How assisted eating becomes a caring practice in institutional settings: Embodied gestures and stages of assisted eating.

Assisted eating is a basic caring practice and the means through which many individuals receive adequate nutrition. Research in this area has noted the challenges of helping others to eat while upholding their independence, though has yet to explicate how this caring practice is achieved in detail and across the lifespan. This paper provides an empirical analysis of assisted eating episodes in two different institutions, detailing the processes through which eating is collaboratively achieved between two persons. Data are video-recorded episodes of infants during preschool lunches and care home meals for adults with dementia, both located in Sweden. Using EMCA's multimodal interaction analysis, three core stages of assisted eating and their underpinning embodied practices were identified: (1) establishing joint attention, (2) offering the food, and (3) transferring food into the mouth. The first stage is particularly crucial in establishing the activity as a collaborative process. The analysis details the interactional practices through which assisted eating becomes a joint accomplishment using a range of multimodal features such as eye gaze, hand gestures, and vocalisations. The paper thus demonstrates how assisted eating becomes a caring practice through the active participation of both caregiver and cared-for person, according to their needs. The analysis has implications not only for professional caring work in institutional settings but also for the detailed analysis of eating as an embodied activity.

Interaction as the foundation for eating practices in shared mealtimes.

Mealtimes shared with other people define how, what, how much, and with whom we eat. On such occasions, whether in private or public spaces, and as formal or informal events, our eating practices are inseparable from our interactions with other people. In this Editorial for the Special Issue on Interactional approaches to eating together and shared mealtimes, we provide an overview of the interdisciplinary field of research on eating together and shared mealtimes to illustrate the breadth and depth of work that has been developed in this area to date. The overview is divided into three broad clusters of research that focus primarily on (1) cultural or societal aspects, (2) individual outcomes, or (3) interactional practices. Commonalities across these clusters are discussed, the need for more research across a greater global and cultural diversity of eating practices is highlighted, and the potential for interdisciplinary collaboration on research on eating together and shared mealtimes across diverse scientific disciplines is explored. The papers in this Special Issue showcase a sample of contemporary work from within the cluster of research on interactional practices, and a brief overview of these papers is discussed. Finally, it is argued that as a common area of interest, social interaction as the foundation of eating practices within shared mealtimes poses considerable potential for interdisciplinary collaboration across scientific disciplines, and between scientists, professionals, and participants from the study populations.

Daring to taste: The organisation of children's tasting practices during preschool lunches.

Tasting food is the first step toward diversifying eating habits, and studies with children have typically focused on their sensory education and willingness to try new foods. While very little is known about how children taste foods during everyday mealtimes, EMCA (ethnomethodological and conversation analytic) research on adult tasting in naturalistic settings has demonstrated regular organisational patterns. This paper brings these two research areas together, using the insights of EMCA research on adult tasting to inform our understanding of how young children taste food during preschool lunches. Data are taken from a large corpus of video-recorded lunches in Sweden, in which children (3- to 6-year-olds) were eating with staff members. Discursive Psychology and multimodal Conversation Analysis were used to analyse the data. The analysis demonstrates how the sequential organisation of child tasting is similar to adult tasting, and how tasting practices are a collaborative, multisensory activity involving various embodied practices: from the orientation to food as 'to be tasted', the withdrawal of mutual gaze and exaggerated mouth movements, to the re-establishment of gaze accompanying the food assessment. In contrast to adult tasting, however, tasting during preschool lunches is often framed in terms of personal development of the child and of the individualising of taste within the framework of the institution. The findings thus provide further support for EMCA research on sensory practices and contribute to psychological research on children's eating by evidencing the importance of the interactional and institutional context on tasting as a sensory practice.

How infant food likes become established as knowledge: Parental food assessments during infant mealtimes in the home.

Early infancy is a critical period for the development of food likes and dislikes, but very little is known about the role of the social context and parent-child interaction within this process, and even less about what happens in the home environment. The current paper addresses this issue by examining how and when parents utter food assessments about their infants' eating practices during mealtimes in the home, and the practices through which infant likes become established as knowledge. A data corpus of 77 video-recorded infant mealtimes from six infants (aged 5-9 months) and their parents was analysed using discursive psychology, with a specific focus on the use of object-side and subject-side assessments. Data were recorded in English-speaking family homes in Scotland and Sweden. The analysis highlights three key findings: (1) infants' interactional rights to assess food are invoked during first tastes, (2) infants' food likes are established through anchoring in family food preferences and as shared knowledge among family members, and (3) infants' potential food dislikes are challenged by parents using object-side assessments and claims about previous likes. Parents thus play a crucial role in the establishment of infant food likes through the formulation of subject-side category assessments during early infant mealtimes. The research suggests that more focus should be placed on examining infant eating practices as collaborative and interactional events in everyday contexts.

Connecting knowledge: First-year health care students' learning in early interprofessional tutorials.

Collaboration across professional boundaries is an essential aspect of health care, and interprofessional education (IPE) is a common way to help increase students' collaborative abilities. Research on how and when IPE should be arranged in a curriculum remains, however, inconclusive. How students actually develop interprofessional competencies have been difficult to demonstrate and is still an under-researched area. Studying IPE in context is therefore important to understand its full complexity. This paper examines how students work with scenarios from professional health care contexts when learning together in interprofessional problem-based learning tutorials during the first year of undergraduate education. The data are video-recorded tutorials of students from medicine, nursing, occupational therapy, speech and language pathology, and physiotherapy programmes. The analysis focuses on students' discussing their readings of the literature. Drawing on "Communities of Practice," findings show that students discuss and connect professional knowledge, with "brokers" (the tutors) and "boundary objects" (scenarios) supporting the emergence of students' professional knowledge. The scenarios, as boundary objects, also enabled the students to turn into brokers themselves. The paper contributes to research on interprofessional learning and offers support for implementing IPE in the early stages of undergraduate education.

Moments of Pleasure: A Preliminary Classification of Gustatory mmms and the Enactment of Enjoyment During Infant Mealtimes.

The enjoyment of food and the sharing of mealtimes is a normative cultural and social practice. Empirical research on eating enjoyment has, however, been a rather neglected area across the social sciences, often marginalized in favor of health or focusing on individual preferences rather than shared enjoyment. Even with regards to children, their enjoyment of food is typically rated retrospectively via parental reports of mealtime behavior. What is missing is an understanding of how enjoyment becomes a normative, cultural practice during mealtimes. This paper examines this issue in the context of parents feeding their 5-8-month-old infants in the family home, since it is within this context that we can see the early emergence of such practices in often highly routinized situations. The enactment of eating as enjoyable, and of the food as appreciated or "liked" in some way, is a culturally normative practice that becomes recognizable through particular non-lexical ("mmm," "ooh") or lexical ("this is nice, isn't it?") utterances. The data comprise 66 infant mealtimes video-recorded over almost 19 h, from five families living in Scotland. The analysis uses discursive psychology and focuses on the sequential position of different types of parental gustatory mmms as produced during the infant meals. A classification of four types of mmm were identified in the corpus-announcement, receipting, modeling, and encouragement mmms-each associated with features of sequential and multimodal organization within the mealtime. In the majority of instances, mmms were uttered alone with no other assessment terms, and parents typically produced these as an orientation to the enjoyment of their infants', rather than their own, eating practices. The receipting mmms, for instance, occurred at the precise moment when the infant's mouth closed around the food. It is argued that eating enjoyment can be considered as much an interactional practice as an individual sensation, and that non-lexical vocalizations around food are an essential part of sensory practices. The paper thus aims to bridge the gap between cultural and psychological studies of eating enjoyment and contribute to developmental studies of infant feeding in everyday interaction.

Stepping Back From Crisis Points: The Provision and Acknowledgment of Support in an Online Suicide Discussion Forum.

Suicide is a global health concern, though little is known about the social practices that might support those who are contemplating suicide. Online forums provide a unique insight into the anonymous discussion of suicide, including sociocultural norms about suicide and the delicate management of online interaction. In this article, we examine the provision and acknowledgment of support in an online discussion forum about suicide, using discursive psychology to analyze the textual interaction. The analysis illustrates how forum threads function as case studies and enable members to gain support on numerous occasions. In this way, members can gain help at crisis points as and when these occur, while still maintaining authenticity as a valid forum member. The analysis also provides additional evidence for models of suicide which highlight the fluid nature of suicidality and contributes to the preventative work on suicide by demonstrating how support can be provided at crisis points.

Qualitative Evaluation of a Practice-based Experience Pilot Program for Master of Pharmacy Students in Scotland.

Objective. To determine the views of pharmacists in central Scotland regarding experiential education for MPharm students. Methods. A thematic analysis was completed by Ms. Gillian Hendry and Dr. Sally Wiggins of interviews conducted with ten practicing pharmacists paired with first-year master of pharmacy (MPharm) students during the 2011-2012 academic year. Relevant comments from the interviews were manually sorted in a Microsoft Excel spreadsheet to bring similarly themed material together to facilitate the identification and naming of recurring themes and subthemes. Results. The pharmacists were unanimous in their opinion that experiential education was valuable for MPharm students and, in particular, that it helped students to develop self-confidence. The pharmacists derived personal satisfaction in developing mentor/mentee relationships with students. They also recognized the value that students provided to the workforce as well as the educational value to themselves in supervising students. The participants' primary dissatisfaction was that the pharmacy workflow limited the time they could spend mentoring students. Conclusion. The results provide guidance to the academic community and the pharmacy practice community in the United Kingdom (UK) regarding the design and integration of experiential education courses in MPharm degree programs.

Adult and child use of love, like, don't like and hate during family mealtimes. Subjective category assessments as food preference talk.

Food preference is now a ubiquitous concept in eating research, and closely associated with actual consumption, particularly in relation to children's food preferences. Research in this area is beginning to reveal the effects of parent-child interaction on eating practices though relatively little attention has been paid to the discursive and lexical processes involved. Food preferences are typically associated with the terms 'likes' and 'dislikes' in food preference research. By contrast, adults and children typically use the terms 'love', 'like', 'don't like' and 'hate' to construct and manage food preferences in everyday meal conversations. A corpus of 270 video- and audio-recorded English and Scottish family mealtimes, involving children aged 1-17 years, was searched and analysed for any and all occurrences of subjective category assessments (SCAs; e.g., 'I like X'), featuring the terms 'love', 'like', 'don't like' and 'hate'. Discursive psychology was used to analyse the transcripts and recordings, and illustrated the disparity between adult and child use of SCAs and food preference talk. Within the data set, parents typically made claims about what their children like, and in doing so claimed epistemic primacy over their children's food preferences. Children, by contrast, typically made claims about their own 'don't likes' and likes, and these were frequently countered by their parents or treated as inappropriate claims. Implications for how parents and researchers might reorient to the food preferences lexicon are discussed.

Can you pull it off? Appearance modifying behaviours adopted by wig users with alopecia in social interactions.

In the academic and medical literature on alopecia, wigs (hair prostheses) are typically recommended as a coping strategy: a device to camouflage, conceal, or cover hair loss, and cope with the psychological impact of a dramatic change in body image. This paper used Goffman's (1959) theory of impression management to demonstrate (a) the social significance of self-presentation, and (b) how adults with alopecia managed their wig use in their daily lives. Data from 14 interviews, two focus groups and six video diaries with 22 Caucasian adults (19 females, 3 males; 29-74 years, SD=13.75) with alopecia in Scotland were analysed using discursive psychology. The analysis detailed how participants managed their wig use and behaviours in relation to social interaction with different categories of people. The paper raises concerns about health and medical discourse about wigs as a coping mechanism, and provides practical suggestions for wig users in social settings.

The social life of 'eugh': disgust as assessment in family mealtimes.

Disgust is a complex phenomenon that pervades a number of social situations. To date, disgust has primarily been understood as an individually experienced emotion or as a way of defining boundaries between people or objects; the detailed social practices through which disgust is choreographed, however, have yet to be fully explored. The social implications of disgust are particularly apparent when food and eating are involved, as it is in such settings that individuals, objects, and social boundaries coincide. In this paper, I argue that the enactment of disgust is an inherently social event, and that we can evidence it as such through the way in which it is produced and oriented to in everyday interaction. The setting for this paper is family mealtimes, as a situation in which children and parents explore the boundaries of what is, and what is not, disgusting. A large corpus of video and audio recordings of mealtimes in England and Scotland were analysed using a discursive psychological approach, with a focus on explicating the sequential and prosodic features of disgust markers (DMs), such as 'eugh' and 'yuck'. The analysis demonstrates that DMs are typically preceded by a 'noticing' by speakers and that 'eugh' is usually uttered alone and at the start of a turn in talk. It is argued that, regardless of their putative status as emotions or cultural concepts, DMs work as assessments of food and eating practices in everyday interaction. They orient others to a trouble source and attend to people's entitlements to 'know' disgust. The implications for our understanding of disgust as a social psychological concept are further explored.

Perceptions of cosmesis and function in adults with upper limb prostheses: a systematic literature review.

BACKGROUND: Technological developments in prosthesis design of upper limb devices are improving rapidly, and understandings of user's perceptions are important to reduce device abandonment and improve user satisfaction rates. OBJECTIVES: The purpose of this review was to establish what is known about adult user's perceptions of upper limb prostheses in terms of both cosmesis and function. STUDY DESIGN: Systematic review. METHODS: A search of the literature between 1990 and 2010 identified over 600 possible citations; these were reduced to 15 citations based on selection criteria. RESULTS: The main themes arising from the review were user satisfaction ratings with current prostheses, priorities for future design and the social implications of wearing a prosthetic limb. While users of cosmetic prostheses were mostly satisfied with their prostheses, satisfaction rates vary considerably across studies, due to variability in demographics of users and an ambiguity over the definitions of cosmesis and function. Design priorities also varied, though overall there is a slight trend toward prioritising function over cosmesis. The qualitative studies noted the importance users placed on presenting a 'normal' appearance and 'not standing out'. CONCLUSIONS: The reviewed studies mostly examine functionality and cosmesis as separate constructs, and conclusions are limited due to the disparity of user groups studied. Recommendations are made for further work to explore understandings of these constructs in relation to upper limb prosthesis use.

Finishing the family meal. The interactional organisation of satiety.

This paper provides an extended review of psychological, sociological and interactional research on mealtimes and satiety (fullness), arguing for a focus on how fullness and finishing a meal is interactionally achieved. Drawing on three specimen data fragments from contrasting family settings, routinely used resources for pursuing completion and expressing satiety are described. We show how checks on completion are tailored to children according to their age, the intimate knowledge family members have of one another and attuned to contingencies, such as, whether there is a further course to be offered. Equally, that in teaching children how to eat together with others, the family also transmits and transforms all manner of other eating practices such as how to comply, or not, with requests to finish. A central aim of the article is to complement the many studies of satiety that have explained its physiological aspects by providing the familial logics that are expressed in bringing the meal to a close. We offer a suggestive analysis, based on conversation analytic principles, to illustrate our argument and to provide a starting point for further work in this field. Where bodies of work have previously used mealtimes as a convenient setting for accessing other social practices, this article turns its focus back toward the tasks of dining together.

Reconciling the good patient persona with problematic and non-problematic humour: a grounded theory.

BACKGROUND: Humour is a complex phenomenon, incorporating cognitive, emotional, behavioural, physiological and social aspects. Research to date has concentrated on reviewing (rehearsed) humour and 'healthy' individuals via correlation studies using personality-trait based measurements, principally on psychology students in laboratory conditions. Nurses are key participants in modern healthcare interactions however, little is known about their (spontaneous) humour use. AIMS: A middle-range theory that accounted for humour use in CNS-patient interactions was the aim of the study. The study reviewed the antecedents of humour exploring the use of humour in relation to (motivational) humour theories. PARTICIPANTS AND SETTING: Twenty Clinical Nurse Specialist-patient interactions and their respective peer groups in a country of the United Kingdom. METHOD: An evolved constructivist grounded theory approach investigated a complex and dynamic phenomenon in situated contexts. Naturally occurring interactions provided the basis of the data corpus with follow-up interviews, focus groups, observation and field notes. A constant comparative approach to data collection and analysis was applied until theoretical sufficiency incorporating an innovative interpretative and illustrative framework. This paper reports the grounded theory and is principally based upon 20 CNS-patient interactions and follow-up data. The negative case analysis and peer group interactions will be reported in separate publications. FINDINGS: The theory purports that patients' use humour to reconcile a good patient persona. The core category of the good patient persona, two of its constituent elements (compliance, sycophancy), conditions under which it emerges and how this relates to the use of humour are outlined and discussed. In seeking to establish and maintain a meaningful and therapeutic interaction with the CNS, patients enact a good patient persona to varying degrees depending upon the situated context. The good patient persona needs to be maintained within the interaction and is therefore reconciled with potentially problematic or non-problematic humour use. Humour is therefore used to deferentially package concerns (potentially problematic humour) or affiliate (potentially non-problematic humour). This paper reviews the good patient persona (compliance, sycophancy), potentially problematic humour (self-disparaging, gallows) and briefly, non-problematic humour (incongruity). CONCLUSIONS: The middle-range theory differentiates potentially problematic humour from non-problematic humour and notes that how humour is identified and addressed is central to whether patients concerns are resolved or not. The study provides a robust review of humour in healthcare interactions with important implications for practice. Further, this study develops and extends humour research and contributes to an evolved application of constructivist grounded theory.

Doing being 'on the edge': managing the dilemma of being authentically suicidal in an online forum.

Those who attempt suicide have often been described as 'crying for help', and there are implications if such cries are not taken seriously. This paper examines how users of an Internet forum for 'suicidal thoughts' work up their authenticity in their opening posts, and how these are responded to by fellow forum users. Data were taken from two Internet forums on suicide over a period of one month and were analysed using discursive psychology. The analysis demonstrates that participants display their authenticity through four practices: narrative formatting, going 'beyond' depression, displaying rationality and not explicitly asking for help. Furthermore, both initial and subsequent posts worked up identities as being psychologically 'on the edge' of life and death. The analysis suggests that the forum in part works as a site for suicidal identities to be tested out, authenticated and validated by individuals. We conclude with some suggestions for the supportive work of suicide 'postvention'.

The purpose and function of humour in health, health care and nursing: a narrative review.

AIM: This paper is a report of a review conducted to identify, critically analyse and synthesize the humour literature across a number of fields related to health, health care and nursing. BACKGROUND: The humour-health hypothesis suggests that there is a positive link between humour and health. Humour has been a focus of much contention and deliberation for centuries, with three theories dominating the field: the superiority or tendentious theory, the incongruity theory and the relief theory. DATA SOURCES: A comprehensive literature search was carried out in January 2007 using a number of databases, keywords, manual recursive searching and journal alerts (January 1980-2007) cross-referenced with the bibliographic databases of the International Society of Humor Studies. An inclusion and exclusion criterion was identified. REVIEW METHODS: A narrative review of evidence- and non-evidence-based papers was conducted, using a relevant methodological framework with additional scrutiny of secondary data sources in the latter. Humour theories, incorporating definition, process and impact constituted a significant part of the appraisal process. RESULTS: A total of 1630 papers were identified, with 220 fully sourced and 88 included in the final review. There is a dearth of humour research within nursing yet, ironically, an abundance of non-evidence-based opinion citing prerequisites and exclusion zones. Examination of physician-patient interaction and the humour-health hypothesis demonstrates that use of humour by patients is both challenging and revealing, particularly with regard to self-deprecating humour. CONCLUSION: Nurses and nursing should adopt a circumspect and evidenced-based approach to humour use in their work.

Talking about taste: using a discursive psychological approach to examine challenges to food evaluations.

This study is concerned with developing the interdisciplinary nature of food research, and with examining eating practices as they occur in everyday situations. The aim is to demonstrate how discursive approaches may contribute to eating research using a specific analytical example. A discursive psychological approach is used to examine mealtime conversations from 10 families with the analysis focusing on how food evaluations are challenged in interaction-for example, asking someone to justify what they think is 'wrong' with the food. Data are presented with 7 examples of the 30 challenges that were found within the data corpus. The analysis demonstrates how people may be held accountable for their expressed taste preferences when being challenged, and how this contributes to our understanding of eating as primarily an individual and embodied experience. It is argued that a specific and detailed analysis of eating interactions provides an alternative way of conceptualising food evaluations as discursive rather than mentalistic concepts. A discursive approach also opens up practical ways in which the social and familial aspects of eating may be examined as they occur as part of food practices.

Good for 'you': generic and individual healthy eating advice in family mealtimes.

Healthy eating is one of the main concerns for health organizations in the UK, and has been widely promoted in recent decades. Yet despite the amount of nutritional information available, levels of obesity, heart disease and other food-related diseases remain high. Existing research in this area often uses individual accounts of consumption to examine the reasons why people may not be eating 'healthily'. An alternative way to approach this issue is to examine how healthy eating advice is constructed and used in everyday interaction. This research uses tape-recorded family mealtimes to examine instances where nutritional advice is embedded and managed in conversational activities. A distinction between generic and individually focused healthy eating talk is illustrated, and the implications for further research are discussed.

Attitudes and evaluative practices: category vs. item and subjective vs. objective constructions in everyday food assessments.

In social psychology, evaluative expressions have traditionally been understood in terms of their relationship to, and as the expression of, underlying 'attitudes'. In contrast, discursive approaches have started to study evaluative expressions as part of varied social practices, considering what such expressions are doing rather than their relationship to attitudinal objects or other putative mental entities. In this study the latter approach will be used to examine the construction of food and drink evaluations in conversation. The data are taken from a corpus of family mealtimes recorded over a period of months. The aim of this study is to highlight two distinctions that are typically obscured in traditional attitude work ('subjective' vs. 'objective' expressions, category vs. item evaluations). A set of extracts is examined to document the presence of these distinctions in talk that evaluates food and the way they are used and rhetorically developed to perform particular activities (accepting/refusing food, complimenting the food provider, persuading someone to eat). The analysis suggests that researchers (a) should be aware of the potential significance of these distinctions; (b) should be cautious when treating evaluative terms as broadly equivalent and (c) should be cautious when blurring categories and instances. This analysis raises the broader question of how far evaluative practices may be specific to particular domains, and what this specificity might consist in. It is concluded that research in this area could benefit from starting to focus on the role of evaluations in practices and charting their association with specific topics and objects.