Does Moral Case Deliberation Help Professionals in Care for the Homeless in Dealing with Their Dilemmas? A Mixed-Methods Responsive Study

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation (MCD) is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization.     

Am I My Brother’s Keeper? Moral Dimensions of Informal Caregiving in a Neoliberal Society

Within the current Dutch policy context the role of informal care is revalued. Formal care activities are reduced and family and friends are expected to fill this gap. Yet, there is little research on the moral ambivalences that informal care for loved ones who have severe and ongoing mental health problems entails, especially against the backdrop of neoliberal policies. Giving priority to one’s own life project or caring for a loved one with severe problems is not reconciled easily. Using a case study we illustrate the moral ambivalences that persons may experience when they try to shape their involvement and commitment when a relative is in need. The case comes from a research project which explores whether it is possible to reduce coercive measures in psychiatry by organizing a Family Group Conference. The purpose of the article is to explore what theoretical concepts such as ‘communities of fate’, ‘communities of choice’ and ‘personal communities’ add in understanding how persons shape their involvement and commitment when a family member experiences recurrent psychiatric crises.     

“What’s in a Name”

Pulmonary parameters including tidal volume, respiratory rate, minute volume, pulmonary flow resistance, dynamic compliance of the lung, and the work of breathing were measured in unanesthetized cynomolgus monkeys. A small group of animals was tested frequently during a period of 78 weeks and regression analysis of the data, including calculations of confidence limits, provided an estimate of the variation and trends in the above parameters. A digital computer technique, which was used for real-time data analysis of the recorded analog signals, was developed to elucidate the effects of long-term exposure to low levels of pulmonary irritants and urban atmospheric pollutants, such as sulfur dioxide and nitrogen dioxide.     

“Mom” as a Protective Strategy Used by Children in Foster Care

How children use language impacts on their adjustment in foster care. It is important to understand the strategies children use with caregivers to protect themselves. The shortage of literature on how children cope in foster care is concerning because it limits placement workers in their ability to help children in care. This paper examines some of the reasons children take it upon themselves to call their foster caregiver Mom even when they have been discouraged from doing so. The phenomenon of children referring to foster caregivers as Mom is examined in this paper for how this strategy provides protection for children, theoretical explanations for how the use of Mom works, and for the opportunities its use brings.     

“It’s intense,you know.” Nurses’ experiences in caring for patients requesting euthanasia

The Belgian Act on Euthanasia came into force on 23 September 2002, making Belgium the second country—after the Netherlands—to decriminalize euthanasia under certain due-care conditions. Since then, Belgian nurses have been increasingly involved in euthanasia care. In this paper, we report a qualitative study based on in-depth interviews with 18 nurses from Flanders (the Dutch-speaking part of Belgium) who have had experience in caring for patients requesting euthanasia since May 2002 (the approval of the Act). We found that the care process for patients requesting euthanasia is a complex and dynamic process, consisting of several stages, starting from the period preceding the euthanasia request and ending with the aftercare stage. When asked after the way in which they experience their involvement in the euthanasia care process, all nurses described it as a grave and difficult process, not only on an organizational and practical level, but also on an emotional level. “Intense” is the dominant feeling experienced by nurses. This is compounded by the presence of other feelings such as great concern and responsibility on the one hand, being content in truly helping the patient to die serenely, and doing everything in one’s power to contribute to this; but also feeling unreal and ambivalent on the other hand, because death is arranged. Nurses feel a discrepancy, because although it is a nice death, which happens in dignity and with respect, it is also an unnatural death. The clinical ethical implications of these findings are discussed.     

Understanding Women’s Choices: How Women’s Perceptions of Quality of Care Influences Place of Delivery in a Rural Sub-County in Kenya. A Qualitative Study

Maternal and Child Health Journal - Maternal mortality is still unacceptably high in Kenya. The Kenyan Government introduced a free maternity service to overcome financial barriers to access. This...     

A Case Study of the Neti Pot’s Rise,Americanization, and Rupture as Integrative Medicine in U.S. Media Discourse

In a period of only one decade in the United States, the neti pot shifted from obscure Ayurvedic health device to mainstream complementary and integrative medicine (CIM), touted by celebrities and sold widely in drug stores. We examine the neti pot as a case study for understanding how a foreign health practice became mainstreamed, and what that process reveals about more general discourses of health in the United States. Using discourse analysis of U.S. popular press and new media news (1999–2012) about the neti pot, we trace the development of discourses from neti’s first introduction in mainstream news, through the hype following Dr. Oz’s presentation on Oprah, to 2011 when two adults tragically died after using Naegleria fowleri amoeba-infested tap water in their neti pots. Neti pot discourses are an important site for communicative analysis because of the pot’s complexity as an intercultural artifact: Neti pots and their use are enfolded into the biomedical practice of nasal irrigation and simultaneously Orientalized as exotic/magical and suspect/dangerous. This dual positioning as normal and exotic creates inequitable access for using the neti pot as a resource for increasing cultural health capital (CHC). This article contributes to work that critically theorizes the transnationalism of CIM, as the neti pot became successfully Americanized. These results have implications for understanding global health practices’ incorporation or co-optation in new contexts, and the important role that popularly mediated health communication can play in framing what health care products and practices mean for consumers.     

Looking for Mr. PG: Masculinities and men’s depression in a northern resource-based Canadian community

Research has attributed the ‘silent suffering’ of men with depression to the influences of dominant masculine ideals such as strength and stoicism. Similarly, rural ideals – romanticized notions about rural places – have been shown to mute mental health issues and create barriers to help-seeking. This article examines the experiences of men with depression in Prince George, a northern resource-based community in British Columbia, Canada. Findings reveal how depressed men and their female partners enacted strategies to positively reinforce men’s gendered sense of self, in a context that otherwise may render them ‘out of place’. While favouring men’s wellbeing, these strategies can also perpetuate an invisible geography of men’s depression.     

Exploring the use of emoji as a visual research method for eliciting young children’s voices in childhood research

Recognition of the need to move from research on children to research with children has prompted significant theoretical and methodological debate as to how young children can be positioned as active participants in the research process. Visual research methods such as drawing, photography, and videography have received substantive attention in child-centred research paradigms. However, despite their increasing ubiquity in young children’s lifeworlds, technology or media-based visual materials have received little interest. This article reports on a study which used emoji as a visual research method for eliciting young children’s (aged three to five years) understandings and experiences of well-being. Findings elucidate the capacity of emoji as a visual research method for eliciting children’s voices, and considerations for its use in child research.     

“Yo No Sabía...”—Immigrant Women’s Use of National Health Systems for Reproductive and Abortion Care

Half of pregnancies worldwide are unintended; half of these end in abortion. Immigrant women encounter more obstacles to reproductive healthcare than non-immigrant women, and access to national healthcare is a particularly important factor in abortion access. Spain’s government recently liberalized abortion laws, including abortion services in the national health system available to immigrants. Evidence suggests that immigrant women in Spain experience difficulties navigating the health system—the impact of the changed abortion laws on immigrant’s women’s access to care is not yet clear. Through a literature review and analysis, this paper examines the experiences of immigrant women with national health systems, and their use of such systems for reproductive and abortion care, in order to explore what could be expected in Spain as the national health system expands to include abortion care, and to illuminate immigrant women’s experiences with using national health systems for reproductive healthcare more broadly.     

Perezhivanie as a phenomenon and a unit of analysis for studying children’s interactions with iPads in the early years of school in Saudi Arabia

In Saudi Arabia, there is a lack of research into the educational use of touch technologies. The literature focuses on how children use these technologies and how they support learning, but little is known about the impact of these devices on children’s socio-emotional outcomes. This study examines how children relate emotionally to both iPads and each other when they are introduced into educational settings in Saudi Arabia, where no tradition for their use exists. Data (80 hours of video observations and interviews) were collected from a grade one class in a Saudi school. The cultural-historical concept of perezhivanie was used to analyse how iPads affect children’s interaction within the classroom, and it was found that the initial introduction of the iPad acted as a tool for both explicit self-regulation and implicit self-regulation. This study contributes to understanding how the use of touch technologies in Saudi Arabia affects children’s emotional development.     

“They Can’t Understand It”: Maternity Health and Care Needs of Immigrant Muslim Women in St. John’s, Newfoundland

Objectives The purpose of this qualitative study was to document and explore the maternity health care needs and the barriers to accessing maternity health services from the perspective of immigrant Muslim women living in St. John’s, Canada. Methods A purposive approach was used in recruiting six individuals to participate in in-depth semi-structured interviews. Data were analyzed using a two-step process of content analysis. Three metathemes were identified and compared to previous research on maternity health and the care needs of immigrant women. Results Women experienced discrimination, insensitivity and lack of knowledge about their religious and cultural practices. Health information was limited or lacked the cultural and religious specificity to meet their needs during pregnancy, labor and delivery, and postpartum phases. There were also significant gaps between existing maternity health services and women’s needs for emotional support, and culturally and linguistically appropriate information. This gap was further complicated by the functional and cultural adjustments associated with immigration. Conclusions Maternity health care information and practices designed to meet the needs of mainstream Canadian-born women lacked the flexibility to meet the needs of immigrant Muslim women. Recommendations for change directed at decision makers include improving access to culturally and linguistically appropriate maternity and health related information, developing the diversity responsiveness of health care providers and the organizations where they work and establishing social support networks and partnerships with immigrant communities. Changes that address the needs of immigrant Muslim women have the potential to create more inclusive and responsive maternity health services for all Canadian women.     

“It’s on everyone’s plate”: a qualitative study into physicians’ perceptions of responsibility for smoking cessation

Background

Little research has investigated in-depth how physicians perceive their role in smoking cessation care. This qualitative study sought to understand physicians’ perceptions of responsibility for smoking cessation.

Methods

Data were collected through individual semi-structured interviews and focus group interviews between June and November 2017 in The Netherlands. We interviewed 5 addiction specialists, 5 anesthesiologist, 4 cardiologists, 8 GPs, 5 internists, 5 neurologists, 2 pediatricians, 6 pulmonologists, 7 surgeons, and 8 youth healthcare physicians (N?=?55). Data analysis followed the framework approach.

Results

The analysis showed that three actors were perceived as responsible for smoking cessation: physicians, patients, and the government. Participants perceived physicians as responsible for facilitating smoking cessation -albeit to different extents-, patients as carrying the ultimate responsibility for quitting smoking, and the government as responsible for creating a society in which smoking uptake is more difficult and quitting smoking easier. Perceptions of smoking itself were found to be important for how participants viewed responsibility for smoking cessation. It remained unclear for many participants which healthcare provider is responsible for smoking cessation care.

Conclusions

The organization of smoking cessation care within health systems should be a focus of intervention, to better define physician roles and perceptions of responsibility. In addition, it seems important to target perceptions of smoking itself on the level of physicians and –as suggested by comments by several participants- the government.

     

“It’s still a great adventure” – exploring offshore employees’ working conditions in a qualitative study

Background

Despite the particular demands inherent to offshore work, little is known about the working conditions of employees in the German offshore wind industry. To date, neither offshore employees’ job demands and resources, nor their needs for improving the working conditions have been explored. Therefore, the aim of this study was to conduct a qualitative analysis to gain further insight into these topics.

Methods

Forty-two semi-structured telephone interviews with German offshore employees (n =?21) and offshore experts (n =?21) were conducted. Employees and experts were interviewed with regard to their perceptions of their working conditions offshore. In addition, employees were asked to identify areas with potential need for improvement. The interviews were analysed in a deductive-inductive process according to Mayring’s qualitative content analysis.

Results

Employees and experts reported various demands of offshore work, including challenging physical labour, long shifts, inactive waiting times, and recurrent absences from home. In contrast, the high personal meaning of the work, regular work schedule (14 days offshore, 14 days onshore), and strong comradeship were highlighted as job resources. Interviewees’ working conditions varied considerably, e.g. regarding their work tasks and accommodations. Most of the job demands were perceived in terms of the work organization and living conditions offshore. Likewise, employees expressed the majority of needs for improvement in these areas.

Conclusions

Our study offers important insight into the working conditions of employees in the German offshore wind industry. The results can provide a basis for further quantitative research in order to generalize the findings. Moreover, they can be utilized to develop needs-based interventions to improve the working conditions offshore.

     

“They Told Me to Come Back”: Women’s Antenatal Care Booking Experience in Inner-City Johannesburg

To assess women’s experience of public antenatal care (ANC) services and reasons for late antenatal care attendance in inner-city Johannesburg, South Africa. This cross-sectional study was conducted at three public labour wards in Johannesburg. Interviews were conducted with 208 women who had a live-birth in October 2009. Women were interviewed in the labour wards post-delivery about their ANC experience. Gestational age at first clinic visit was compared to gestational age at booking (ANC service provided). ANC attendance was high (97.0 %) with 46.0 % seeking care before 20 weeks gestation (early). Among the 198 women who sought care, 19.2 % were asked to return more than a month later, resulting in a 3-month delay in being booked into the clinic for these women. Additionally 49.0 % of women reported no antenatal screening being conducted when they first sought care at the clinic. Delay in recognizing pregnancy (21.7 %) and lack of time (20.8 %) were among the reasons women gave for late attendance. Clinic booking procedures and delays in diagnosing pregnancy are important factors causing women to access antenatal care late. In a country where a third of pregnant women are HIV infected, early ANC is vital in order to optimise ART initiation and thereby reduce maternal mortality and paediatric HIV infection. It is therefore imperative that existing antenatal care policies are implemented and reinforced and that women are empowered to demand better services.