Finding the balance between person-centred and treatment-centred discussions in advance care planning-a qualitative analysis of conversations within the MUTUAL (Multidisciplinary Timely Undertaken Advance Care Planning conversations) intervention using a narrative analysis.

INTRODUCTION: Advance care planning (ACP) aims to create conditions for more person-centred care. We aimed to explore variations in person-centred care discussions and treatment-centred care discussions within ACP conversations in the Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention and how person-centred care discussions could be encouraged. The MUTUAL intervention consists of the following: (i) timely patient selection, (ii) the patient and healthcare professionals preparing for the conversation, (iii) a scripted ACP conversation in a multidisciplinary setting and (iv) documentation. METHODS: We conducted a narrative analysis of ACP conversations. A narrative summary template was created and used to analyse 18 audio-recordings. RESULTS: We noticed variations in person-centred and treatment-centred focus within the ACP conversations. We identified three important strategies that facilitated person-centred care discussions within ACP conversations. First, healthcare professionals' acceptance that ACP is an individual process. We believe it is important that healthcare professionals recognise and accept where the patient is in his or her individual ACP process; not making decisions right away can also be part of a decisional process. Secondly, exploring the underlying motivation for treatment wishes can give insights into patient's wishes, values and needs. Lastly, healthcare professionals who demonstrated an adaptive, curious and engaged attitude throughout the ACP process achieved more person-centred ACP conversations. This coincided with elaborating on the patient's emotions, fears and worries. CONCLUSION: Person-centred and treatment-centred focus varied within the ACP conversations in the MUTUAL intervention. Certain strategies by healthcare professionals facilitated a more person-centred focus.

Transforming self-experienced vulnerability into professional strength: a dialogical narrative analysis of medical students' reflective writing.

Medical students' efforts to learn person-centered thinking and behavior can fall short due to the dissonance between person-centered clinical ideals and the prevailing epistemological stereotypes of medicine, where physicians' life events, relations, and emotions seem irrelevant to their professional competence. This paper explores how reflecting on personal life experiences and considering the relevance for one's future professional practice can inform first-year medical students' initial explorations of professional identities. In this narrative inquiry, we undertook a dialogical narrative analysis of 68 essays in which first-year medical students reflected on how personal experiences from before medical school may influence them as future doctors. Students wrote the texts at the end of a 6-month course involving 20 patient encounters, introduction to person-centered theory, peer group discussions, and reflective writing. The analysis targeted medical students' processes of interweaving and delineating personal and professional identities. The analysis yielded four categories. (1) How medical students told their stories of illness, suffering, and relational struggles in an interplay with context that provided them with new perspectives on their own experiences. Students formed identities with a person-centered orientation to medical work by: (2) recognizing and identifying with patients' vulnerability, (3) experiencing the healing function of sharing stories, and (4) transforming personal experiences into professional strength. Innovative approaches to medical education that encourage and support medical students to revisit, reflect on, and reinterpret their emotionally charged life experiences have the potential to shape professional identities in ways that support person-centered orientations to medical work.

A psychobiographical analysis of Empress Dowager Cixi: exploring the femininity castrated complex.

In Chinese culture, there is a widely circulated phrase, 'A hen crows in the morning'. This phrase is used to humiliate women who steal power and engage in the political field. It demonstrates the complicated relationship between women and power in the context of Chinese culture. Women are not completely excluded from the politics, but women in power are often stigmatised. This study explores the life of Empress Dowager Cixi (1835-1908), the last female dominator in Chinese history, takes psychobiography as the research method, and attempts to understand the complicated relationship between women and power in Chinese culture through analysing Cixi's life from the perspective of complex and cultural complex theory which originated with C.G. Jung and analytical theory. The research findings show that humiliating and suppressing women with political talent can trigger their complexes, both personal and cultural. This study attempts to propose the femininity castrated complex to better describe the conscious and unconscious psychological dynamics impacting on women within patriarchal, political Chinese culture. This complex further relates to (1) denying her biological sex in order to avoid accusations of superego and, (2) the relationship with her son who is not only her son, but also her enemy regarding (political) power.

The Greek photographer Nelly's: the interplay of personal and socio-cultural theme of 'rebirth'.

This article presents a psychobiography study of the famous Greek photographer Ellie Sougioultzoglou-Seraidari (Nelly's) (1899-1998). Nelly's was born in Aidini (Asia Minor), and in her early years she experienced the tragic events of the Greek-Turkish War (1919-1923). She studied photography in Dresden (Germany), and worked in Athens (Greece) and New York (U.S.A.). A narrative and cultural psychology framework was adopted to explore the way that Nelly's constructed her life story. An adjusted version of the 'Life-Story Interview' (McAdams & Bowman, 2001) was used that distinguishes between redemption versus contamination narratives. The narrative analysis of autobiographical materials revealed turning points and a central life theme. The photographer appeared to construct her life story as a process of reinventing herself or managing 'rebirth'. This construction matches the dominant narrative of Greek refugees of Asia Minor, following what is known in European history as the Asia Minor 'Great Catastrophe' (1922). Both narratives are surviving and thriving stories of 'rebirth'. The importance of making meaning of life stories within a specific socio-cultural and historical context is emphasised. Practice and research suggestions are provided.

Narratives of Disconnection: A Life Course Perspective of Methamphetamine Use Among Sexual Minority Men Living with HIV.

BACKGROUND: Sexual minority men (SMM) are exposed to societal and structural stressors that translate into poor health outcomes. One such outcome is substance use, which research has long documented as a prominent disparity among SMM. Methamphetamine is a particularly deleterious substance for SMM because its use is often framed as a coping response to social and structural stressors. METHOD: Guided by stress and coping theory and a life course perspective, the purpose of this qualitative study is to assess the development of coping strategies in the context of prominent social and structural determinants among SMM living with HIV who use methamphetamine. RESULTS: Data were collected from 2016 to 2018 via in-depth interviews with 24 SMM living with HIV who use methamphetamine in San Francisco, CA. Mean age of participants was 47 and over half self-identified as ethnoracial minorities. Narrative analysis surfaced a sequential pattern of disconnection at foundational, relational, and recovery levels. This analysis revealed that multi-level stressors were present across the life course that amplified engagement in methamphetamine use. CONCLUSION: Findings highlight the benefits of holistic, integrated, and trauma-informed approaches to address the function of methamphetamine use as a response to societal, cultural, and institutional processes of stigmatization and discrimination. Peer-based approaches may also be beneficial to reframe the ways in which SMM living with HIV who use methamphetamine form and sustain relationships.

Between equilibrium and chaos, with little restitution: a narrative analysis of qualitative interviews with clinicians and parent carers of children with medical complexity.

BACKGROUND: Children with medical complexity (CMC) comprise 1% of the paediatric population, but account for over 30% of health service costs. Lack of healthcare integration and coordination for CMC is well-documented. To address this, a deep understanding of local contextual factors, experiences, and family-identified needs is crucial. The aim of this research was to investigate the lived experiences of CMC, their families, and healthcare staff, focusing on understanding the dynamics of care coordination and the challenges faced in providing integrated care, in order to inform the development of effective, family-centred models of care. METHODS: In April to July 2022, 31 semi-structured interviews were conducted with parents/guardians of CMC and healthcare professionals who care for CMC. Interviews explored complex paediatric care and care coordination barriers. An inductive thematic analysis was undertaken. Themes were then further explored using Frank's narrative approach. RESULTS: Through analysis, we identified that the restitution typology was absent from both staff and parent/guardian narratives. However, we uncovered narratives reflective of the chaos and quest typologies, depicting overwhelming challenges in managing complex medical needs, and proactive efforts to overcome barriers. Importantly, a novel typology termed 'equilibrium' was uncovered. Narratives aligning with this typology described medical complexity as a balance of power and a negotiation of roles. Within the equilibrium typology, illness trajectory was described as a series of negotiations or balancing acts between healthcare stakeholders, before finally reaching equilibrium. Participants described seeking a balance, where their expertise is respected, whilst maintaining the ability to rely on professional guidance and support. These insights provide a nuanced understanding of the multifaceted narratives shaping care experiences for CMC and their families. CONCLUSIONS: Our research delineates multifaceted challenges within the care landscape for CMC, their families, and healthcare staff. Embracing the equilibrium narrative typology highlights the criticality of tailored, integrated care models. This necessitates prioritising clear role delineation and communication among caregivers, implementing support systems addressing the challenges of continuous caregiving, and integrating parents/guardians as essential members of the care team. These insights advocate for pragmatic and sustainable strategies to address the unique needs of CMC and their families within healthcare systems.

Unintended pregnancies in the lives of young people in Luwero, Uganda: a narrative analysis.

Using a feminist narrative approach, this article explores how unintended pregnancy can rupture young lives, and how young people respond to and navigate these ruptures. We analyse qualitative data from a longitudinal cohort study in Luwero, Uganda, focusing on narratives of a girl and a boy about their recent experiences of unintended and unwanted pregnancy during COVID-19 school closures. We argue that laws, policies and norms relating to education, sexual and reproductive health, and the family in Uganda position young people in complex and contradictory ways, that create the conditions for unintended pregnancies, and restrict the choices open to them. The analysis traces how pregnancy ruptures their everyday lives, their identities, and relationships. Their narratives reveal gendered ways in which they enact identities to manage the ruptures. Families are sites of contestation, where gender and sexuality are regulated, but are also mobilised by young people to support their efforts to repair the ruptures. Our analysis underscores the importance of working with young people to understand their positionalities, resource environments and social networks as they make and navigate decisions about pregnancy, and of addressing the structural forces that underpin the rupturing effects of pregnancy on teenage lives.

Understanding the Narratives of Child Sexual Abuse.

This qualitative study consisted of in-depth, retrospective interviews with participants over the age of 18 who experienced child sexual abuse. Through narrative analysis, study findings shed light on three overall findings: the perception of memories, the perception of grooming, and the perception of the lived lives of child sexual abuse survivors. Findings suggest that the narratives elicited from the participants included current views but also past experiences and anticipation about the future, including individual and societal levels of meaning. These narratives are furthermore entangled and inexorably linked - temporally, culturally, generationally, materially, and emotionally - and the results are thus presented from a holistic perspective. Study findings help explain the complex dimensions concerning the lived experiences of child sexual abuse. As such, this research speaks to the field of social and health care practitioners working with children and families facing the complex phenomenon of child sexual abuse.

"I Will Die by My Own Hand": Understanding the Development of Suicide Capability in the Narratives of Individuals Who Have Attempted Suicide.

Suicide capability is a multidimensional concept that facilitates the movement from suicidal ideation to suicide attempt. The three-step theory of suicide posits that three overarching contributors comprise suicide capability: acquired (fearlessness about death and high pain tolerance), dispositional (genetics), and practical (knowledge and access to lethal means) capability. Although extensive research has investigated relationships between individual contributors of capability and suicide attempts, little research has considered how an individual's capability for suicide develops as a combination of contributors. Given suicide is multifaceted and complex, our understanding of capability development is relatively limited. This potentially negatively impacts prevention and capacity reduction-focused intervention efficacy. Therefore, this study aimed to explore how suicide capability develops. Fourteen community-based suicide attempt survivors were recruited using convenience sampling. Individual narratives were collected using open-ended interviews, and data were analysed using narrative analysis. Results indicated that participant narratives contained two elements. The first included how capability development and suicide attempt facilitation were often underpinned by the relational interplay between acquired and practical contributors. For example, participants without a high pain tolerance seeking attempt methods that were perceived to be painless. The second element contained a novel finding relating to the agentic role of participants when deciding and attempting suicide. Agency was revealed within and across narratives emphasising the active role the individual plays in their movement from ideation-to-action. The role of individual agency in coming to a decision to take one's own life and then acting warrants further consideration within contemporary suicide theories.

'Staying cool, calm and positive': A dialogical narrative analysis of emotional reactions in narratives about operable lung cancer.

BACKGROUND: Patients with lung cancer suffer from physical, psychosocial and particularly emotional challenges. Twenty-five percent of patients with lung cancer are offered surgery as a potential cure. Nevertheless, 40% of surgically treated patients will experience recurrence. Paradoxically, research shows a dominant narrative of operable lung cancer patients 'being lucky', which silences other narratives about suffering, worries and emotional challenges. AIM: To explore narratives about operable lung cancer, particularly emotional reactions to illness and suffering in these narratives. METHODS: A qualitative design was applied. Six women and four men diagnosed with operable lung cancer were included from one university hospital in Denmark and interviewed 1 month after surgery using active interviews. The interviews were subject to dialogical narrative analysis. The theoretical foundation is social constructivism, with socio-narratological inspiration. FINDINGS: A typology of three emotional narratives emerged: 'staying cool', 'staying calm' and 'staying positive'. All three types of narrative are characterised by managing emotional reactions. Staying cool is characterised by not showing emotional reactions; staying calm narratives acknowledge emotional reactions, but that they need to be managed so that they do not burden relatives; and the last, staying positive, is characterised by managing emotional reactions in a positive direction. Together this typology of three emotional narratives revealed that operable lung cancer patients are under normative pressure from these socially preferred narratives of ideal emotional reactions to lung cancer. CONCLUSION: A typology of three emotional narratives were identified and can be called 'feeling rules' that guide patients after lung cancer surgery to manage their emotions. Consequently, if patients do not live up to these three emotional narratives of staying cool, calm and positive, they may be socially isolated and restricted from access to support.

Sacred breath: Ohio nurses respond to COVID-19.

In the fall of 2021, the Wick Poetry Center, a recognized international leader in creative writing interventions, launched the website Sacred Breath: Voices of Ohio Nurses in Response to COVID-19 (sacredbreathproject.com) with funding from the Ohio Nurses Foundation. The purpose of the website was to offer Ohio nurses an accessible platform to reflect on their personal and professional lived experiences as caregivers during an historic time of pandemic, sacrifice, uncertainty, and scarcity, and to share their voice with others. What resulted was 204 submissions over a three-month period with participant responses touching on widespread sentiments including grief, fatigue, anger, and resilience. It was from the gap in the current literature on pandemic narratives that the researchers of this study began a basic qualitative thematic analysis of the Sacred Breath project website (SBP) responses to gain a better understanding of how nurses, nurse educators, and nursing students made sense of and gave voice to their personal and professional lived experiences during the ongoing COVID-19 pandemic. While stories of nursing during the Covid-19 pandemic have been widely available and disseminated by popular media, academic studies have been slower to utilize qualitative and experimental methods to specifically address pandemic narratives and the resulting discourses by nurses working in and around clinical settings. The Wick Poetry Center at Kent State University has spent nearly forty years working in the community to address urgent social needs using expressive writing methods that are often overlooked by traditional social and arts outreach. The Wick Poetry Center engaged local academic networks and community health partners to invite nurses, nursing students, and nurse educators the Sacred Breath Project By evaluating responses to the intervention website, this qualitative study is aimed to fill this gap in the current literature as well as begin to understand how nurses made sense of their work lives during the ongoing Covid-19 pandemic. What does this paper contribute to the wider global clinical community? What is already known: What this paper adds.

Supporting each other towards independence: A narrative analysis of first-year nursing students' collaborative process.

Collaboration for nursing is a core competence and therefore educational interventions are essentials for collaborative skills. To identify such interventions, we carried out a study to understand nursing students' collaborative process. A narrative inquiry method was used to explore the collaborative process of first-year undergraduate nursing students. The analysis was conducted on field notes from 70 h of observation of 87 nursing students' collaboration during skills lab activities. It also included transcriptions of four focus group discussions with 11 students. The results are presented as a sequential process of (1) navigating in unfamiliar territory, (2) navigating together to cope, and (3) navigating together towards independency and the future nursing profession. We identified a transition from teacher-led assistance and guidance to student interdependency and reciprocal learning, ending with student-led assistance supporting independency. In line with Vygotsky's theory of zone of proximal development, different scaffolding interventions are needed depending on where the students are in the collaborative process.

Supporting an Invisible Workforce: The Case for the Creation of the Home Healthcare Workers Support Act.

This Article seeks to synthesize academic research on home healthcare workers during the COVID-19 pandemic to understand how their workplace challenges were magnified. Crisis communication researchers note that a crisis provides both opportunities and threats for growth. This Article argues that many of the issues that have impacted home healthcare workers have always been present, but the pandemic allows policy makers the ability to see them clearly because the pandemic brought a spotlight to the issues that home healthcare workers face on a daily basis. Consequently, the author employed a narrative analysis of the literature concerning home healthcare workers during the pandemic to understand how the pandemic exacerbated structural issues that led to an increase in mental health difficulties for this population. By understanding how the pandemic exacerbated mental health issues, policy makers can craft solutions that can withstand the next public health crisis which will undoubtedly impact the most disenfranchised.

Women and shame: narratives of recovery from alcohol dependence.

OBJECTIVE: Existing literature indicates distinct pathways and the key role of shame and stigma into alcohol dependence (AD) and recovery for women. Internationally, there is a paucity of research exploring these factors from women's perspectives. METHODS AND MEASURES: Taking a critical realist epistemological position, unstructured life story interviews were analysed via narrative analysis to explore how seven women from the UK, storied shame in their recovery from AD. RESULTS: Shame followed a common trajectory across participants' stories, appearing as a reoccurring factor throughout AD and recovery. Participants narrated shame as gendered, contributing to a loss of personal control in defining a valued personal identity. Drinking began as a shame-management strategy but evolved into a source of shame, compounded by fears of being labelled an 'alcoholic woman'. Recovery involved reclaiming the self through de-shaming a shame-based identity and developing a positive, non-drinking identity. By evaluating 'shaming' recovery frameworks, sharing stories and reconstructing their own, participants were able to work through shame, resist pathologising identity labels and internalise esteemed 'sober' identities. CONCLUSION: This research provides important insights into the intersection between shame, identity, gender and culture in women's recovery from AD. Implications for clinical practice, future research and policy are considered.

Body-Related Existential Dilemmas During Gender Transition: Research in the Italian Context.

The scientific literature shows that gender transition is effective in improving the general well-being of transgender people. However, so far, little attention has been paid to the actual role of the body concerning the existential dilemma that holds the person hostage during transition. This study investigates the relationship between the body-here considered in its concrete, experienced, imagined, and intersubjective dimensions-and gender identity. Twenty-five transgender people who live in Italy were interviewed to identify interpretive repertoires and identity positionings. Four main repertoires and positionings emerged: 1) Interpretative repertoires on the body in transition, where an enduring influence of gender binarism and biological determinants were observed; 2) Expectations regarding medically induced modifications of the body ranging from self-confidence to uncertainty; 3) Positionings toward medically induced bodily modifications, ranging from enthusiasm to resignation; and 4) Inter- and Intrapersonal positionings, where the other than self was found to act as a self-confirming resource or as a constant unpredictable and potentially threatening source of disconfirmation. Practitioners need to develop a stronger awareness of the different dimensions, meanings, and discourses surrounding bodily experience to more effectively intervene in their clinical practice with transgender people.

Maintaining resilience over time: A qualitative exploration of the experiences of living with chronic musculoskeletal pain.

BACKGROUND: Living with chronic pain can have several negative consequences. However, some individuals are more resilient despite pain. Although a large body of research exploring resilience-enhancing factors exists, there is a lack of research focused on the changes of individual's resilience over time. OBJECTIVES: This study aims to explore how people with chronic musculoskeletal pain (CMP) describe their experience regarding the maintenance of resilience in the long term. METHODS: Within the framework of the qualitative research strategy, semi-structured interviews and two focus groups with 17 purposefully selected research participants (ages 29-64) were conducted. The data were analysed by integrating thematic analysis and narrative analysis. RESULTS: To maintain resilience in the long term, it is important to take responsibility for one's physical and mental well-being by practicing regular ability-adjusted physical activity, giving up unrealistic expectations, focussing on finding opportunities, not obstacles, maintaining a positive future perspective, and finding significance in life despite experiencing chronic pain. Financial support from the government and access to rehabilitation can facilitate better self-care for those with limited finances. CONCLUSION: This study may be useful for healthcare professionals, psychologists, social workers, and other specialists who daily encounter patients with CMP and aspire to understand the main challenges and needs of this particular group of patients.

Community narratives on rural homelessness: Tales of terror and tales of compassion.

Homelessness is often assumed to be mostly confined to urban spaces, leaving experiences of homelessness in rural contexts largely unexamined. The present study aims to understand the discursive context, or public understanding, of homelessness in rural communities. We examined community narratives related to the idea of "homelessness" in rural spaces. Semi-structured qualitative interviews were conducted with 70 key stakeholders from four rural communities in the U.S. State of Maine. Participants were asked to give their impressions related to homelessness in their community. We conducted a systematic qualitative analysis of these interviews and our analysis was grounded in a critical discourse analysis perspective. Using Rappaport's framework for understanding helpful and harmful community narratives, we identified three community narratives that harm by stereotyping or erasing homelessness in rural communities: Not Here, That One Guy, and Mainly Outsiders. We also examined counter-narratives that worked against each of the three primary narratives: It Looks Different, It's More Hidden, and Local Struggle and Lack of Resources. The counter-narratives tell a different, more compassionate, story of homelessness in rural spaces. Our main goal was to analyze the "work" that each of these narratives were doing in terms of constructing different understandings of "rural homelessness." The implications for policy and practice are discussed.

Education, relationships, and place: life choices in the narratives of university master students.

Choice is one of the most roughly defined concepts in contemporary social sciences. Previous studies have elucidated the factors that influence young people's choices in different life situations. However, it is still unclear how young people evaluate these choices and how they integrate them into their biographies. In this study, we examine the narratives of 30 first-year master's students at HSE University with regard to two categories of life choices: those that they perceive as fortunate and those that they perceive as unfortunate. Using a written online survey, the data was collected in the spring of 2022. To categorize the different decision kinds, thematic analysis was applied. Overall, we discovered that narratives about the life choices made by master students concentrated on education, relationships and place.

Revealing patient-reported experiences in healthcare from social media using thedesign-acquire-process-model-analyse-visualise framework.

Understanding patient experience in healthcare is increasingly important and desired by medical professionals in a patient-centred care approach. Healthcare discourse on social media presents an opportunity to gain a unique perspective on patient-reported experiences, complementing traditional survey data. These social media reports often appear as first-hand accounts of patients' journeys through the healthcare system, whose details extend beyond the confines of structured surveys and at a far larger scale than focus groups. However, in contrast with the vast presence of patient-experience data on social media and the potential benefits the data offers, it attracts comparatively little research attention due to the technical proficiency required for text analysis. In this article, we introduce the design-acquire-process-model-analyse-visualise framework to provide an overview of techniques and an approach to capture patient-reported experiences from social media data. We apply this framework in a case study on prostate cancer data from /r/ProstateCancer, demonstrate the framework's value in capturing specific aspects of patient concern (such as sexual dysfunction), provide an overview of the discourse, and show narrative and emotional progression through these stories. We anticipate this framework to apply to a wide variety of areas in healthcare, including capturing and differentiating experiences across minority groups, geographic boundaries, and types of illnesses.

Nurse Who Had MERS-CoV Complications with A Near-Death Experience during Pregnancy: A Narrative Analysis.

BACKGROUND: According to prevailing views in neuroscience, near-death experiences (NDE) occurring after severe head trauma, critical illness, or coma are often life-transforming experiences in which no awareness or sensory experience of any kind is possible. Although there are general patterns, each case is quite different from the other and requires accurate recording and reporting to potentially explain the phenomenon. AIM: This narrative study aimed to explore a pregnant woman's NDE due to complications from MERS-CoV. METHODS: This was a qualitative narrative study with the administration of two unstructured interviews. After the second interview, the participant completed the Greyson NDE scale, presented through descriptive statistics. Qualitative data were analyzed using Labov's model of narrative analysis through abstract, orientation, complicating action, evaluation, resolution, and coda. RESULTS: The Greyson scale resulted in a total score of 12, confirming that the patient had experienced an NDE. Labov's model of narrative analysis revealed that the patient's experience was not limited to the NDE but had implications for her recovery and life. The patient experienced all three types of NDEs: out-of-body, transcendental, including the transition of consciousness to another dimension, and a combined experience. She also suffered from prolonged hallucinations, neuropathy, and post-intensive care syndrome (PICS). At the same time, the patient experienced what is known as NDE aftereffects, which are caused by a change in beliefs and values; she began to lead a more altruistic life and became interested in the meaning of life. CONCLUSIONS: NDE survivors should be encouraged to talk more and share their stories with others if they wish. This study not only investigates the NDE but also considerably adds to the existing literature by integrating a unique cultural view from a country outside of the US and other Western nations, and it highlights the significant role of healthcare providers in NDEs and the importance of communication with comatose patients. It underscores the need for compassion when dealing with patients with NDEs.