Making sense together: dance improvisation as a framework for a collaborative interdisciplinary learning processes.

This editorial outlines the outcome of an interdisciplinary session on collective sense-making through dance improvisation, which took place during the 'Neural and Social Bases of Creative Movement' workshop. We argue that joint improvisation practices place the scientist in a privileged position to reveal the nature of cognitive and creative behaviors.

Women's use of online health and social media resources to make sense of their polycystic ovary syndrome (PCOS) diagnosis: a qualitative study.

BACKGROUND: With the growing availability of online health resources and the widespread use of social media to better understand health conditions, people are increasingly making sense of and managing their health conditions using resources beyond their health professionals and personal networks. However, where the condition is complex and poorly understood, this can involve extensive "patient work" to locate, interpret and test the information available. The overall purpose of this study was to investigate how women with polycystic ovary syndrome (PCOS) across two healthcare systems engage with online health resources and social media to better understand this complex and poorly understood lifelong endocrine disorder. METHODS: A semi-structured interview study was conducted with women from the US ( N = 8 ) and UK ( N = 7 ) who had been diagnosed with PCOS within the previous five years. Transcribed data was analysed using a reflexive thematic analysis method. RESULTS: We highlight the information needs and information-seeking strategies women use to make sense of how PCOS affects them, to gain emotional support, and to help them find an effective treatment. We also show how women with PCOS use online health and social media resources to compare themselves to women they view as "normal" and other women with PCOS, to find their sense of "normal for me" along a spectrum of this disorder. CONCLUSION: We draw on previous models of sense-making and finding normal for other complex and sensitive health conditions to capture the nuances of making sense of PCOS. We also discuss implications for the design and use of social media to support people managing PCOS.

A longitudinal interpretative phenomenological analysis study of athletes' lived experiences in elite disc golf competitions.

Gaining the inside perspective of an elite athlete throughout the competitive season provides a unique approach to understand the lived experience during multiple competitive events. The purpose of the present study was to investigate how elite disc golf athletes perceive and interpret their experiences of performing during various training and competitive events over the course of an elite disc golf season. Two elite disc golf athletes, one man and one woman, were recruited using homogeneous purposive sampling. The participants were interviewed three times and observed during three competitive events, as well as before and after a training session. A longitudinal interpretative phenomenological analysis (LIPA) was adopted to capture temporal and dynamic changes of the participants' lived experiences. The findings illustrated the athletes' personal experiences of performing during competitive disc golf events, with both athletes' experiences of competition changing during the season. Their competitive experiences appear to relate to the meaning disc golf has for the athletes, which in this study had both an experiential and existential level of meaning over time. Such a finding illustrates the importance of honoring athletes' unique experiences in making sense of their performances during an elite disc golf season. Taking the time to understand athletes' perceptions of their personal experiences appear important in attempting to understand their sense-making of their hot cognition before, during, and after competitions.

Family caregivers' sense-making of the results of functional neurodiagnostics for patients with Prolonged Disorders of Consciousness.

Functional neuroimaging and electrophysiological assessments can identify evidence of residual consciousness and cognition in patients with prolonged disorders of consciousness (PDOC) who are otherwise behaviourally unresponsive. These functional neurodiagnostics are increasingly available in clinical settings and are recommended by international clinical guidelines to reduce diagnostic and prognostic uncertainty, and thereby assist family caregivers in their best-interests decision-making. Nevertheless, little is known about how family caregivers make sense of the results of these state-of-the-art functional neurodiagnostics. By applying Interpretative Phenomenological Analysis (IPA) to interviews with family caregivers of patients with diagnoses of PDOC who had received a functional neurodiagnostic assessment, we identify three primary themes of sense-making: The special significance of "brain scans"; A dynamic sense-making process; Holding on to hope and holding on to the person. These themes highlight the challenges of helping family caregivers to balance the relative importance of functional neurodiagnostic results with other clinical assessments and identify an ability of family caregivers to hold a contradiction in which they hope for recovery but simultaneously express a rational understanding of evidence to the contrary. We offer several recommendations for the ways in which family caregivers can be better supported to make sense of the results of functional neurodiagnostics.

"Sense for Gambling" Among Jewish Ultra-Orthodox Men With Gambling Disorder.

Making sense of the social world is an intricate process heavily influenced by cultural elements. Gambling is a prevalent leisure-time activity characterized by risk-taking conduct. While some individuals who engage in it do so without experiencing any harm, others will develop gambling problems. Judaism tends to perceive gambling negatively since it contradicts fundamental Jewish principles. The current study focuses on the Jewish Ultra-Orthodox community in Israel which is characterized as a cultural enclave with minimal interaction with the secular world. Hence, it provides a unique and novel socio-cultural context to inquire how individuals with gambling disorder (GD) from this community make sense of gambling. Following constructivist grounded theory guidelines, 22 Ultra-Orthodox men with GD were interviewed using a purposeful sampling design. Sixteen Rabbis were also interviewed, illuminating the socio-cultural context of Halachic regulations and norms regarding gambling in this community. An abductive analysis of the data, interwoven with Bourdieu's concept of habitus, yielded an overarching theme that we dub as "sense for gambling," encompassing matrices of Ultra-Orthodox external (e.g., a conservative cultural structure with numerous prohibitions and life marked by poverty) and internal (e.g., feelings of loneliness, dissatisfaction, and deviance) dispositions imprinted onto the body, creating diverse embodied reactions (emotional and sensory) to gambling, and leading to developing GD. We recommend placing the body, as the locus of internalized dispositions, at the core of examination when researching pathways to GD. We propose that this intricate interplay between external and internal dispositions shapes the decision-making regarding gambling, thus mitigating individual responsibility for GD.

Exploring the journey of supporters in bereavement support groups: Experiences, sense-making, and social connections.

This study aimed to explore facilitators' experiences in bereavement support groups as they relate to their experiences of personal loss. Semi-structured interviews were conducted with nine facilitators who had experienced such grief, and data were analyzed qualitatively using a modified grounded theory approach (M-GTA). The analysis revealed two categories and nine subcategories: (i) 'Experiences in group activities,' encompassing positive and negative experiences during activities, and (ii) 'Structuring of Meaning,' the process of deciphering for oneself in relation to one's experience of loss and life. These two categories interacted with each other, and it was important for facilitators to find meaning in their activities, loss experiences, and lives for the stable continuation of bereavement support group activities. These findings underscore the importance of facilitators following and supporting the sense-making process.

Complaining, Regret, Superiority, and Discovery: Chinese Patients' Sense Making of Depression in an Online Forum.

Drawing on observations of a Chinese online depression community, this article explored the members' sense making of depression by analyzing their narrative accounts of depression. Four types of sense making were predominant among the depression sufferers: complaining, regret, superiority, and discovery. The complaining narrative is the members' telling about the pain caused by family (parental control or neglect), school bullying, stress from study or work, and social norms. The regret narrative is the members' reflection on their habit of perfectionism and lack of self-disclosure. The superiority narrative is the members' attribution of depression to their intelligence and morality that surpass the average people. The discovery narrative is the members' novel understanding of the self, significant others, and key events. The findings suggest that the social and psychological explanation of the causes of depression, instead of the medical model, is popular among the Chinese patients. Their stories of depression are also stories of marginalization, visions for the future, and realizing the normalization of identity as depression patients. The findings have implications for public policy around support for mental health.

Using ethnodrama to support parents in sense-making after prenatal or neonatal diagnosis of a child's disabling condition.

BACKGROUND/AIMS: This study describes the process of developing video vignettes to meet the parent-expressed need for balanced, meaningful messages about what life may be like for parents who have a child with a disability. Each vignette teaches a general audience salient concepts derived from a grounded theory of the parental process of Rescuing Hope after a child's diagnosis with a developmental disability. METHODS: Using ethnodrama methodology, we completed a secondary analysis of 21 interviews with parents who learned of their child's diagnosis of Down syndrome. RESULTS: Understanding the grounded theory of Rescuing Hope has the potential to help parents construct meaning and purpose as they adapt to parenting a child with a disability. DISCUSSION: The short dramatic vignettes may be placed across platforms, settings and partnerships, with relevance for teachers, clinicians, family members, caregivers. Designed for wide distribution, video vignettes may reach the people who most need sense-making support.

A quest for meaning: A qualitative exploration among children with advanced cancer and their parents.

OBJECTIVE: Meaning-making may assist individuals in adaptation to stressful life events, particularly bereavement. However, few studies have examined meaning-making among pediatric populations with advanced illness to understand how this process unfolds before the child's death. This study explores meaning-making pre-bereavement among children with advanced cancer and their parents. METHODS: As part of a larger study examining shared decision-making near the end of life, 24 children with advanced cancer and/or high-risk cancer, 26 mothers, and 11 fathers participated in individual, semi-structured interviews. Analyses focused on questions regarding meaning-making. Four coders analyzed the data via directed content analysis. RESULTS: Three major meaning-making themes emerged: (1) sense-making (i.e., unknown, no sense/meaning, religious/spiritual explanations, scientific explanations), (2) benefit-finding, and (3) purpose/legacy. Some stated they were unable to make sense of the diagnosis, because there was no reason, they were not there yet, or they were dealing with the situation and moving forward. Others reported finding meaning through spiritual and scientific explanations. Many identified benefits related to the child's illness, such as personal growth and stronger relationships. Some parents expressed their purpose in life was to live for their children, while others shared their child's legacy as a way to find meaning. CONCLUSIONS: Our findings highlight the struggle children and parents often face when attempting to make sense of the child's advanced or high-risk illness. Clinicians might consider if meaning-centered interventions designed for use in adults at the end of life and bereaved parents may be helpful for children with advanced or high-risk cancer and their parents.

Response to a sexual risk reduction intervention provided in combination with hepatitis C treatment by HIV/HCV co-infected men who have sex with men: a reflexive thematic analysis.

BACKGROUND: Hepatitis C virus reinfections in HIV-positive men-who-have-sex-with-men (MSM) challenge the effectiveness of antiviral treatment. To fight this problem, an adapted sexual risk reduction intervention was implemented within a hepatitis C treatment trial. Following this, the current study had two aims and describes 1) how the program was received by participants; and 2) their responses to the program regarding sexual risk taking. Based on the participants' input, we hoped to judge the intervention's potential for scale-up. METHODS: Seventeen participants who received the sexual risk reduction intervention in addition to hepatitis C treatment were recruited for semi-structured interviews six to 12 months post-intervention. We evaluated the responses via reflexive thematic analysis and applied the concept of sense-making. RESULTS: Giving hepatitis C a place and living without it again illustrates how participants received the program and how their experiences were altered by the impact of sense-making. Based on their responses, we allocated participants to three groups: 1. Avoid risks: get rid of hepatitis C for life. For these men, hepatitis C remained a life-threatening disease: they actively modified their risk behavior and felt supported by the intervention in maintaining their behavioral changes. 2. Minimize risks: live as long as possible without hepatitis C. In contrast to group 1, these men saw hepatitis C as a manageable disease. The intervention facilitated reflection on risks and how to develop behavioral changes that suited them individually. 3. Accept risks; live with the risk of hepatitis C. These men perceived behavioral changes as much more difficult than "easy" medical treatment. They expected to either undergo repeated rounds of treatment or stay HCV re-infected. CONCLUSION: These results illustrate the diversity of men's responses and their decisions regarding sexual risk behavior after participating in a combination of antiviral treatment and a sexual risk reduction intervention. Two major aspects were identified: 1) Teachable moments, particularly at the time of diagnosis/treatment, could offer an opportunity to develop openness for behavioral change; 2) adapting sexual risk reduction interventions to sense-making patterns could help to improve its effectiveness. Support for reducing infection risk and raising awareness of preventative measures are additional benefits. TRIAL REGISTRATION: Clinical Trial Number: NCT02785666 , 30.05.2016.

Students' Sense Making of Higher Education Policies During the Vertical Transfer Process.

More than a third of students enter higher education at a community college; most aim to earn a baccalaureate. Drawing on sense-making theory and longitudinal qualitative data, we examined how community college students interpret state transfer policies and how their interpretations influence subsequent behavior. Data from 3 years of interviews revealed how students adjudicate betweenmultiple intersecting policies. The higher education context, where institutions provided competing signals about policies, left students to navigate complex messages to achieve their transfer goals. Students' approaches to understanding transfer policies primarily followed one of two patterns: adopting policy signals as step-by-step procedures or adapting and combining policy signals to create a customized transfer pathway. Both approaches had important implications for students' transfer outcomes.

Making sense of experiences in suicide helpline calls: Offering empathy without endorsing suicidal ideation.

The question of how people make sense of experiences in relation to health is central to medical sociology and lies at the heart of suicide helpline practice. This article draws on a corpus of 900 audio-recorded suicide helpline calls to examine how call-takers respond to the challenge of reframing callers' suicidal ideation while still treating their experiences as legitimate. Conversation analysis of a subselection of calls revealed two call-taker practices, involving the framing of the caller's suicidal ideation as (1) being ambivalent or (2) having legitimate feelings in a difficult situation. While callers resisted the former, 'feeling formulations' laid the interactional foundations for exploring alternatives to suicide. This may be because call-takers' empathy increased their rights to subtly negotiate callers' experiences. By focusing on recipients' contributions in these critical interactional moments, the article widens the sociological approach to examining sense-making of health experiences as a thoroughly social process.

Prioritizing people and rapid learning in times of crisis: A virtual learning initiative to support health workers during the COVID-19 pandemic.

The Western Cape province was the early epicentre of the coronavirus disease 2019 pandemic in South Africa and on the African continent. In this short article we report on an initiative set up within the provincial Department of Health early in the pandemic to facilitate collective learning and support for health workers and managers across the health system, emphasising the importance of leadership, systems resilience, nonhierarchical learning and connectedness. These strategies included regular and systematic engagement with organised labour, different ways of gauging and responding to staff morale, and daily 'huddles' for raid learning and responsive action. We propose three transformational actions that could deliver health systems that protect staff during good times and in times of system shocks. (a) Continuously invest in building the foundations of system resilience in good times, to draw on in an acute crisis situation. (b) Provide consistent leadership for an explicit commitment to supporting health workers through decisive action across the system. (c) Optimise available resources and partners, act on improvement ideas and obstacles. Build trusting relationships amongst and across actors.

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study.

BACKGROUND: Safe clinical practice for patients hospitalised in mental health care during a suicidal crisis is situated within a dynamic, non-linear and uncertain context. Under such complex conditions, the adaptive capacity is considered vital to handling challenges and changes in clinical care. This study aimed to explore safe clinical practice for suicidal patients hospitalised in mental health wards through understanding healthcare professionals' (HCPs') capacities to adapt to challenges and changes in clinical care. METHODS: This study applied a qualitative design with focus group and individual interviews. Twenty-five HCPs participated in the focus groups, and 18 participated in individual interviews. The study was conducted in open and locked wards in a university hospital in Norway providing specialised mental health services for patients with mental illness. RESULTS: HCPs described their adaptive capacities for clinical practice relative to three themes. 1) HCPs used expertise to make sense of suicidal behaviour to support complex decision making. Their strategies included setting aside forms and checklists to prioritise trust and making judgements based on more than just patients' spoken words. They improved their understanding by seeking others' perspectives through collaborative sense-making processes involving the healthcare team and patient. 2) HCPs individualised the therapeutic milieu to address the diversity of patients with suicidal behaviour by creating individual clinical pathways, making trade-offs between under- and over-protection and adjusting observations. 3) HCPs described managing uncertainty as necessary for providing safe clinical practice. They managed uncertainty as a team by developing mutual collegial trust and support and creating a shared understanding. CONCLUSION: HCPs' adaptive capacities are vital to the complex set of practices involved in safe clinical practice for patients hospitalised during a suicidal crisis. By using expertise, individualising the therapeutic milieu, and managing uncertainty, HCPs individually and collectively develop their capacities to adapt to challenges and changes in clinical care. HCPs cannot easily ensure safe clinical practice by following standards; safe clinical practice depends on HCPs' adaptations. Ward systems that ensure collegial trust and support, as well as arenas that foster shared understanding and situational awareness, are needed.

Navigating and making sense of urgent and emergency care processes and provision.

BACKGROUND: Whilst many health systems offer a range of urgent and emergency care services to deal with the need for unscheduled care, these can be problematic to navigate. OBJECTIVE: To explore how lay people make sense of urgent care provision and processes. DESIGN: Qualitative study, incorporating citizen panels and longitudinal semi-structured qualitative interviews. SETTING AND PARTICIPANTS: Two citizens' panels, comprising purposively selected public populations-a group of regular users and a group of potentially marginalized users of urgent and emergency care. Semi-structured interviews were conducted with 100 people, purposively sampled to include those over 75, aged 18-26 years, and from East/Central Europe. A sub-sample of 41 people received a second interview at +6-12 months. Framework analysis was thematic and comparative, moving through coding to narrative and interpretive summaries. FINDINGS AND DISCUSSION: Participants narratives illuminated considerable uncertainty and confusion regarding urgent and emergency care provision which in part could be traced to the contingent nature of urgent and emergency care need. Accounts of emergency care provision were underpinned by strong moral positioning of appropriate help-seeking, demarcating legitimate service use that echoed policy rhetoric, but did not necessarily translate into individual behaviour. People struggled to make sense of urgent care provision making navigating "appropriate" use problematic. CONCLUSIONS: The focus on help-seeking behaviour, rather than sense-making, makes it difficult to move beyond the polarization of "appropriate" and "inappropriate" service use. A deeper analysis of sense-making might shift the focus of attention and allow us to intervene to reshape understandings before this point.

A conceptual model of urgent care sense-making and help-seeking: a qualitative interview study of urgent care users in England.

BACKGROUND: Theoretical models have sought to comprehend and conceptualise how people seek help from health professionals but it is unclear if such models apply to urgent care. Much previous research does not explain the complex interactions that influence how people make sense of urgent care and how this shapes service use. This paper aims to conceptualise the complexity of sense-making and help-seeking behaviour in peoples' everyday evaluations of when and how to access modern urgent care provision. METHODS: This study comprised longitudinal semi-structured interviews undertaken in the South of England. We purposively sampled participants 75+, 18-26 years, and from East/Central Europe (sub-sample of 41 received a second interview at + 6-12 months). Framework analysis was thematic and comparative. RESULTS: The amount and nature of the effort (work) undertaken to make sense of urgent care was an overarching theme of the analysis. We distinguished three distinct types of work: illness work, moral work and navigation work. These take place at an individual level but are also shared or delegated across social networks and shaped by social context and time. We have developed a conceptual model that shows how people make sense of urgent care through work which then influences help-seeking decisions and action. CONCLUSIONS: There are important intersections between individual work and their social networks, further shaped by social context and time, to influence help-seeking. Recognising different, hidden or additional work for some groups may help design and configure services to support patient work in understanding and navigating urgent care.

Patient factors influencing symptom appraisal and subsequent adjustment to oesophageal cancer: A qualitative interview study.

Oesophageal cancer (EC) is characterised by vague symptoms and is often diagnosed at an advanced stage, leading to poor outcomes. Therefore, we aimed to investigate whether there might be any patient factors contributing to delay in EC diagnosis, and focused on the symptom appraisal and help-seeking strategies of people diagnosed with EC in the UK. Semi-structured interviews were conducted with 14 patients aged >18 years with localised EC at point of diagnosis. Purposive sampling was used to include patients from 1 to 9 months post-diagnosis. Analysis of the interviews identified three main themes: Interpreting symptoms, Triggers to seeking help and Making sense of an unfamiliar cancer. Findings suggested that participants normalised symptoms or used previous health experiences as a means to interpret their symptoms. The majority of participants were not alarmed by their symptoms, mainly because they had very little knowledge of EC specific symptoms. Lack of knowledge also influenced participants' sense-making of their diagnosis. The findings highlight that the process of symptom appraisal in EC is likely to be inaccurate, which may hinder early presentation and thus diagnosis. Public health campaigns communicating EC specific symptoms, however, could shorten the appraisal period and lead to earlier diagnosis.

Exploring reasoning mechanisms in ward rounds: a critical realist multiple case study.

BACKGROUND: Ward rounds are an important and ubiquitous element of hospital care with a history extending well over a century. Although originally intended as a means of educating medical trainees and junior doctors, over time they have become focused on supporting clinical practice. Surprisingly, given their ubiquity and importance, they are under-researched and inadequately understood. This study aims to contribute knowledge in human reasoning within medical teams, meeting a pressing need for research concerning the reasoning occurring in rounds. METHODS: The research reported here aimed to improve the understanding of ward round reasoning by conducting a critical realist case study exploring the collaborative group reasoning mechanisms in the ward rounds of two hospitals in Victoria, Australia. The data collection involved observing rounds, interviewing medical practitioners and holding focus group meetings. RESULTS: Nine group reasoning mechanisms concerning sharing, agreeing and recording information in the categories of information accumulation, sense-making and decision-making were identified, together forming a program theory of ward round reasoning. In addition, themes spanning across mechanisms were identified, further explaining ward round reasoning and suggesting avenues for future exploration. Themes included the use of various criteria, tensions involving mechanisms, time factors, medical roles and hierarchies. CONCLUSIONS: This paper contributes to the literature by representing rounds in a manner that strengthens understanding of the form of the group reasoning occurring within, thus supporting theory-based evaluation strategies, redesigned practices and training enhancements.

Empathy, engagement, entrainment: the interaction dynamics of aesthetic experience.

A recent version of the view that aesthetic experience is based in empathy as inner imitation explains aesthetic experience as the automatic simulation of actions, emotions, and bodily sensations depicted in an artwork by motor neurons in the brain. Criticizing the simulation theory for committing to an erroneous concept of empathy and failing to distinguish regular from aesthetic experiences of art, I advance an alternative, dynamic approach and claim that aesthetic experience is enacted and skillful, based in the recognition of others' experiences as distinct from one's own. In combining insights from mainly psychology, phenomenology, and cognitive science, the dynamic approach aims to explain the emergence of aesthetic experience in terms of the reciprocal interaction between viewer and artwork. I argue that aesthetic experience emerges by participatory sense-making and revolves around movement as a means for creating meaning. While entrainment merely plays a preparatory part in this, aesthetic engagement constitutes the phenomenological side of coupling to an artwork and provides the context for exploration, and eventually for moving, seeing, and feeling with art. I submit that aesthetic experience emerges from bodily and emotional engagement with works of art via the complementary processes of the perception-action and motion-emotion loops. The former involves the embodied visual exploration of an artwork in physical space, and progressively structures and organizes visual experience by way of perceptual feedback from body movements made in response to the artwork. The latter concerns the movement qualities and shapes of implicit and explicit bodily responses to an artwork that cue emotion and thereby modulate over-all affect and attitude. The two processes cause the viewer to bodily and emotionally move with and be moved by individual works of art, and consequently to recognize another psychological orientation than her own, which explains how art can cause feelings of insight or awe and disclose aspects of life that are unfamiliar or novel to the viewer.

Conceptual frameworks for the workplace change adoption process: elements integration from decision making and learning cycle process.

Sound workplace ergonomics and safety-related interventions may be resisted by employees, and this may be detrimental to multiple stakeholders. Understanding fundamental aspects of decision-making, behavioural change, and learning cycles may provide insights into pathways influencing employees' acceptance of interventions. This manuscript reviews published literature on thinking processes and other topics relevant to decision making and incorporates the findings into two new conceptual frameworks of the workplace change adoption process. Such frameworks are useful for thinking about adoption in different ways and testing changes to traditional intervention implementation processes. Moving forward, it is recommended that future research focuses on systematic exploration of implementation process activities that integrate principles from the research literature on sense-making, decision-making, and learning processes. Such exploration may provide the groundwork for development of specific implementation strategies that are theoretically grounded and provide a revised understanding of how successful intervention adoption processes work. Practitioner summary: Adoption and acceptance of workplace changes may be facilitated through sound implementation strategies. This manuscript explores several principles of sense-making and decision-making processes that can potentially be used by industrial practitioners to inform the design and development of implementation strategies for interventions that improve workplace ergonomics and safety. ABBREVIATIONS:  Musculoskeletal Disorders (MSDs); National Institute for Occupational Safety and Health (NIOSH); National Occupational Research Agenda (NORA); Health and Safety Executive (HSE).