Aging in Indigenous Communities: Perspective from Two Ancestral Communities in the Colombian Andean-Amazon Region.

The phenomenon of world aging is not foreign to indigenous communities. In the last few years, research about these communities around the world has increased, but aging in indigenous towns still has not been studied widely. The purpose of this research is to interpret the meaning of old age in two indigenous communities from the Colombian Andean-Amazon region (the Inga and Kamëntsa) to reinforce the relevance of the local sociocultural context within the configuration of the meaning of old age and to emphasize the importance of considering particular regional characteristics for the design of policies and interventions aiming to recognize and integrate indigenous populations. This is a qualitative study with an interactionism-symbolism approach. In total, six indigenous people older than 60 years from two ancestral communities from the Colombian Andean-Amazon region participated in the in-depth interviews. Data analysis was carried out in three moments: discovery, coding, and relativization of the information. The results show that old age means wisdom, "I am wise," which is supported in the cosmology and the trajectory of life, reinforces the identity and autonomy, and allows them to be agents in the dynamics of their communities from the "I do," in other words, their roles as builders of the family-society and as guards of ancestral knowledge. The loss of this knowledge and the elements that it is composed of uproot them and put them at risk of disappearing as individuals and as a collective. In conclusion, the meaning of old age in these communities is not centered on a determinate age; you are not old, you are wise, and as such, they play a central role in their communities. Moreover, wisdom is built in parallel with their cosmology and assigns them the task of safekeeping ancestral knowledge. In order to do this, they use oral tradition as a tool, words that are born in their territories, travel in a nonlinear timeline, and get strengthened by the community while also protecting it and building it. Knowing what aging means for Indigenous communities can facilitate to the development of policies and initiatives and to provide culturally appropriate and effective programs.

How can white parents raise anti-racist children? Introducing the routes to effective anti-racist parenting (REAP) model.

In response to highly publicized instances of overt racial injustice, there has been a recent resurgence of interest and commitment to identifying processes through which anti-racist behaviors develop among White individuals. One particularly important context in which anti-racist behaviors can develop is within families and as a result of childrearing. Theories of anti-racism typically neglect the role of families and family science research typically neglects a focus on anti-racist parenting outcomes. To further research and applied work on fostering anti-racism within White families, this paper introduces a new integrative model called routes to effective anti-racist parenting (REAP). The model draws on theories from various fields, including family science and social psychology, and uses a metaphor of nurturing a plant to explain the nuanced, multi-faceted approaches to anti-racist parenting. The model incorporates factors related to the "pot" (i.e., fundamental values and structure necessary to contain more specific anti-racist skills and behaviors), "soil" (i.e., characteristics that define anti-racist commitment), "seeds" (i.e., direct transmission of anti-racism skills), and "environment" (i.e., influential external factors). Finally, we describe the intended benefits that can be reaped from this intentional approach to anti-racist parenting. The REAP model contributes to the family science literature by providing an empirically grounded theoretical model describing the roles that parents can play in children's anti-racist development.

Thriving psychological well-being in undergraduate nursing student: a grounded theory study with the life grid approach.

BACKGROUND: Psychological well-being (PWB) plays a vital role in successful adaptation to the Bachelor of Nursing journey and affects career development. However, there is little known about the functional and social processes associated with enhancing well-being specific to the subjective perspective of nursing students. AIM: To investigate how nursing students promote their psychological well-being to conceptualize thriving psychological well-being. METHOD: This qualitative study analyzed and reviewed a life grid and semi-structured in-depth interviews of 20 Chinese Nursing graduates by investigators and participants, following Charmaz's constructivist grounded theory. The constant comparative method was used to analyze data. This study took place between 2020 and 2022. RESULTS: All participants experienced fluctuations in psychological well-being. This study identified a new understanding of how nursing students enhance their psychological well-being. Thriving awareness was co-constructed as the core category and based on the relationship with a supportive environment, the thriving psychological well-being of nursing students is conceptualized. CONCLUSIONS: It is imperative to enhance the psychological counseling and support for nursing students during their clinical placements, during the period just entering university as well as after repeated outbreaks of COVID-19. Nursing educators and administrators could develop appropriate educational programs and interventions based on the theoretical model-Thriving psychological well-being.

Negotiating mental illness across the lay-professional divide: Role play in peer work consultations.

Patient involvement is a prominent policy aim in modern health care. Today, mental health services employ peer workers (PWs) who have personal experiences with mental illness. Based on 22 interviews with PWs and 26 audio recordings of real-life consultations, we show how PWs talk about their personal experiences as professional qualifications. Furthermore, we demonstrate how in real-life encounters, PWs and patients convert personal experiences into a professional approach through an interactionist role play that balance PWs role as former patients and current professionals. Our analysis shows that PWs combine the personal pronoun 'I' (stressing that it is personal) with the indefinite pronoun 'one' (referring to generalised patient experiences) when they recount illness experiences. This convey that PWs engage with mental illness as both a personal and professional topic. In addition, the analysis shows that PWs (and patients) use professional clues to manifest PWs' positions as professionals. Overall, the article demonstrates that instead of focussing on authentic patient relationships, as previous research has done, it is beneficial to investigate peer work from a symbolic interactionist approach revealing how PWs and patients skilfully manoeuvre the contradictions embedded in the PWs' dual role as former patients and current professionals.

Volunteers do the fun stuff - Experiences from volunteer-professional caregiver cooperation in nursing homes.

BACKGROUND: The number of volunteers in Danish nursing homes is increasing. Volunteers cooperate with professional caregivers to improve the residents' well-being and quality of life as part of their palliative care. The Danish government encourages this volunteer involvement, which is partly intended to alleviate the resource constraints in municipal healthcare. Although volunteer roles are defined as complementary to the professional caregiver role, volunteer-professional caregiver cooperation can be challenging. AIM: This article explores the challenges experienced in volunteer-professional caregiver cooperation in the general palliative care provided in nursing homes. METHOD: A qualitative design and a sociological phenomenological approach were adopted to answer the research question: What is experienced as challenging in the cooperation between volunteer and professional caregivers in the provision of care for elderly residents in everyday life in a nursing home? And what meanings and understandings are associated with these experiences? Data were collected by combining participant observations and interviews, and thematic analysis structured the analytical process. FINDINGS: The analysis of 115 hours of participant observations in two Danish nursing homes with 50-60 volunteers involved and 16 interviews (eight with volunteers, eight with professional caregivers) identified two overall themes: 'Symbolic indications of them and us' (two sub-themes) and 'Meaning and action regarding the residents best interest' (three sub-themes). CONCLUSIONS: An institutional distinction between volunteer versus professional caregiver domains contributed to a sense of 'them and us', which hindered common experiences and raised challenges concerning the mutual understanding of actions. The professional caregivers felt that they lacked the time to engage in social care activities with residents, for which volunteers otherwise had time. The coordinator role was a crucial link in coordinating the daily care activities for residents but marked by a sense of ambivalence among the professional caregivers.

"They're just, like, there": A constructivist grounded theory study of student experiences with school resource officers.

School-based policing has become common practice, but there is limited qualitative research examining what meanings students make of police presence in their schools. This study sought to understand how students construct narratives of police presence in their schools based on their experiences with school resource officers (SROs). Drawing on constructivist grounded theory methodology with a sample of 17 students, this study found that students are continuously integrating multiple conflicting narratives about SROs: students experience SROs as an established yet ambiguous presence, which produces mixed feelings of reassurance, wariness, and intimidation. Students manage the conflicts between these narratives by positioning school-based police as a fixed structure with pitfalls and positives but no alternatives. Additionally, students experience SROs as being available to them in relational capacities. The primary recommendations from this study are for schools and communities to (1) reconsider the appropriateness of SRO programs with student perspectives at the center of dialogue, and (2) invest in non-law enforcement school-based professionals who students experience as available and relational.

GPs' perspectives of the patient encounter - in the context of standardized cancer patient pathways.

Objective: We aim to explore how GPs assign meanings and act upon patients' symptoms in primary care encounters in the context of standardized cancer patient pathways (CPPs).Design, setting and subjects: Thirteen individual interviews were conducted with GPs, at primary healthcare centers (n = 4) in one county in northern Sweden. Interviews were analyzed using grounded theory method. The results were then linked to symbolic interactionism.Main outcome measures: GPs' perspectives about assigning meanings to patients' presented symptoms and perception about CPPs.Results: In the encounter, GPs engaged in two simultaneous interactions, one with patients' symptoms - and the other with CPPs. The core category Disentangling patients' care trajectory consists of three categories, interpreted as GPs' strategies developed to assign meaning to symptoms. These strategies are carried out not in a straightforward manner but rather in a conflicting way, illuminating the complexity of GPs' daily work.Conclusions: Interacting with patients is vital for assigning meaning to presented symptoms. However, nowadays GPs are not only required to interact with patients, they are also required to interact with CPPs. These standardized routines might create pressure and demands on GPs, especially for those experiencing a lack of information about CPPs. Beside of carrying out the challenging patient/person-centered dialogues and interpreting presented symptoms, GPs also need to link the interpreted symptoms to CPPs. Therefore, it is essential that GPs are given opportunities at their workplaces to continuously be informed and be supported in order to practice CPPs and thereby optimize trajectories for patients undergoing cancer diagnostics.Key points Current awareness: • GPs deliberation about patients' trajectories is a complex process, often dealing with vague symptoms. How CPPs influence this process within the encounter has not been studied. Main statements: • GPs in our study were involved in two simultaneous interactions, one with patients' symptoms in the encounter - and the other with CPPs within the healthcare organization. • Symbolic interactionism helped capture how GPs deliberated about conflicting and paradoxical aspects of the encounter, in terms of balancing two contradictory ways of action that GPs face when providing patient/person-centered care and linking to CPPs. • Based on our results, primary care needs support from healthcare organizations to build capacity about CPPs and how to use them.

A Theoretical Exploration of Live Discharge from Hospice for Caregivers of Adults with Dementia.

Patients with dementia may be discharged from hospice if their condition stabilizes. The loss of professional support and an already complex grief process needs careful attention. A live discharge presents a unique experience for each hospice patient, caregiver, and hospice team, which varies from traditional bereavement theories used to describe the grieving process. This article explores live discharge from hospice for caregivers of adults with dementia through a theoretical lens of Symbolic Interactionism (SI) and Attachment Theory (AT). The theories of SI and AT support and assist in understanding the experience of caregivers who lose hospice support due to ineligibility. In addition, caregivers watch the gradual deterioration and psychological loss of someone with dementia while they remain alive described as an ambiguous loss. Ambiguous loss as a subset of traditional bereavement theories provides a framework for this exploration and provides a relevant illustration of the complex needs. This article will conclude with implications for social work practice. It is important for hospice clinicians to be aware of current termination practices necessary to manage appropriate attachments, support the symbolic meaning of the hospice experience, validate the ambiguous losses, and maintain a sense of hope through a live discharge from hospice.

A dimensional analysis of inner strength in people ageing with serious illness.

Nursing models of care show promise in addressing the needs of older adults facing serious illness through supporting inner strength. However, previous conceptual and theoretical models of inner strength are limited. This concept analysis used dimensional analysis methods to explore inner strength in people ageing with serious illness to address limitations by defining a pragmatic, data-driven model. This study analyzed published literature of adults with serious illness that describes inner strength. Thirty articles were selected after review. The result was an explanatory matrix that describes inner strength from the perspective of where have I been, where am I going? within the context of being a person who is living and dies and you have a serious illness. The conditions spotlighting by actors around me and taking stock of others and ideas lead to processes of looking in/looking out and seeing me as I'm seen. The final consequence of this process is meeting me. This updated concept analysis of inner strength improves upon previous models by providing a clinically relevant situation-specific model of inner strength for people with serious illness. Implications for nursing scholarship and practice are described including exploration of person-centered care, relational practice, and health communication.

"Thou Shalt Not Die in This Place": An Ethnomethodological Approach to an Ecuadorian Hospice Through Symbolic Interactionism.

Ecuador, located in South America, has a population of 16 million people. According to the National Institution of Statistics in Ecuador, every year 8 out of a 1000 individuals die due to various causes. Palliative care and hospice are relatively new concepts for the Ecuadorian society. In Ecuador people usually die at home, in hospitals, or in nursing homes. In 2012, the first Ecuadorian hospice was created. According to symbolic interactionism theory, research needs to study participants' world in order to understand the dynamic nature of human behavior. Symbolic interactionism proposes that human beings cannot be understood without the context of their interactions. Through an ethnomethodological approach, the following research aims to understand the way that individuals understand and describe death while in the local hospice in Ecuador. Results emerge from the introspection of real stories, field notes, participant observation, and informal conversations at the hospice. Based on a thematic analysis, the following study presents major themes that emphasize the dynamic process of creating meaning of death.

Patients´ experiences and perspectives of challenges and needs related to nonmyeloablative stem cell transplantation: Involving patients in developing a targeted rehabilitation programme.

AIMS AND OBJECTIVES: To explore patients' experiences and perspectives of their challenges and needs regarding their return to everyday life after allogeneic nonmyeloablative haematopoietic stem cell transplantation (NMA-HSCT). BACKGROUND: NMA-HSCT can cure patients with malignant blood diseases, but during the following years, the majority of patients suffer from serious side effects and complications. Hence, it is a major challenge for patients treated with NMA-HSCT to rehabilitate, maintain physical and psychosocial functioning and return to a life in restored balance. DESIGN: The design was qualitative using the interpretive description methodology, and the theoretical framework symbolic interactionism inspired the interview guide and analysis. METHODS: Between April to May 2017, five focus group interviews were conducted with 15 outpatients in a haematological ward in Denmark. The patients were treated with NMA-HSCT 8-30 months prior to the interviews. The study adheres to the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: The impaired functioning was the overarching theme and seemed to be the trigger entailing rehabilitation needs related to the following main themes: realising decline, adapting to changes, the meaning of motivation and reliance on relations. These findings seemed to affect and influence the patients' struggle for a return to an everyday life like before being diagnosed or just before undergoing NMA-HSCT. CONCLUSION: This study adds to our understanding of important elements to consider when developing a targeted rehabilitation programme. RELEVANCE TO CLINICAL PRACTICE: Based on our findings, the rehabilitation programme should encompass: extensive variation regarding how to address the impaired functioning through individualised approaches, multimodal interventions, interventions through several months with varying intensity, an interdisciplinary team approach supporting motivation and visualisation of every progress by tangible goal setting, communication regarding hope and support, extended supportive care for patients living alone and finally increased adherence through social sessions with relatives and fellow patients.

Evaluating sense of community in the residential environment from the perspectives of symbolic interactionism and architectural design.

The paper fills the gap between the design and the actuality of how buildings, and its surroundings, urban design, and the built environment influence its occupants' behavior and interactions. We assess how the built environments can be influenced by humans and their control, both physical and symbolically, of the urban landscapes. In this regard, our paper merges symbolic interactionism, sense of community, and architectural design to aid our understanding of the man-environment relationship. Specifically, we assess qualitative data on Ekbatan Residential Complex in Tehran. We use Ekbatan as a case study to see how a sense of community among residents reflects both physical features of the complex and the symbolic meaning attached to these features by residents and those living outside the community. We conclude by suggesting that combining the interests of urban sociologist, community psychology, and architects via symbolic interactionist concepts may be a fruitful avenue for studying factors affecting sense of community and larger urban processes.

K-12 School Employee Sexual Abuse and Misconduct: An Examination of Policy Effectiveness.

Despite federal and state laws and policies aimed at preventing sexual misconduct by school employees, one in ten American students will experience sexual abuse or misconduct at the hands of a K-12 school employee. To explore why such sexual misconduct continues to occur, this study examined the effectiveness of education policies by investigating whether and how school employees understand these policies, how they are implemented, and how loopholes may undermine their intent. This qualitative case study was conducted in three Virginia school districts and included 46 semi-structured interviews with school district employees and county, state, and federal government employees associated with cases of school employee sexual misconduct, and extensive document analysis of school policies and procedures, laws, and court records. Analyses revealed an absence of policy implementation, demonstrated most seriously by a lack of awareness and understanding of policies among school employees, underreporting, and ineffective data collection. The study also identified a number of loopholes in the implementation of policies, resulting from a mismanaged intergovernmental system. The analysis suggests that understanding and implementation of policies meant to prevent sexual misconduct by school employees are fragmented; this fragmentation may be contributing to the continued prevalence of sexual misconduct by school employees.

'Just because a doctor says something, doesn't mean that [it] will happen': self-perception as having a Fertility Problem among Infertility Patients.

Only some individuals who have the medically defined condition 'infertility' adopt a self-definition as having a fertility problem, which has implications for social and behavioural responses, yet there is no clear consensus on why some people and not others adopt a medical label. We use interview data from 28 women and men who sought medical infertility treatment to understand variations in self-identification. Results highlight the importance of identity disruption for understanding the dialectical relationship between medical contact and self-identification, as well as how diagnosis acts both as a category and a process. Simultaneously integrating new medical knowledge from testing and treatment with previous fertility self-perceptions created difficulty for settling on an infertility self-perception. Four response categories emerged for adopting a self-perception of having a fertility problem: (i) the non-adopters - never adopting the self-perception pre- or post-medical contact; (ii) uncertain - not being fully committed to the self-perception pre- or post-medical contact; (iii) assuming the label - not having prior fertility concerns but adopting the self-perception post-medical contact; and (iv) solidifying a tentative identity - not being fully committed to a self-perception pre-medical contact, but fully committed post-medical contact. (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA).

Implementing augmentative and alternative communication in critical care settings: Perspectives of healthcare professionals.

AIMS AND OBJECTIVES: To describe the perspectives of healthcare professionals caring for intubated patients on implementing augmentative and alternative communication (AAC) in critical care settings. BACKGROUND: Patients in critical care settings subjected to endotracheal intubation suffer from a temporary functional speech disorder and can also experience anxiety, stress and delirium, leading to longer and more complicated hospitalisation and rehabilitation. Little is known about the use of AAC in critical care settings. METHOD: The design was informed by interpretive descriptive methodology along with the theoretical framework symbolic interactionism, which guided the study of healthcare professionals (n = 48) in five different intensive care units. Data were generated through participant observations and 10 focus group interviews. RESULTS: The findings represent an understanding of the healthcare professionals' perspectives on implementing AAC in critical care settings and revealed three themes. Caring Ontology was the foundation of the healthcare professionals' profession. Cultural Belief represented the actual premise in the interactions during the healthcare professionals' work, saving lives in a biomedical setting whilst appearing competent and efficient, leading to Triggered Conduct and giving low priority to psychosocial issues like communication. CONCLUSION: Lack of the ability to communicate puts patients at greater risk of receiving poorer treatment, which supports the pressuring need to implement and use AAC in critical care. It is documented that culture in biomedical paradigms can have consequences that are the opposite of the staffs' ideals. The findings may guide staff in implementing AAC strategies in their communication with patients and at the same time preserve their caring ontology and professional pride. RELEVANCE TO CLINICAL PRACTICE: Improving communication strategies may improve patient safety and make a difference in patient outcomes. Increased knowledge of and familiarity with AAC strategies may provide healthcare professionals with an enhanced feeling of competence.

Willingness to Interact After Therapeutic Recreation in a Patient With Schizophrenia.

The study aim was to describe how a patient with schizophrenia who had been in a psychiatric hospital for an extended period of time changed in his desire to interact with others after participating in the therapeutic recreation program, and to interpret his inner process based on symbolic interactionism theory. Data from a patient who showed marked changes in narratives of an interview held after the program and through observation during sessions were analyzed. The patient gained a sense of willingness, including the desire to interact with others and began to act accordingly.

The Humanbecoming theory as a reinterpretation of the symbolic interactionism: a critique of its specific nature and scientific underpinnings.

Discussions about real knowledge contained in grand theories and models seem to remain an active quest in the academic sphere. The most fervent of these defendants is Rosemarie Parse with her Humanbecoming School of Thought (1981, 1998). This article first highlights the similarities between Parse's theory and Blumer's symbolic interactionism (1969). This comparison will act as a counterargument to Parse's assertions that her theory is original 'nursing' material. Standing on the contemporary philosophy of science, the very possibility for discovering specific nursing knowledge will be questioned. Second, Parse's scientific assumptions will be thoroughly addressed and contrasted with Blumer's more moderate view of knowledge. It will lead to recognize that the valorization of the social nature of existence and reality does not necessarily induce requirements and methods such as those proposed by Parse. According to Blumer's point of view, her perspective may not even be desirable. Recommendations will be raised about the necessity for a distanced relationship to knowledge, being the key to the pursuit of its improvement, not its circular contemplation.

Parent-healthcare provider interaction during peripheral vein cannulation with resistive preschool children.

AIM: The aim of this study was to increase understanding of parent-healthcare provider interaction in situations where newly admitted preschool children resist peripheral vein cannulation. BACKGROUND: Parent-healthcare provider interaction represents an important context for understanding children's resistance to medical procedures. Knowledge about this interaction can provide a better understanding of how restraint is used and talked about. Symbolic interactionism informed the understanding of interaction. DESIGN: An exploratory, qualitative study was chosen because little is known about these interactions. METHODS: During 2012-2013, 14 naturalistic peripheral vein cannulation -attempts with six newly hospitalized preschool children were video recorded. Eight parents/relatives, seven physicians and eight nurses participated in this study. The analytical foci of turn-taking and participant structure were used. RESULTS: The results comprised three patterns of interactions. The first pattern, 'parents supported the interaction initiated by healthcare providers', was a response to the children's expressed resistance and they performed firm restraint together. The second pattern, 'parents create distance in interaction with healthcare providers', appeared after failed attempts and had a short time span. Parents stopped following up on the healthcare providers' interaction and their restraint became less firm. In the third pattern, 'healthcare providers reorient in interaction', healthcare providers took over more of the restraint and either helped each other to continue the interaction or they stopped it. CONCLUSION: Knowledge about the identified patterns of interactions can help healthcare providers to better understand and thereby prepare both parents and themselves for situations with potential use of restraint.

Role and Image of Nursing in Children's Literature: A Qualitative Media Analysis.

UNLABELLED: Nurses' role and image as portrayed in young children's literature were described and analyzed. DESIGN AND METHODS: A total of 30 children's books (pre-kindergarten through grade two audience) written in English were chosen using progressive theoretical sampling. Included were books, both fiction and non-fiction and with varying years of publication, that mentioned nurses and/or were about general healthcare topics. The books were analyzed using the method of qualitative media analysis which is derived from the theoretical framework of symbolic interactionism. RESULTS: Nurses were generally portrayed positively but simply and inaccurately in this sample of children's literature. The seven themes discovered were labeled as nurse characters using traits evident in the sample: nurse unlikely, nurse minimal, nurse caring, nurse subordination, nurse skillful, nurse diversity, and nurse obvious. CONCLUSION: The image of nursing is socially and culturally constructed, and accurate portrayals of nurses and their roles are necessary in all media. Thus, better representation of nurses in children's books is needed as young children's literature is an important first exposure to the art and science of nursing. PRACTICE IMPLICATIONS: Future children's books authored by nurses may more closely reflect accurate contemporary nursing practice and contribute to an improved image of the nursing profession.

Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.