Living and doing with chronic pain: clients' and occupational therapists' perspectives

The purpose of this research was to investigate how people with chronic pain manage their pain in the long term and what factors influence that management. The perspectives of past participants of a chronic pain management program (PMP) and occupational therapists working with people with chronic pain were sought to see if there was compatibility or difference in their points of view. The overarching research questions that arose from a review of the literature were: • What factors predict successful pain management in the long term? • How do people live and do with chronic pain in their everyday lives? These questions formed the foundation for further detailed exploration of how social factors, personal beliefs and meanings, individual attributes and strategies influenced pain management. The study design was based on qualitative methods, in this instance narrative inquiry, to gain stories from PMP participants of living with pain and therapist-participants of working in pain practice. Narrative inquiry was selected as it allowed participants to tell their stories of living and working with chronic pain. Stories inherently contain aspects of the past, present and future. This was an important element to capture in relation to the time contingent process of chronic pain management (Charmaz, 1991). Fifteen PMP participants were recruited in Stage 1 of the research, both males and females, with ages ranging from 31 to 64 years. Nine therapist-participants were recruited in Stage 2, who worked across a range of chronic pain settings including private practice, community-based and hospital-based pain programs. Data were gathered through semi-structured interviews predominantly conducted at PMP participants’ homes and therapist-participants’ places of work. Interviews were tape-recorded and transcribed verbatim, with all participants receiving a summary of interviews for comment. Data analysis used an iterative and interpretive approach. Transcripts were read as whole stories, with initial researcher impressions noted and recorded. Transcripts were then subjected to closer scrutiny, with key themes, words and phrases noted using the participants’ language. These detailed themes were sorted into common groupings and compared across participants. Idiosyncratic themes were not discarded. The main themes that emerged related to the categories of self/identity, meaning ascriptions about pain, strategies used, and the influence of the social world. Within each of these categories, factors became apparent that influenced whether a person was predominantly agentic, active in their pain self-management, or victimic and passive, relying on external support (Polkinghorne, 1995). A conceptual model is proposed based on (a) knowing (meanings ascribed to chronic pain), (b) doing (strategies and methods used to engage in everyday activities), and (c) being (aspects of the self intrinsically and socially constructed) as critical to managing chronic pain. These factors are significant when considering how people live with chronic pain within the community in the long term and also how and when health care services specific to chronic pain might best be utilised to achieve favourable outcomes.

Living and doing with chronic pain: clients' and occupational therapists' perspectives

The purpose of this research was to investigate how people with chronic pain manage their pain in the long term and what factors influence that management. The perspectives of past participants of a chronic pain management program (PMP) and occupational therapists working with people with chronic pain were sought to see if there was compatibility or difference in their points of view. The overarching research questions that arose from a review of the literature were: • What factors predict successful pain management in the long term? • How do people live and do with chronic pain in their everyday lives? These questions formed the foundation for further detailed exploration of how social factors, personal beliefs and meanings, individual attributes and strategies influenced pain management. The study design was based on qualitative methods, in this instance narrative inquiry, to gain stories from PMP participants of living with pain and therapist-participants of working in pain practice. Narrative inquiry was selected as it allowed participants to tell their stories of living and working with chronic pain. Stories inherently contain aspects of the past, present and future. This was an important element to capture in relation to the time contingent process of chronic pain management (Charmaz, 1991). Fifteen PMP participants were recruited in Stage 1 of the research, both males and females, with ages ranging from 31 to 64 years. Nine therapist-participants were recruited in Stage 2, who worked across a range of chronic pain settings including private practice, community-based and hospital-based pain programs. Data were gathered through semi-structured interviews predominantly conducted at PMP participants’ homes and therapist-participants’ places of work. Interviews were tape-recorded and transcribed verbatim, with all participants receiving a summary of interviews for comment. Data analysis used an iterative and interpretive approach. Transcripts were read as whole stories, with initial researcher impressions noted and recorded. Transcripts were then subjected to closer scrutiny, with key themes, words and phrases noted using the participants’ language. These detailed themes were sorted into common groupings and compared across participants. Idiosyncratic themes were not discarded. The main themes that emerged related to the categories of self/identity, meaning ascriptions about pain, strategies used, and the influence of the social world. Within each of these categories, factors became apparent that influenced whether a person was predominantly agentic, active in their pain self-management, or victimic and passive, relying on external support (Polkinghorne, 1995). A conceptual model is proposed based on (a) knowing (meanings ascribed to chronic pain), (b) doing (strategies and methods used to engage in everyday activities), and (c) being (aspects of the self intrinsically and socially constructed) as critical to managing chronic pain. These factors are significant when considering how people live with chronic pain within the community in the long term and also how and when health care services specific to chronic pain might best be utilised to achieve favourable outcomes.

The effect of production system characteristics on resilience capabilities:a multiple case study

Purpose To date, the literature has usually assumed that a universal approach to resilience is appropriate in which different resilience capabilities are equally important for all organizations independent of contextual characteristics. In contrast this study investigates if production process characteristics affect resilience capabilities in terms of redundancy, flexibility, agility and collaboration. Design/methodology/approach An in-depth exploratory multiple case study was carried out in eight companies across different industries. Data were gathered through multiple interviews with key informants in each company. Findings The authors find differences in, and trade-offs between, resilience capabilities and practices related to redundancy, agility and collaboration induced by the different configurations of production system characteristics: especially between discrete and process industries. Further, a major influential characteristic is the production strategy employed (make-to-stock or make-to-order) which stresses or limits collaboration and redundancy. Originality/value This is one of the first studies to explore the effects of production system characteristics as a major contingency factor on the resilience capabilities of an organization. As such it provides valuable insights into the development of a more nuanced contingency approach to how organizations can build resilience and employ specific practices that fit their situation

Retrospection and reflection : the emerging influence of an institutional professional recognition scheme on professional development and academic practice in a UK university

Raising the quality and profile of teaching and student learning is something universities across the UK are aspiring to achieve in order to maintain reputations. Currently, the UK Professional Standards Framework (UKPSF) provides a standard by which academic staff can gain professional recognition for their academic practice and many UK universities are now offering professional development opportunities via in-house recognition schemes, based on retrospection and reflection, to enable staff to achieve an HEA Fellowship. This paper provides a case study of one such institutional recognition scheme and discusses the impact it is beginning to have on experienced academics. The findings suggest that recognition schemes contribute to participants’ staff development, provide opportunities for the enhancement of practice and that those who participate in the scheme identify value in the reflective process for reconciliation, confirmation of achievements and reinforcing commitment to teaching and/or supporting learning

Modelling water transport and phosphorus eutrophication in an interconnected lake system : a scenario study

The water in the south-western Frisian lake district is highly eutrophicated. Summer chlorophyll-a concentrations often exceed 150 μg.l -1, while total phosphorus (TP) concentrations are mostly above 0.2 mg.l -1. Therefore, a research project was started in 1984 to study the origin and dynamics of phosphorus (P) in the area. The nutrient P was chosen because reducing TP concentrations was believed to result in favourable conditions for restoration of the aquatic ecosystem. The objective of the study was to model the TP dynamics and to use the model for the simulation of management reduction scenarios. In order to achieve this objective, three problems had to be solved. Firstly, information about the water transport, especially in the boundary canals, was poor. This problem was solved by the application of a wind driven water transport model using water levels in the boundary canals. Secondly, the lack of large-scale information about the TP loads from the surrounding polders was solved by an intensive monitoring program. Thirdly, knowledge about the distribution of TP in sediments and about TP exchange processes between water and sediments had to be assessed. The simulations with the dynamic TP mass balance model resulted in TP balances during three periods, showing that there were two main sources in the area: from the surrounding polders and from Lake IJssel. Moreover, management simulation scenarios showed that 75% TP concentration reductions in the external loads would be necessary to achieve the 0. 15 mg.l -1TP concentration standard and incidentally the 0.07 mg.l -1. target concentration

Editorial

Occasionally, we strike moments in our professional and personal lives that are turning points; not just in our own personal odyssey, but within the wider context of our nation and indeed, human civilisation. Jim Bowler and Alan Thorne experienced just such an epiphany, while excavating in the Willandra Lakes Region on February 25, 1974. Careful excavation of some lunettes at Lake Mungo revealed remains of an adult male, sprinkled with red ochre. Now dated at 40,000 yr (40 ±20), this is probably one of the earliest known examples of a sophisticated burial ritual in Australia. Mungo Man’s discovery followed that of Mungo Lady in 1969 (by Jim Bowler) which also indicated ritualistic burial rights and mourning rituals

Editorial

Many of you will have followed the recent political events which prompted the world-wide ‘March for Science’ protests, and incredulity at the US government’s choice of a ‘proud’ climate-change denier as their Secretary of the Interior. Never before has the gap between scientists and non-scientists been so publicised and scrutinised

Silent Transitions in Automata with Storage

We consider the computational power of silent transitions in one-way automata with storage. Specifically, we ask which storage mechanisms admit a transformation of a given automaton into one that accepts the same language and reads at least one input symbol in each step. We study this question using the model of valence automata. Here, a finite automaton is equipped with a storage mechanism that is given by a monoid. This work presents generalizations of known results on silent transitions. For two classes of monoids, it provides characterizations of those monoids that allow the removal of \lambda-transitions. Both classes are defined by graph products of copies of the bicyclic monoid and the group of integers. The first class contains pushdown storages as well as the blind counters while the second class contains the blind and the partially blind counters.Comment: 32 pages, submitte