Bearing witness and being bounded; the experiences of nurses in adult critical care in relation to the survivorship needs of patients and families

Aim: To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. Background: The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such is the proximity to death and the pressure of work. Design: A constructivist grounded theory approach with constant comparative analysis. Methods: As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) applied. Results: The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding and the data presented reveals the challenges that nurses experience along the way. Conclusion: The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. Relevance to Clinical Practice: Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially this limits nurses’ ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds has contributed further to occupational stress in this care setting

How did the Welsh government manage to reform council tax in 2005?

Repeated calls have been made for council tax (CT) in the UK to be reformed. A ‘tyranny of the status quo’ suggests that politicians will avoid this because they fear a backlash from the losers of reform. This paper claims that the tyranny of the status quo is not a fixed law. The Welsh government revalued CT in 2005 but did not communicate the complexity of reform sufficiently. Reform requires greater efforts to communicate the complexity of winning and losing

The role of institutional and family embeddedness in the failure of Sub-Saharan African migrant family businesses

There is considerable interest among European politicians and policymakers in how to integrate migrants in the local and national economy. Drawing on in-depth qualitative interviews with 20 owners of Sub-Saharan African migrant family businesses (SSAMBs) in the United Kingdom, this article critically examines why SSAMBs fail or underperform. This investigation draws upon three streams of literature – notably migrant business failure, institutional theory and family embeddedness. The findings highlight the challenges of doing business and the reasons for business failure among this group. These are different from other small businesses and include culture, family interference and ethnicity. The main contribution of the article lies in the development of a conceptual model that highlights the relationships between institutional contexts and migrant family business outcomes. The model proposes that institution and family embeddedness results in the enactment of ethnic behaviours that drive migrant businesses into cultural markets leading to business underperformance or failure

Lived experience of connected practice : Clavier

Actors in a large scale Online Intercultural Exchange (OIE) (O’Dowd, 2016) known as Clavier (MacKinnon, 2016) took time to reflect on their personal experiences of an OIE Network (OIEN) through creating auto ethnographic accounts (Nunan & Choi, 2010). Data reflect different contexts, roles and identities. The data were analysed using a grounded theory method to explore the various perspectives, convergences, and divergences. Through this analysis, “[t]he researcher creates an explication, organisation and presentation of the data rather than discovering order within the data. The discovery process consists of discovering the ideas the researcher has about the data after interacting with it” (Charmaz, 1990, p. 1169, cited in Willig, 2013, p. 77, emphasis in original). This ‘discovery process’ was followed by a series of online discussions where we grappled with the question of how best to present this complex picture with its many facets given the short period of presentation time in the conference. An account emerged of the transformative nature of connected practice. The process of preparing this performance for the UNICollaboration conference in Krakow took the actors to a new point in their professional lives

Life interrupted and life regained? Coping with stroke at a young age

Stroke is a leading cause of disability across the developed world, affecting an increasing number of younger people. In this article, we seek to understand the experience of stroke as a disabling life situation among young people and the strategies that they use to recover and cope. Directed content analysis was conducted from interviews with 17 community-dwelling stroke survivors aged 55 years and younger across the United Kingdom. The sample was drawn from a larger maximum variation sample of stroke survivors. Using the sociological concepts of biographical disruption and biographical repair as a guide, excerpts from the interviews pertaining to aspects of the patients’ life that were interrupted, in addition to how they coped with the changes, were selected and analysed. All individuals described an ‘‘altered sense of self,’’ a theme that included loss of identity, family disruption, and/or loss of valued activities. Individuals sought to adapt their sense of self by seeking external support, by restoring normality, and/or through positive reflection. Despite the adapted self that emerged, most individuals continued to experience impairments. While young stroke survivors adapt to their illness over time, they continue to experience impairments and disruptions in their personal and work lives.Aholistic model of rehabilitation that helps individuals regain the capacity for everyday activities related to work, family life, and leisure can begin to address the emotional ramifications of diseases such as stroke, restore wellness, and work towards minimizing the burden felt by family caregivers and children

Dying at home: A qualitative study of the perspectives of older South Asians living in East London

South Asians constitute the single largest ethnic minority group in the United Kingdom, yet little is known about their perspectives and experiences on end-of-life care. Aim: To explore beliefs, attitudes and expectations expressed by older South Asians living in East London about dying at home. Methodology and methods: Five focus groups and 29 in-depth semi-structured interviews were conducted with a total of 55 older adults (24 men and 31 women) aged between 52 to 78 years. Participants from six South Asian ethnic groups were recruited via 11 local community organisations. Data were analysed using a constructive grounded theory approach. Findings: Two key themes were identified. The theme of ‘reconsidering the homeland’ draws on the notion of ‘diaspora’ to help understand why for many participants the physical place of death was perceived by many as less important than the opportunity to carry out cultural and religious practices surrounding death. The second theme ‘home as a haven’ describes participants’ accounts of how their home is a place in which it is possible to perform various cultural and religious rituals. Cultural and religious practices were often seen as essential to achieving a peaceful death and honouring religious and filial duties. Conclusion: Older people of South Asian ethnicity living in East London perceive home as more than a physical location for dying relatives. They make efforts to adhere, but also adapt, to important social and cultural values relating to death and dying as part of the wider challenge of living in an emigrant society

Life interrupted and life regained? Coping with stroke at a young age

Stroke is a leading cause of disability across the developed world, affecting an increasing number of younger people. In this article, we seek to understand the experience of stroke as a disabling life situation among young people and the strategies that they use to recover and cope. Directed content analysis was conducted from interviews with 17 community-dwelling stroke survivors aged 55 years and younger across the United Kingdom. The sample was drawn from a larger maximum variation sample of stroke survivors. Using the sociological concepts of biographical disruption and biographical repair as a guide, excerpts from the interviews pertaining to aspects of the patients’ life that were interrupted, in addition to how they coped with the changes, were selected and analysed. All individuals described an ‘‘altered sense of self,’’ a theme that included loss of identity, family disruption, and/or loss of valued activities. Individuals sought to adapt their sense of self by seeking external support, by restoring normality, and/or through positive reflection. Despite the adapted self that emerged, most individuals continued to experience impairments. While young stroke survivors adapt to their illness over time, they continue to experience impairments and disruptions in their personal and work lives.Aholistic model of rehabilitation that helps individuals regain the capacity for everyday activities related to work, family life, and leisure can begin to address the emotional ramifications of diseases such as stroke, restore wellness, and work towards minimizing the burden felt by family caregivers and children

Building community broadband: Barriers and opportunities for community‐based organizations in the federal BTOP and BIP broadband development programs

Despite $7.2 billion of recent federal investments in broadband infrastructure through the Broadband Technology Opportunities and Broadband Initiatives Programs (BTOP and BIP), questions around the effectiveness of such national‐scale initiatives at the local level remain. Drawing on ethnographic interviews, observation, and documentary evidence, this paper charts the experience of twenty‐seven grassroots and community‐based organizations (CBOs) from around the country that have engaged the BTOP and BIP process. We explore the challenges CBOs have faced in initiating, developing partnerships, and executing BTOP and BIP grant applications. We find that CBOs often struggled to define the effective scope of potential BTOP projects; to align these with traditional organizational goals; to develop effective project partnerships, including with larger and more institutionalized partners; and to meet the formal evaluation, reporting, and management requirements of a large‐scale and sensitive federal program. Despite these barriers, several community‐based organizations have engaged in successful BTOP and BIP applications, which are now moving into operational stage. This paper documents these experiences, and concludes with recommendations for reform of the BTOP, BIP, or possible successor programs that could improve the inclusion and effectiveness of community‐based organizations as agents of broadband development and social change.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90169/1/14504801169_ftp.pd

Not all the bots are created equal:the Ordering Turing Test for the labelling of bots in MMORPGs

This article contributes to the research on bots in Social Media. It takes as its starting point an emerging perspective which proposes that we should abandon the investigation of the Turing Test and the functional aspects of bots in favor of studying the authentic and cooperative relationship between humans and bots. Contrary to this view, this article argues that Turing Tests are one of the ways in which authentic relationships between humans and bots take place. To understand this, this article introduces the concept of Ordering Turing Tests: these are sort of Turing Tests proposed by social actors for purposes of achieving social order when bots produce deviant behavior. An Ordering Turing Test is method for labeling deviance, whereby social actors can use this test to tell apart rule-abiding humans and rule-breaking bots. Using examples from Massively Multiplayer Online Role-Playing Games, this article illustrates how Ordering Turing Tests are proposed and justified by players and service providers. Data for the research comes from scientific literature on Machine Learning proposed for the identification of bots and from game forums and other player produced paratexts from the case study of the game Runescape