Finding meaning in complex care nursing in a hospital setting.

This study explores the experiences of nurses that provide 'complex', generalist healthcare in hospital settings. Complex care is described as care for patients experiencing acute issues additional to multimorbidity, ageing or psychosocial complexity. Nurses are the largest professional group of frontline healthcare workers and patients experiencing chronic conditions are overrepresented in acute care settings. Research exploring nurses' experiences of hospital-based complex care is limited, however. This study aims to add to what is known currently. Four 'complex care' nurses undertook in-depth semistructured interviews and their narratives were analysed using the conceptual framework of complex adaptive phenomenology. Two overarching themes constituting the 'essence' of complex care nursing were identified: Contextual factors and attribute/value-based elements. Creating meaningful patient outcomes and feeling part of a team were experienced as fulfilling, whereas time constraints, institutional settings and systemic barriers to comprehensive caregiving diminished the experience of providing complex care. Overall, work meaning presented as a dynamic phenomenon, shaped by personal and professional values, local settings and systemic factors. It is recommended that more expansive research be undertaken to explore the experience of complex care for nurses. Such knowledge can contribute to initiatives that draw a skilled, effective and engaged hospital-based complex care nursing workforce.

The Lifeworld of the Complex Care Hospital Doctor: A Complex Adaptive Phenomenological Study.

The ever-increasing prevalence of chronic conditions over the last half century has gradually altered the demographic of patients admitted to acute care settings; environments traditionally associated with episodic care rather than chronic and complex healthcare. In consequence, the lifeworld of the hospital medical doctor often entails healthcare for a complex, multi-morbid, patient cohort. This paper examines the experience of providing complex healthcare in the pressurised and fast-paced acute care setting. Four medical doctors from two metropolitan health services were interviewed and their data were analysed using a combinatorial framework of phenomenology and complexity theory. The horizon of complex care revealed itself as dynamic, expansive, immersive, and relational, entailing a specialised kind of practice that is now common in acute care settings. Yet this practice has made inroads largely without heralding the unique nature and potential of its ground. Herein lies opportunity for complex care clinicians to expand notions of health and illness, and to shape research, practice, and system design, for a future in which care for health complexity is optimised, irrespective of care settings.

Daughters' experiences of maternal bereavement during adolescence: A scoping review.

ABSTRACTThe purpose of the scoping review was to synthesize peer-reviewed literature of daughters' experiences of maternal bereavement. The search was conducted across eight databases and included peer-reviewed, qualitative research that reported on daughters' experiences of the death of their mother. The review identified 21 studies. Experiences included recurrent grief including secondary losses, difficulties establishing and maintaining relationships, and intrapersonal and daily lifestyle changes. Implications for maternal loss during adolescence, and recommendations for those supporting women whose mothers have passed away have been provided. Further research is needed to identify the experiences of loss at different developmental stages.

"In any crisis there is an opportunity for us to learn something new": Australian teacher experiences during COVID-19.

The aim of this study was to investigate the factors that supported Australian teachers to meet the needs of all learners during COVID-19 lockdowns. A qualitative design was used, and interviews were conducted with teachers who were purposely identified. The participants (n = 5) worked across different educational contexts ranging from primary to secondary school settings. The interview data were analysed using thematic analysis. Five themes were identified related to teachers' intrinsic strengths: passion and commitment, a proactive and organised approach, enhanced flexibility, building relationships and access to online technology. A further three extrinsic supporting factors were identified: supportive school teams, supportive school leadership (empowerment, autonomy and time) and supportive school systems and structures. The implications of these findings are discussed and the need for sharing and applying learnings across the profession are emphasised as an opportunity to further improve the access of every learner to a high quality and inclusive education.

Who Cares? Service Users' Opinions and Opportunities for Family Involvement in Mental Health Care.

Involving families in mental health care can provide benefits to service users, their families and clinicians. However, family involvement is neither uniform nor routine. Understanding the complexities of this involvement is critical to improving application. This study sought to increase current knowledge about service users' opinions and opportunities for family involvement in mental health care. Data were collected from a total of 10 adult participants through 10 individual semi-structured interviews of approximately 30 min each. Findings are reported in accordance with COREQ and EQUATOR guidelines. Thematic analysis identified several consistent themes: respect for service user opinions of family involvement; opportunities for family involvement; negative and positive service user opinions of family involvement. Our findings support previous appeals for routine family involvement in care but extend this charge with the assertion that as important is a customary discussion with service users to ask their opinions about this involvement. Establishing this dialogue prior to treatment commencement has the potential to alleviate or resolve service user concerns and potentially improve and/or increase how families are engaged.

Complex adaptive phenomenology: A conceptual framework for healthcare research.

RATIONALE: Healthcare research exploring the lived experiences of health care professionals from different disciplines, such as nursing, medicine, and allied health, has repeatedly highlighted many methodological challenges, especially in understanding the individual human experience within complex systems. In response, complexity theory and phenomenological approaches emerged and evolved in ways that potentially offered researchers frameworks to inform an understanding of the individual human experience. However, while these two theoretical approaches inform a method of inquiry, there is a gap in understanding the phenomenon of 'being' and how this is embodied within complex systems such as the healthcare system. THE AIMS AND OBJECTIVES: The aim of this paper is to present an integrated theoretical framework, namely complex adaptive phenomenology (CAP). CAP aims to address this inquiry gap by offering a structured conceptual framework wherein complexity theory and phenomenology are complementary but multi-dimensional. The key objective of CAP was to synthesize and integrate two methods of inquiry that examine the relational aspects of 'being', that is the gestalt of perception, action, and context, The authors argue that CAP is well-suited to complex research contexts such as healthcare. The framework focuses on the reciprocal, co-constructive relationships extant between perception, meaning, context, and action that shape experiences of 'being' within complex systems. Complexity theory's connectionist orientation explains the relationships that are formative of the experience of being, while phenomenology explores the manifestations of these formative relationships by attending to the notion of 'being' itself. CONCLUSION: The authors propose that an integrated framework, of phenomenology and complexity theory, can provide a platform for deeper understandings of the experiences of health professionals and contribute to healthcare scholarship.

Coping through the unknown: School staff wellbeing during the COVID-19 pandemic.

Approximately one quarter of all teachers experience feelings of stress throughout their careers, for many this leads to emotional exhaustion and burnout. In this article we present a case study that explores the wellbeing of three teaching staff from an Australian Primary School, during the COVID-19 pandemic. The Transactional Model of Stress and Coping devised by Lazarus and Folkman was used as the framework to interpret this group of experiences. The findings indicated that the additional stress induced by fear of the 'unknown' imposed by the pandemic further intensified the emotional toll experienced by participants. These emotional responses included feelings of guilt about their providing the best education for students, anxiety about the unknown implications on schooling and frustration at the lack of communication and inconsistent decision making by people holding leadership positions. Despite this, these teaching staff shared many positive strategies for coping and grow through the experience.