatory care; Prompt and effective management and prevention of acute episode; Timely and safe discharge with appropriate support. The loops show that reduction of avoidable hospital use helps relieve hospital bed pressure; improved bed capacity then has a decisive, positive influence on patient pathway and thus outcome and experience in the hospital; in turn, better in-hospital care and discharge help patients and carers self-care and cope better back home with better support from community-based health and social care services, which then reduces their future emergency hospital use. To optimise acute and emergency cancer care, it is also essential that patients, carers and other clinicians caring for cancer patients have prompt access to senior cancer specialists for advice, assessment, clinical decision and other support. The findings provide a useful framework and focus for service planners aiming to optimise care

Parental terminal cancer and dependent children: a systematic review

Background When a parent has terminal cancer, their children are part of that experience. Parents often want to protect their children from their disease and prognosis. Knowledge of dependent children’s experience will help ensure they receive appropriate support. To date, there is lack of synthesis of this evidence examining children’s perspectives. Objectives To systematically search and synthesise the qualitative literature exploring the experiences of dependent children when their parent has terminal cancer. Methods Databases of MEDLINE, Embase, PsycINFO, CINAHL, Assia and the Cochrane library were searched systematically from inception to July 2020 to determine eligible studies. Included studies were appraised for quality and thematically synthesised using Thomas and Harden’s thematic synthesis framework. Results Fourteen studies were included, which interviewed children about their experiences (n=654 children aged 4–18 years at the time of parental death), from six countries. Five descriptive themes were identified, further categorised into two broad themes: (1) finding out about parental cancer and its impact on the family and (2) coping with life with parental cancer, death and beyond. Conclusion Children want to be involved in their parent’s cancer experience and to help support the family. Healthcare professionals are ideally placed to support and encourage parents to include their children. They should reassure parents that children can cope well and that maintaining normality will help, and explain the benefits of honest and open communication and how they can include dependent children from diagnosis and beyond