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Sources of moral distress among obstetrician-gynecologists after Dobbs: A qualitative, multi-state study 多布斯事件后妇产科医生的精神压力来源:一项跨州定性研究
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-10 DOI: 10.1016/j.ssmqr.2024.100483
Mara Buchbinder , Kavita S. Arora , Samantha M. McKetchnie , Erika L. Sabbath

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.

自 2022 年美国最高法院对多布斯诉杰克逊妇女健康组织一案做出判决以来,美国已有 18 个州颁布了功能性堕胎禁令,但人们对这些法律如何导致临床医生的工作压力及其后遗症却知之甚少。本研究的目的是描述禁止堕胎州的妇产科医生(OB-GYNs)的道德压力来源--当临床医生知道采取正确的临床行动,但受到外部限制而无法采取该行动时,就会产生道德压力。截至 2023 年 3 月,14 个州中有 13 个州禁止堕胎,我们对其中 13 个州的 54 名妇产科医生进行了半结构化定性访谈。通过定性描述编码方法,我们确定了四种导致道德困扰的临床情况:延误对产科并发症患者的治疗、与其他临床医生发生冲突、拒绝提供多布斯案之前他们本应在当地提供的治疗以及限制临床咨询。这些情况引发了愤怒、沮丧、无助和情感衰竭等情绪。除了在法律灰色地带处理产科急诊的沉重负担外,参与者还将精神痛苦归因于经常无法提供循证医疗服务所造成的累积损失,而这种情况相对较少。研究结果表明了一种以前未曾报道过的道德困扰来源:当妇产科医生无法以患者所需的方式为患者提供医疗服务时,职业操守每天都在受到侵蚀。下一步工作包括制定机构层面的政策和计划,以支持临床医生,使他们能够在限制堕胎的政策环境中开展合乎道德的医疗工作。
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引用次数: 0
‘ … You become a prisoner of your life’: A qualitative study exploring the experience of joint pain and accessing care in Hai, Tanzania '......你成了生活的囚徒':一项定性研究,探索坦桑尼亚海市关节疼痛和获得护理的经历
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-08 DOI: 10.1016/j.ssmqr.2024.100481
Emma Laurie , Elizabeth F. Msoka , Sally Wyke , Nateiya M. Yongolo , Christopher Bunn , Perry Msoka , Emma McIntosh , Blandina T. Mmbaga

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.

近年来,非传染性疾病(NCDs)发病率的上升促使包括坦桑尼亚在内的许多中低收入国家(LMICs)制定政策来管理这些疾病造成的负担。在中低收入国家,关节炎等肌肉骨骼(MSK)疾病造成的残疾年限占总残疾年限的 20%,但非传染性疾病战略却很少涉及这些疾病。在高收入国家,关于 MSK 疾病对人们生活造成的破坏已有大量研究,但对低收入国家的生活体验却知之甚少。我们对东非坦桑尼亚海区的参与者进行了 48 次深入的定性访谈,调查了他们对 MSK 病症的体验,所有参与者都患有 MSK 疾病(通过临床检查确认,是更广泛研究的一部分)。我们发现,与 MSK 疾病相关的行动不便和疼痛严重限制了人们的日常生活和生计。大多数工作都需要他人(主要是家庭成员)的帮助,而那些得到的帮助有限或没有帮助的人则会遇到特别的问题。我们发现,在坦桑尼亚的正规医疗服务机构中,获得护理和治疗的障碍主要表现为高昂的直接和间接(通过旅行)护理费用。我们认为,应该更加关注在低收入和中等收入国家日益严重的 MSK 疾病问题,并且应该以患者为中心的方法来推动这一议程,设计目标人群可以获得的服务,并在设计中承认他们的专业技能。
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引用次数: 0
Health impacts of climate change in the UK: A qualitative synthesis detailing the conjuncture of social structure, extreme weather, and mental health 英国气候变化对健康的影响:详细描述社会结构、极端天气和心理健康关系的定性综述
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-08 DOI: 10.1016/j.ssmqr.2024.100475
Steven Dodd , Mette Kragh-Furbo , Jessica Davies , Scott Butterfield , Abigail Morris , Heather Brown
This qualitative synthesis explores the experiences of UK communities facing growing health risks from climate change and extreme weather. The eight included studies show the profound impacts of extreme weather events such as floods on mental health, including challenges to self-identity and anxiety from the fear of flooding returning. Included data reveal individual and household impacts of extreme weather are mediated by a complex interaction of institutional support, community support, gender inequalities and personal agency. These factors are assessed against the backdrop of broader concepts in the social science and adaptation literature, including the role of the state, the inseparability of nature and society, the overlooked role of social structure, and environmental justice. It is argued that the use of qualitative synthesis methods in this topic area allows for an interconnected and context-sensitive analysis of the health impacts of climate change facing communities, diverging from other analytical approaches through inclusion of considerations such as social power, community dynamics, and the inter-relation of institutional action, community cohesion and individual agency. The resulting findings show how locally specific and highly contextual qualitative data can be used by those seeking to understand health risks from climate change within a locality.
这篇定性综述探讨了英国社区面临气候变化和极端天气带来的日益严重的健康风险时的经历。收录的八项研究表明,洪水等极端天气事件对心理健康产生了深远的影响,包括对自我认同的挑战和因担心洪水卷土重来而产生的焦虑。纳入的数据显示,极端天气对个人和家庭的影响是由机构支持、社区支持、性别不平等和个人能动性的复杂互动所促成的。这些因素是在社会科学和适应性文献中更广泛概念的背景下进行评估的,包括国家的作用、自然与社会的不可分割性、被忽视的社会结构作用以及环境正义。研究认为,在这一主题领域使用定性综合方法可以对社区面临的气候变化对健康的影响进行相互关联、具有背景敏感性的分析,通过纳入社会权力、社区动态以及机构行动、社区凝聚力和个人能动性之间的相互关系等考虑因素,与其他分析方法有所不同。研究结果表明,那些寻求了解气候变化对当地健康造成的风险的人,可以如何利用针对当地具体情况的、具有高度背景性的定性数据。
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引用次数: 0
“I am empowered by this opportunity”: The role of abortion funds as an antidote to abortion stigma "这个机会赋予我力量":堕胎基金作为堕胎耻辱化解剂的作用
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-06 DOI: 10.1016/j.ssmqr.2024.100478
Al Garnsey , Jessica L. Liddell , Annie Glover , Celina M. Doria , Alex Buscaglia , Lauren Buxbaum

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.

在美国,除了获得堕胎护理的许多结构性障碍外,堕胎污名化也是获得及时服务的有力障碍,是一些堕胎者经历的伤害性特征(Sorhaindo & Lavelanet, 2022)。本研究采用定性方法探讨了落基山地区 830 名人工流产基金申请者的经历,以更好地了解他们在获得护理时面临的独特障碍、污名化在影响人工流产基金支持申请中所起的作用,以及为那些在寻求护理时面临孤立和敌意的人扩大支持基础设施的策略提供信息。对于本研究中的申请者而言,污名化经常被认为是寻求堕胎基金支持的一个推动因素,也是这一经历本身的一个负担。成见--无论是内在化的、感知到的、已实施的还是结构性的--阻止了许多申请人从其社会网络中寻求物质或情感支持,并刺激了人际关系的解体--造成了深远的情感和物质后果。研究结果表明,堕胎基金远不止提供物质支持这么简单,它还能通过促进申请者之间的相互联系和相互性来消除与堕胎鄙视相关的伤害。虽然在申请中普遍存在鄙视的说法,但申请者也采取了无数的抵抗策略来挑战鄙视的说法,并将其堕胎的选择定位为道德和必要的。
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引用次数: 0
“It's the patient that suffers from poor communication”: Analyzing communication gaps and associated consequences in handover events from nurses’ experiences "沟通不畅,病人遭殃":从护士的经验分析交接事件中的沟通漏洞及相关后果
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-06 DOI: 10.1016/j.ssmqr.2024.100482
Roger A. Atinga , Mtebi Nkrabia Gmaligan , Alice Ayawine , John K. Yambah

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.

背景虽然临床轮班团队之间的常规沟通障碍是导致不良护理和治疗结果的重要原因,但在面临患者安全问题的中低收入国家,对这一现象的现有分析仍然有限。本研究从加纳护士的经验出发,分析了沟通障碍的驱动因素和相关的偶发后果。数据收集包括现场观察和对急诊室、重症监护室、住院病房和产科三周期轮班制的普通护士、助产士和员工护士进行深入访谈。采用两阶段数据分析,将演绎和归纳代码整合成广泛的主题类型,解释沟通差距的驱动因素及其后果。结果轮班小组之间的沟通差距主要是由以下三大因素共同造成的:a) 不良职业道德、文件记录不全、人际冲突和使用非常规语言等态度因素影响了有效沟通;b) 繁重的工作要求、有限的培训机会和缺乏正式的交接沟通程序等组织动态因素使得轮班小组采用默认的沟通行为模式;c) 文化价值观、刻板印象和偏见行为限制了轮班小组之间的包容性互动。这些沟通缺陷造成了诊断和治疗失误、并发症和住院时间延长等不良的偶发效应。结论:研究结果强调,有必要制定标准指南,指导有序的沟通,同时培养轮班团队的情商能力,以克服影响沟通中断的文化和行为逆境。
{"title":"“It's the patient that suffers from poor communication”: Analyzing communication gaps and associated consequences in handover events from nurses’ experiences","authors":"Roger A. Atinga ,&nbsp;Mtebi Nkrabia Gmaligan ,&nbsp;Alice Ayawine ,&nbsp;John K. Yambah","doi":"10.1016/j.ssmqr.2024.100482","DOIUrl":"10.1016/j.ssmqr.2024.100482","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>Communication gaps among shift teams were largely driven by a combination of three broad factors: <em>a</em>) Attitudinal elements of poor work ethics, poor documentation, interpersonal conflicts and use of unconventional language that impaired effective communication; <em>b</em>) 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 <em>c</em>) 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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":74862,"journal":{"name":"SSM. Qualitative research in health","volume":"6 ","pages":"Article 100482"},"PeriodicalIF":1.8,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266732152400091X/pdfft?md5=4103e54e35cbf646c8b04ad22c9e912b&pid=1-s2.0-S266732152400091X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
People discuss the men who can't get it up, but what about the women who can't get it in? Women's help-seeking experiences for sexual pain-penetration disorder 人们讨论的是无法勃起的男性,那么无法插入的女性呢?性疼痛-插入障碍的女性求助经历
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-03 DOI: 10.1016/j.ssmqr.2024.100480
Rashmi Pithavadian , Jane Chalmers , Vijayasarathi Ramanathan , Tinashe Dune

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.

目的人们常听到男性因勃起功能障碍而 "硬不起来",却很少讨论女性 "插不进去 "的问题。这些女性通常符合性疼痛-插入障碍(SPPD)的标准,这使得阴道插入疼痛或困难。由于缺乏对 SPPD 的认识,以及从阴道炎到 SPPD 的术语变化,使得寻求帮助变得更加复杂。然而,目前还缺乏有关妇女就 SPPD 寻求帮助的经历的研究。因此,本研究旨在探讨澳大利亚妇女为获得信息、诊断、治疗和支持而正式和非正式寻求 SPPD 帮助的主观经历。对 21 名因 SPPD 而寻求帮助的参与者进行了半结构式访谈,并对访谈结果进行了归纳式主题分析。(1) 对求助必要性的认识因参与者的 SPPD 表现而异。(2) 开始寻求帮助包括与第一联系人联系和获得诊断。(3) 通过治疗来控制症状包括常规治疗、辅助治疗和替代治疗。妇女们讨论了使用性玩具替代阴道训练器、疼痛阈值协商与治疗进展之间的相关性,以及她们对肉毒杆菌毒素和神经阻滞的看法。(4) 穿越正规医疗网络促进或阻碍了求助。(5) 不支持/支持性非正式网络包括妇女的伴侣、家人、朋友和网络社区。建议改进医疗专业人员的方法,包括在网络空间中的方法。妇女的直接非正式支持网络应参与医疗保健管理。
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引用次数: 0
The collective trauma of HIV/AIDS and contemporary constructions of health: Older gay men's perspectives 艾滋病毒/艾滋病的集体创伤与当代健康结构:老年男同性恋的观点
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-09-03 DOI: 10.1016/j.ssmqr.2024.100477
Ingrid Handlovsky , Jessy Sidhu , Anthony Theodore Amato , Olivier Ferlatte , Hannah Kia
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引用次数: 0
Redefining ‘family’: Conceptualising social support networks of transfeminine women in the Western Cape, South Africa - A case descriptive study of in-depth qualitative data from the HPTN 071 (PopART) trial 重新定义 "家庭":南非西开普省女性输血者社会支持网络的概念化--对来自 HPTN 071(PopART)试验的深入定性数据的案例描述性研究
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-13 DOI: 10.1016/j.ssmqr.2024.100474
L. de Villiers , L. Swartz , P. Bock , J. Seeley , A. Stangl , G. Hoddinott , the HPTN 071 (PopART) study team

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.

变性女性(出生时被指定为男性并认同女性性别身份)有可能因其性别、性取向及其社会身份的其他部分(包括年龄、阶级和种族)而受到交叉性污名。这些多层次的污名可能导致与身体和情感暴力、药物使用、高风险性行为和艾滋病毒暴露相关的身心健康问题增加。社会网络是女性变性者的重要支持结构,可以缓解强加的风险和污名。我们调查了南非西开普省八名变性女性的家庭网络、家庭结构和社区支持系统。这项研究的数据包含在规模更大的 HPTN 071(PopART)试验的定性部分中。数据包括深入访谈记录、基因图活动和社区地图绘制。我们发现,没有生活在支持性家庭结构中的参与者面临着耻辱和健康风险。此外,我们还发现了一些例子,说明处于不支持性社会环境中的变性女性如何构建自己的家庭和住户单位以获得支持。我们的研究结果与其他研究结果一致,即当变性人的家人不支持或排斥她们时,她们通常会依靠大家庭成员、朋友或同龄人作为社会支持。了解变性女性如何重组社会单元以获得更好的支持非常重要,这样才能在南非本地和国际背景下为她们提供更好的医疗服务。需要进一步研究性别和性少数群体的家庭重组问题。
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引用次数: 0
‘New worlds open up’: A qualitative study on Wonder Lab practices in Dutch paediatric palliative care with parents, healthcare professionals, and students 打开新世界":与家长、医护人员和学生一起对荷兰儿科姑息关怀中的 "奇妙实验室 "实践进行定性研究
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-10 DOI: 10.1016/j.ssmqr.2024.100473
Liesbeth Geuze , Samuel Schrevel , Paula van Driesten – van Roozen , Anne Goossensen

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.

在儿科姑息关怀中,家属和服务提供者之间建立开放、平等和相互信任的关系至关重要。然而,在实践中,建立关系可能具有挑战性。着力于更好地理解彼此的参照系和基本价值观的差异似乎很重要。奇妙实验室实践提供了一个探索这些差异的空间,以好奇和苏格拉底式的方式共同关注生活现象。参与荷兰儿科姑息治疗的家长、医护人员和学生共同组织了 "奇妙实验室"。本研究旨在了解参与者参与 "奇妙实验室 "的经历。我们对 "奇妙实验室 "的参与者进行了 20 次深入访谈,并采用归纳式主题分析法进行数据解读。我们确定了五个主题:放慢脚步、欣赏故事、变得脆弱、敞开心扉、潜入其中、重塑观点。通过参与 "奇妙实验室",母亲、医疗保健专业人员和学生能够加深体验,并进一步了解在照顾患有局限性疾病和危及生命的儿童的过程中发生了什么。通过在多元化小组中开展工作,参考框架和理解相互补充,并可能发生变化。参与者在参与之后,往往会对参与护理的其他人采取更加开放的态度,并调整日常做法。在儿科姑息关怀中讨论敏感问题及其背后的个人和专业信仰与价值观,必须成为合作的一部分,而不是以具体的关怀情况作为催化剂。这可以促进在寻求生命质量、死亡和丧亲之痛时所需的相互理解。
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引用次数: 0
‘Paramedic decision-making in out of hospital cardiac arrest. A descriptive phenomenological study’ 院外心脏骤停的辅助医务人员决策。描述性现象学研究
IF 1.8 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Pub Date : 2024-08-03 DOI: 10.1016/j.ssmqr.2024.100472
Karl Charlton , Mark Bevan

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.

在院外心脏骤停期间,医护人员会做出开始、继续或终止复苏的决定。在何时进行复苏方面存在差异,有证据表明,这些决定是复杂的,并受到患者临床特征以外因素的影响。这项描述性现象学研究共有八名参与者,于 2021 年 4 月至 9 月期间在东北救护服务 NHS 基金会信托基金会进行。辅助医务人员讲述了他们遇到院外心脏骤停患者时的故事和反思,讲述了辅助医务人员的角色如何与自我身份和公众身份联系在一起,不确定死亡何时发生与突然发生的可逆事件,对他人承担的义务的伦理道德以及生命世界的多元性。复苏具有重要的仪式价值,通常是在人们的期望下进行的,在死亡识别、自我护理和对他人的护理过程中发挥着重要的社会功能。需要进一步开展研究,以了解决策的多变性对患者结果的影响,以及这与患者和公众期望之间的关系。
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SSM. Qualitative research in health
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