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

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

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

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

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

<i>“We’re Seeking Relevance”</i>: Qualitative Perspectives on the Impact of Learning Analytics on Teaching and Learning

Whilst a significant body of learning analytics research tends to focus on impact from the perspective of usability or improved learning outcomes, this paper proposes an approach based on Affordance Theory to describe awareness and intention as a bridge between usability and impact. 10 educators at 3 European institutions participated in detailed interviews on the affordances they perceive in using learning analytics to support practice in education. Evidence illuminates connections between an educator’s epistemic beliefs about learning and the purpose of education, their perception of threats or resources in delivering a successful learning experience, and the types of data they would consider as evidence in recognising or regulating learning. This evidence can support the learning analytics community in considering the proximity to the student, the role of the educator, and their personal belief structure in developing robust analytics tools that educators may be more likely to use

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

Living with a long-term condition: understanding well-being for individuals with thrombophilia or asthma

range of literature has explored the experience of living with a long-term condition (LTC), and frequently treats such experiences and conditions as problematic. In contrast, other research has demonstrated that it may be possible to adapt and achieve well-being, even when living with such a condition. This tends to focus on meaning and the qualitative experience of living with an LTC, and offers alternative perspectives, often of the same or similar conditions. As a result of these conflicting views, this study chose to consider two conditions which, though they may lead to life-threatening illness on occasion, do not appear to impact significantly the lives of all those affected on a daily basis. The aim of this research was to explore and explain how people make sense of two long-term, potentially life-threatening health conditions, namely, thrombophilia and asthma. In doing so, it specifically considered the contribution made by information about the condition. A constructivist grounded theory approach was adopted; this enabled the generation of a theory regarding how people make sense of their LTC, whilst acknowledging the social circumstances in which this was situated. Semi-structured interviews were conducted with 16 participants who had given consent to take part in the research. The findings demonstrate that participants undergo a two-stage process * gaining knowledge and living with a long-term condition . The theory based on these findings indicates that those who are knowledgeable about their condition, making informed decisions in relation to it, and accept their condition are able to live with it, whilst those who do not accept their condition do not fully adapt to it or integrate it into their live

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

Systematic review of grounded theory studies in physiotherapy

Aim: This systematic review aimed at appraising the methodological rigor of grounded theory research published in the field of physiotherapy to assess how the methodology is understood and applied. A secondary aim was to provide research implications drawn from the findings to guide future grounded theory methodology research. Methods: A systematic search was conducted in MEDLINE, CINHAL, SPORT Discus, Science Direct, PubMed, Scopus and Web of Science to identify studies in the field of physiotherapy that reported using grounded theory methodology and/or methods in the study title and/or abstract. The descriptive characteristics and methodological quality of eligible studies were examined using the assessment guidelines developed by Hutchison, Johnston and Breckon (2011). Findings: The review included sixty-eight studies conducted between 1998 and 2017. The findings showed that grounded theory methodology is becoming increasingly used by physiotherapy researchers. Thirty-six studies (53%) demonstrated a good understanding and appropriate application of grounded theory methodology. Thirty-two studies (47%) presented descriptive findings and were considered to be of poor methodological quality. Conclusions: There are several key tenets of grounded theory methodology that are integral to the iterative process of qualitative theorizing and need to be applied throughout all research practices including sampling, data collection and analysis