Anthropologies of health policy.

In this introduction to our special issue, we take a wide view of the history and epistemic stakes of anthropological and ethnographic approaches to health policy. Drawing on the history of critical medical anthropology, the anthropology of policy, and critical policy studies, we show how anthropologies of health policy are particularly essential in this current moment, as policy production becomes increasingly abstracted and even more entwined with specific forms of evidence making. Taken together, the contributors of this special issue argue that anthropology's interventions into health policy are essential in three ways. First, they shed light on the practices of policy 'communities', the pragmatic parameters under which they work, and the central logics under which health policy actors are operating. Second, they examine the effects of policy implementation upon those intended to be the subjects of health policy, highlighting the effects of policy for those marginalised by gender, race, and caste. Here, anthropology provides a view into the 'lived experience' of those targeted by health policy, but it also demands that anthropologists provide 'counter-stories' and 'counter-evidences' that dismantle narrow systems of policy knowledge production. Finally, anthropological attention provides an essential lens into the things that carry over in the act of policy reform-the past reverberations and imperial inheritances. Together with our contributors, we call for anthropologies of health policy that work to highlight and dismantle such inheritances.

Integrating Social Determinants of Health in Critical Care.

BACKGROUND: Social determinants of health (SDOHs) mediate outcomes of critical illness. Increasingly, professional organizations recommend screening for social risks. Yet, how clinicians should identify and then incorporate SDOHs into acute care practice is poorly defined. RESEARCH QUESTION: How do medical ICU clinicians currently operationalize SDOHs within patient care, given that SDOHs are known to mediate outcomes of critical illness? STUDY DESIGN AND METHODS: Using ethnographic methods, we observed clinical work rounds in three urban ICUs within a single academic health system to capture use of SDOHs during clinical care. Adults admitted to the medical ICU with respiratory failure were enrolled prospectively sequentially. Observers wrote field notes and narrative excerpts from rounding observations. We also reviewed electronic medical record documentation for up to 90 days after ICU admission. We then qualitatively coded and triangulated data using a constructivist grounded theory approach and the Centers for Disease Control and Prevention Healthy People SDOHs framework. RESULTS: Sixty-six patients were enrolled and > 200 h of observation of clinical work rounds were included in the analysis. ICU clinicians infrequently integrated social structures of patients' lives into their discussions. Social structures were invoked most frequently when related to: (1) causes of acute respiratory failure, (2) decisions regarding life-sustaining therapies, and (3) transitions of care. Data about common SDOHs were not collected in any systematic way (eg, food and housing insecurity), and some SDOHs were discussed rarely or never (eg, access to education, discrimination, and incarceration). INTERPRETATION: We found that clinicians do not incorporate many areas of known SDOHs into ICU rounds. Improvements in integration of SDOHs should leverage the multidisciplinary team, identifying who is best suited to collect information on SDOHs during different time points in critical illness. Next steps include clinician-focused, patient-focused, and caregiver-focused assessments of feasibility and acceptability of an ICU-based SDOHs assessment.

Professionalisation experiences of a 'business-minded' HIV targeted intervention NGO in India: An organisational ethnography.

This paper contributes to the literature on the professionalisation of NGOs in the context of the rise of 'business-minded' approaches whereby donors establish a market environment in which NGOs compete for funding by demonstrating their achievement of targets and implementing globally recognised management models. Theoretically, we use the distinction between 'economies of performance' and 'ecologies of practice' to explore how NGOs simultaneously 'perform' themselves publicly as meeting expected professional standards while simultaneously producing themselves practically through 'unprofessional' means. Limited global health and development literature addresses professionalisation as an empirical practice and experience. We report on an ethnography of a Bill and Melinda Gates Foundation-funded, HIV-targeted intervention NGO in western India, drawing on six months of participant observation and 17 interviews with NGO workers. The organisation meets 'business-minded' success criteria but does so through informal, personal, hierarchical arrangements at odds with the professionalisation model. Frontline workers are demotivated by their professionalisation experience, are suspicious of the performance of success, and find ways of achieving their vocation despite a system which they feel does not recognise the value of human relationships. Showing that 'business-minded' approaches do not necessarily rule out informal, potentially 'corrupt' ways of working, we argue against the 'professional-unprofessional' binary.

A Clinically Immersive Medical Innovation Program for US MD Students: Curricular Description and Program Outcomes.

Background: There is growing need for physician-innovators to address the mounting challenges within the US healthcare system. Despite this, there remains a significant gap in understanding of the efficacy of innovation programs for US MD candidates. We present initial program outcomes of a novel, clinically immersive medical innovation program offered to MD candidates at the David Geffen School of Medicine (DGSOM) at UCLA. Methods: A novel clinically immersive medical innovation curriculum was developed based on existing and reputable medical innovation frameworks and tailored for medical students. Curricular topics broadly included clinical ethnography, interviewing techniques, mind mapping, needs formulation and prioritization, quality improvement, intellectual property, reimbursement pathways, solution landscaping and prioritization, regulatory processes. The program was trialed during an unscheduled summer with voluntary enrollees from DGSOM Class of 2024. The traditional four-level Kirkpatrick model was employed to assess program outcomes. Results: Program outcomes were positive on all four Kirkpatrick levels. Students rated enjoyment at 9.5/10 for lectures and 9.1/10 for clinical immersion. Student-perceived confidence in key skills increased by 43%, and 75% of faculty directly perceived improvement in ethnographic skills. Students were highly engaged in both didactics and clinical immersion, discovering on average 2.6 faculty-verified needs per week. Faculty largely felt their students discovered important unmet clinical needs and added value to their clinical practice. Conclusion: We developed and trialed a novel clinically immersive medical innovation curriculum tailored for medical students. This program achieved positive outcomes on all four levels of the Kirkpatrick model. Our findings have driven the local adoption of this program into our institution's medical school curriculum. We hope that the program efficacy demonstrated herein catalyzes more institutions to trial similar medical innovation programs.

We conducted this investigation after recent literature identified a significant gap in our understanding of the role of innovation and entrepreneurship (I&E) programs in the United States (US) medical education. I&E programs are meant to teach the skills necessary to identify and assess ongoing challenges in health care and subsequently formulate a solution for such challenges. The rate of adoption of I&E programs into US medical education has been unexplainably slow, despite a strong reported interest among medical students in learning the associated topics. We sought to answer the question: how effectively can an I&E curriculum be integrated into the traditional US medical doctorate (M.D). curriculum? We designed a novel medical innovation program tailored for medical students and offered this six-week program to 16 M.D. candidates at UCLA during an unscheduled summer. By describing the curriculum in detail and presenting our holistic assessment of program outcomes including learners' feeling, learnings, transference of knowledge, and the program's real-world impact, we demonstrate methods by which medical innovation can effectively be taught to medical students and the impact this may have on our future physician workforce. Our implementation of a quality improvement conceptual framework examining multiple process measures enabled iterative and real-time improvement of the program throughout its offering. Our surveys were administered at regular intervals through the course, thereby allowing iterative feedback from enrolled students to drive course improvement, similar to how quality improvement frameworks incrementally improve outcomes through closed-loop feedback in health care settings. We posit that analogous medical innovation curricula should be increasingly integrated into MD curricula more broadly.

Care, co-survival, and decency: expanding the understanding of outdoor life and smaller alcohol and drug scenes in Denmark and Norway.

Introduction: Public spaces where alcohol and other drugs are openly used and marginal citizens gather, exist in many Nordic cities. The biggest open drug scenes in the Nordic countries are in cities like Oslo and Copenhagen; however, there are smaller scenes in other cities and suburbs, centered around shed-like structures, offering some form of shelter and a designated space for marginalized people involved in heavy drug and alcohol use who hang out in public space. In this paper, we investigate, in a comparative perspective, the characteristics and functions of smaller open alcohol and drug scenes, and how their existence is negotiated in the local community and among the citizens using them. Methods and material: This article is a comparative case-study based on data from fieldwork (participating observation and interviews) carried out in two specific, yet somewhat similar, locations in Denmark and Norway between 2017 - 2022. A cross-case analysis was performed to identify commonalities and differences. Results: Smaller open alcohol and drug scenes are non-regulated spaces of ambivalence and ongoing negotiation in local communities. Based on the data across locations, they represent possibilities for informal care and community for citizens in marginalized situations. The scenes are further, across location, characterized by a mutual agreement of performing decency, e.g., not allowing minor drug sale/use. Discussion: To enable public spaces as smaller alcohol and drug scenes can play a role in reducing harm for marginalized citizens. Communication and dialogue between citizens using an open drug scene and the wider community may help reduce stigma.

Does bride price harm women? Using ethnography to think about causality.

Many institutions claim that bride price - where the groom's family transfers wealth to the bride's family at marriage - harms women. Owing to its long-term engagement with communities that practise bride price, ethnography is well placed to identify causal mechanisms at play in this issue, and there is a substantial literature on its effects in a variety of world regions, including Melanesia. Here, we condense this literature, drawing out key causal arguments made about bride price in various Melanesian societies. This reveals a complex, multi-causal picture: rather than being singularly harmful, bride price may involve a mixture of drawbacks and benefits, making it a double-edged sword with contested implications. Bride price may constrain women's options before and during the marriage but also serves as a safety net that enhances their status. Its effects are probably influenced by many other variables, including age, kinship networks and residence structures. These dynamics have been transformed by conversion to Christianity, the (post-)colonial state, market integration, urbanisation and formal education, often yielding ambiguous outcomes. Rather than reducing ethnography to a collection of datapoints, we show that it can serve as a source of verbal arguments that can be used to challenge reductive narratives about sensitive issues and to formulate hypotheses for testing with quantitative data.

Institutional ethnography: A methodology for exploring complex problems in healthcare systems.

Healthcare professionals experiencing barriers in the delivery of care are often unaware of factors within complex institutions that create and perpetuate those problems. Institutional ethnography in healthcare is a research methodology that starts from the perspective of a problem that clinicians or people receiving care experience and seeks to identify how those negative experiences are coordinated by institutional structures. This paper describes and advocates for the use of institutional ethnography as a powerful tool to investigate problems experienced by individuals or groups in the complex systems of healthcare design and delivery. It is a research methodology that has been adopted across settings in North America, although it has the potential to be utilized more broadly across other settings by clinicians and researchers. This echoes calls from other authors for its use across a wider range of healthcare disciplines and settings. Institutional ethnography is an underutilized research methodology that has potential to address a wide range of challenges experienced in contemporary healthcare. It offers healthcare clinicians the opportunity to better understand and resolve issues affecting their practice within complex healthcare systems.

The Ethnographic Interview: An Interdisciplinary Guide for Developing an Ethnographic Disposition in Health Research.

Interviews are central to the health ethnographers' toolkit. In this article, we offer a critical engagement with methodological literature coupled with reflective examples from our own research, in order to articulate the value of the ethnographic interview in health research. We contribute to literature on ethnographic interviews in two ways: by decoupling ethnographic interviews from the necessity of accompanying participant observation, and by outlining an ethnographic disposition towards interviewing. We define the seven key epistemic dispositions underpinning the ethnographic interview. These are humility, a readiness to revise core assumptions about a research topic, attentiveness to context, relationality, openness to complexity, an attention to ethnographic writing, and a consideration of the politics and history of the method. The strength of an epistemic understanding of the ethnographic interview is that it offers flexibility for developing a diverse array of interview techniques responsive to the needs of different research contexts and challenges. Ethnographic interviews, we show, contribute to the study of health through a richly explorative, responsive, contextualised, and reflexive approach.

Conceptualizing Community Engagement for Mental and Brain Health Research in Low- and Middle-Income Countries: A Case of Kilifi County, Kenya.

Community engagement (CE) has increasingly been recognized as a critical element for successful health promotion and intervention programs. However, the term CE has been used to mean different things in different settings. In this article, we explore how CE has been conceptualized in the field of mental and brain health in Kilifi County, Kenya. We used ethnographic methods encompassing focused group discussions, key informant interviews, and observations with 65 participants, purposively recruited from Kilifi County. Data were transcribed verbatim and thematically analyzed. Our findings show that community members and stakeholders had diverse perceptions of and experiences with CE. Factors such as trust between researchers and community members, sensitization, and awareness creation were key for acceptance of research projects. Partial involvement in research, lack of access to information, poverty and socio-economic challenges, and financial expectations from researchers hindered CE and led to resistance to participation in research projects. For effective CE, there is a need to work closely with community gatekeepers, create awareness of the research projects, use local languages, and ensure continuous engagement that promotes equitable research participation. Our findings suggest that tacit knowledge, context, and mechanisms for research are all critical features of CE and should be considered to enhance acceptance and sustainability of mental and brain health interventions in Kenya.

Qualitative social and human science research focusing on actors in and around dairy farming- An invited review.

Qualitative research related to humans, dairy cows, calves and farming has been published by scientists from a variety of disciplines in many journals targeting dairy science audiences. We aimed to investigate how scientific communities other than those working in dairy science describe, analyze and discuss dairy farming, because we found it important to bring this research to the attention of dairy scientists. In total, 117 articles were identified as involving one or more qualitative research methods in relation to dairy cattle. The review brought out a wealth of perspectives, new insights and discussions related to dairy cattle, farmers, farming and the sector, and in relation to societal issues and food and ecological landscapes. A broad range of qualitative research methods were used, and the literature targeted issues at the animal, farm, societal, food system and landscape level. Some raised critical questions about existing structures, highlighted unfairness in the industry, or pointed to new potential futures and contemporary agendas. We expect that it will be inspirational and stimulating for researchers to review new sources of literature and suggest a closer interdisciplinary collaboration among researchers from different disciplines for the future development of research involving dairy cattle. Further, it could be relevant and even necessary to engage in such interaction to avoid increasing polarization around future development of the sector, for example related to climate change or how industrialization seems to push inequity or ignore the agency of animals themselves. Exploring perspectives of farming from different angles could enrich the outcomes of future dairy research.

An ecosystem of accepting life with chronic pain: A meta-ethnography.

Background: Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. Methods: We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. Findings: We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Conclusion: Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem.

A systematic review and meta-ethnography of client and therapist perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences.

This review aimed to develop a conceptual model of the therapeutic alliance in the context of psychotherapy and suicidal experiences from therapist and client perspectives. The protocol was pre-registered on PROSPERO (CRD42021268273). MEDLINE, PsycINFO, Web of Science, Embase and CINAHL were systematically searched from database inception to April 2024. Eligible studies were peer-reviewed, qualitative, and included client and/or therapist's perspectives of the therapeutic alliance in the context of psychotherapy and suicidal experiences. Studies were critically appraised and analysed using a meta-ethnography approach involving a reciprocal translation of studies and line of argument synthesis. Thirty-seven papers were included, generating two overarching themes; 'Working on the edge' and 'Being ready, willing, and able to build an alliance in the context of suicidal experiences'. Therapeutic alliance in the context of suicidal experiences is unique, fluid, potentially lifesaving, and influenced by multiple inter-connected internal and external processes and systems. Clinical implications emphasise the need to improve training, supervision, and support for therapists to equip them with the additional skills required in navigating the intricacies of the therapeutic alliance with clients who have suicidal experiences. Flexibly interweaving risk assessment into therapeutic conversation was beneficial to the alliance with suicidal clients and enhanced their safety.

Fathers' experiences of nurses' roles and care practices during their preterm infant's stay in the neonatal intensive care unit.

INTRODUCTION: Neonatal intensive care unit (NICU) nurses play a crucial role in providing infant care, as well as in bridging the communication gap with parents. AIM: Explore fathers' perceptions and interactions with nurses during their preterm infants' stay in a NICU. DESIGN: Qualitative study using ethnographic data collection techniques. METHODS: Twenty fathers of preterm infants were purposively sampled in a level III NICU in Italy. Data collection comprised 120 h of participant observation, 68 informal conversations, and 20 semi-structured interviews. Data analysis was performed using reflexive thematic analysis. RESULTS: Analysis revealed five primary themes: (i) communication and clarity about infants' health condition and progress, (ii) inclusiveness and guidance from nurses, (iii) fathers' satisfaction with nurses' support for mother, (iv) nurses' personal attention to the babies, and (v) nurses' varied personalities. CONCLUSION: Nurses are crucial in facilitating father-infant bonding in the NICU. Although the content of nurse communication is critical for fathers, the delivery style becomes especially relevant during their infant's hospitalization. Discrepancies in messages and guidance can negatively impact fatherly confidence and their ability to care for their preterm infants and support partners. Thus, training that emphasizes the recognition of the unique ways that fathers exhibit distress is crucial. RELEVANCE TO CLINICAL PRACTICE: Nurses play a critical role in shaping the fathers' experiences in NICU. Emphasizing clear communication and individualized care is vital. To strengthen father support in NICU settings, recommended approaches include regular training, holistic care, fostering inclusivity, emotional support, and improving bonding opportunities. REPORTING METHOD: Adherence to the COREQ guidelines.

Sero-Kinship: How Young People Living With HIV/AIDS Survive in Southeast Nigeria.

Research on the lived experiences of HIV survivors, including young people living with HIV, has primarily emphasized broader sociocultural concerns, such as stigmatization and cultural attitudes toward sexuality and gender, while giving less attention to the interconnectedness of these issues with the mental well-being of those affected by the illness. This study, drawing on relational ethnography including observations and interviews at four antiretroviral-administering healthcare facilities in Enugu State, southeast Nigeria, explores how young people living with HIV strive toward viral suppression and how they develop collaborative psychosocial support along with the global efforts in eradicating the HIV epidemic. We found that, in and between themselves, young people living with HIV weave for themselves a network of relationships, though discreetly, to foster and encourage survivorship. Such relatedness, where mutual trust and support have emerged and rebuilt HIV survivors' faith in a livable life, forms what we conceptualize as "sero-kinship." That is, sero-kinship, which focuses on how people create and change meanings in their everyday lives that ultimately contribute to controlling HIV and treatment management, forms an essential foundation on which a life with HIV becomes thinkable, bearable, then manageable, and acceptable.

Telecare that works: lessons on integrating digital technologies in elder care from Indian transnational families.

In recent decades, policy makers around the world have been working on implementing various technologies into healthcare, and the Covid19 pandemic fueled this process. The specialized technological solutions for telecare - the use of technologies for care at a distance - are often adopted by users in different ways than intended, or are abandoned if the users cannot find applications that are meaningful to them. However, beyond specialized healthcare technologies, people are incorporating mundane digital technologies into their (health)care practices. In this paper, we draw on ethnographic research on the use of everyday digital technologies in Indian families where migrating children who are professional nurses care for their aging parents at a distance. Our findings show that 1) remote elder care is enacted through frequent calling which further fosters trust, necessary to provide healthcare remotely; 2) the motivation for older adults to engage with digital technologies is grounded in the value of family and affect which is consequential also for health; 3) technologies, too, require care-work in the form of everyday maintenance; and 4) in-person visits from children remain important, indicating that hybrid interaction is optimal for good care at a distance. We conclude that taking these findings into account may contribute to a more successful implementation of formal telecare systems.

Data science's cultural construction: qualitative ideas for quantitative work.

Introduction: "Data scientists" quickly became ubiquitous, often infamously so, but they have struggled with the ambiguity of their novel role. This article studies data science's collective definition on Twitter. Methods: The analysis responds to the challenges of studying an emergent case with unclear boundaries and substance through a cultural perspective and complementary datasets ranging from 1,025 to 752,815 tweets. It brings together relations between accounts that tweeted about data science, the hashtags they used, indicating purposes, and the topics they discussed. Results: The first results reproduce familiar commercial and technical motives. Additional results reveal concerns with new practical and ethical standards as a distinctive motive for constructing data science. Discussion: The article provides a sensibility for local meaning in usually abstract datasets and a heuristic for navigating increasingly abundant datasets toward surprising insights. For data scientists, it offers a guide for positioning themselves vis-à-vis others to navigate their professional future.

Strengthening open disclosure in maternity services in the English NHS: the DISCERN realist evaluation study.

Background: There is a policy drive in NHS maternity services to improve open disclosure with harmed families and limited information on how better practice can be achieved. Objectives: To identify critical factors for improving open disclosure from the perspectives of families, doctors, midwives and services and to produce actionable evidence for service improvement. Design: A three-phased, qualitative study using realist methodology. Phase 1: two literature reviews: scoping review of post-2013 NHS policy and realist synthesis of initial programme theories for improvement; an interview study with national stakeholders in NHS maternity safety and families. Phase 2: in-depth ethnographic case studies within three NHS maternity services in England. Phase 3: interpretive forums with study participants. A patient and public involvement strategy underpinned all study phases. Setting: National recruitment (study phases 1 and 3); three English maternity services (study phase 2). Participants: We completed n = 142 interviews, including 27 with families; 93 hours of ethnographic observations, including 52 service and family meetings over 9 months; and interpretive forums with approximately 69 people, including 11 families. Results: The policy review identified a shift from viewing injured families as passive recipients to active contributors of post-incident learning, but a lack of actionable guidance for improving family involvement. The realist synthesis found weak evidence of the effectiveness of open disclosure interventions in the international maternity literature, but some improvements with organisation-wide interventions. Recent evidence was predominantly from the United Kingdom. The research identified and explored five key mechanisms for open disclosure: meaningful acknowledgement of harm; involvement of those affected in reviews/investigations; support for families' own sense-making; psychological safely of skilled clinicians (doctors and midwives); and knowing that improvements to care have happened. The need for each family to make sense of the incident in their own terms is noted. The selective initiatives of some clinicians to be more open with some families is identified. The challenges of an adversarial medicolegal landscape and limited support for meeting incentivised targets is evidenced. Limitations: Research was conducted after the pandemic, with exceptional pressure on services. Case-study ethnography was of three higher performing services: generalisation from case-study findings is limited. No observations of Health Safety Investigation Branch investigations were possible without researcher access. Family recruitment did not reflect population diversity with limited representation of non-white families, families with disabilities and other socially marginalised groups and disadvantaged groups. Conclusions: We identify the need for service-wide systems to ensure that injured families are positioned at the centre of post-incident events, ensure appropriate training and post-incident care of clinicians, and foster ongoing engagement with families beyond the individual efforts made by some clinicians for some families. The need for legislative revisions to promote openness with families across NHS organisations, and wider changes in organisational family engagement practices, is indicated. Examination of how far the study's findings apply to different English maternity services, and a wider rethinking of how family diversity can be encouraged in maternity services research. Study registration: This study is registered as PROSPERO CRD42020164061. The study has been assessed following RAMESES realist guidelines. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research Programme (NIHR award ref: 17/99/85) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 22. See the NIHR Funding and Awards website for further award information.

This study describes the experiences of families and healthcare professionals involved in incidents in NHS maternity care. The incidents caused harm-like injury or death to the baby or woman. We wanted to know whether services involved families in investigations and reviews and how this was done, what worked well, what did not work well and why. To do this, we first looked at what had already been written about 'open disclosure' or OD. Open disclosure is when the NHS admits to families that the care they provided has directly caused harm. After open disclosure occurs, families should be involved in making sure that the NHS learns so it can deliver better care for families in the future. In our reading, we found that families want a meaningful apology, to be involved in reviews or investigations, to know what happened to their loved one, to be cared for by knowledgeable doctors and midwives who are supported in providing open disclosure and to know things have changed because of what happened. Recommendations for involving families in open disclosure have improved, but there is still work to be done to make sure families are involved. Next, we talked to over 100 healthcare professionals involved in government policy for open disclosure in maternity services and 27 families who experienced harm. We spent 9 months observing the work of clinicians at three maternity services to watch open disclosure. We shared early findings with families, doctors, midwives and managers, and included their views. We found that services need to provide dedicated time, education and emotional support for staff who provide open disclosure. Services need to ensure that families have ongoing support and better communication about incidents. Finally, families must be involved in the review process if they want to be with their experiences reflected in reports and kept informed of ongoing improvements.

Immigrant and minority parents' experiences in a neonatal intensive care unit: A meta-ethnography review.

AIMS: To examine immigrant and minority parents' experiences of having a newborn infant in the neonatal intensive care unit and explore healthcare professionals' experiences in delivering care to immigrant and minority families. DESIGN: A meta-ethnographic review informed by eMERGe guidelines. METHODS: We conducted a systematic literature review. Studies were included if they explored immigrant or minority parent experiences in neonatal intensive care units and health professional experiences delivering care to immigrant and minority families in neonatal intensive care. Reporting followed ENTREQ guidelines. DATA SOURCES: Database searches included CINAHL, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar. Boolean search strategies were used to identify qualitative studies. No limitations on commencement date; the end date was 23rd August 2022. PRISMA guidelines used for screening and article quality assessed using Joanna Briggs Institute criteria for qualitative studies. RESULTS: Initial search yielded 2468 articles, and nine articles met criteria for inclusion. Three overarching themes were identified: (1) Overwhelming Emotions, (subthemes: Overwhelming Inadequacy; Cultural Expressions of Guilt; Not Belonging), (2) Circles of Support, (subthemes: Individual Level-Spirituality; External Level-Connecting with Family; Structured Peer-to-Peer Support), (3) Negotiating Relationships with Healthcare Professionals (subthemes: Connecting; Disconnected; Linguistic Barriers). Interactions between healthcare professionals and immigrant and minority parents were the strongest recurring theme. CONCLUSIONS: There can be a mismatch between immigrant and minority families' needs and the service support provided, indicating improvements in neonatal intensive care are needed. Despite challenges, parents bring cultural and family strengths that support them through this time, and many neonatal intensive care staff provide culturally respectful care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Professionals should be encouraged to identify and work with family strengths to ensure parents feel supported in the neonatal intensive care unit. Findings can inform policy and practice development to strengthen health professionals capabilities to support immigrant and minority families in neonatal units. REPORTING METHOD: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklists were used to report the screening process.

Identifying Facilitators and Inhibitors of Shared Understanding: An Ethnography of Diagnosis Communication in Acute Medical Settings.

BACKGROUND AND AIMS: Communication is important in determining how patients understand the diagnostic process. Empirical studies involving direct observation of communication within diagnostic processes are relatively limited. This ethnographic study aimed to identify communicative practices facilitating or inhibiting shared understanding between patients and doctors in UK acute secondary care settings. METHODS: Data were collected in acute medical sectors of three English hospitals. Researchers observed doctors as they assessed patients; semistructured interviews were undertaken with doctors and patients directly afterwards. Patients were also interviewed 2-4 weeks later. Case studies of individual encounters (consisting of these interviews and observational notes) were created, and were cross-examined by an interdisciplinary team to identify divergence and convergence between doctors' and patients' narratives. These data were analysed thematically. RESULTS: We conducted 228 h of observation, 24 doctor interviews, 32 patient interviews and 15 patient follow-up interviews. Doctors varied in their communication. Patient diagnostic understanding was sometimes misaligned with that of their doctors; interviews revealed that they often made incorrect assumptions to make sense of the fragmented information received. Thematic analysis identified communicative practices that seemed to facilitate, or inhibit, shared diagnostic understanding between patient and doctor, revealing three themes: (1) communicating what has been understood from the medical record, (2) sharing the thought process and diagnostic reasoning and (3) closing the loop and discharge communication. Shared understanding was best fostered by clear communication about the diagnostic process, what had already been done and what was achievable in acute settings. Written information presents an underutilised tool in such communication. CONCLUSIONS: In UK acute secondary settings, the provision of more information about the diagnostic process often fostered shared understanding between doctor and patient, helping to minimise the confusion and dissatisfaction that can result from misaligned expectations or conclusions about the diagnosis, and the uncertainty therein. PATIENT/PUBLIC CONTRIBUTION: A patient and public involvement group (of a range of ages and backgrounds) was consulted. They contributed to the design of the protocol, including the timing of interviews, the acceptability of a follow-up telephone interview, the development of the interview guides and the participant information sheets.

El sueño de llagar a ser futbolista. Reflexiones disciplinares para una Terapia Ocupacional híbrida / The dream of becoming a footballer. Disciplinary reflections for a hybrid Occupational Therapy / O sonho de tornar-se um jogador de futebol. Reflexões disciplinares para uma Terapia Ocupacional híbrida

El giro gradual que la Terapia Ocupacional ha tenido, desde posiciones teórico-metodológicas radicadas en las ciencias naturales hacia otras situadas en las ciencias sociales, ha propiciado diversos debates en la disciplina. Uno de los aspectos que se pone en cuestión, se refiere a las formas de comprender al otro, lo que a su vez deriva en métodos específicos de relación para generar conocimiento. Esto ha llevado a reconfigurar un marco epistémico, entendido como un conjunto interconectado de principios que subyacen a la investigación científica y a la propia práctica profesional. Tomando como inspiración una investigación etnográfica que tuvo lugar en la ciudad de Mar del Plata, Argentina, con cuatro clubes infantiles de fútbol, este texto presenta una reflexión acerca de las potencialidades de lo que aquí se denomina Terapia Ocupacional híbrida, como síntesis productiva entre su especificidad disciplinar y profesional y los aportes teóricos y metodológicos de la Antropología Social. Este ejercicio se torna en un llamado al encuentro de saberes que trascienda las fronteras académicas y disciplinares, produzca o alimente nuevos campos de actuación profesional o fortalezca los existentes.

The gradual shift in Occupational Therapy from theoretical-methodological positions rooted in the natural sciences to those situated in the social sciences has sparked various debates within the field. One of the aspects that is questioned refers to the ways of understanding others, which in turn leads to specific methods of relationship to generate knowledge. This has resulted in the reconfiguration of an epistemic framework, understood as an interconnected set of principles underlying scientific research and professional practice itself. Inspired by an ethnographic study conducted in the city of Mar del Plata, Argentina, with four junior football teams, this text presents a reflection on the potentialities of what is here referred to as hybrid Occupational Therapy, a productive synthesis between its disciplinary and professional specificity and the theoretical and methodological contributions of Social Anthropology. This exercise becomes a call for the convergence of knowledge that transcends academic and disciplinary boundaries, produces or nurtures new fields of professional action, or strengthens existing ones

A virada gradual na Terapia Ocupacional, das posições teórico-metodológicas radicadas nas ciências naturais para outras situadas nas ciências sociais, tem promovido diversos debates na disciplina. Um dos aspectos que é questionado refere-se às formas de compreender o outro, o que por sua vez resulta em métodos específicos de relação para produzir conhecimento. Isso levou a uma reconfiguração de um quadro epistêmico, entendido como um conjunto interconectado de princípios que fundamentam a pesquisa científica e a própria prática profissional. Inspirado por uma pesquisa etnográfica realizada na cidade de Mar del Plata, Argentina, com quatro clubes de futebol infantil, este texto apresenta uma reflexão sobre as potencialidades do que aqui se denomina Terapia Ocupacional híbrida, como síntese produtiva entre sua especificidade disciplinar e profissional, além das contribuições teóricas e metodológicas da Antropologia Social. Este exercício torna-se um chamado para a convergência de saberes que transcenda as fronteiras acadêmicas e disciplinares, produza ou alimente novos campos de atuação profissional ou fortaleça os já existentes