Integrating Clinical Intuition for a Whole Person Approach to Empowerment

Real-time data collection and analysis processes have been designed and an initial capability is demonstrated for the July, 1994 JTMDSN test data. The JTMDSN is a one-year, distributed interactive simulation (DIS) demonstration sponsored by the Defense Modeling and Simulation Office (DMSO). The JTMDSN is built on past TACCSF and RESA DIS accomplishments such as their War Breaker support, to make two more major contributions to the DIS community. First Army, Navy, Air Force, and National Systems interfaced via tactical data links using signal Protocol Data Units (PDUs). Second, the data was collected online from PDUs and reduced to records of key events which could be used to display mission performance and network performance measures in real-time. This paper focuses on this data collection and analysis capability. The JTMDSN DIS Gateway, including the data collection process, was designed and developed by Martin Marietta Corporation. Data analysis processes are being developed by BDM Engineering Services Company. >

Our aim with this article is to demonstrate how the researchers use bracketing as a method of demonstrating the validity after initiating a phenomenological study. Although bracketing is a method of demonstrating the validity of the da ta collection and analysis process in most phenomenological studies, how the researchers use them in practice is rarely demonstrated explicitly. We collected data through our experiences in preparing a phenomenological research study. We suggest that the concept of bracketing should be adopted upon initiating the research proposal and not merely in the data collection and analysis process. We propose four strategies for doing bracketing that are guided by the thinking activity of reflexivity: mentality assessment and preparation before deciding the research paradigm, deciding the scope of the literature review according to the prevailing gate - keeping policy, planning for data collection using semi - structured interviews guided by open - ended questions, and planning for data analysis using Colaizzi’s method. Our proposition highlights that thorough preparation for doing bracketing is essential before entering the data collection and analysis process in phenomenology, because they are sequentially related.

BackgroundTelemonitoring (TM), as part of telehealth, allows physiotherapists to monitor and coach their patients using remotely collected data. The use of TM requires a different approach compared with face-to-face treatment. Although a telehealth capability framework exists for health care professionals, it remains unclear what specific capabilities are required to use TM during physiotherapy treatments.ObjectiveThis study aims to identify the capabilities required to use TM in physiotherapy treatment.MethodsAn exploratory qualitative study was conducted following a constructivist semistructured grounded theory approach. Three heterogeneous focus groups were conducted with 15 lecturers of the School of Physiotherapy (Bachelor of Science Physiotherapy program) from the Amsterdam University of Applied Sciences. Focus group discussions were audiotaped and transcribed verbatim. Capabilities for using TM in physiotherapy treatment were identified during an iterative process of data collection and analysis, based on an existing framework with 4 different domains. Team discussions supported further conceptualization of the findings.ResultsSixteen capabilities for the use of TM in physiotherapy treatment were found addressing 3 different domains. Four capabilities were identified in the “digital health technologies, systems, and policies” domain, 7 capabilities in the “clinical practice and application” domain, and 5 capabilities in the “data analysis and knowledge creation” domain. No capabilities were identified in the “system and technology implementation” domain.ConclusionsThe use of TM in physiotherapy treatment requires specific skills from physiotherapists. To best use TM in physiotherapy treatment, it is important to integrate these capabilities into the education of current and future physiotherapists.

Purpose: Despite considerable interest in the effects of music in an exercise context, there is a dearth of research examining the use of music-videos. This is surprising given the ubiquity of this medium in exercise facilities. The present study sought to examine the impact of a music-video channel on the social process of exercising in a public exercise facility. Method: A grounded theory approach underpinned by pragmatism and symbolic interactionism was employed. Thirteen exercisers completed reflective diaries following each attendance at the facility over a 4-week period. Subsequently, 11 exercisers were interviewed regarding the impact of the music-video channel on the social process of exercising at the facility. Staff members’ perspectives were deemed important throughout the iterative process of data collection and analysis. Accordingly, four staff members were interviewed with reference to the social process of managing an exercise facility that featured a music-video channel. Data were analyzed using open, axial, and selective coding. Results: The results provide support for a three-stage substantive theory that commences with the content of the music-video channel. The second stage depicts a series of moderators (e.g., exercise factors, temporal factors) that revolve around the core category, appraisal of the appropriateness of channel content. Lastly, a range of effects pertaining to exercisers and facility staff are predicted, and relevant social processes are expounded. Conclusion: Given the prevalence of music-video channels in contemporary exercise and health facilities, the substantive theory bears relevance to exercisers, health/performance practitioners, and researchers.

BackgroundIn families where one of the siblings has an eating disorder (ED), research indicates that the siblings without eating disorders (EDs) experience insufficient care and negative changes in family life. The illness then takes up a great deal of space within the family. Support from the siblings without EDs is considered to be important for the recovery of the sibling with ED. A key issue is how to involve siblings without EDs in treatment and establish what kind of support they themselves need. A majority of the research on EDs and family has focused on children and adolescents with EDs. The aim of this study is to expand knowledge about the experiences and coping strategies of sisters and brothers of adult women with anorexia nervosa or bulimia nervosa.MethodsThis qualitative study used a constructivist grounded theory approach. Individual semi-structured interviews were conducted with 10 sisters and brothers (aged 20–31 years). They were recruited from eating disorders and general psychiatrics units and from user organisations for patients with eating disorders within Norway. An iterative process of data collection, coding and analysis was employed in order to generate a theory about these participants’ experiences and strategies.ResultsThe core category is “put your own oxygen mask on first”. It indicates that the siblings realize that they need to take care of themselves first, in order to be able to stay involved with their sister with the ED. The three subcategories; “taking a new role”, “distancing” and “adapted care” describe how the siblings handle their situation as the relatives of adult sisters with an ED. The siblings without ED became more responsible and independent and assumed a caregiving role. They downplayed their own needs to reduce their parents’ burden. This new role became difficult to fulfil and the siblings experienced that over time they needed more distance. Eventually, they developed a more manageable way of caring for their sister.ConclusionsThe findings suggest that the ED challenged the boundaries within the family. The siblings without ED assumed a caregiver role, gradually leading to exhaustion and the need to distance from the sister with the ED, to take care of themselves.

High-quality data are essential for developing knowledge in qualitative inquiries. Language impairments affect the ability to meet the requirements that constitute good qualitative data. In this article, we focus on generating good qualitative data in persons with aphasia following stroke. We drew on experiences from a longitudinal nursing intervention to discuss how to maximize data generation in accordance with norms for data quality in this population. The longitudinal design, using a combination of research methods, and the iterative process of data generation and analysis over time constituted a continuity that enhanced communication, mutual understanding, and a trustful partnership.

ObjectivesTo understand and report on the direct-to-consumer virtual care industry in Canada, focusing on how companies collect, use and value patient data.DesignQualitative study using situational analysis methodology.SettingCanadian for-profit virtual care...

Massive volumes of health data flow to commercial data brokers worldwide, yet little empirical research has examined how this industry functions and the implications for patients. To describe and analyze the primary care medical record industry in Canada and its data collection and commercialization practices. This qualitative study of the Canadian primary care health data industry used situational analysis, a grounded theory methodology. Data sources included semistructured interviews of individuals affiliated with the commercial health data industry from May 2022 to May 2023 and publicly available documents. Data were analyzed from May 2022 to May 2024. Individual semistructured interviews and relevant publicly available documents were analyzed to gain an understanding of data collection and commercialization practices in the primary care record industry. The analysis involved a continuous and iterative process of data collection and analysis, theoretical sampling, data-driven coding, and creation of theoretical concepts. A total of 19 interviews were conducted and 22 documents were sampled. Study participants described the primary care medical record industry in Canada as consisting of complex reciprocal relationships between commercial health data brokers, physicians, for-profit chains of primary care clinics, and pharmaceutical companies. In an emerging vertically integrated business model, the data broker brought the primary care clinics and physicians in house as a clinical subsidiary, thus obtaining more control over clinical practices. Participants understood the primary care medical record industry as having potential to transform patient care, but-because of financial considerations-also tied to pharmaceutical industry interests. According to participants, patients were not involved in decisions related to how their records were collected and used. This qualitative study found that each entity within the Canadian primary care medical record industry contributes to, and benefits from, the conversion of patient medical records into commercial assets. The industry's activities reflect the pharmaceutical companies' interests. Patients are notably absent from decision-making; thus, the industry's activities may not reflect their values or interests.

Understanding the spatial and temporal characteristics of individual and group behavior in social networks is a critical component of visual tools for intelligence analysis, emergency management, consumer analysis, and human geography. Identification and analysis of patterns of recurring events is an essential feature of such tools. In this paper, we describe an interactive visual tool for exploring the visitation patterns of guests at two hotels in central Pennsylvania from 1894 to 1900. The centerpiece of the tool is a wrapping spreadsheet technique, called reruns, that reveals regular and irregular periodic patterns of events in multiple overlapping artificial and natural calendars. Implemented as a coordinated multiple view visualization in Improvise, the tool is in ongoing development through an iterative process of data collection, transcription, hypothesis, design, discovery, analysis, and evaluation in close collaboration with historical geographers. Numerous discoveries have driven additional data collection from archival newspaper and census sources, as well as plans to enhance analysis of spatial patterns using historic weather records and railroad schedules. Distributed online evaluations of usability and usefulness have resulted in feature and design recommendations that are being incorporated into the tool.

IntroductionProstate cancer is one of the most frequent cancers among men. However, screening for prostate cancer carries many risks and a small benefit. Thus, based on the available evidence, most...

'My Transplanted Self': Adolescent recipients' experience of post-traumatic growth following thoracic transplantation.

Increased global competition between destinations has given rise to sophisticated marketing to potential visitors. At the same time, consumers are increasingly sceptical of organisation generated marketing messages, instead turning to their own personal networks for timely, accurate and credible information through word-of-mouth (WOM). WOM is a communication phenomenon which occurs in a social context. On one level the basic premise of WOM is widely understood by academics, practitioners and consumers alike. Word of mouth exchanges provide a balance of information and opinion, in a setting that provides the flexibility to 'tailor make' the message in terms of detail in a highly efficient and congruent way. However, how and why these exchanges unfold within the context of travellers and those with whom they interact during travel remains an under researched area. Following a review of literature from sociology, social psychology, marketing, communications, tourism and other relevant areas, the theoretical, empirical and methodological gaps were identified. The lack of research into WOM between visitors at a destination directed the focus of the thesis which explored how the interaction between travellers at a destination impacts the WOM dynamic. Specifically, the thesis examines the relationship constructs of homophily (similarity) and tie-strength (closeness) with communication and settings to address these gaps. A case study methodology was used to better understand the richness of the WOM phenomenon as it applies to travellers during their visit in the context of their network of relationships. Two groups of traveller were selected, caravanners and backpackers, due to the similarities (flexible itineraries, motivation to socialise, communal accommodation and homogeneity of each group), but also due to the differences between the groups (mode of travel, travel party, demographics) – necessary for the purpose of comparison. Cairns in Far North Queensland was selected as the research site because it is a major destination for both groups. The research comprised four phases; observation of travellers in-situ, semi-structured interviews with destination based industry representatives, focus groups with participants from each of the two traveller groups and then surveys of each traveller group. An iterative process of data collection and analysis was used whereby each phase shaped the subsequent phase. Key ideas emerged from the iterative process of collection and analysis with reference made to the existing literature. The emergence of relationships, settings and communication bounded in time were the key themes. Based on these themes an explanatory model of at-destination WOM is proposed and detailed. The nested model shows the interrelated nature of these themes and examines both the elements of the model and explains the model as a whole. The findings also indicate a shift from the traditional thinking of independent travellers influenced by external forces, such as the destination marketing organisation, to a new 'networked independent traveller' who is constantly connected both in a corporeal and virtual sense to others. Finally, the research dismisses the widely held view in the academic literature that WOM is solely an output of social interaction between visitors at a destination. Instead, the study finds that WOM is both a contributor to and a consequence of travellers' social interactions at a destination. The study broadens the current view of WOM, the travellers who use it and how it fits in the social interaction of travellers at a destination. It builds on what is already known and offers researchers and marketers valuable insights into the human side of WOM but one that also incorporates technology as a key communication media. The study progresses research by tying the intricate and complex micro WOM episodes to the macro WOM phenomenon. It offers an approach which captures the nuance, reveals the episodic meaning, addresses research gaps and builds on existing tourism communication network theory.

In the study, which was carried out to compare the perception of organizational power distance of the academic staff working at the university with the social networks they established with their colleagues at the university, the quantitative and qualitative data collection and analysis processes were carried out simultaneously using the Convergent Parallel Design, one of the mixed methods research designs, and the results of the data analysis were integrated. This research compares the organizational power distance perceptions of the faculty members working at A University, a public university in Turkey, with the social networks they have established with their colleagues at the university. In the quantitative dimension of the research carried out with the mixed method, the research population consists of 1848 academic staff working at A University, one of the public universities in Turkey, in the 2020-2021 academic year. The research sample consists of 319 academic staff. 385 academic staff from 30 academic units, 14 faculties, and 16 colleges/vocational schools, were included in the research. In the qualitative dimension of the research, 27 of 34 academic staff working in the C Department of the B Faculty of the A University were included in the study group. Convergent Parallel Design was used in the research; within this context, the quantitative and qualitative data collection and analysis processes were carried out simultaneously and the data analysis results were integrated. The quantitative data were analyzed with the SPSS 21 program, the participants' views on organizational power distance were analyzed with the MAXQDA 2022 program, and social network analysis data were analyzed with the UCINET 6.0 program. According to the research findings' conclusion, the academic staff's general social network tendencies in the quantitative dimension were high, and the participants had the highest perception of "liking to connect." It was determined that the academic staff's general organizational power distance perceptions were at a moderate level, and the participants had the highest perception of "acquiescence of power." Another conclusion was that the social network tendencies of academic staff did not differ according to the academic title variable. However, the organizational power distance differed significantly in favor of research assistants. It was revealed that there was no statistically significant relationship between the general social network tendencies of the academic staff and their perception of organizational power distance. In the qualitative dimension of the study, it was observed that the participants expressed their opinions on organizational power distance mostly in terms of accepting power and least in terms of consenting to power. Social network analysis revealed that the professional network had a denser structure than the friendship network, but the friendship network had more structured and stronger ties. In social networks, professors and research assistants were found to be at the center of the network. The study observed that the results of quantitative and qualitative data analysis confirmed each other at many points. This study is expected to contribute to the literature, policymakers in higher education management, university senior management, academics, and researchers.

Current approaches to health advocate (HA) training leave many physicians feeling ill-equipped to advocate effectively. Likewise, faculty perceive the HA role as challenging to teach, role model, evaluate and assess. Progress on improving HA training is further stalled by debate over the role's importance and whether it should be considered intrinsic to medical practice. Recent graduates are well-positioned to comment on how these challenges affect HA training and preparation for practice. Therefore, our purpose was to explore the perspectives of new-in-practice physicians who are keen to be effective advocates. Ten early-career physicians participated in semi-structured interviews exploring their perceived competence and motivation to engage in health advocacy. Constructivist grounded theory informed the iterative data collection and analysis process. Participants wished they knew during training how much they would use advocacy in practice. While training imparted adequate patient-level advocacy skills, participants felt underprepared to enact system-level advocacy-which they conceptualized as a wide-range of activities including political advocacy. In turn, participants grappled with lack of preparation, waning motivation, feelings of futility, lack of value for advocacy and need for self-preservation. For these reasons, they questioned whether system-level advocacy should be expected of all physicians. Although training may adequately prepare physicians for patient-level advocacy, system-level advocacy training remains insufficient. While patient-level advocacy is integral to good care, whether system-level advocacy should be a universal expectation deserves closer consideration. Perhaps system-level health advocacy may be better conceptualized as a specialized role requiring additional training. Regardless, physician advocates' efforts need to be valued for their contributions.

Objective: To better understand the day‑to‑day lived experiences of those adults with type 2 diabetes, in particular, their historical and current ability to self manage this condition. Design: This qualitative study utilised aspects of both phenomenology and grounded theory to inform the study design, namely an iterative thematic content data collection and analysis process. This enabled the identification of emerging themes. Setting: Sample subjects all resided in Whanganui, New Zealand and were interviewed either in their own home, workplace or in a private room at the Whanganui Regional Primary Health Organisation. Subjects: Nine in depth interviews were conducted with a purposively selected sample of adults living with type 2 diabetes; five females and four males; four New Zealand Europeans, four Māori and one Samoan. Years since diagnosis ranged from one to twenty three. Results: The results demonstrate similarities between this research and that conducted internationally in terms of the impact of the diagnosis of type 2 diabetes and the difficulties adopting and adapting to the complex self care tasks required to manage this chronic condition on a daily basis. Support to self manage in this study was harnessed more readily from spiritual beliefs, family and friends rather than from health professionals. Conclusion: Development of a sense of ownership or control of the condition is paramount to enable people to self manage effectively on a day to day basis and is determined primarily by the individual’s personal support systems. The primary focus of care should therefore be on the ‘person’, their story, needs and support systems, including the provision of health services and educational programs, well versed with and reflective of the broad principles of self management in a multi cultural environment.