Lived experiences of end-of-life communication among nursing home staff: An interpretive phenomenological study.

AIMS: To explore and understand lived experiences of end-of-life communication among nursing home staff. DESIGN: Interpretive phenomenological study. METHODS: In-person, semi-structured, in-depth interviews were conducted from May to August 2021 with 21 nursing home staff members involved in end-of-life communication (four managers, four chief nurses, three chief medical officers, three nurses, three psychologists, two occupational therapists, one chief nurse aide and one nurse aide). Data were analysed by van Manen's hermeneutic approach, which uses the lifeworld existentials of spatiality, corporeality, temporality and relationality to guide reflection on the human experience. Data were reported according to the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Thirteen categories were identified and framed within the four existentials. Regarding spatiality, end-of-life communication took place in a physical, mental, socio-cultural and professional competence space. With regard to corporeality, interviewees reported difficulties in managing their own feelings and those of family caregivers. For temporality, interviewees reported delays in end-of-life communication due to staffing issues and an increase in urgent and temporary relief admissions to nursing homes. To compensate, they tried to assure that all interactions that did take place were of high quality. Finally, with regard to relationality, interviewees lived end-of-life communication through their relationships with family caregivers and colleagues. The supportive role of colleagues was expressed as teamwork, which helped promote reflexivity about how to tailor communication, manage challenging emotions and situations, set aside time for communication, and prepare family caregivers for death. CONCLUSION: End-of-life communication was an all-encompassing experience for nursing home staff. The supportive role of colleagues was stressed across all existentials, suggesting that teamwork is essential in delivering effective communication at the end-of-life. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution to this study, which addresses the experiences of nursing home staff only.

The experiences of seven women living with pelvic surgical mesh complications.

INTRODUCTION: This research sought to address a gap in the literature about women's lived experience of pelvic surgical mesh complications, conducted by an insider researcher. An increasing number of women who have pelvic mesh surgeries with a view to improving their lives are experiencing life-altering complications. Without knowledge of these experiences we cannot know how best to care for affected women and prevent harm to further women. METHODS: Van Manen's hermeneutic phenomenological method was used. Seven women with pelvic mesh complications aged 43-69 years were enrolled using criterion sampling. Four of the seven women had surgical mesh for both pelvic organ prolapse (POP) and stress urinary incontinence (SUI), one for POP only, and two for SUI only. The women completed a modified ICIQ-LUTSqol questionnaire pre-interview and answered a separate global spiritual question adapted from the HOPE tool, a framework for spiritual assessment. Women were interviewed once using a semi-structured approach. Data were analysed using Van Manen's selective reading technique and organized according to Lifeworld Existentials. RESULTS: Modified ICIQ-LUTSqol scores ranged between 43 and 76 (range 19-76), with a mean of 62.2 (SD + 10.011) demonstrating significant impact on quality of life. Themes emerging from the analysis were: (1) lived space: 1(a) feeling powerless in the medical space, 1(b) living in a shrinking world; (2) lived body: 2(a) living with unrelenting pain, 2(b) inhabiting a body that can no longer be relied on; (3) lived time: 3(a) living in the gap between what was and what could have been; (4) lived other: 4(a) suffering in silence, 4(b) finding absolute Other and others as a source of strength. CONCLUSIONS: Pelvic surgical mesh complications have an extensive adverse impact on the lifeworld of women experiencing complications. Failure to acknowledge mesh complications as treatment injury stalls the development of safer alternatives and changes needed to industry practices, regulation, clinical practice, and monitoring to keep women undergoing innovative urogynaecological procedures safe.

Life as Experienced Within and Through the Body After the Age of 85 Years: A Metasynthesis of Primary Phenomenological Research.

The body is central to the experience of aging. In this metasynthesis, the authors located, analyzed, and reconceptualized phenomenological research on how life is experienced within and through the body after 85 years. Sandelowski and Barroso's metasynthesis method was employed. Seven databases were searched for primary phenomenological studies. After systematic screening and quality appraisal, 19 studies were included for review. Analysis was guided by Maurice Merleau-Ponty's existential philosophy of embodiment. Findings were organized using Max van Manen's reflective lifeworld existentials. Four ontological dimensions emerged, namely, being in a body (corporeality), being in time (temporality), being in place (spatiality), and being with others (relationality). Each dimension captures a distinct experiential dimension of this stage of the life course. The results suggest vast heterogeneity in the ontological experience of aging, supporting the view that diversity grows with age. The ability to adapt to multidimensional losses was identified as a source of resilience.

Transformative and therapeutic benefits of digital storytelling: a phenomenological lifeworlds study of Patient Voices participant experiences.

BACKGROUND: References to transformative and therapeutic benefits of digital storytelling are often made, yet this remains an under-explored area, which we foreground in this study. METHODS: A phenomenological research design was adopted to explore through interview how a purposive sample of Patient Voices storytellers experienced participation in more than one digital storytelling workshop. Analysis was through thematic coding, linguistic analysis and use of van Manen's lifeworld existentials framework. RESULTS: We find that for this particular group, the therapeutic and transformative experiences that re-centre and re-frame personal meaning do so through inter-personal connections and can be understood as a process of social learning. The lifeworld existentials analysis demonstrates that a pluralist and relational conception of wellbeing holds and there is a close relationship between this and Yalom's 11 therapeutic factors. CONCLUSIONS: Drawing on group analytic literature, we suggest the concept of a social learning methodology as useful in grounding further research that seeks to understand the beneficial impacts of digital storytelling methodologies in healthcare and in contributing evidence in this field with fidelity to the lived experience as central.