Narrative Case Research Articles

Mining the past: The case for historical narratives in global justice theorizing

Debates on global justice, it is claimed, can be enriched in important ways by more explicitly historicizing our approach and using historical narratives, stories and debates to expand our conceptual vocabulary and theoretical purview. The claim is illustrated through a specific analysis of Paul Robeson’s relationship with the Welsh Miners. It is argued such a historical turn, grounded in a wider interdisciplinary engagement with subjects such as cultural studies may see at least three key benefits accrue in terms of our understanding of the field. Firstly, it can uncover philosophical and theoretical ideas and alternatives so far unconsidered; secondly, it can generate a shift in the empirical frame that accounts for and seeks to identify means for “real world” political change; lastly, it should encourage us to question the in/out dichotomy at the heart of the western debate, which projects global injustice as being “out there.”

Martin’s Lounge: From Valuation Engagement to Fraud Examination

ABSTRACT This case utilizes a fictional bar to engage students in using accounting information to detect and monitor for asset misappropriation by employees. Students are given background information about Martin’s Lounge and a task of identifying asset misappropriation and estimating losses due to asset misappropriation. All information necessary to solve the case is provided in the case narrative and the six Excel files supplied with the case. Students can use generalized audit software (e.g., IDEA), Microsoft Excel, or data analytic/visualization software to solve the case. The case challenges students to consider how accounting data can be used to detect instances of asset misappropriation and the possible perpetrator of a fraud. The case can be assigned as an individual assignment or a small group assignment.

Like Water, We Re-Member: A Conceptual Model of Identity (Re)formation through Cultural Reclamation for Indigenous Peoples of Mexico in the United States

Background: Diasporic Indigenous peoples of Mexico living in the United States continue to survive and reclaim their cultures despite multiple disruptions to identity formation resulting from systematic violence and cultural silencing enacted through white settler colonialism in the United States and Mexico. Honoring Indigenous survivance, the authors present a conceptual model of Indigenous identity healing and reformation that mirrors the dynamic qualities of water for Indigenous Mexican peoples living in the United States. Methods: The conceptual model arose from a ceremony-based, participatory, digital archiving project documenting Indigenous oral histories. The model is illustrated through case analysis of three Indigenous Mexican individuals living in the United States whose stories holistically represent the model’s components. Results: The case narratives illustrate how Indigenous Mexican identities are (re)formed by moving through the model components of Rift (disconnection from land, culture, and community), Longing (yearning to find what was lost), Reconnecting (reclaiming cultural practices), and Affirmation (strengthening of identity through community), via Reflection (memory work which propels movement through each stage). Conclusions: Findings suggest that identities can be (re)formed through reclaiming cultural practices and reconnecting with the community. This conceptual model may be useful for further understanding Indigenous Latinx identity development and healing.

Music teacher mothers’ career navigation during the COVID-19 pandemic

The purpose of this narrative case study was to re-present and re-story the experiences, particularly related to career navigation, of music teacher mothers in the United States during the COVID-19 pandemic. We explored how music teacher mothers had to adjust the balance between work, family, and personal life during the pandemic, in what ways the pandemic may have changed the way music teacher mothers parent, and how the pandemic may have affected, or already changed, music teacher mothers’ long-term career goals. Three participants, selected based on the diversity of their family structures, teaching backgrounds, and locations, shared their stories through a series of two interviews conducted via Zoom. Participants’ stories illuminated the relational, vocational, financial, and health-related struggles brought about by the nexus of teaching music during the pandemic. We explore resonances between their stories related to priorities, boundaries, career decisions, and financial considerations.

Backstage at the Barristers’ Case Conference: A Dramaturgical Analysis

Socio-legal ethnographies have focused largely on the dramaturgical themes present in the competing performances seen in adversarial trials. Drawing on ethnographic observations of British homicide investigations, we illuminate the hidden “backstage” space of prosecution barristers’ case conferences. Using Goffman’s dramaturgical framework, we analyze the interactions, deliberations, and negotiations that are enacted between barristers, homicide detectives, forensic scientists, and other specialists. To our knowledge, the work that happens in these conferences has never been documented. Our findings reveal how prosecution narratives evolve and are tested behind the scenes before being performed in court. We pay particular attention to the role of anticipatory work in guiding how criminal justice actors choreograph the prosecution case. The findings add to our understanding of narrative case building and elaborate Goffman’s dramaturgical framework. We discuss the implications of our findings for due process.

Treatment of cerebral ventriculitis with a new self-irrigating catheter system: narrative review and case series

Cerebral ventriculitis is a life-threatening condition that requires prompt and effective pharmacological intervention. The continuous irrigation of the cerebral ventricles with fluid and its drainage is a system to remove toxic substances and infectious residues in the ventricles; this system is called IRRAflow®. We used this kind of ventricular irrigation/drainage system to treat two patients with post-surgical cerebral ventriculitis and a patient with bacterial meningitis complicated with ventriculitis. In this case series, we discuss the management of these three cases of cerebral ventriculitis: we monitored cytochemical parameters and cultures of the cerebrospinal fluid of patients during their ICU stay and we observed a marked improvement after irrigation and drainage with IRRAflow® system. Irrigation/drainage catheter stay, mode settings, and antibiotic therapies were different among these three patients, and neurological outcomes were variable, according to their underlying pathologies. IRRAflow® system can be applied also in other types of brain injury, such as intraventricular hemorrhage, intracranial abscess, subdural hematomas, and intracerebral hemorrhage, with the aim to remove the hematic residues and enhance the functional recovery of the patients. IRRAflow® seems a promising and useful tool to treat infectious and hemorrhagic diseases in neuro-intensive care unit.

Complete transverse transection of the normal-sized non-pregnant uterus associated with wearing a safety belt in abdominal blunt trauma: Narrative review and case study.

This review and case study illustrates a patient with a complete transverse transection of a non-pregnant uterus caused by blunt trauma associated with wearing a safety belt. The 31-year-old patient, who had a previous cesarean section, presented with impending hypovolemic shock caused by intra-abdominal hemorrhage secondary to blunt trauma while wearing a safety belt. On physical examination, a transverse straight line of ecchymosis along the line of a fastened safety belt was noted without any other external injury. The operative findings revealed a complete transverse transection which had cut through the lower part of the non-pathological, normal-sized uterus with active bleeding and mild injury to the small bowel without active bleeding. Total hysterectomy and simple closure of the small bowel were performed with successful outcomes. We hypothesize that transection was caused by the enormous pressure produced by blunt trauma transmitted through the abdomen by the fastened safety belt and the weakness of the uterine wall caused by the previous low transverse cesarean section which facilitated the separation and extension to the entire wall. In conclusion, this case study provides the following learning points: (1) Enormous forces produced by a fixed fastened safety belt during a car accident can cause complete transverse transection of a normal-sized, non-pathological uterus, leading to life-threatening intra-abdominal hemorrhage. (2) A previous cesarean section may potentiate the transection, especially when the uterus is repositioned above the pelvic brim. (3) The gynecologic condition should also be included in the differential diagnoses in cases of intra-abdominal hemorrhage. If highly suspected, gynecologists should be notified for early recognition and avoidance of delayed actions.

Preparing for Death While Investing in Life: A Narrative Inquiry and Case Report of Home-Based Paediatric Palliative, End-of-Life, and After-Death Care.

Paediatric palliative care is pivotal for addressing the complex needs of children with incurable diseases and their families. While home-based care offers a familiar and supportive environment, delivering comprehensive services in this context is challenging. The existing literature on home-based palliative care lacks detailed guidance for its organization and implementation. This qualitative narrative inquiry explores the organization and provision of home-based paediatric palliative care. Data were collected from healthcare practitioners using conversations, storytelling, and reflective journaling. Schwind's Narrative Reflective Process was applied to synthesize the data, resulting in an in-depth case description. The narrative approach illuminates the complexities of home-based paediatric palliative, end-of-life, and after-death care. Key findings encompass the importance of early-care coordination, interprofessional collaboration, effective symptom management, emotional and psychosocial support, and comprehensive end-of-life planning. Through the case study of the child patient, the challenges and strategies for providing holistic, family-centred care within the home environment are described. Practical insights gained from this report can inform the development and improvement of home-based palliative care programs, benefiting researchers, practitioners, and policymakers seeking to optimize care for children and families in similar contexts.

Equity M&M - Adaptation of the Morbidity and Mortality Conference to Analyze and Confront Structural Inequity in Internal Medicine.

At morbidity and mortality (M&M) conferences, medical teams review cases for medical education and system improvement. Adverse outcomes are often driven by social inequity, but processes to analyze such outcomes are lacking. Adapt quality improvement and patient safety (QIPS) tools in the M&M format to systematically analyze adverse patient outcomes rooted in social and structural determinants of health (SSDH). One-hour conferences conducted in health systems in Seattle, WA, and Dallas, TX. Equity M&M conferences were held 11 times, each with approximately 45 participants comprised of internal medicine trainees, faculty, and non-medical staff. Conferences included a case narrative and counternarrative highlighting SSDH, an equity-framed root cause analysis, and potential interventions. Conferences were received well across both institutions. Following conferences, most respondents reported increased identification of opportunities for action towards equity (88.5%) and confidence in discussing equity issues with colleagues (92.3%). Equity M&M conferences are a structured tool for deconstructing and confronting structural inequity that leads to adverse patient outcomes. Evaluations demonstrate educational impact on participants. Anecdotal examples suggest institutional impact. Other health systems could adopt this model for similar advocacy and system improvement.

Acute cholecystitis as a complication of diverting loop ileostomy: A case series and narrative review

Introduction: Diverting ileostomy is increasingly utilized in modern colorectal surgery for the management of colorectal cancer and inflammatory bowel disease (IBD) among other bowel pathologies. Cholelithiasis has known associations with ileostomy and IBD, potentially caused by changes to enterohepatic circulation and cholesterol absorption in the gallbladder. However, cases of cholecystitis following ileostomy have not been reported across the literature. Case Series: We present three cases of cholecystitis following diverting loop ileostomy in a 56-year-old female, 74-year-old female, and 73-year-old female. A digital literature search was conducted on databases PubMed and EMBASE in February 2023 covering literature from 1974 to 2023 to identify any further cases; however, none were identified. To our knowledge, these are the first reported cases of cholecystitis following ileostomy. Conclusion: We believe these three cases highlight that developing symptomatic gallstones following diverting ileostomy occurs, and patients should be carefully counseled of the risks preoperatively, and be educated of gallstone-related symptoms to enable early engagement of upper gastrointestinal surgeons for treatment. Additionally, we recommend preoperative gallbladder imaging and close monitoring prior to and after ileostomy formation for development of gallstone complications. Ultimately, this case series and narrative review lay the groundwork for further research investigating any causality between diverting loop ileostomy formation and development of complications of gallstone disease.

The cultural and religious complexities of Amish-focused mental health conditions research: insights from an exhaustive narrative review and case study of counseling controversies

ABSTRACT This exhaustive review of Amish mental health conditions research suggests that studies are well-executed by methodological protocols but that (1) findings are inconsistent or limited in generalizability, (2) instrument validity remains contested, and (3) study investigation into Amish cultural-religious dynamics is limited. We present a case study from a sizeable Amish settlement finds that documents how competing ideologies – notably old Amish religious theology, the scientific-psychological, and the Evangelical Protestant – have generated Amish-internal controversies over defining and treating mental health conditions, suggesting that Amish mental health conditions research may produce inconsistent findings if not accounting for internal cultural-religious dynamics. Future research should include pre-study investigations into the targeted population's cultural and religious dynamics, consist of more nuanced case reports from therapists and psychiatrists, and include replication studies at different times and places, with deliberate attention to contextual factors.

The Utilisation of Social Media for Accessing Farming Information by Progressive Farmers

Background: It is more prominent in developing and under-developing nations where large number of populations resides in a rural area with agriculture as their main source of livelihood. Agricultural research, education and extension are critical components to increase productivity and fulfil the demands of an expanding population. Under India’s current extension delivery system, knowledge or information is vital for improving productivity. Digital advancement and social media have gained importance as technical leap leading to various software’s and applications making life easier, mankind can access various civic services, has led to two-way communication making system more accountable, sensible, responsible, a tool in curbing corruption. People, particularly progressive farmers, are using developing social media like WhatsApp, YouTube, Instagram as various platform of social media. India is an agrarian country and social media is helping in imparting knowledge and information to our farmers about recent technological developments such as hybrid seeds, irrigation methods, soil testing in farming. Methods: Narrative textual case study technique was used (NTCS). We used social media to gather information. Social media is making farmers and other people aware of sustainable use of resources. Result: Researchers have seen social media as more beneficial in obtaining agriculture-related information and putting digital knowledge into practice than other sources of information.

Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia.

Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively. First, we triangulated data between the peer-reviewed and grey literature; in-depth key informant interviews with subject matter experts; and quantitative metrics of population health and health system functioning. We used these data to construct thick descriptive narratives for each case. Finally, we performed a cross-case comparison by applying a thematic matrix based on the Essential Public Health Services framework to each case narrative. In Liberia, post-Ebola routine immunization coverage surpassed pre-epidemic levels, a feat attributable to investments in surveillance, comprehensive risk communication, robust political support for and leadership around immunization, and strong public-sector recovery planning. Recovery efforts in Haiti were fragmented across a broad range of non-governmental agencies. Limitations in funding, workforce development, and community engagement further impeded vaccine uptake. Consequently, Haiti reported significant disparities in subnational immunization coverage following the epidemic. This study suggests that embedding in-country expertise within outbreak response structures, respecting governmental autonomy, aligning post-epidemic recovery plans and policies, and integrating outbreak response assets into robust systems of primary care contribute to higher, more equitable levels of routine immunization coverage in resource-constrained settings recovering from epidemics.

Case report and narrative review of the literature: a rare colonic stent failure in a palliative patient

IntroductionWith palliative patients, a holistic approach is important. Interventions should minimise length of hospital stay, maximise quality of life, and control symptoms. A self-expanding metal stent (SEMS) for the palliative treatment of malignant large bowel obstruction (MLBO) is designed to provide these benefits to patients approaching the end of their life. We present the case of a patient treated with a SEMS over 2 years earlier for MLBO. He was treated with palliative intent at diagnosis because his frailty and medical co-morbidities precluded surgery. He later presented with severe tenesmus, and these new symptoms were later found to be due to a rare stent failure in which the stent had fractured and was irretrievable. This had to be managed conservatively before the patient sadly passed away 7 months later.DiscussionA SEMS is considered the first-line treatment to relieve MLBO caused by inoperable left-sided colonic cancer. This treatment offers a reduced length of hospital stay, reduced stoma rates, fewer complications, and comparable survival compared to de-functioning stoma. However, SEMSs are not expected to be in use for extended periods of time. The literature reports an average survival after a colonic stent insertion of between 121 and 199 days when used in a palliative setting.ConclusionThis is one of the first case reports to describe a colonic stent failure occurring over 2 years after insertion. This case argues that further research into the longer-term outcomes of this management option is warranted, particularly as palliative patients are living longer.

Sociocultural and Economic Barriers to Land Ownership Among Widows in Rural Western Kenya

Background Widows still face immense barriers in owning land and get inferior reliable rights to land than males across most Kenyan communities. The objective of this study, therefore, was to establish the sociocultural and economic factors that continue to bar widows from owning land in rural Western Kenya. Methods A cross-sectional study employing qualitative data collection methods was adopted in this study where six widows participated in Case Narratives (CN), and two Focus Group Discussions (FGDs) each with five widows and one FGD comprising eight men were conducted. In addition, six widows were identified from the FGD participants for in-depth interviews (IDIs) and 10 key informant interviews with stakeholders were carried out. Data from the qualitative interviews were transcribed for coding and analysis. The thematic content analysis method was used to identify themes related to sociocultural and economic factors hindering women from land ownership. Results Economic marginalisation, traditional land ownership structures, and practices such as the skewed land inheritance that disfavour women due to the deep-rooted patriarchy, low level of education and lack of awareness of existing land laws were found to be the major hindrances to land ownership by widows. In addition, the tedious process of accessing land documents and widow inheritance is also to blame. Conclusion The study concludes that the existence of a legal regime that accords women and widows the right to own land may not be sufficient in realising the intended gains for women if it is not backed up with an effective implementation and awareness creation on the laws as well as economic empowerment of the widows through targeted social protection schemes.

Family dyads, emotional labor, and holding environments in the simulated encounter: co-constructive patient simulation as a reflective tool in child and adolescent psychiatry training

BackgroundPatient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric populations, particularly in child and adolescent psychiatry, is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care, nor does it provide learners with an opportunity to engage with and reflect on these dynamics.MethodsWe organized as an educational opportunity a series of seven observed patient simulation sessions with a cohort of a dozen child and adolescent psychiatrists (eight fellows approaching graduation and four senior educators). In these sessions, we utilized the co-constructive patient simulation model to create the simulation cases. We included the use of at least two patient actors in most sessions, and two of the case narratives were longitudinally followed across multiple simulation sessions. We approached the data collected during the simulations and their respective debriefings by using thematic analysis informed by a symbolic interactionist approach.ResultsBased on data from the debriefing sessions and longitudinal narratives, we identified four overarching themes: (1) Reflecting on dyadic challenges: role reversal and individuation; (2) Centering the child, allying with the parent, and treating the family system; (3) Ambivalence in and about the parent-child dyad; and (4) Longitudinal narratives and ambivalence over time.ConclusionThe emotional experience of the simulations, for interviewers and observers alike, provided an opportunity to reflect on personal and professional experiences and triggered meaningful insights and connections between participants. These simulated cases called for emotional labor, particularly in the form of creating holding environments; in this way, the simulated encounters and the debriefing sessions became dialogic experiences, in which the patient and provider, parent and child, and learner and instructor could co-construct meaning and foster professional development as reflective practitioners.

Narrative abilities in individuals with Down syndrome: single case-profiles.

Narrative abilities are an important part of our everyday lives and social interaction with others. Nevertheless, narration is a complex ability influenced by language and cognition. This makes it difficult for individuals with language and cognitive impairment, such as in children and adolescents with Down syndrome. Previous studies have shown distinct narrative impairments in individuals with Down syndrome; nevertheless, this research was based on overall group means in most cases. To identify individual strengths and weaknesses and to draw conclusions for speech and language therapy, the narrative profile of every participant should be considered equally. Following this approach, the current study aims to describe single case narrative profiles in individuals with Down syndrome. The narrative transcripts of 28 children and adolescents with Down syndrome (aged 10;0-20;1), based on a non-verbal picture book, were rated using the Narrative Scoring Scheme across seven macro- and microstructural categories. Point scores across the whole group are displayed - nevertheless, the paper specifically addresses the individual narrative profiles of the participants. The participants could be assigned to narrative profile groups which show different characteristics, strengths and weaknesses. Group comparisons and correlations were computed for the relation to language abilities (especially vocabulary) and nonverbal cognitive abilities. The results of the two profile groups with minimal and developing narrative skills differ significantly not only concerning narrative outcomes in the Narrative Scoring Scheme but also for language abilities and developmental stage of nonverbal cognition. Individuals that show floor effects in narrative abilities are characterized by an overall weakness in language and cognition. In contrast, a group of approximately equal size shows distinct strengths in their narrative profiles which are in line with their vocabulary strengths, MLU and nonverbal cognition. The current study uses a new approach to identify individual narrative profiles in a group of individuals with Down syndrome. The results of the investigation underline the existence of narrative impairments in many individuals with Down syndrome but also point to individual strengths of the participants. Furthermore, the study outcomes suggest that narrative abilities might be representative for overall language and cognition in individuals with Down syndrome. However, intervention studies addressing narration are missing.

Hydrofluoric acid ingestions: Retrospective evaluations from cases reported to the National Poison Data System 2007-2017.

Hydrofluoric acid (HF) is associated with systemic toxicity, particularly with high-concentration formulations. However, most existing data describe dermal exposures; there is a paucity of data related to outcomes after ingestions. To determine the morbidity and mortality associated with HF ingestions as reported to the National Poison Data System (NPDS). A secondary objective is to assess for clinical criteria that are associated with serious outcomes after HF ingestion. We performed a retrospective review of HF ingestions reported to the NPDS from 2007 to 2017. Data including patient demographics, exposure and caller sites, electrolyte abnormalities, treatments, and serious (moderate or major effect or death as documented in NPDS) and non-serious outcomes were abstracted from case narratives. Cases meeting the criteria for a qualifiable HF ingestion were included in the study. During the study period, there were 653 HF ingestions reported to NPDS, of which 142 were included in the final data analysis. Most HF exposures occurred in men (68.3%), and the most common exposure site was at the exposed individual's own residence (78.2%). Nearly half of all exposures (46.5%) were due to transfer into a non-labeled secondary storage container. Total of 45.8% of the cases resulted in a serious outcome. Electrolyte disturbances were associated with an increased risk of a serious outcome. Hypocalcemia was the most frequently reported electrolyte abnormality, occurring in 24.6% of cases. Nine (6.3%) individuals died. Mortality after HF ingestion is low. However, a large cohort of exposures occurred after the transfer of HF to secondary containers. Targeted interventions to reduce this practice are necessary to decrease hazardous chemical exposures.

Health Care Professional Association Agency in Preparing for Artificial Intelligence: A Multiple-Case Study of Radiation Medicine and Medical Imaging in the Canadian Context

As artificial intelligence (AI) is increasingly integrated in healthcare, it is incumbent on healthcare professional associations (HPAs) to assist their memberships in preparing for related change. HPAs hold a unique role in establishing the socio-cultural, normative, and regulative elements of healthcare professions. An exploratory multiple-case study approach was employed to consider how, when faced with AI as a disruptive technology, HPAs engage in sense-making and legitimation of the change in order to support their membership in preparing for future practice. The Canadian Association of Medical Radiation Technologists, Canadian Association of Radiation Oncology, Canadian Association of Radiologists, and Canadian Organization of Medical Physicists were selected as cases. Data collection involved key-informant interviews and document review, anticipated impact of AI on care and practice, reflections on perceptions of the professional membership and the role and actions of the HPA in influencing such perceptions and work. Concept coding allowed for inductive framing of individual case narratives and subsequent cross-case analysis. Eighteen interviews were conducted and documents spanning 2013 to 2020 were reviewed. Eleven coding categories and 25 subconcepts were identified, spanning perceived impact of AI, perspectives on prevalent mindsets, roles of HPAs in preparing their membership, including changing education needs. The HPAs studied engaged in work to support AI consideration in varying ways, with perceived roles in education, advocacy, and leadership. Emergent trends across the four HPAs suggested three factors that might influence engagement; factors related to the organization, those related to the profession, and those related to the innovation in question. All HPAs acknowledged AI's impact on practice in medical imaging and radiation medicine, while some saw it as more of a disruptive force and assigned it greater priority in the organizations. Conceptualizations of the potential threat to the profession and the HPA's role in supporting members in navigating that future landscape were also key insights. This research suggests how healthcare professions are engaging at the macro level in the implementation and normalization work related to AI, and sheds light on nuanced perspectives on AI of groups that would interface with it.

Conscientisation and Communities of Compost: Rethinking management pedagogy in an age of climate crises

The unprecedented scale of the climate crisis has led to a questioning of conventional approaches to sustainability in management education, centred around business case for sustainability narratives. Such critique gives rise to serious questions around how we approach teaching the universality of the climate crisis, species extinction and biodiversity loss differently. Working with Freire’s stress on the political role of the educator, action rooted in the concrete and the interconnections he establishes between pedagogy and political organisation, our contribution is to connect these interventions with Haraway’s call to stay ‘with the trouble’ and generate Communities of Compost – that is, collective more than human communities of multi-species flourishing. In doing so, we propose threading together ecocentric and political economy approaches in management education, to present an alternative to corporate sustainability solutionism and to politically rethink scalar mismatches – that is when problems and proposed ‘solutions’ to the climate crisis apply to different sets of relations. As a way of addressing this, we develop pedagogical practices around Haraway’s multi-species Communities of Compost and combine this with the political movement of La Via Campesina – focusing on its campaigns for agroecology and food sovereignty.