Constant Comparative Technique Research Articles

Our Hands, Our Health: Developing a Promising Group Healthcare Model for Pediatric to Adult Transition in a Sickle Cell Disease Clinic

Background: The transition of adolescents and emerging adults (AEA) from pediatric to adult care is often challenging. This is especially true for those with sickle cell disease (SCD) because transition coincides with a time period of rapidly increasing mortality risk. Gaps in knowledge and lack of appropriate communication skills can contribute to this risk. Many SCD AEA do not know which variant of SCD they have, cannot explain their relevant medical history, do not understand or take ownership over requesting prescription refills, and do not have the skillset to navigate health insurance. Additionally, pain is an invisible complication that cannot be objectively measured and requires communication skills. Many patients lack the necessary communication skills to effectively articulate their pain to healthcare providers. To address the transition needs of individuals with SCD, our team adapted and developed an innovative group healthcare model based on the core components of the well-established Centering® healthcare model. We produced a group healthcare curriculum entitled Our Hands, Our Health based on these gaps in knowledge. At each session, the 8-10 patients in the group will have a one-on-one visit with their hematologist and then meet with the entire group for 60 minutes of health education through group discussions led by two facilitators using interactive activities, games, and role-plays. Patients form relationships with other members of the group and with the co-facilitators as they collaboratively discuss and generate health education strategies. Methods: Using a constant comparative technique, we reviewed the core components of the Centering® model and systematically integrated these into the Our Hands, Our Heath program. The health education content reflects the needs of all AEA as well as the unique healthcare needs of AEA with sickle cell disease as they prepare to transition to adult care. Next, we completed a 6-session feasibility and acceptability study with four participants who met monthly. Then, we expanded the program from 6 to 10 sessions and conducted a full-scale pilot meeting every other month (n=13). Direct observations of sessions, debriefings, and interviews with participants and co-facilitators were used to evaluate the model. Results: Participants and co-facilitators enthusiastically embraced the Centering-based group care model. The feasibility participants (n=4) stated that they preferred group care to individual care. From the pilot, there was only one participant who did not like meeting in a group; all others (n=9) reported that they enjoyed group meetings and preferred getting their care this way. Three participants were lost to follow-up due to moving (n=2) and full-time employment (n=1). After the 4th session, six participants reported feeling more prepared for transition. Participants described the value of shared experiences and appreciated the engaging learning environment. Participants felt group meetings offered a supportive environment allowing them to develop relationships with peers who can relate, as well as with their healthcare provider, who was a co-facilitator. They were comfortable asking questions for clarification and liked being able to have in-depth discussions. Co-facilitators reported that it was more efficient to convey health education material in groups than repeating things to each patient one by one and observed participants in group care had an increased understanding of the health education messages. Some structural changes included securing a room larger, how patients were checked in and checked out, how vital signs were taken, and the hiring of a phlebotomist. Conclusions: The Centering-based group care model was feasible and acceptable by participants and co-facilitators. In addition to patient-focused assessments, we suggest including provider satisfaction and perceived quality of care measures. Sustainability is an important consideration and a costs/benefits analysis is needed. Based on our developmental research, a Centering-based group care model appears to offer a promising strategy to increase health education and will facilitate a successful transition from pediatric to adult care. Our long-term goal is to test the efficacy of such a model. DisclosuresNo relevant conflicts of interest to declare.

Seeking “better ways”: early career faculty researcher development

PurposeResearcher development is an important but underexplored topic with implications for knowledge production, graduate education, faculty development and equity in higher education. The purpose of this constructivist instrumental case study was to understand how the process of writing and publishing from qualitative dissertations sparked researcher development among two pre-tenure faculty members in higher education.Design/methodology/approachTwo researchers and seven data sources (i.e. six essays and one dialogue transcript) were used to construct the case. Researchers first inductively and independently coded the data sources. Researchers then collectively used the constant comparative technique (Charmaz, 2014) for data analysis.FindingsData analysis uncovered an iterative, three-phase process of seeking “better ways” (Evans, 2011) to translate dissertations into publications. This process included (1) recognizing one or more issues in the research design or conveyance of data, (2) rallying in a multitude of ways to seek better ways to address the issue(s) and (3) resolving the issue(s) by following internal voices and finding “better ways”.Originality/valueFindings offer implications for faculty members’ approaches to mentoring and graduate preparation, and for postdoctoral and early career scholars’ agentic approaches to publishing, teaching and reflecting on one’s own researcher development.

Abstract 133: "I’m Not the Same Person....": Understanding Cardiac Arrest Survivorship and Long -Term Outcomes From the perspective of Survivors and Families

Background: Of those victims that are discharged alive following sudden cardiac arrest (SCA), the five-year survival rate is upwards of 75%. However, the survivor experience of “living” and their quality of life after such a life-changing event can be quite variable. Unfortunately traditional outcome measures in the SCA literature make gross, snapshot assumptions about what constitutes a “good” outcome and rarely account for life after hospital discharge. The objective of this study was to understand the survivor and family/caregiver experience of life after SCA and what outcomes are important to them as “life goes on”. Methods: In-depth qualitative interviews were conducted with survivors and their families/caregivers at various stages of survival. Survivors and family members were interviewed together and separately. The interviews focused on concepts such as what their recovery journey was like, what long-term issues were most important to them and how we might implement measures of such concepts into more research and practice. Interviews were audio-taped, transcribed verbatim and analyzed by the authors using constant comparative thematic analysis techniques. Results: During in-depth interviews with more than 30 survivors and caregivers we heard that despite being a relatively high functioning group, their lives have been deeply affected by their cardiac arrest experience. They spoke about the importance of both psychologic and physical recovery and the influence of latent depression, anxiety, memory-loss, fatigue, infertility, changes in body image and relationships with loved ones. For some there have also been unique challenges with having an implanted cardiac defibrillator (ICD). Spouses/family members spoke about the caregiver burden, anxiety around their loved ones health and the impact of not having any sense of what to expect after discharge. Conclusions: The psycho-social type outcomes identified as very influential by survivors and families are almost entirely unmeasured in the resuscitation literature. This robust qualitative work gives us important insight that we hope to use to design more survivor-centred outcome measures for prospective use in research and practice. (*Abstract will be co-presented with an SCA survivor)

Evaluating the use of text message communication in a postpartum patient navigation program for publicly insured women

ObjectiveTo compare communication between navigators and women according to follow-up status in a postpartum patient navigation program (“Navigating New Motherhood” [NNM]). MethodsThis is a mixed methods secondary analysis of text message and email transcripts from NNM. Transcripts were analyzed by number of messages sent, received, and unanswered. Message themes were qualitatively analyzed using constant comparative technique. Bivariable and multivariable tests were conducted. ResultsMost women (98.2%) communicated with navigators via text message. Women who completed postpartum follow-up sent and received more texts than women who did not (7.8 vs. 3.7, p < 0.001 and 11.5 vs. 8.0, p < 0.05, respectively); exchange of ≥6 messages was associated with greater odds of follow-up (adjusted odds ratio 2.89, 95% CI1.13–7.41). Lack of patient response was also associated with lack of follow-up (p < 0.001). Four categories of message themes were identified: Rapport-building, Postpartum Care Coordination, Maternal Health, and Motherhood. Message threads with more Rapport-building or Maternal Health messages were associated with more frequent patient follow-up (p < 0.01 and p < 0.05, respectively), as was average number of emoticons per message thread (2.1 vs. 1.2, p = 0.01). ConclusionMore frequent and multidimensional communication was associated with follow-up in a postpartum patient navigation program. Practice ImplicationsText messaging can serve as a favorable communication platform within patient navigation.

Tensions Living Out Professional Values for Physical Therapists Treating Injured Workers.

Health care services provided by workers' compensation systems aim to facilitate recovery for injured workers. However, some features of these systems pose barriers to high quality care and challenge health care professionals in their everyday work. We used interpretive description methodology to explore ethical tensions experienced by physical therapists caring for patients with musculoskeletal injuries compensated by Workers' Compensation Boards. We conducted in-depth interviews with 40 physical therapists and leaders in the physical therapy and workers' compensation fields from three Canadian provinces and analyzed transcripts using concurrent and constant comparative techniques. Through our analysis, we developed inductive themes reflecting significant challenges experienced by participants in upholding three core professional values: equity, competence, and autonomy. These challenges illustrate multiple facets of physical therapists' struggles to uphold moral commitments and preserve their sense of professional integrity while providing care to injured workers within a complex health service system.

Factors impeding efficient functionality of community operated urban water schemes: the experience of Kisumu, Kenya

Numerous studies have measured the benefits of community participation in promoting equity and efficiency in the water service-provisioning sector. However, few have focused on factors which affect functionality in community operated water schemes in urban centers. The purpose of this study is to fill this gap in knowledge. Using qualitative data gathered through focus group discussions and employing constant comparative analytic techniques this study identify four unique factors which affect functionality in community operated water schemes in Kisumu, an urban area in Kenya. The following factors seem to influence this process: (1) clannism; (2) colonial planning/zoning laws; (3) physical/geographical constraints; and (4) population increase/community fatigue. Three policy suggestions are made which can be adopted to address these impediments. One, feasibility studies should precede the execution of most future urban-based community operated water schemes in the developing world. Two, funding agencies should focus on developing strategies to collaborate with the communities upon the completion of the projects. Third, managing community urban water systems requires adequate integration and coordination between the beneficiary community and city planners on issues of land use.

Exploring Patient and Caregiver Perceptions of Primary Healthcare Sector Home Care for Simple Acute Wounds.

To provide information about a study exploring patient and caregiver perceptions of home wound care for patients with simple acute wounds in Singapore. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. After completing this continuing education activity, you should be able to:1. Assess benefits and barriers to home wound care management.2. Analyze the methodology, results, and implications of the study. To control healthcare expenditure, patients with simple, acute, low-risk wounds are encouraged to perform self-wound care at home. However, patient perception of this care is not known. To explore patient and caregiver perceptions of home wound care for patients with simple acute wounds in the primary healthcare sector in Singapore. This study used the constructivist grounded theory approach. Nine participants from 2 polyclinics were interviewed. In vivo codes were extracted, and the constant comparative technique was applied throughout the analytical process. Fear, lack of knowledge, and the difficulty in performing care resulted in many patients avoiding self-wound care. Age, educational level, and cost did not have much impact. Participants with some first aid knowledge and those who appreciated the flexibility of self-wound care were more likely to embrace this concept. Participants also suggested that telecommunications and mobile nurses could assist in this concept. Generally, patients are willing to accept this self-wound care concept. To ensure successful implementation, nurses should encourage eligible patients to attend educational programs to prepare them to perform wound care at home.

The Dentist's Role in Southern Brazilian Teaching Hospitals: A Grounded Theory Study.

The aim of this study was to develop a theoretical model to describe the role that the dentist plays in Brazilian hospital settings. This qualitative study was based on the grounded theory research method. Participants were a total of 27 individuals in three groups: dentists and general practice and oral and maxillofacial surgery residents; faculty; and other health professionals who interacted with dental patients in the hospital setting during the 2012-13 year. Data were collected in three teaching hospitals in the state of Santa Catarina, Brazil, through scripted interviews using open-ended questions. The stages of collection, codification, ordination, and integration of data were guided by constant comparative techniques to formulate a theoretical model. The codes generated were organized into seven categories: identifying the hospital as a working and teaching environment; recalling the dentists' professional pathways; reflecting on the dentist's work in the hospital; considering the political and organizational dimension of the role of the dentist in the hospital; understanding patients' life and health contexts; education and professional practice; and moving on towards interdisciplinary practices in the hospital setting. Integrating the categories led to a theoretical model called "The Dentist's Role in the Hospital Setting: An Interdisciplinary Construction." This theoretical model provides a framework to understand how dentists perform in the hospital setting, with a focus on interdisciplinary practice, which in this study was shown to be incipient and heterogeneous.

Exploring Language Teachers’ Perceptions of Cyclical Presentation of Materials in an EFL Context: A Grounded Theory

Numerous studies have tested and verified the potential of cyclical presentation of materials in developing proficiency and achievement in various contexts. None of them, however, have explored language teachers’ perceptions of cyclical presentation of materials. Since teachers’ perceptions may catalyze or nullify the effect of this approach, this study aims at exploring experienced language teachers’ perceptions through the reformulated grounded theory (Stauss &amp; Corbin, 1990). Using non-probability sampling procedures, fifteen experienced teachers, both male and female, were selected from the population of language teaches teaching in junior high schools of Shahrood, a major city in Semnan province, Iran. Iterative data collection and analysis and the constant comparative techniques yielded “Merits of Cyclical Presentation” and “Suggestions for Practice” as the two main categories each subsuming some propositions. Among other things, the emerged propositions revealed that cyclical presentation: helps students internalize materials; reduces students’ level of stress and tension; serves a remedial function; and increases students’ motivation. Since the syllabus imposed by central agencies is linear in nature, participants suggested down-to-earth techniques to modify the syllabus and pave the way for cyclical presentation of materials where possible. The findings have clear implications for language teachers, syllabus designers and language learners.

The impact of life story work on person-centred care for people with dementia living in long-stay care settings in Ireland.

The potential of life story work to add quality to dementia care is widely acknowledged. Whether this potential is always realised in practice and under what circumstances is less clear. This paper explores whether knowing the person’s life story enhances healthcare professionals’ understanding of the person with dementia and whether this understanding impacts on the person’s care. In-depth interviews were conducted with 11 registered nurses and 12 healthcare assistants who had used life story work with people with dementia living in long-stay care settings. Data were analysed using the constant comparative technique. Engaging in life story work enabled staff to see the person behind the dementia. Understanding (as opposed to knowing) the person with dementia’s life story changed staff’s thinking on what is important when delivering care to people with dementia, with staff giving concrete examples of changes in how they delivered care to the person with dementia and what they considered important when delivering that care. It was concluded that life story work can facilitate a shift to person centred dementia care but how it is implemented matters if this outcome is to be achieved.

Knowledge transfer: Theoretical framework to systematically spread best practice

In the service sector, there is widespread understanding of how knowledge transfer contributes to increased productivity. However, there is no evidence of the extent to which school nursing services benefit from transfer of externally sourced and internally generated knowledge. This study aims to explore and describe the perception and practice of knowledge transfer in school nursing, and to establish whether school nurses were aware of knowledge repositories and what tools were available for access. The study also aims to generate a knowledge transfer framework and describes the reasons why perceived productivity was low or high within a school nursing service. The study used grounded theory strategy, and with a purposive sampling of 20 participants, data were collected using open questions in semi-structured interviews. The constant comparative analysis techniques were employed to code the data into themes to form conclusions. The coding was supported with the use of QSR NVivo 10 qualitative analysis software. The findings suggest that knowledge exists in the form of best practice, cumulative competence, and expertise in school nursing. However, the absence of a framework to link this knowledge to enhance productivity was highlighted. The study findings have highlighted that there was exasperation with the interface between resource and practice and that structural issues in school nursing services made the transfer of knowledge challenging. In conclusion, school nursing knowledge repositories were variable and lacked frameworks to link to enhanced productivity. School nursing teams and caseload allocation must be reviewed, and performance measured in a systematic manner.

Improving Students’ Speaking Competence Using Authentic Materials

&lt;p&gt;This study focused on the implementation of using authentic materials in improving the students’ speaking competence in a bilingual boarding of high school in Central Java. The goals of this study are, (1) to describe whether the use authentic materials can improve the students’ speaking competence in class, (2) to reveal the difficulties of using authentic materials in this research. I adopted Classroom Action Research (CAR) which requires four steps, namely planning, implementing, observing, and reflecting. The participants are 26 high school students. The methods of data collection are observation, diary, interview, photograph, pre-test, and post-test. In analyzing data I used (1) constant comparative technique by Burns (1999) (qualitative), (2) descriptive statistic technique (quantitative). After analyzing the data, I found out that the change in improvement of the students’ speaking in class is seen clearly and all the responses from the students are positive. The average score of the students` speaking skill increased from 63.46 to 79.80.&lt;/p&gt;&lt;p align="left"&gt; &lt;/p&gt;

Multiple constraints compromise decision-making about implantable medical devices for individual patients: qualitative interviews with physicians

BackgroundLittle research has examined how physicians choose medical devices for treating individual patients to reveal if interventions are needed to support decision-making and reduce device-associated morbidity and mortality. This study explored factors that influence choice of implantable device from among available options.MethodsA descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites. They were asked how they decided what device to use in a given patient, sources of information they consulted, and how patients were engaged in decision-making. Sampling was concurrent with data collection and analysis to achieve thematic saturation. Data were analyzed using constant comparative technique by all members of the research team.ResultsTwenty-two physicians from five Canadian provinces (10 cardiovascular, 12 orthopedic; 8, 10 and 4 early, mid and late career, respectively) were interviewed. Responses did not differ by specialty, geographic region or career stage. Five major categories of themes emerged that all influence decision-making about a range of devices, and often compromise choice of the most suitable device for a given patient, potentially leading to sub-optimal clinical outcomes: lack of evidence on device performance, patient factors, physician factors, organizational and health system factors, and device and device market factors. In the absence of evidence from research or device registries, tacit knowledge from trusted colleagues and less-trusted industry representatives informed device choice. Patients were rarely engaged in decision-making. Physician preference for particular devices was a barrier to acquiring competency in devices potentially more suitable for patients. Access to suitable devices was further limited to the number of comparable devices on the market, local inventory and purchasing contract specifications.ConclusionsThis study revealed that decision-making about devices is complex, cognitively challenging and constrained by several factors limiting access to and use of devices that could optimize patient outcomes. Further research is needed to assess the impact of these constraints on clinical outcomes, and develop interventions that optimize decision-making about device choice for treating given patients.

Improving Students’ Participation in Speaking Class Through Think-Pair-Share Technique

This study focuses on the implementation of think-pair-share technique&lt;strong&gt; &lt;/strong&gt;in improving students‟ participation in a bilingual boarding high school in Central Java. The goals of this study are, (1) to identify how think-pair-share can improve the student participation in speaking class, (2) to identify what problems appear during the application of think-pair-share. I adopted Classroom Action Research (CAR) which requires four steps, namely planning, implementing, observing, and reflecting. The participants are 26 high school students. The methods of data collection are observation, diary, interview, photograph, pre-questionnaire, and post-questionnaire. In analyzing data I used (1) constant comparative technique by Burns (qualitative), (2) Likert scale (quantitative). After analyzing the data, I found out that the change in participation in class was clearly seen and all the responses from the students were positive. Moreover the average score of students` participation in class increased from 30.69 to 45.42.

Homeschooling in Southern Thailand: Status and proposed guidelines for learning process management

The objectives were: 1) to examine the status of learning process management regarding homeschooling, and 2) to propose guidelines for homeschooling families in Southern Thailand. The research was divided into two phases: Phase 1 involved quantitative data collection from 25 homeschooling families in 10 southern provinces via a questionnaire, and Phase 2 concerned qualitative data gathered from focus group discussions with nine participants using printed handouts as a research instrument. Quantitative data were analyzed using frequency, percentage, mean, and standard deviation, with qualitative data processed for content analysis using constant comparative techniques. The findings revealed that homeschooling families agreed at a high level regarding learning process management. Within each domain, usage of media and learning resources, learning and instructional methods, and learning assessment were at high levels with only curriculum recorded at a neutral level. Qualitative data results suggested four learning process management guidelines: 1) families, homeschooling networks, and Educational Service Area Offices should research, develop the curriculum, and establish independent homeschooling centers; 2) public agencies should create channels to facilitate continuous learning among family communities; 3) families should be assisted and encouraged to access and share the learning resources of educational institutes through a Memorandum of Understanding; and 4) education officers should assess the needs and requirements of homeschooling families and maintain communication via simplified terminologies.

Grandparents’ Perspectives on Parent-Adult Child Relationships During the Transition to Grandparenthood

Objective: The aim of this study on the transition to grandparenthood is to capture grandparents’ perspectives on their relationship and communication with their adult children when their adult children was expecting their first child or became new parents within the past year. More specifically, the study aimed to uncover 1) Intergenerational issues identified by grandparents during the transition to grandparenthood and 2) Factors influencing grandparents’ communication and relationships with their adult children during this time of family transition. Method: Participants were 19 grandparents in the U.S., 15 grandmothers and 4 grandfathers who were about to welcome the first child of one of their children (N = 8), who had welcomed the first child of one of their children in the past year (N = 10), or who had both a child who was expecting and a child who had welcomed their first child within the past year (N = 1). Qualitative data analysis was conducted on transcripts from the grandparent interviews utilizing the constant comparative technique and thematic analysis to identify categories and emergent themes. Results: Grandparent participants shared their perspectives on the intergenerational transmission of parenting practices, reflected on changes in parental roles over time, and identified communication facilitator and barriers during this time of transition. These categories and emergent themes are explicated in the results section along with supporting excerpts from grandparent interviews. Conclusion: The transition to grandparenthood impacts communication and relationships between grandparents and their adult children by shaping the content, frequency, and medium of communication. Understanding grandparents’ perspectives on this time of transition adds to existing research on families focused mainly on the adult child’s perspective.

A safe haven for the injured? Urban trauma care at the intersection of healthcare, law enforcement, and race

Patients with traumatic injuries often interact with police before and during hospitalization, particularly when their injuries are due to violence. People of color are at highest risk for violent injuries and have the poorest outcomes after injury. The purpose of this study was to describe how injured, Black patients perceived their interactions with police and what these perceptions reveal about police involvement within trauma care systems. We combined data from two qualitative studies to achieve this aim. The first was ethnographic fieldwork that followed Black trauma patients in the hospital through the physical and emotional aftermath of their injuries. The second was a qualitative, descriptive study of how patients experienced trauma resuscitation in the emergency department (ED). Both studies were conducted between 2012 and 2015 at the Trauma Center at Penn, an academic medical center in Philadelphia, Pennsylvania, United States. The present study includes data from 24 adult, Black participants undergoing treatment for injury. We reanalyzed all interview data related to law enforcement encounters from the scene of injury through inpatient hospitalization and coded data using a constant comparative technique from grounded theory. Participants described law enforcement encounters at the scene of injury and during transport to the hospital, in the ED, and over the course of inpatient care. Injured participants valued police officers' involvement when they perceived that officers provided safety at the scene, speed of transport to the hospital, or support and information after injury. Injured participants also found police questioning to be stressful and, at times, disrespectful or conflicting with clinical care. Communities, trauma centers, and professional societies have the opportunity to enact policies that standardize law enforcement access in trauma centers and balance patients’ health, privacy, and legal rights with public safety needs.

Nurses' Error Management in Critical Care Units: A Qualitative Study.

Nursing errors are common in critical care units, and nurses are in the first line of confrontation. The purpose of this study was to explore the processes of managing nursing errors in critical care units in Iran and to develop a theoretical explanation of the phenomenon. This was a grounded theory study. We recruited a sample of 18 critical care nurses for the study. The sampling method was purposive and then changed to theoretical. The data were collected through in-depth interviews. For data analysis, we employed the constant comparative analysis technique. The core category of the study was "continuous situational analysis." The main categories were situational analysis and error removal. When nurses confronted an error, they opted for analyzing the error situation in terms of the nature of error, probable consequences, monitoring, and life threat. Accordingly, they employed error removal strategies such as self-action, cooperation, notifying, and censoring. These steps happened concurrently, successively, or cyclically. To manage their committed errors, nurses usually go through an informal process. Nurse-managers need to design effective error management strategies and require the practicing nurses to adhere to them. A practical model for effective prevention and management of nursing errors in critical care units is necessary.

"We can't get along without each other": Qualitative interviews with physicians about device industry representatives, conflict of interest and patient safety.

ObjectivesPhysician relationships with device industry representatives have not been previously assessed. This study explored interactions with device industry representatives among physicians who use implantable cardiovascular and orthopedic devices to identify whether conflict of interest (COI) is a concern and how it is managed.DesignA descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites, and interviewed about their relationships with device industry representatives. Sampling was concurrent with data collection and analysis. Data were analyzed and discussed using constant comparative technique by all members of the research team.ResultsTwenty-two physicians (10 cardiovascular, 12 orthopedic) were interviewed. Ten distinct representative roles were identified: purchasing, training, trouble-shooting, supplying devices, assisting with device assembly and insertion, supporting operating room staff, mitigating liability, conveying information about recalls, and providing direct and indirect financial support. Participants recognized the potential for COI but representatives were present for the majority of implantations. Participants revealed a tension between physicians and representatives that was characterized as “symbiotic”, but required physicians to be vigilant about COI and patient safety, particularly because representatives varied regarding disclosure of device defects. They described a concurrent tension between hospitals, whose policies and business practices were focused on cost-control, and physicians who were required to comply with those policies and use particular devices despite concerns about their safety and effectiveness.ConclusionsGiven the potential for COI and threats to patient safety, further research is needed to establish the clinical implications of the role of, and relationship with device industry representatives; and whether and how hospitals do and should govern interaction with representatives, or support their staff in this regard.

Vocabularies of Citizenship: West Coast Secondary Students Describe Their Civic Subjectivities, Skills, and Classrooms

Canada’s changing geopolitical landscape will require a generation of engaged and active citizens. Citizenship education in British Columbia must negotiate conflicting narratives while opening spaces for students to develop civic skills and subjectivities. Given negative program reviews, empirical evidence for the impact of identity - especially group identifications - on behaviours and beliefs, and continued low youth political engagement, there is a great need to understand how citizenship and civic subjectivities are constructed in real school contexts in order to gain insight into how secondary civics classrooms might support students’ active political voices and development of efficacious subjectivities. This article reports preliminary results from a large mixed methods, multiple-case study project. The data reported here focuses on students (n = 64) from two purposefully sampled secondary school classrooms on Vancouver Island: a special civics program, and a regular stream Social Studies classroom in the same school. Data collection consisted of a class-wide online survey near the beginning of the course. Grounded in the larger understandings of social identity theory and rooted cosmopolitanism, qualitative data from open-ended questionnaire responses analyzed with a constant comparative coding technique explored the extent to which students construct regional, national, or global notions of citizenship. A preliminary report of quantitative items investigates the level of conflict present between levels of identification and suggests avenues for future research. Examined against previous research and the theory of rooted cosmopolitanism, this project aims to question the popular narrative of youth apathy and to describe the ways in which students characterize their civic subjectivities. In giving voice to student perspectives on their civic selves and their Civics classrooms, this study aims to contribute to more representative classrooms and pedagogies.