SSM. Qualitative research in health最新文献

Since the US Supreme Court's 2022 decision in Dobbs v Jackson Women's Health Organization, 18 states have enacted functional bans on abortion, yet little is known about how these laws contribute to workplace stress and its sequelae among clinicians. The purpose of this study was to characterize sources of moral distress—which occurs when a clinician knows the right course of clinical action but is barred from taking that action by external constraints—among obstetrician-gynecologists (OB-GYNs) in states with abortion bans. We conducted qualitative, semi-structured interviews with 54 OB-GYNs practicing in 13 of 14 states where abortion was illegal as of March 2023. Using a qualitative descriptive coding approach, we identified four types of clinical situations leading to moral distress: delaying treatment for patients with obstetric complications, conflict with other clinicians, denying care they would have provided locally prior to Dobbs, and restrictions on clinical counseling. These situations provoked feelings of anger, frustration, helplessness, and emotional exhaustion. Participants attributed moral distress to the cumulative toll of routinely being unable to provide evidence-based healthcare, in addition to the acute burden of managing obstetric emergencies in legal gray areas, which was relatively rarer. The findings demonstrate a previously unreported source of moral distress: the everyday chipping away of professional integrity that occurs when OB-GYNs cannot care for patients in the way that patients need. Next steps include developing institutional-level policies and programs to support clinicians and enable them to practice ethical medicine in abortion-restrictive policy environments.

The increased prevalence of non-communicable diseases (NCDs) in recent years has led many Low- and Middle-Income Countries (LMICs), including Tanzania, to develop policies to manage their burden. Musculoskeletal (MSK) conditions, such as arthritis, account for 20% of all years lived with disability in LMICs, but the NCD strategies rarely address them. There is substantial research on the disruption MSK conditions cause to people's lives within High-Income Countries, but very little is known about the lived experiences in LMICs. We investigated the experience of MSK conditions in 48 in-depth qualitative interviews with participants from the Hai District in Tanzania, East Africa, all of whom had a MSK disorder (confirmed through clinical examination as part of a broader study). We found that loss of mobility and pain associated with MSK disorders severely limits people's everyday lives and livelihoods. Help from others, mainly those within a household, is necessary for most tasks and those with limited or no support experience particular problems. We found barriers to accessing care and treatment in the form of high direct and indirect (through travel) care costs within formal health services in Tanzania. We argue for increased attention to the growing problem of MSK disorders in LMICs and that this agenda should be driven by a patient-centred approach which designs services accessible to the target population and designed to recognise their embodied expertise.

Beyond the many structural obstacles to obtaining abortion care in the United States, abortion stigma is a forceful impediment to accessing timely services and an injurious feature of the experience for some people who have abortions (Sorhaindo & Lavelanet, 2022). This study utilized a qualitative methodology to explore the experiences of 830 abortion fund applicants in the Rocky Mountain Region to better understand the unique barriers they face in accessing care, the role that stigma plays in influencing applications for abortion fund support, and inform strategies to expand support infrastructure for those facing isolation and hostility in their pursuit of care. For the applicants in this study, stigma was frequently cited as an impetus for seeking abortion fund support and a burdensome aspect of the experience itself. Stigma—whether internalized, perceived, enacted, or structural—prevented many applicants from seeking material or emotional support from their social networks and spurred the dissolution of interpersonal relationships—with far-reaching emotional and material consequences. The results suggest that abortion funds go far beyond merely providing material support, also acting as an antidote to the harms associated with abortion stigma by promoting feelings of interconnectedness and mutuality among applicants. While accounts of stigma were pervasive in the applications, so, too, were the myriad strategies of resistance that applicants called upon to challenge stigmatizing narratives and position their choice to have an abortion as both moral and necessary.

Background

Although routine communication gaps among clinical shift teams significantly account for adverse care and treatment outcomes, existing analysis of the phenomenon remain limited in low middle income countries battling with patient safety issues. This study analyzed the drivers and associated episodic consequences of communication gaps from nurses’ experiences in Ghana.

Methods

Qualitative design implemented in two referral hospitals. Data collection involved site observations and in-depth interviews with general nurses, midwives, and staff nurses across 3-cycle shift regimes in the emergency, ICU, inpatient wards, and maternity units. A two-stage data analysis was adopted by integrating deductive and inductive codes into broad thematic typologies explaining drivers of communication gaps and the consequences thereof.

Results

Communication gaps among shift teams were largely driven by a combination of three broad factors: a) Attitudinal elements of poor work ethics, poor documentation, interpersonal conflicts and use of unconventional language that impaired effective communication; b) organizational dynamics of taxing job demands, limited training exposure and lack of formal handover communication procedures which allowed shift teams to adopt default patterns of communication behavior; and c) cultural values, stereotyping and prejudicing behaviors that restricted inclusive interactions among shift teams. These communication gaps produced adverse episodic effects of diagnostic and treatment errors, complications, and extended hospitalizations.

Conclusion

The findings underscore the need to develop standard guidelines to direct structured communication alongside equipping shift teams with competences on emotional intelligence to overcome cultural and behavioral adversities that influence communication breakdown.

Purpose

While it is common to hear of men who ‘can't get it up’ due to erectile dysfunction, people rarely discuss the women who ‘can't get it in’. These women often meet the criteria for sexual pain-penetration disorder (SPPD), which makes vaginal penetration painful or difficult. Lacking awareness of SPPD and the changing terminology from vaginismus to SPPD complicates help-seeking. Yet, there is lacking research on women's help-seeking experiences for SPPD. Therefore, this study aimed to examine Australian women's subjective experiences of formal and informal help-seeking for their SPPD to gain information, diagnosis, treatment, and support.

Methods

Help-seeking theory informed the study. Semi-structured interviews were conducted with 21 participants who sought help for their SPPD, which were inductively thematically analysed.

Results

Five major themes were developed. (1) Recognition that help-seeking is necessary varied depending on participants' presentation of SPPD. (2) Initiating help-seeking included accessing first points of contact and gaining diagnosis. (3) Management of symptoms with treatment involved conventional, complementary, and alternative treatments. Women discussed using sex toys as alternatives to vaginal trainers, the correlation between negotiating pain thresholds and treatment progress, and their perceptions towards Botox and nerve blocks. (4) Traverse formal healthcare networks facilitated or hindered help-seeking. (5) Navigation of un/supportive informal networks included women's partners, family, friends, and online communities.

Conclusions

The benefit of self-help kits, and complementary and alternative treatments for SPPD should be evaluated. Recommendations involve improving health professionals' approaches, including in online spaces. Women's immediate informal support networks should be engaged in healthcare management.

Transfeminine women (assigned male sex at birth and identifying with a feminine gender identity) are at risk for intersectional stigma related to their gender, sexual orientation, and other parts of their social identities (including age, class, and race). These layered stigmas can result in increased physical and mental health concerns related to physical and emotional violence, substance use, high risk sexual behaviour and HIV exposure. Social networks are important support structures for transfeminine women to ameliorate imposed risk and stigma. We investigated the family networks, household structures and community support systems of eight transfeminine women in the Western Cape, South Africa. The data for this study are embedded in a qualitative component of the larger HPTN 071 (PopART) trial. Data included in-depth interview transcripts, genogram activities and community map drawings. We found that participants who were not living in a supportive family and household structure faced stigma and health risks. In addition, we found examples of how transfeminine women in unsupportive social situations constructed their own family and household unit for support. Our findings agree with those of other studies in that transgender people often rely on extended family members, friends, or peers as social support when their families do not support or ostracise them. Understanding how transfeminine women re-organise social units to be better supported is important so that better health services can be provided to them in the local South African and international context. Further research on family re-structuring among gender and sexual minority groups is needed.

Within paediatric palliative care, it is essential for families and providers to have open, equal, and trusting relationships. In practice, however, building relationships can be challenging. Investing in better understanding the differences in each other's frames of reference and underlying values seems important. Wonder Lab practices provide a space to explore these differences by focusing together on life phenomena in curious and Socratic ways. Wonder Labs were organised with parents, healthcare professionals, and students involved in Dutch paediatric palliative care. The aim of this study was to develop an understanding of how participants experienced participating in Wonder Labs. We conducted twenty in-depth interviews with Wonder Lab participants and used inductive thematic analysis for data interpretation. Five themes were identified: Slowing down, Appreciating stories, Becoming vulnerable, Opening up and diving in, and Reframing perspectives. Participating in Wonder Labs allowed mothers, healthcare professionals, and students to contribute to deepening experiences and gain an expanded understanding of what is at play in caring for children with life-limiting and life-threatening conditions. Through working in pluralised groups, frames of reference and understandings complemented each other and could change. Participants often adopted a more open attitude towards others involved in care after participating and adapted day-to-day practices. Deliberating within paediatric palliative care on sensitive issues and their underlying personal and professional beliefs and values must be part of working together, without specific care situations being the catalyst. This may foster the mutual understanding needed in searching for quality of life, death, and bereavement.

During out of hospital cardiac arrest paramedics make decisions to commence, continue or terminate resuscitation. There is variability in when resuscitation is provided, and evidence suggests these decisions are complex and influenced by factors other than patient clinical characteristics. Through first-hand accounts of paramedics who bear witness to, and make, life and death decisions during out of hospital cardiac arrest, this study aimed to describe how paramedics decide to provide resuscitation.

This descriptive phenomenological study involved eight participants and was conducted between April–September 2021 in North East Ambulance Service NHS Foundation Trust.

Paramedic stories and reflections on their encounters with out of hospital cardiac arrest speak of how the role of paramedic is bound to Selfhood and public identity, uncertainty about when death has occurred versus a sudden reversible event, the ethics and morality of an obligation to Others and the plurality of lifeworld.

Resuscitation has significant ritualistic value, is often delivered in light of expectation and serves important social functions in the process of death recognition, Selfcare and care for Others. Further research is needed to understand the impact variability in decision-making has on patient outcomes and how this relates to patient and public expectations.