Oral history makes a critical contribution in articulating the perspectives of people often overlooked in histories written from the standpoint of dominating class, gender, ethnic or professional groups. Using three interrelated approaches - life stories, oral history, and narrative analysis - this paper analyzes family responses to psychiatric care and mental illness in oral history interviews with family members who experienced mental illness themselves or within their family between 1930 and 1975. Interviews with three family members in Alberta, Canada are the primary focus. These stories provide an important avenue to understand the meaning and transformations of mental health-care from the point of view of families. Family members' stories reveal contradictory responses to the dominant cultural discourse. Using a performative framework of interpretation, the narratives reveal a complex interplay between medical, social and cultural conceptions of mental illness, deepening our understanding of its meaning. The history of mental health-care can be substantially enriched by the analysis of family members' stories, not only revealing the constructed nature of mental illness, but also illustrating the family as a mediating context in which the meaning of mental illness is negotiated.
This article aims to show how a discourse and communication based approach in the context of the care of the elderly provides a basis for reflecting on pain. Based on six hours of data from talk encounters between care professionals and elderly clients, an activity analysis of institutional settings and categorization of interactional discourse was undertaken. The focus was: (a) how elderly people initiated painful accounts, and (b) how the professionals oriented to such accounts. It is found that pain-talks are governed by the institutional practice of different phases:framing; mapping troubles and symptoms; clients' self presentations; counseling, and concluding. This phase structure exemplifies knowledge of communicative activities and is part of practical knowledge which the party, or at least the professional, is expected to become acquainted with. A thematic interactional map of critical moments related to pain as (a) social death and hope, and (b) presentation of self as past and self as present emerges. The caring aspect is to support hope and to change the focus from social death to life and recovering. In foregrounding health, it is important for the elderly people to affirm their identity of themselves as being good and honest persons.
BACKGROUND: This paper describes a study that explores the experiences of internationally educated nurses (IENs) in their efforts to gain entry to practice as Registered Nurses (RNs) in the province of Ontario, Canada. AIM: The aim was to uncover, in part, the issues related to professional nursing credentialling. METHODS: This study was guided by a biographical narrative (qualitative) research methodology. A convenience sample of 12 IEN students volunteered for this study representing the Philippines, Mainland China, Korea, Ukraine and India. FINDINGS: The findings were that the IENs progress through a three-phase journey in their quest for licensure in Ontario. These phases include: (1) hope - wanting the Canadian dream of becoming an RN in Ontario; (2) disillusionment - discovering that their home-country nursing qualifications do not meet Ontario RN entry to practice; and (3) navigating disillusionment - living the redefined Canadian dream by returning to nursing school to upgrade their nursing qualifications. CONCLUSIONS: Professional regulatory nursing bodies and nursing educators, as well as practising nurses, must be aware of the potentially confusing and unpleasant processes IENs go through as they qualify for the privilege of practising nursing in Ontario.
BACKGROUND: The aim of this study was to describe the kinds of ethical dilemmas surgeons face during practice. METHODS: Five male and five female surgeons at a University hospital in Norway were interviewed as part of a comprehensive investigation into the narratives of physicians and nurses about ethically difficult situations in surgical units. The transcribed interview texts were subjected to a phenomenological-hermeneutic interpretation. RESULTS: No gender differences were found in the kinds of ethical dilemmas identified among male and female surgeons. The main finding was that surgeons experienced ethical dilemmas in deciding the right treatment in different situations. The dilemmas included starting or withholding treatment, continuing or withdrawing treatment, overtreatment, respecting the patients and meeting patients' expectations. The main focus in the narratives was on ethical dilemmas concerning the patients' well-being, treatment and care. The surgeons narrated about whether they should act according to their own convictions or according to the opinions of principal colleagues or colleagues from other departments. Handling incompetent colleagues was also seen as an ethical dilemma. Prioritization of limited resources and following social laws and regulations represented ethical dilemmas when they contradicted what the surgeons considered was in the patients' best interests. CONCLUSION: The surgeons seemed confident in their professional role although the many ethical dilemmas they experienced in trying to meet the expectations of patients, colleagues and society also made them professionally and personally vulnerable.
The focus of this study is how skills acquired from everyday life in one's native country can represent a resource in language training and work for immigrants and refugees. The specific aim is to explore what significance activity and participation in activity have on language training.
This qualitative study is based on fieldwork carried out in relation to a group of illiterate immigrants at a centre for adult education. The sample consists of 11 adult immigrants and refugees, male and female, between the ages of 20 and 65. The interviews with all the participants were carried out with the help of an interpreter.
The main findings were that the individual immigrant's history of activities received little attention during the language training. There was hardly any mention of previous experience from everyday life and work. By relying on different activities in the language training, the resources and background of the individual immigrant would have become more visible. Familiar activities from one's own culture enable communication when language skills are limited.
To evaluate an intervention aimed at enriching day centres for people with psychiatric disabilities by exploring staff experiences from developing and implementing the intervention.
Each staff group developed a tailor-made intervention plan, following a manual, for how to enrich the day centre. They received supervision and support from the research team. The study was based on focus-group interviews with a total of 13 staff members at four day centres. Narrative analysis with a thematic approach was used. A first round resulted in one narrative per centre. These centre-specific narratives were then integrated into a common narrative that covered all the data.
A core theme emerged: User involvement permeated the implementation process and created empowerment. It embraced four themes forming a timeline: "Mix of excitement, worries and hope", "Confirmation and development through dialogue, feedback and guidance", "The art of integrating new activities and strategies with the old", and "Empowerment-engendered future aspirations".
The users' involvement and empowerment were central for the staff in accomplishing the desired changes in services, as were their own reflections and learning. A possible factor that may have contributed to the positive outcomes was that those who were central in developing the plan were the same as those who implemented it.
The aim of this study was to describe the experiences of being a father to a prematurely born infant. Eight fathers of prematurely born children were interviewed using a narrative approach, and a thematic content analysis was used to analyse the interviews. The fathers described that the preterm birth gave them the chance to get to know their infant as they had to spend time at the intensive care unit. They also felt better educated by professionals who helped them take care of their infant. Their feelings and attachment for their infant increased over time and the fathers felt that they had a stronger bond with their child compared with friends who had babies born at term. As time passed, they became more confident as a father. In spite of the strain, the experience made them change as a person and they expressed having different values. The relationship with their partner was strengthened as they handled this situation together as a couple. However, the fathers felt fortunate despite everything and described having managed a prematurely born infant rather well. Although there are similarities between being a father to a child born at term and to one born preterm, it is significant to gain further knowledge about the specific experiences of fathers of prematurely born infants. The results of this study have implications for nurses working with families who have children born prematurely.
The authors used a transcendental phenomenological approach to describe adolescent mothers' satisfactory and unsatisfactory inpatient postpartum nursing care experiences. They analyzed data from 14 in-depth interviews and found that adolescent mothers' satisfaction is dependent on their perceptions of the nurse's ability to place them "at ease." Nursing care qualities that contributed to satisfactory experiences included nurses' sharing information about themselves, being calm, demonstrating confidence in mothers, speaking to adolescent and adult mothers in the same way, and anticipating unstated needs. Nursing care was perceived to be unsatisfactory when it was too serious, limited to the job required, or different from care to adult mothers, or when nurses failed to recognize individual needs. In extreme cases, unsatisfactory experiences hindered development of an effective nurse-client relationship. These findings illustrate the value of qualitative inquiry for understanding patients' satisfaction with care, can be used for self-reflection, and have implications for nursing education programs.
Different types of client attachment insecurity may affect the psychotherapeutic process in distinct ways. This exploratory study compared the in-session discourse of clients with dismissing and preoccupied attachment states of mind on Adult Attachment Interviews conducted prior to therapy in the context of a randomized clinical trial of psychoanalytic and cognitive-behavioural psychotherapy for bulimia nervosa. In a subsample of six sessions from each of eight therapy dyads, preoccupied clients were found to talk more and have longer speaking turns than dismissing clients, who in turn generated more pauses. Using the Narrative Processes Coding System, preoccupied clients were found to show more narrative initiative; whereas, differences in terms of narrative process modes were not as clearly interpretable. Contrary to expectations, the two insecure states of mind were equally different in the relationship-focused psychoanalytic therapy and in the symptom-focused cognitive-behavioural therapy. Suggestions for further investigations of the in-session discourse of clients with different attachment states of mind are given.
Fear can be problematic for children who come into contact with medical care. This study aimed to illuminate the meaning of being afraid when in contact with medical care, as narrated by children 7-11 years old. Nine children participated in the study, which applied a phenomenological hermeneutic analysis methodology. The children experienced medical care as "being threatened by a monster," but the possibility of breaking this spell of fear was also mediated. The findings indicate the important role of being emotionally hurt in a child's fear to create, together with the child, an alternate narrative of overcoming this fear.