Fixed Nodes of Transience: Narratives of Homelessness and Emergency Department Use.

Discourse in popular media, public policy, and academic literature contends that people who are homeless frequently make inappropriate use of hospital emergency department (ED) services. Although researchers have investigated the ED experiences of people who are homeless, no previous studies have examined how this population understands the role of the ED in their health care and in their day-to-day lives. In the present study, 16 individuals participated in semistructured interviews regarding their ED experiences, and narrative analysis was applied to their responses. Within the context of narratives of disempowerment and discrimination, participants viewed the ED in differing ways, but they generally interpreted it as a public, accessible space where they could exert agency. ED narratives were also paradoxical, depicting it as a fixed place for transient care, or a place where they were isolated yet felt a sense of belonging. Implications for policy and practice are discussed.

Risk factors for post-injury mental health problems.

Serious nonfatal physical injuries and burns are common occurrences that can have substantial implications for personal, social, and occupational functioning. Such injuries are frequently associated with significant mental health issues, and compromised quality of life and well-being. The purpose of this review is to summarize the current literature on physical, psychological, and social risk factors for mental health issues post-injury and to contextualize findings using Engel's biopsychosocial framework. We distinguish between pre-injury, injury-related, and post-injury risk factors for mental health problems. Female sex, history of mental health problems or trauma, type of injury, and level of pain are among the strong risk factors for mental health problems post-injury. We highlight inconsistent findings in the literature, identify directions for future research, and explore the implications of the risk factors identified for treatment and prevention.

Broken heart stories: understanding Aboriginal women's cardiac problems.

Many Aboriginal communities call heart problems, and in particular cardiovascular disease, "White man's sickness." At the same time, Aboriginal women present with some of the highest rates of this disease. Against this backdrop, we explored how women with cardiac problems understand their heart health and used narrative-discursive methods to analyze interviews conducted with women from two First Nations in North America. The women told stories that were riddled with contradictions, unfolding a complicated personal and cultural reality of living with cardiovascular disease. In many stories, heart disease was described as resulting from a "community imbalance" in the wake of colonialism whereby the women had to take over the traditional roles of men. Their ideas of heart disease risk and healing flowed from this understanding. They derived a sense of strength, however, from their ability to undertake both gender roles. Based on our findings, we provide some recommendations for cardiac care.

Recovered or recovering: negotiating rehabilitation after stroke.

The role of narrative discourse has been increasingly recognized as crucial to all partners involved in the rehabilitation process after acquired brain injury. Particularly within the family, narrative offers an experiential space for meaning-making. To better understand this joint meaning-making process, a narrative-discursive methodology was used to analyze a family's conversation that took place 1 year after the mother had a stroke. In one narrative, a particular incident was used to illustrate that the mother has recovered; in another narrative, the same event was used to demonstrate that the mother was still recovering. The 2 narratives are associated with different rights, responsibilities, and rehabilitation trajectories. To holistically understand the rehabilitation process, health professionals need to be aware of the often hidden narrative meaning-making processes that take place within the family.

Psychological distress and self-care engagement: healing after a cardiac intervention.

Silencing the self, a relational concept, occurs when individuals overvalue others' standards, self-sacrifice their needs for others, inhibit self-expression, and experience a sense of dividedness between their inner and outer self. Given the emerging literature highlighting the importance of relational beliefs and experiences in coronary heart disease, the contribution of a concept such as self-silencing to the cardiac healing process is valuable to consider. This study investigated self-silencing dimensions, psychological distress (anxiety and depressive symptoms), and self-care engagement after a serious cardiac event. Forty women and 80 men attending a rehabilitation program completed a series of questionnaires six months post-cardiac intervention. Multivariate regression analyses were performed to examine the role of self-silencing after the influence of cardiac health and sociodemographics were taken into account. Self-silencing was positively associated with anxiety and depressive symptoms for both sexes. For self-care engagement, sex interacted with some of the silencing dimensions. The findings were interpreted in the context of participants' attendance in a rehabilitation program. Women who are self-silencing may benefit from the self-care expectations associated with a cardiac program whereas for men, even engaging in cardiac self-care may be perceived as self-silencing.

Longitudinal Mixed Modelling of Emergency Department Use Among a Sample of Homeless Participants in a Housing First Demonstration Trial.

The present Canadian study sought to identify predictors of emergency department (ED) use in a sample of adults who are homeless. Four hundred eighty-three participants were interviewed quarterly for two years, reporting their housing status, income, food security, physical/mental health, and other social determinants of health. Survey data were linked to administrative health and social services data. Predictors of ED visits were analyzed using negative binomial longitudinal mixed modelling. Emergency department visits were positively and reliably predicted by pre-baseline ED use, as well as by concurrent increased social assistance, primary care visits, ratings of physical health, substance use problems, and case management visits. Increased concurrent housing instability and food insecurity, and decreased homelessness history, positively predicted ED visits, but effect reliability was lower. Participant ill health appears to be a primary driver of ED utilization. The findings challenge misconceptions about the appropriateness of ED use among people who are homeless.

Continuity amid chaos: neurotrauma, loss of memory, and sense of self.

In serious illness or disability, individuals commonly say that their sense of self has dramatically changed. One might expect that the experience of a radically altered sense of self would be even more profound in individuals after neurotrauma because it is the brain itself that suddenly, and often literally, becomes "strange." The aim of this study was to investigate how people left with autobiographical memory impairments--impairments that also affect the capacity to organize complex linguistic productions such as autobiographical narratives--experience themselves and, specifically, their sense of self. Seven adults who had primarily anterograde memory impairments for 1 year were interviewed. Regardless of the profound changes in their everyday functioning and lives, the stories the participants told evoke a surprising sense of a continuous self. Employing several narrative and discursive techniques, they emphasized sameness and an unbroken connection between their pre- and post-morbid lives. We believe that most individuals felt they did not have to recover their former sense of self because they subjectively seemed to have never lost it.

Men, fire, and burns: Stories of fighting, healing, and emotions.

Burn recovery is a difficult process full of physical and psychological challenges. With increasing survival rates, there has been renewed interest in the psychological aspects of burn recovery. As men represent over 70% of all burn patients, it is particularly important to study how men experience and interpret this process. We interviewed a purposeful sample of ten adult male burn survivors from different age and cultural groups in the first 16 weeks of their recovery and asked them to discuss the problems they faced. Narrative analysis was used to interpret the interviews. In their narratives, the men tended to emphasize gains in their physical recovery; that is, they often used metaphors of "fighting" to demonstrate how committed they were to their healing. Further, they put less emphasis on the emotional aspects of their recovery. In our discussion, we compare these complex storylines to coping strategies identified in the literature and discuss why men may choose these strategies. Based on our findings we argue that it is important for health care providers to be aware of societal pressures which may influence burn survivors to minimize affective elements of burn recovery. Additionally, we encourage exploring and capitalizing on men's "fighting" stories during rehabilitation in order to foster an active role which men can take in their recovery.

Making sense of traumatic experiences: telling your life with fragile X syndrome.

The discourse of individuals with fragile X syndrome has been described as fragmented, tangential, and associatively connected, resulting in autobiographical narratives that are incoherent and difficult to understand. In this article, the authors discuss the case of an adolescent female with moderate mental retardation due to fragile X syndrome. The analysis of her autobiographical stories, rather than being primarily reflective of cognitive impoverishment, reveals a different--narrative--mode of thought. The authors present and examine some of her narratives in terms of their specific functions: communication, coherence, exploration, distancing, and evaluation. Their findings suggest that narrative analysis can be an important complement to traditional neuropsychological assessment.

"Put on your face to face the world": women's narratives of burn injury.

The survival rate of individuals with burn injury has significantly increased due to medical advances in burn care. This has led to a need to focus on psychological aspects of burn injury recovery, particularly on how people come to terms with their changed bodies. The literature suggests that burn size and severity are not directly associated with the degree of distress but that subjective perceptions and interpretations - of, for instance, body image - are pertinent. Body image appears to be particularly important for women and thus, in this study, we investigated women's experiences of their bodies following mild to moderate burns. We conducted in-depth interviews with 10 female burn survivors in the first year after injury, using methods of narrative analysis for the investigations of the transcripts. Thirteen consecutive women who met inclusion criterion were approached at regional burn care follow-up clinic. In their narratives, the women predominantly emphasized how well they were doing; however, counter-narratives emerged indicating dissatisfaction and distress. The tension between these two different kinds of narratives suggests an ambivalent relationship with the burn injury. We concluded that it is imperative for health care professionals to be cognizant of these conflicting experiences in order to adequately address burn survivors' needs in rehabilitation.

Heart stories: men and women after a cardiac incident.

In this study we explore the views and beliefs of men and women about cardiovascular disease and the emotions and social relations that are involved. Women and men attending a cardiovascular rehabilitation program participated in two in-depth interviews carried out with each individual six months after a first serious cardiac event. The transcribed interviews were analyzed using a narrative-discursive methodology. Although there were numerous differences between the men and women's stories, an outstanding commonality was that their narrative efforts to negotiate healing and rehabilitation were guided by gendered identities and societal roles.

Living with Parkinson's disease-managing identity together.

The specific aim of this paper is to discuss how individuals living with Parkinson's disease and their main family supports perceive communications with each other, with a focus on their roles related to care. The paper is based on individual interviews conducted with individuals and their main family support person. The transcripts were analyzed based on grounded theory and "managing identity together" emerged as the core category. This is discussed in terms of independence, a sense of self-sufficiency and an overall sense of personhood. Implications for other populations conclude the paper.

Remembering without a past: individuals with anterograde memory impairment talk about their lives.

This paper describes the linguistic resources people with anterograde amnesia draw on in conversational narratives. Because of their problems in recollecting post-morbid memories, it is particularly challenging for such individuals to refer to personal experiences. Seven patients with anterograde memory impairments due to neurotrauma were interviewed one year post-event. Among other topics, they were asked to talk about their new lives and selves, which was expected to be a precarious affair given that they did not have many or any autobiographical memories. Microanalyses of their narratives identified three readily available linguistic resources that participants used to facilitate their storytelling. These were categorized as "memory importation" (transplanting a past memory into the present), "memory appropriation" (taking another's memory as one's own), and "memory compensation" (searching for memories). It is argued that although these resources were not always efficiently used by participants and their use often violated conversational expectations, these linguistic techniques provided a helpful means to sustain the production of personal narratives, even in the absence of autobiographical memory.

Islands of memory: Autobiographical remembering in amnestics.

In amnestics with anterograde amnesia, memories of post-onset autobiographical experiences, if present at all, are typically barren and impoverished. However, there have been sporadic reports of islands of memory--memories that are vivid, detailed, and specific to time and place. The aim of this study was to verify the presence of such memories and examine their incidence rate. Anterograde amnestics were interviewed in their home using a narrative interviewing strategy with a view to describing memory in everyday life. Each autobiographical memory of a post-onset event was coded for quantity-length, and quality-episodicity. In just over half of the amnestics (8 out of 14), a memory that was lengthy, rich in personal details, and localisable was recollected. The quantitative and qualitative aspects of these island memories were significantly different from the other autobiographical memories that the amnestics supplied. These memories were at odds with what would be expected on the basis of their performance on standardised memory instruments. Our findings suggest there is occasionally more variability in remembering of autobiographical experiences in some amnestics than has traditionally been believed.

Interpretative memories of artworks.

It is well known that memories of self-relevant experiences are reconstructed over time. Artworks often require an elongated period of interpretative meaning-making. Such works were therefore used to study temporal aspects of memory construction. In a longitudinal study, individuals' memories of artworks were examined to explore the idea that only with the passage of time would autobiographical memory and emotion be associated with thematic integration of the artwork memory. We also expected that integrated artwork memories would be more differentiated (in terms of number of details) than memories that were not integrated. Memories of artworks were collected from visitors to an art gallery in person as they left the gallery, and 5 months later in a phone interview. Participants were also asked, at both interviews, whether the memory recollection was associated with an autobiographical memory and with an emotion. Associations among the elements of autobiographical memory, emotion, differentiation, and integrated artwork memories were significant only at the time of the longer-term recollection. The data suggest that, during an incubation period, these elements moved from a state of disconnection to interconnection.