Why are some people in the UK reluctant to seek support for their pets?

Drawing upon data from a study examining experiences of accessing support for pets from the UK animal welfare charity Blue Cross, this paper illuminates reasons why people might not seek support when they need it. This applies to those who are struggling financially and are eligible for, but do not take, free/reduced cost veterinary care, or are having other problems (e.g. the animal's disruptive behaviour or ill health, struggling to care for the pet due to changing circumstances or health problems, or coping with pet loss). Twenty Blue Cross service users (15 female, five male, age 29-67) took part in individual online interviews using a semi-guided narrative approach, where they were encouraged to share their experiences of reaching out. They were also asked to reflect upon why others may not do the same, and if they had any recommendations for organisations to help them reach these people. Findings echo other studies that highlight a fear of being judged, disclosure and stigma. Guilt, shame, lack of awareness, financial concerns, and wanting to manage independently, all play important roles. These factors have implications for the way support services are advertised and delivered to ensure animals receive the care needed. We describe these reflections and recommendations and identify three broader ideological narratives underpinning participants' stories: 'giving back'; 'equity', and 'sacrifice'. These reveal how wider societal attitudes and values shape identities and behaviours. It is vital that support on offer is reframed to explicitly counteract these influences to ensure optimal animal and human welfare.

Chronic temporomandibular disorder pain patients with a history of neuropathic pain treatment: a narrative research on their diagnosis and treatment history.

The aims of this qualitative research were (1) to gain more insight in the diagnostic and treatment history of patients with chronic temporomandibular disorder (TMD) pain; (2) to get a deeper understanding of possible factors that are involved in the possible delay in setting a TMD-pain diagnosis and receiving appropriate treatment; and (3) to get a deeper understanding of the perspectives and experiences of chronic TMD-pain patients on the possible improvement of various aspects of their diagnostic and treatment journey.MethodsIn this narrative research, semi-structured interviews took place with patients who experienced chronic orofacial pain (OFP) for at least three years before getting diagnosed with, and treated for, TMD pain by an OFP specialist in an interprofessional setting.ResultsIn total, ten patients were interviewed in-depth. Patients experienced their chronic OFP in different ways, but all reported a significant impact of their pain on their quality of life. All patients visited numerous health care professionals before their TMD diagnosis was set. Among others, they underwent anti-neuropathic pain medication therapies and invasive surgeries, which did not significantly reduce their chronic OFP. The interprofessional TMD-pain treatment reduced the suffering of the chronic OFP substantially, also 6 months after the start of therapy, and improved the quality of life for all patients. In most of them, the OFP intensity was also decreased.ConclusionChronic TMD-pain patients with a history of neuropathic pain treatment may experience a long journey until receiving the appropriate diagnosis and treatment. This stresses the need to improve the implementation of chronic TMD-pain guidelines.

Using Culturally Focused Storytelling to Empower Appalachian Kentucky Youth to Understand and Address Cancer Disparities in Their Communities.

Kentucky has the highest cancer incidence and mortality rates in the nation with the Appalachian region of the state being most affected. These rates are driven by health behaviors and inequities in social determinants of health. Herein, Appalachian Kentucky students with the University of Kentucky's Appalachian Career Training in Oncology (ACTION) program were engaged in a storytelling exercise by writing culturally framed essays. Students discussed their personal experiences with cancer and their thoughts on the causes of and potential solutions to Appalachian Kentucky's cancer disparities. Content analysis was used to identify common themes, subthemes, and subtopics in the essays regarding cancer types, causes of cancer in Appalachia, and solutions to the high cancer rates. Common cancer types experienced by the students included breast, lung, and prostate. The most frequently identified themes that drive cancer rates in Appalachian Kentucky were identified as geography, environmental factors, tobacco use, education, poverty, prevention, and mistrust. Common proposed solutions to decrease cancer rates were to increase education and awareness, screening, and tobacco cessation. Overall, through storytelling, youth gained a better understanding of cancer in their communities and envisioned culturally tailored, community-based intervention strategies that can aid in reducing the cancer burden in Appalachian Kentucky.

List-keepers and other carrier bag stories: Academic mothers' (in)visible labor during the COVID-19 pandemic.

Beginning in 2020, the COVID-19 pandemic disrupted familiar rhythms of work and life when academic women from the United States sheltered-in-place in their homes. The pandemic brought forth challenges which accentuated that caregiving with little or no support disproportionately affected mothers' abilities to navigate their new lives inside the home, where work and caregiving abruptly collided. This article takes on the (in)visible labor of academic mothers during this time-the labor mothers saw and viscerally experienced, yet that which was often unseen/unexperienced by others. Using Ursula K. Le Guin's Carrier Bag Theory as a conceptual framework, the authors engage with interviews of 54 academic mothers through a feminist-narrative lens. They craft stories of carrying (in)visible labor, isolation, simultaneity, and list-keeping as they navigate the mundaneness of everyday pandemic home/work/life. Through unrelenting responsibilities and expectations, they each find ways to carry it all, as they carry on.

Practices and experiences of European frontline nurses under the shadow of COVID-19.

The COVID-19 pandemic has caused health professionals to deal with new situations they have not encountered before. Nurses were forced to cope with increased workloads, seriously ill patients, numerous patient deaths, and unresolved ethical dilemmas. This study aimed to examine the lived experiences of nurses across Europe during the first wave of the COVID-19 pandemic. This was a qualitative narrative research study. Eighteen nurses from eight European countries (four each from the UK and Israel, three from Portugal, two each from the Netherlands and Ireland, and one each from Belgium, Italy, and Sweden) submitted narratives about their professional experiences during May-June 2020. The narratives were analyzed using thematic analysis. Seven categories across the narratives were condensed and interpreted into three themes: opportunities and growth, care management, and emotional and ethical challenges. The COVID-19 pandemic has affected nurses emotionally and provided an opportunity to actively develop systems and skills needed to minimize harm and maximize benefits to patients and nurses.

Family Narratives About Providing End-of-Life Care at Home.

Currently, the dying process in Spain is moving to the home environment where responsibility for care falls largely on the family, thereby challenging and testing the stability of the family. Previous research has focused on the impact of illness on the primary caregiver; therefore, a knowledge gap exists. This study aimed to understand families' unitary experiences of providing home care to terminally ill family member. Using the "Model of Interpersonal Relationship Between the Nurse and the Person/Family Cared For," narrative research included family and individual interviews with nine families (9 groups/23 individuals). Thematic narrative analysis was used to interpret the interviews. The results highlight the impact of illness on family well-being as a whole. Family members often felt abandoned while caring for an ill family member and wished to be cared for themselves. However, their immediate community and the nurses caring for their ill family member neglected them. A paradigm shift is required by society and in home care at the end of life to better support the family.

"I'm just a long history of people rejecting referrals" experiences of young people who fell through the gap between child and adult mental health services.

The paediatric-adult split in mental health care necessitates young people to make a transition between services when they reach the upper end of child and adolescent mental health services (CAMHS). However, we know that this transition is often poor, and not all young people who require ongoing support are able to continue care in adult mental health services (AMHS). These young people are said to have fallen through the gap between services. This research aimed to explore the reasons why young people fall through the gap between CAMHS and AMHS, and what effect this has had on them and their families. Narrative interviews were conducted with 15 young people and 15 parents, representing 19 unique transition stories. Themes were identified collaboratively using thematic analysis. Reasons for falling through the gap were grouped into systemic problems and problems with the quality of care received. Effects of falling through the gap were grouped into separate themes for young people (feeling abandoned; struggling to manage without continued care; problems with medication) and parents (emotional impact of care ending; parents taking an active role in the young person's care). To our knowledge, this is the first qualitative study that has focused only on the experiences of young people who have fallen through the gap between services. This research adds novel findings to existing literature regarding barriers to transition and the effects of discontinuity of care.

The Parental Struggle With the Israeli Genital Socialization Process.

The focus of this article is on how parents of children with "nonnormative" genitalia cope with the conflict between the genital socialization process and their children's genital autonomy in the Israeli medical-sociocultural context. Based on a qualitative narrative study that included 18 parents of children born with atypical genitalia and 23 parents who had chosen not to circumcise their sons, I compare parents' experiences and perceptions of genital autonomy and examine the challenges posed by the Israeli genital socialization process from their perspective. In this study, I aim to shed light on the stressful and powerful Israeli genital socialization process, in which the medical, familial, and religious forces reproduce gendered normative genital appearances. The parents' physical and emotional experiences include feelings of doubt and a critical stance toward genital socialization, changes in perceptions regarding genital appearance, and parental practices that challenge the meaning and outcomes of genital surgeries.

From physiotherapy to the army: negotiating previously developed professional identities in mature medical students.

Professional identity formation, the process of transformation from lay person to doctor, is at the heart of medical education. Medical student cohorts can include students who enter medicine from a previous career, i.e. with developed professional identities and who are usually older and more mature. Students with previously developed professional identities may have specific challenges in negotiating their new 'doctor' identity. This study examined the development of professional identity in mature medical students who had a variety of previous careers prior to entering medical school. A narrative inquiry was undertaken using interviews of mature medical students with backgrounds that included physiotherapy, clinical physiology, public health and nutrition, and the armed forces. A narrative analysis was conducted combining both thematic and structural perspectives using linguistics and positioning theory as interpretive tools. Three main themes emerged that portray the development processes that arise in this cohort as they develop their medical professional identity: holding back aspects of the previous self; foregrounding aspects of the previous self; and developing new aspects towards forming a 'new' self. These themes and their implications are discussed in the context of current literature, highlighting some of the specific challenges that this cohort faces in developing their medical identity. We argue that dedicated faculty and student development be offered, exploring how professional identity formation in mature medical students can be facilitated and supported, so staff and students are better equipped to engage and shape mature students' professional identity in a meaningful way.

Complicating "the good result": narratives of colorectal cancer screening when cancer is not found.

OBJECTIVES: In this paper, we analyze narratives from a Photovoice project on colorectal cancer screening that was carried out with people who had undergone screening and were found to not have cancer. METHODS: Three groups, totaling eighteen participants, took part in the project, meeting multiple times over the course of approximately 10 weeks, and discussing photos they took about colorectal cancer screening. RESULTS: A common way in which the participants conveyed their screening experiences was through reflection on their own or other people's illnesses. Our findings highlight the multiple meanings of receiving a "good" or noncancerous screening result after undergoing cancer screening. CONCLUSION: Such findings suggest that framing noncancerous results only in terms of relief or other positive emotions may ignore the realities people and their families face and their remaining concerns. This paper has broader implications for policies to reduce cancer disparities as well as public health and patient-provider communication about screening.

Exploring educational and social inequality through the polyphonic voices of the poor: A habitus listening guide for the analysis of family-schooling relations.

The aim of this methodological article is to contribute a new form of qualitative data analysis that is relevant for the comparative study of family cultures and schooling. We describe the development of our Habitus Listening Guide linking Bourdieu's theory of social reproduction to critical narrative theory. The interpretative tool outlines (a) social-structural (b) horizontal intergenerational (c) vertical gender and (d) mythic-ritual listenings which can be used to explore the engagement of youth and their families with schooling. Such listenings reveal the dispositional positioning of schooling in family values and the complex structural and human relational effects of schooling on family members' livelihood and wellbeing. It offers the possibility of comparing families in terms of their gendered and generational relations and the ways in which religious and mythic-ritual discourses legitimate their aspirations in the context of changing communities. The Guide offers a way of accessing and comparing subjective micro level experiences of social inequality and the contribution that schooling plays, or is expected to play, in relation to individual and/or family social mobility.

The 'lived experience' of palliative care patients in one acute hospital setting - a qualitative study.

BACKGROUND: There is limited understanding of the 'lived experience' of palliative care patient within the acute care setting. Failing to engage with and understand the views of patients and those close to them, has fundamental consequences for future health delivery. Understanding 'patient experience' can enable care providers to ensure services are responsive and adaptive to individual patient need. METHODS: The aim of this study was to explore the 'lived experience' of a group of patients with palliative care needs who had recently been in-patients in one acute hospital trust in the north-west of England. Qualitative research using narrative interviews was undertaken, and data was analysed using thematic analysis. A sample of 20 consecutive patients complying with the inclusion/exclusion criteria were recruited and interviewed. RESULTS: Patient Sample: Of the 20 patients recruited, there was a fairly equal gender split; all had a cancer diagnosis and the majority were white British, with an age range of 43-87 years. Findings from Interviews: Overall inpatient experience was viewed positively. Individual narratives illustrated compassionate and responsive care, with the patient at the centre. Acts of compassion appeared to be expressed through the 'little things' staff could do for patients, i.e., time to talk, time to care, humanity and comfort measures. AHSPCT involvement resulted in perceived improvements in pain control and holistic wellbeing. However, challenges were evident, particularly regarding over-stretched staff and resources, and modes of communication, which seemed to impact on patient experience. CONCLUSIONS: Listening to patients' experiences of care across the organisation provided a unique opportunity to impact upon delivery of care. Further research should focus on exploring issues such as: why some patients within the same organisation have a positive experience of care, while others may not; how do staff attitudes and behaviours impact on the experience of care; transitions of care from hospital to home, and the role of social networks.

Constructing and Expanding Suicide Narratives From Gay Men.

In this study, we document life stories of gay men who attempted suicide as adults. Our goal is to expand the collection of narratives used to understand this persistent health inequity. We interviewed seven adult gay men, each of whom had attempted suicide two to four times, and identified five narratives. Pride narratives resist any connection between sexuality and suicide. Trauma-and-stress narratives enable coping through acknowledgment of sexual stigma as a fundamental trauma and cause of subsequent stress and suicidal thoughts. Memorial narratives prevent suicide by maintaining a strong sense of "permanent" identity. Outing narratives demand that the listener confronts the legacy of unjust practices of homosexual surveillance and "outing," which historically resulted in gay suicides. Finally, postgay narratives warn of the risk of suicide among older generations of gay men who feel erased from the goals of modern gay movements. Sexual identity concealment or invisibility featured prominently in all five narratives.

Supported Decision-Making: The Expectations Held by People With Experience of Mental Illness.

Supported decision-making (SDM) is a principle guiding mental health service provision, which aims to improve people's ability to make informed decisions about their care. Understanding diverse individual needs is vital to its success. Based on 29 narrative interviews with people diagnosed with mental illness in Australia, we examine how participants reflected on their own experiences of SDM. We find that participants' conceptualization of mental health expertise, their own experiences and sense of agency, and their varying needs for dependence and independence influenced their relationships with mental health practitioners. These factors in turn shaped their expectations about SDM. Four narrative positions emerged: the "Inward Expert," the "Outward Entrustor," the "Self-Aware Observer," and the "Social Integrator." These positionings influenced the type or style of support that participants expected and considered most useful. Our findings are relevant to developing effective approaches to SDM that take into account service users' needs and preferences.

Narrative research on mental health recovery: two sister paradigms.

BACKGROUND: Despite the breadth of narrative studies on individuals with severe mental illness, the suitability of narrative inquiry to exploring mental health recovery (MHR) has not been examined. AIMS: (1) Examining the appropriateness of narrative inquiry to studying MHR; (2) assessing the extent to which narrative studies on MHR conform to the unique features of narrative research, as a distinctive form of qualitative inquiry. METHODS: Review of empirical, theoretical and methodological literature on recovery and narrative inquiry. RESULTS: Considering the perspectives of recovery and narrative as paradigms, the similarity between their ontology and epistemology is shown, evident in 10 common emphases: meaning, identity, change and development, agency, holism, culture, uniqueness, context, language and giving voice. The resemblance between these "sister" paradigms makes narrative methodology especially fruitful for accessing the experiences of individuals in recovery. Reviewing narrative studies on MHR suggests that, currently, narrative research's uniqueness, centered on the holistic principle, is blurred on the philosophical, methodological and textual levels. CONCLUSIONS: Well-established narrative research has major implications for practice and policy in recovery-oriented mental health care. The narrative inquiry paradigm offers a possible path to enhancing the distinctive virtues of this research, realizing its potential in understanding and promoting MHR.

Care beyond the hospital ward: understanding the socio-medical trajectory of herpes simplex virus encephalitis.

BACKGROUND: Herpes simplex virus (HSV) encephalitis is a life-threatening infection of the brain, which has significant physical, cognitive and social consequences for survivors. Despite increasing recognition of the long-term effects of encephalitis, research and policy remains largely focused on its acute management, meaning there is little understanding of the difficulties people face after discharge from acute care. This paper aims to chart the problems and challenges which people encounter when they return home after treatment for HSV encephalitis. METHODS: The paper reports on data from 30 narrative interviews with 45 people affected by HSV encephalitis and their significant others. The study was conducted as part of the ENCEPH-UK programme grant on Understanding and Improving the Outcome of Encephalitis. RESULTS: The findings show the diverse challenges which are experienced by people after treatment for HSV encephalitis. We first chart how peoples' everyday lives are fragmented following their discharge from hospital. Second, we document the social consequences which result from the longer-term effects of encephalitis. Finally, we show how the above struggles are exacerbated by the lack of support systems for the post-acute effects of encephalitis, and describe how people are consequently forced to devise their own care routines and strategies for managing their problems. CONCLUSION: The paper argues that in order to improve long-term outcomes in encephalitis, it is vital that we develop pathways of support for the condition beyond the acute hospital setting. We conclude by making recommendations to enhance communication and care for the post-acute consequences of encephalitis, to ensure those affected are fully supported through the chronic effects of this devastating disease.

What nursing students reveal about and learn from mentors when using stories of clinical practice.

Aim This article considers findings from a narrative research analysis that illustrate what nursing students can reveal about being mentored through their stories of clinical practice experience. The aim is to advocate the use of stories as tools to assist mentors in their roles, and to express to them students' concerns, sensitivities and priorities about clinical placement experiences. The findings are extracted from the author's unpublished doctoral thesis Learning from Practice: The Value of Story in Nurse Education ( Edwards 2013 ). Method The data are drawn from nursing students' stories about clinical practice experiences when engaged in the care of patients, and their perceived learning from them. Results Findings suggest stories can help develop understanding of nursing students' concerns, sensitivities and priorities, and can support mentors' important roles in students' learning. Conclusion The article illustrates the value of stories as learning tools in the workplace and, by looking at nursing students' stories about clinical practice, shows that paying attention to their concerns, sensitivities and priorities can improve the already significant role played by mentors in student learning.

Between My Body and My "Dead Body": Narratives of Coma.

This article is based on narrative research that focuses on corporeal experience during coma and during the rehabilitation process. Seventeen participants from different areas of Israel who had been in various kinds of coma states reveal what the corporeal experience of coma is. The participants are divided into three types of narrative protagonists--"dead-alive," "rational," and "emissaries." Each of the participants redefined the boundaries of the body, especially in cases when they spoke of experiences they did not understand as corporeal, for example, out-of-body experiences, near-death experiences, or experiences of being between the earthly and unearthly. Their struggle to find suitable words to tell their coma stories emphasizes these boundaries between experiencing and telling, which crossed the normative discursive border of the medical establishment and illustrates the ambiguous nature of human existence.

Narrative analysis: how students learn from stories of practice.

AIM: To describe and recommend a variety of data analysis methods when engaging in narrative research using story as an aid to nursing students' learning. BACKGROUND: Narrative research methodology is used in many nursing research studies. However, narrative research reports are generally unspecific regarding the analysis and interpretive process. DISCUSSION: This article examines the qualitative analytical approaches of Lieblich et al's ( 1998 ) narrative processes of holistic content and analysis of form, incorporated as overarching theories. To support these theories and to provide a more rounded analytical process, other authors' work is included. Approaching narrative analysis from different perspectives is recommended. For each cycle of analysis, it is important to conceptualise the analysis using descriptors drawn from the initial literature review and the initial text. Rigour and transparency are foremost, and tables are generated that reflect each stage of the analysis. The final stage of analysis is to clearly report, organise and present findings to reflect the richly varied and diverse potential of stories. CONCLUSION: Engaging in narrative research and then dealing with the large quantities of data to analyse can be daunting, difficult to manage and appear complex. It is also challenging and rewarding. With clear descriptors, examining the data using multiple lenses can serve to develop a greater level of insight into understanding nursing students' learning from their clinical experiences, presented as stories, when involved in the care of individuals. IMPLICATIONS FOR PRACTICE: There are many approaches to narrative analysis in nursing research and it can be difficult to establish the main research approach best suited to the study. There is no single way to define narrative analysis and a combination of strategies can be applied.

Mothers' Experiences with Pastoral Care in Cases of Child Sexual Abuse.

This article reports on case study research with four mothers who asked for help from their pastors when they learned, or had reason to believe, that their husbands had sexually abused children in their families. In their own words, mothers gave accounts of how the pastors responded. Some were helpful and knowledgeable, some appeared bewildered, and others were hostile and blaming toward the women. This article will sensitize pastors and other pastoral counselors to issues that child sexual abuse raises. In addition, the research responds to Mahoney's (J Marriage Fam 72:805-827, 2010) observations about the scarcity of knowledge on whether religion helps or harms families during times of stress.