Living with an incomplete vagina and womb: an interpretative phenomenological analysis of the experience of vaginal agenesis

Background Acquired Brain injury (ABI) causes ripples throughout the occupational and social fabric. It enters people’s lives at a significant personal cost, encroaching on people’s sense of self. Vocational rehabilitation is a viable venue to regain control of their life and support them in forming a new sense of self. From an occupational perspective, little is known about how vocational rehabilitation can support people through transforming their sense of self. Aim This study aims to explore how vocational rehabilitation may influence the relationship between sense of self and occupational engagement for persons with ABI. Material and Methods: Six persons with ABI were purposely sampled. Data were collected using semi-structured individual interviews and analysed using a hermeneutic approach. Results The analysis resulted in three themes: a new sense of my former self, engaging in occupations as transformation, and the significance of support. Conclusions Participating in vocational rehabilitation can enable persons with ABI to form a new sense of self. Engaging in occupations and professional support is significant in the transformation process. Significance From an occupational perspective, the knowledge gained in this study stresses the essential role occupational engagement and proper targeted support have for people struggling to return to work after ABI.

Despite an increasing interest in the experiences of people who have been diagnosed with dementia, there is still a dearth of research into how people cope with the onset of the illness. This study uses qualitative methodology to examine the appraisals and coping processes of 20 men diagnosed with early-stage Alzheimer’s disease. Semi-structured interviews were conducted with the men and their wives. These were analysed using Interpretative Phenomenological Analysis. The men’s accounts suggested that they attempted to manage their sense of self by balancing their wish to maintain a prior sense of self against their need to reappraise and construct a new sense of self. This seemed to be an ongoing, circular process. Ways in which services can assist men in the process of managing their sense of self are explored.

This study seeks to investigate the lived experiences of multi-locational actors and the production of unique forms of socialization and community using the seasonal movements and settlements of the Québécois population (also referred to as “Floribécois”) in Broward County, Florida during the winter months. This study employs interpretative phenomenological analysis (IPA) which is theoretically rooted in hermeneutic phenomenology. IPA recognizes that there are shared perspectives and lived experiences of a group of people about a concept or a phenomenon. This analysis comprises of collectively shared meanings, while being mindful of the unique experience of a single individual and/or subgroup. The IPA methodology is especially applicable in this study because its emphasis is on the construction of meaning, context, and various aspects of everyday life practices within social phenomena. The findings of this thesis tie together meanings from the narratives. What emerged were themes of familiarity, consistency and reliability vis-a-vis space, a relationship between spontaneity/adventure and limitations of sameness, repetition, and routine in relation to the concept of “freedom”. The narrative of mobility as freedom in these cases converged to stories about having a place where individuals carve out private spaces and have “freedom” of choice about everyday routines. Such different practices and subjectivities display another way of interacting with existing forms of space and mobility, unlocking lifestyles untethered from the restraint of existing theories. In sum, this study reveals how a new sense of self is formed and redefined, and how mobility and space configurations are constantly shifting within existing structures.

Purpose - The purpose of this study is to examine whether a psychological concept enhances healthcare users’ service experience. Specifically, the study proposes and empirically examines a model of perceived control in which the user’s sense of control is postulated as exerting positive influences upon his/her motivation, self-efficacy associated with his/her role as a patient, and satisfaction with his/her medical service experience. Methodology - Data were collected by a professional research company, using an online survey method. Participants of the study included adults nineteen years or older who had visited a medical service institute at least once during the previous one-year period. For the test of the research hypotheses, structural equation modeling using AMOS was used. Findings - Findings of this study denote a unique insight into the users’ comprehension of medical service experiences and their behaviors. First, the concept of perceived control is identified as a factor that enhances the quality of individuals’ medical service experiences. A sense of control directly influences medical users’ self-efficacy to comply with doctor’s recommendations, their motivation to comply with doctor’s recommendations, and their satisfaction with the medical service experience. Second, one’s perceived self-efficacy is found to exert positive influences upon both motivation and satisfaction. Third, one’s motivation to comply with the doctor’s recommendation is found to exert a positive influence upon one’s satisfaction. Additionally, perceived control is found to exert an indirect influence upon medical service users’ satisfaction through the mediation of both self-efficacy and motivation. Research Implications - The findings of the study support the notion that perception of control among medial service users enhances their service experience as patients. The main thrust of this study suggests that it is necessary for healthcare practitioners to consider implementing service encounter strategies that purposefully enhance the sense of control among their patients. The identification of significant inter-relationships among perceived control, motivation, self-efficacy, and satisfaction among medical service customers should also serve as a meaningful seed for further research pursuits.

BackgroundLiterature reports that the psychological impact for women following severe perineal trauma is extensive and complex, however there is a paucity of research reporting on women’s experience and perspective of how they are cared for during this time. The aim of this study was to explore how women experience and make meaning of living with severe perineal trauma.MethodsA qualitative interpretive approach using a feminist perspective guided data collection and analysis. Data were collected through semi-structured face to face interviews with twelve women in Sydney, Australia, who had experienced severe perineal trauma during vaginal birth. Thematic analysis was used to analyse the data.ResultsThree main themes were identified: The Abandoned Mother describes how women feel vulnerable, exposed and disempowered throughout the labour and birth, suturing, and postpartum period and how these feelings are a direct result of the actions of their health care providers. The Fractured Fairytale explores the disconnect between the expectations and reality of the birth experience and immediate postpartum period for women, and how this reality impacts upon their ability to mother their newborn child and the sexual relationship they have with their partner. A Completely Different Normal discusses the emotional pathway women travel as they work to rediscover and redefine a new sense of self following severe perineal trauma.ConclusionHow women are cared for during their labour, birth and postnatal period has a direct impact on how they process, understand and rediscover a new sense of self following severe perineal trauma. Women who experience severe perineal trauma and associated postnatal morbidities undergo a transition as their maternal body boundaries shift, and the trauma to their perineum results in an extended physical opening whereby the internal becomes external, and that creates a continual shift between self and other.

This study explored long-term consequences of obesity surgery. Interpretative phenomenological analysis was used to analyse transcripts of 10 interviews with patients who underwent surgery 8 or more years ago. Experiences were described under three broad themes: eating behaviours, relationship with food and quality of life. Although patients described variability within these themes, describing different patterns of change, analysis revealed associations between themes and outcomes. In particular, those who reported successful weight loss also described the functionalization of food, the development of new coping strategies and a process of positive reinvention creating a new sense of self.

To investigate the experiences of ischaemic stroke survivors during the transitional period from the hospital through the first 4weeks after discharge home. Ischaemic stroke survivors describe the transition from hospital to home as an important time in their recovery and describe various physical and cognitive concerns early within the recovery period. Adequate transitional care interventions should be informed by such experiences. This is a qualitative descriptive study. This study used semistructured telephone interviews and an inductive approach to enable thematic analysis of information from 31 persons experiencing an ischaemic stroke. Five major themes emerged: (a) the shock of a stroke interrupting a normal day; (b) transition to an unfamiliar home; (c) uncertainty; (d) understanding a new sense of self; and (e) adjusting to a new sense of self. All participants articulated a need to cope with uncertainty and adjusting to a new sense of self. Ischaemic stroke survivors who experienced less uncertainty described that return to their prior daily routine, preventing another stroke, depended on a helpful support system including frequent follow-up and communication with healthcare professionals. All ischaemic stroke survivors are at risk for complications during recovery, regardless of stroke severity. This study found that, even after experiencing minimal physical or cognitive symptoms, ischaemic stroke survivors can have difficulty adjusting to life after discharge. Adjusting to life after a stroke during the first 4weeks after discharge home is an in individualised experience. For the complex psychosocial and physical needs of ischaemic stroke survivors, nurses can play an important role beyond symptom management by fostering a dynamic relationship through individualised transitional care based on ischaemic stroke survivors experiences.

Although non-invasive ventilation (NIV) can benefit survival and quality of life, it is rejected by a substantial proportion of people with motor neurone disease (MND). The aim of this study was to understand why some MND patients decline or withdraw from NIV. Nine patients with MND (male=7, mean age=67years) participated in this study. These patients, from a cohort of 35 patients who were offered NIV treatment to support respiratory muscle weakness, did not participate in NIV treatment when it was clinically appropriate. Semi-structured interviews and interpretative phenomenological analysis (IPA) were employed to explore these patient's experience of MND and their thoughts and understanding of NIV treatment. Using IPA, four themes were identified: preservation of the self, negative perceptions of NIV, negative experience with health care services, and not needing NIV. Further analysis identified the fundamental issue to be the maintenance of perceived self, which was interpreted to consist of the sense of autonomy, dignity, and quality of life. The findings indicate psychological reasons for disengagement with NIV. The threat to the self, the sense of loss of control, and negative views of NIV resulting from anxiety were more important to these patients than prolonging life in its current form. These findings suggest the importance of understanding the psychological dimension involved in decision-making regarding uptake of NIV and a need for sensitive holistic evaluation if NIV is declined. Statement of contribution What is already known on this subject? Non-invasive ventilation is widely used as an effective symptomatic therapy in MND, yet about a third of patients decline the treatment. Psychological disturbance generated by NIV use leads to negative experiences of the treatment. Decision-making about treatment potentials is complex and unique to each individual affected by perceived impact of disease. What does this study add? A decision concerning NIV uptake was influenced by perceived impact on individuals' sense of self. Sense of self was influenced by the maintenance of autonomy, dignity, and quality of life. Individuals' sense of self was identified to have been challenged by the disease, NIV, and their experience of health care service.

Patients’ perceptions of repair, rehabilitation and recovery after major orthopaedic trauma: a qualitative study

To construct a satisfaction evaluation indicator system based on patients' experiences of medical services. A questionnaire was designed by expert interview and literature review and 400 copies were randomly handed out to inpatients and outpatients from five 3A-public hospitals in Shanghai. The patient's evaluation of importance of various factors in medical services was analyzed and the mean and weight of indicators in terms of recognition, importance and evaluation were determined to establish a satisfaction evaluation indicator system. A total of 396 valid questionnaires were retrieved, with an effective response rate of 99%. By analyzing survey data, the patient satisfaction evaluation indicator system was constructed with 5 primary indicators (hospital environment, medical procedures, attitude, and quality of care and patient rights) and 25 secondary indicators (convenient hospital environment, auxiliary facilities, reasonable arrangement, clearly mark, convenient appointment, simple procedures, short time, the attitude of medical staff, solutions of medical dispute, medical technology, treatment, medical equipment, medical expenses, respect, patient privacy, etc.). A patient satisfaction evaluation indicator system has been established based on patients' experience of medical services in the study, which may be applicable to measure patients' satisfaction and to improve medical services in hospitals.

Child Protection and Mental Health

The Global and the Local: Mapping Changes in Irish Childhood Tom Inglis (bio) The global image of Ireland has changed. It has moved from De Valera’s dream of a nation of romping, sturdy children, athletic youths and comely maidens, to one in which innocent boys and girls were incarcerated in industrial and reformatory schools where they were demeaned, abused, and brutalized. And yet the Irish seemed deeply committed to children, at least to having them. Throughout most of the twentieth century Irish fertility was higher than that in most other Western societies. It would appear that successive generations of women who married wanted to have large families. For many people, growing up with numerous brothers and sisters was central to childhood. Now fertility is more controlled, families are smaller, and more mothers are working. Given this change in demographics, Luddy and Smith (2009, 6) ask some simple questions: “What if anything is new about how childhood is currently understood in Ireland? How has the understanding of Irish childhood changed over time? And how do earlier conceptions of Irish childhood feed into and/or inform more recent conceptualizations?” One of the main changes is that married women no longer see themselves simply or primarily as mothers, and that the reduction in family size, together with an increase in economic prosperity, has led to changes in the way that children are seen, understood, and treated, which in turn has led to a new sense of self among Irish children. If we can describe and analyze what is different about contemporary Irish childhood, we may understand how Ireland itself has changed. I suggest that what has changed most in Ireland is the influence [End Page 63] of global culture. The regimes of caring, disciplining, and controlling children have altered. The everyday life of children revolves around a new individualism that is based on self-expression and self-fulfillment. Irish children live locally but have adopted lifestyles, tastes, and practices that are increasingly similar to those in the rest of the West. This new sense of self stands in contrast to the culture of self-denial and humility that was central to family and school life in the last century when the Catholic church dominated social and cultural life. Parents have the competence and resources to plan when children are born, the wealth and resources to fulfill their children’s interests and pleasures, and more importantly, they have the time, space, and competence to develop close, emotional relations with their children. These changes have been linked to a shift from formal to informal relations, from authority to mutual bonding between adults and children, thus altering the way in which children and adults see and understand each other (Wouters 1999; 2007). If the prophecies of some globalization theorists are correct (Bryman 2004; Cook 2004; Peterson 2005), some of which are supported by recent research findings (Haller 2010), then it may well be that the sense of self, embodied through socialization experiences, which was central to Irish cultural difference, is being slowly swallowed up within Western culture. Irish children’s lives have become permeated by images, ideas, and practices that emerge from global media and markets. To develop an understanding of this process, we need to make use of theories and concepts which enable us to look for evidence of the impact of global culture. I argue that it is best to analyze changes in Irish childhood in terms of children being caught up in global flows. But they are also caught up in local and national flows. What is required, then, is an analysis of how the global and the local come together in children’s lives—what some commentators refer to as glocalization. We also need to use innovative research methods. As part of an exploratory study in the globalization of Irish childhood, I make use of short essays written by some schoolchildren that provide insights into their daily lives and sense of self. I conclude that what is different about contemporary Irish childhood is the permeation of messages about the importance of self and the pursuit of pleasure. This sense of self-worth and confidence can be linked to the rise...

Italian anthropologist Ernest De Martino (1908–1965) devoted much of his writing to the analysis of “the crisis of presence,” an existential dilemma evidenced in a disturbed sense of self and often expressed as illness, emotional distress, or “alienation.” This article describes De Martino's conceptualization of the crisis of presence as a problem of consciousness with moral and emotional dimensions and applies it in interpreting the conversion narratives of three Italian Pentecostal Christians. The resolution of the crisis, for these Christians, entails the construction of a new sense of self, and particularly a new relationship to time and history. [De Martino, Pentecostalism, religion, existential crisis, Italy]

A grounded theory methodology was used to explore patients' experiences with end-stage renal disease (ESRD) and hemodialysis. The emerging theory suggests that a "new sense of self" is an emotional/psychological state that fluctuates with the evolving meanings of illness and treatment and perceived quality of supports. The findings indicate that when confronted with this new way of being in the world, the individual becomes cognizant of an uncertain future, continued dependence on life-sustaining technology and the expertise of health care providers, and the demands on and sacrifices incurred by significant others. All aspects of patients' experiences with ESRD and hemodialysis treatment must be considered if health care providers are to facilitate positive health outcomes.

Previous research regarding Early Intervention in Psychosis (EIP) services has mainly adopted quantitative methodologies, in order to study the effectiveness of EIP services. Research studies that have explored service-users' experiences of EIP services are small in number. This research aimed to explore service-users' experiences of being in contact with an EIP service, its impact of their experience of psychosis and current life situation. Interpretative Phenomenological Analysis (IPA) was used to conduct an in-depth qualitative study of a small sample of EIP service-users, in order to explore their experiences of being in contact with the service. Flexibly guided interviews were conducted with eight service-users who had been receiving a service from an EIP team for more than 2 years and were recruited using a purposive sampling method. Verbatim interview transcripts were analysed using IPA. Five super-ordinate themes, developed from the analysis, are discussed in sections: Stigma, Relationships, Understanding the experiences, Sense of agency, and Impact on sense of self. Sub-themes of these super-ordinate themes are also discussed. The themes developed from the analysis were envisioned as representing an overarching theme of 'A personal journey of recovery', which was influenced by participants' involvement with the EIP service. Clinical implications include the need for EIP services, as with other mental health services, to find ways to promote recovery and create opportunities for agency and control. Future research directions are also discussed.