Experience Research Articles

The Development of an Electronic Medical Record System to Improve Quality of Care for Individuals With Type 1 Diabetes in Rwanda: Qualitative Study

Background Electronic medical record (EMR) systems have the potential to improve the quality of care and clinical outcomes for individuals with chronic and complex diseases. However, studies on the development and use of EMR systems for type 1 (T1) diabetes management in sub-Saharan Africa are few. Objective The aim of this study is to analyze the need for improvements in the care processes that can be facilitated by an EMR system and to develop an EMR system for increasing quality of care and clinical outcomes for individuals with T1 diabetes in Rwanda. Methods A qualitative, cocreative, and multidisciplinary approach involving local stakeholders, guided by the framework for complex public health interventions, was applied. Participant observation and the patient’s personal experiences were used as case studies to understand the clinical care context. A focus group discussion and workshops were conducted to define the features and content of an EMR. The data were analyzed using thematic analysis. Results The identified themes related to feature requirements were (1) ease of use, (2) automatic report preparation, (3) clinical decision support tool, (4) data validity, (5) patient follow-up, (6) data protection, and (7) training. The identified themes related to content requirements were (1) treatment regimen, (2) mental health, and (3) socioeconomic and demographic conditions. A theory of change was developed based on the defined feature and content requirements to demonstrate how these requirements could strengthen the quality of care and improve clinical outcomes for people with T1 diabetes. Conclusions The EMR system, including its functionalities and content, can be developed through an inclusive and cocreative process, which improves the design phase of the EMR. The development process of the EMR system is replicable, but the solution needs to be customized to the local context.

Selective memory may be at play during written reflection: analysis of the noticing of mathematics teacher-researchers

ABSTRACT This article investigates the significant disparities that often occur between mathematics teachers’ written reflections of their class from memory and their reflections after later observing a video of the same class. Data was collected from journal and video documentation made during in an M.Ed. course about post-lesson analysis. The disparities were examined based on the theoretical literature with the participation of the teachers, who shared their interpretations as to the reasons for them. The three educational and cognitive theories that formed the basis for the discussion were Tulving’s theory regarding episodic (personal experience) and semantic (general knowledge) memory; Mason’s theory about noticing and awareness; and Wimber et al.‘s theory about memory mechanisms that can lead to forgetting specific memories or by which remembering specific events can lead to forgetting others. As a result of the analysis, three disparity types were defined: “memory extinction”, “misguided interpretation”, and “false memory”, indicating that selective memory and forgetfulness may be at play when teachers write their reflections. The results of the study led to suggesting a five-stage reflective analysis method to enhance teachers’ noticing focus and abilities. They also emphasize the importance of group discussions on theories related to ‘reflection’, ‘noticing’, and ‘memory’ to improve teachers’ interpretation of teaching events.

“You have to stay in your house…because trouble can come”: The impact of education, policy, and COVID-19 on menstruation experiences in Florence, Italy

Starting from menarche to menopause, menstruators have an overall negative view of menstruation, and there is a prevalent need for community awareness to increase regarding this topic. Menstruators in Italy and Europe arrive at menarche earlier than they have in previous decades, allowing less time for them to receive preparatory knowledge. Some European countries have started employing menstrual policies, yet current menstruation education minimally supports menstruators in terms of recognizing irregular symptoms and learning how to manage them. Additionally, the COVID-19 pandemic caused menstrual lifestyle patterns and experiences to be altered. The purpose of this study is to gain an understanding of menstruation-related education and policies accessible to menstruators and the impact COVID-19 had on menstruators. Researchers conducted 28 in-depth interviews in English with menstruators aged 18+ years who lived in or around Florence, Italy. All interviews were transcribed verbatim. Researchers used thematic analysis during coding to explore and understand participants’ menstruation education at menarche, menstrual leave policy opinions, and how COVID-19 impacted their menstruation experiences and the availability of menstrual resources. Participants discussed varying timelines regarding when they were taught about menstruation. Their education sources varied between family, peers, personal experiences, and school. Most participants expressed enthusiastic feelings toward menstrual leave policies. Many participants reported having faced challenges accessing menstrual products during COVID-19. Most participants expressed having positive impacts, while few expressed negative impacts during COVID-19. Results found most menstruators learned about menstruation through their family before menarche but did not consider themselves prepared for their first cycle. The COVID-19 pandemic influenced many menstruators to adopt some lifestyle habits, shedding light on the varying opinions on the need for a menstrual leave policy. Revamped policies related to timing, education type, and personal leave should be considered.

Dentists’ Mental Health: Challenges, Supports, and Promising Practices

Objectives: The mental health of dentists, like all health professionals, is a growing concern. The objectives of this study were to identify the mental health challenges experienced by Canadian dentists and to describe the support needs and promising practices to better support them. Methods: This study used a mixed-methods case study design to gather data from semistructured qualitative interviews and a survey for triangulation. Results: Thirty-six dentists and 17 stakeholders participated in the interviews, and 397 dentists participated in the survey. The interview and survey data revealed that dentists have experienced several challenges personally, professionally, and socially. Around 44% of participating dentists experienced a wide range of mental health issues, including depression, anxiety, and posttraumatic stress disorder. Sex/gender shaped the mental health experiences of female dentists, who reported more stress related to caring responsibilities. They had a higher percentage of mental health issues (50%) than men (37%). Caretaking emerged as the main challenge in the social and personal domain, particularly for female dentists in both survey and interview findings. The dentists’ role in practice was one of the most frequently reported professional challenges. While practice owners reported challenges with staff and practice management, associate dentists experienced difficulties with the lack of autonomy and conflicts with office managers and owners. Other challenges reported by participating dentists included patient care responsibilities, loneliness, and isolation. To address these challenges and their impact, dentists and stakeholders identified several support needs and promising practices, including increasing awareness about mental health issues, expanding existing mental health resources, incorporating mental health content in dental education, and encouraging engagement in organized dentistry, particularly for women. Conclusions: The impact of mental health challenges on dentists’ career trajectory and productivity is an ongoing concern in Canada. Gender-specific strategies to support the mental health of dentists should be developed. Knowledge Translation Statement: This study identified the mental health challenges of dentists in Canada to inform the development of interventions and strategies to promote the health and well-being of dentists and dental students. It also highlighted the need for clinicians, students, and individuals in leadership positions in institutions and professional organizations to recognize and consider the working conditions of dentists in various positions to avoid negative consequences on their mental health, reduce the attrition from the professional, and improve patient care outcomes.

‘Women Bleed in Private’ / Miscarriage Goes Public: A Relational Response to Social Silence over Miscarriage in Sarah Ruhl’s Writings

This article discusses Sarah Ruhl’s miscarriage experience in her autobiographical work Smile (2022) and in a selection of poems from 44 Poems for You (2020). The discussion considers Ruhl’s account as quest narratives in which she voices what she considers a tragic event in her life to underline the need to overcome the usual social silence that reigns over miscarriage. Ruhl’s prose and lyrical approaches to her miscarriage are both physical and emotional, but also social, cultural and political. Her accounts help to destigmatize this loss and to hold control over her own experience in ways that transcend the social constructions of how to experience miscarriage. As argued, Ruhl’s approach is that of a communicative dyadic body that informs us on the signals of miscarriage, of her personal experience, and what she did to get pregnant again and reconcile with this loss. Beyond the medical usefulness of her work, through her writings, Ruhl invites readers to question the social and cultural assumptions surrounding miscarriage. And in doing so, she helps women who have experienced miscarriage to regain confidence in their own bodies and the strength to revisit and fight against the common conception and representation of miscarriage as merely a physical and emotional wasteland.

Reimagining Biologically Adapted Somatostatin Receptor–Targeted Radionuclide Therapy: Perspectives Based on Personal Experience and Observations on Recent Trials

Reimagining Biologically Adapted Somatostatin Receptor–Targeted Radionuclide Therapy: Perspectives Based on Personal Experience and Observations on Recent Trials

Polite Language on Facebook: Maintaining Ethics in Interactions on Social Media

The objective of this study was to examine the present condition of politeness in language usage on Facebook, determine the factors that impact the use of polite language, and suggest approaches to promote civility in digital interactions. Using a qualitative methodology, the data collection process involved analyzing the content of posts and comments from public Facebook pages and groups. Additionally, semi-structured interviews were conducted with users to gather their personal experiences and perceptions. Our analysis of the content uncovered notable disparities in the levels of politeness observed. Community-oriented groups demonstrated elevated levels of politeness, likely attributed to their shared interests and established norms. Conversely, discussions centered around political matters were more susceptible to impoliteness, largely influenced by the anonymity of participants and the intensity of emotions involved. Interviews emphasized the significance of cultural variations, the design features of Facebook, and the crucial role of personal responsibility in upholding politeness. Effective moderation and well-defined guidelines were determined to be essential in handling discourteous conduct. The results highlight the importance of adopting a holistic strategy towards digital communication, encompassing the promotion of cultural sensitivity, the improvement of digital literacy, and the development of ethical platform features. These measures aim to cultivate a more respectful and constructive online environment.

Epistemic Shortcuts and Unjust Diagnostic Practices

ABSTRACT When diagnosing psychological disorders, doctors are expected to take the mental anguish of patients and offer fast and accurate explanations. The pressure that comes with this often leaves doctors in need of epistemic shortcuts for faster diagnoses. One such epistemic shortcut is to lean on statistical data when offering a diagnosis. When used justly, doctors consider a patient’s testimony, exhibited symptoms and statistical data relating to the general features of the patient such as age, weight and sex to determine if a patient has a given disorder or illness. Practices such as this have the capacity to yield good results at a quick pace, however, such practices may also be abused. With a focus on gender statistics and psychological diagnoses, I argue that systematic practices of epistemic injustice may occur when the statistical data becomes over-valued and the epistemic privilege of patients to be able to assert their own bodily and mental experiences is ignored. This places patients at risk of misdiagnosis, long-term damage and pain, or even death. It also produces patient mistrust both of themselves and of the medical community, which can carry further repercussions for public health.

Building Confidence, Diminishing Stress: A Clinical Incivility Management Initiative for Nursing Students

Objective: The aim of this study was to evaluate the effectiveness of an interactive program designed to reduce nursing students’ perceived stress and improve self-efficacy and readiness to professionally address incivility during clinical practice. Background: Incivility in clinical settings adversely impacts learners, educators, institutions, and healthcare systems, undermining safety and the teaching–learning process. Despite its increasing global prevalence, effective interventions remain largely unexplored. Methods: Our mixed-methods study, conducted from March to April 2024, involved senior baccalaureate pre-licensure nursing students (N = 35) from a California State University. The three-week, one-hour-per-week, interactive clinical incivility management program was developed through an extensive literature review. Pre- and post-intervention differences were assessed using a 10 min self-administered online survey that included the Uncivil Behavior in Clinical Nursing Education (UBCNE; 12 items), Perceived Stress Scale (PSS; 10 items), General Self-Efficacy Scale (GSE; 10 items), and a sample characteristics questionnaire (11 items). A one-hour face-to-face focus group (n = 11) then provided qualitative data on personal experiences of clinical incivility. Quantitative data were analyzed using SPSS version 27, while qualitative data were analyzed using Colaizzi’s method. Results: Clinical incivility prevalence was 71.4% (n = 25 out of 35). No statistically significant differences were found in UBCNE, PSS, and GSE scores between pre- and post-intervention. However, professional responses to clinical incivility significantly improved after the intervention (t = −12.907, p < 0.001). Four themes emerged from the qualitative data: (a) uncivil behaviors or language from nurses, (b) emotional discouragement and low self-confidence, (c) resource and personnel shortages at clinical sites for education, and (d) the necessity for interventions to manage clinical incivility. Conclusions: Nursing schools and clinical agencies should collaborate to establish monitoring systems, enhance communication, and implement evidence-based policies and interactive interventions to prevent and manage clinical incivility experienced by nursing students from clinical sites.

A qualitative descriptive study examining the impact of child‐raising experience on Japanese family doctors

AbstractBackgroundThe Patient‐Centered Clinical Method (PCCM) plays an important role in family doctors' ability to communicate effectively with patients. Although the parenting experiences of healthcare providers can be utilized to communicate with patients, it is unclear how they contribute to family doctors' practice.MethodsA qualitative descriptive study focusing on the parenting experiences of Japanese family doctors and their perceptions of how these experiences interfaced with their clinical practice of the PCCM was conducted. Participants were selected using snowball sampling, and the data were collected via semi‐structured interviews while recording online, which were transcribed verbatim and analyzed using qualitative descriptive analysis, with data‐derived codes being systematically applied and reflexively interpreted. The categories were refined concurrently with the interviews. Once it was established that no additional categories were required, the recruitment and analysis process was concluded.ResultsThe eight participants were recruited, and the following themes were extracted; these were “Developing patience and new perspectives through raising children,” “Empathizing with the experiences of others,” “Building awareness of social factors and home context,” “Reflecting on one's own words and behavior,” “Forming partnerships with patients through shared parenting experiences,” and “Facilitating interpersonal growth.”ConclusionThe communication skills that have been refined through personal experiences of raising children are transferable between professional and family situations. This research shows that such skills are not mutually exclusive to professional or family settings and can be used effectively to improve clinical practice as part of the PCCM model of consulting.

Building bridges: Resilience and Autism- a Mixed Methods Study

Background: Families dealing with Autism Spectrum Disorder (ASD) children try to adapt with different strategies. Objectives: To assess the resilience of parents dealing with children having ASD and its associated factors (2) To explore the perspective and strategies of families dealing with children having ASD Methodology: This was a mixed-methods study done over a period of 3 months among parents having children diagnosed with ASD; undergoing institutional therapy for more than 6 months in duration. Data collection was done using the PREQ questionnaire and Key informant interviews (KII). Informed consent was taken prior to each interview and audio recordings. Relevant tests of significance and deductive analysis followed. Results: There was an equal divide observed between the low (50%) and high resilience (50%) groups. Binary logistic regression showed that the upper socio-economic class showed higher odds of better resilience (OR 4.038, 95% CI 2.857-4.894) as compared to the lower socio-economic class, and those with higher levels of education showed better resilience (OR 9.903, 95% CI 2.502-3.483) than the lesser educated. KII explored different perspectives on personal experiences, concerns, challenges, attitudes, etc. and it was observed that although opinions differed, eventually ways of self-resilience were taught, respectively. Conclusion: Education and socio-economic backgrounds played a role in mending the resilience and adaptive narratives of children with ASD varies from individual to individual.

Flashbulb and first-hand memories for campus closings due to COVID-19: consistency and change

ABSTRACT Flashbulb memories (FBM) refer to the vivid and detailed retrieval of the reception context of a highly salient event. We examined FBMs and personal memories for one college’s sudden transition to remote learning due to COVID-19. We explored whether the announcement of the campus’ closure resulted in FBMs, how respondents felt about the decision, and the impacts of the decision. Employing a two-wave longitudinal survey conducted in March and May 2020, participants responded to questions regarding learning about the campus’ closure and a control memory (an event from the same week chosen by participants). Participant reports suggested they did form FBMs, and FBMs were more consistent over time than control memories. Confidence did not differ across memory types. Additionally, we observed an initial strong positive response to the decision to close the campus – a sentiment that intensified over time. Lastly, participants’ emotional responses transitioned from negative feelings in the first wave of testing to more neutral feelings in the second. This work offers a unique exploration of FBMs within the broader context of a global health crisis that intruded into daily life, effectively merging the typically public and distant nature of flashbulb events with first-hand, personal experience.

Did the COVID-19 pandemic fuel public support for social protection?

Abstract Since the onset of the COVID-19 pandemic, both viral infection and the corresponding economic turmoil have wreaked havoc across the globe, highlighting the imperative function of the state as a social protection provider. The pandemic has seemingly created favourable political circumstances for rapidly expanding social protection, but its influences on public welfare attitudes remain unclear. In this study, I argue that the impact of pandemic-driven economic risk is too limited to spur strong public support for social protection. The employed empirical analyses using panel data collected in South Korea show that unemployment induced by the pandemic is conducive to higher degrees of individual support for social protection measures, but the impact is only short-lived. Further analyses show that, once individuals are re-employed and as the time spent in economic difficulties becomes more distant, personal unemployment experiences are no longer positively associated with support for social protection. Finally, pandemic-induced unemployment experiences have a lasting impact primarily on young adults. The evidence therefore suggests that significant institutional changes in the welfare state are hard to achieve by solely relying on the impact of economic risk.

“Nothing about us, without us”: A dis/abled depiction of psyche

Background This paper presents a comprehensive analysis of the themes of lack, desire, and denial in the realm of disability culture as conceptualized by Dan Goodley. In Disability Studies: An Interdisciplinary Introduction (2011), Goodley re-examines the psychoanalysis of disabled characters, Emphasizing the necessity of a critical approach to psychoanalysis rather than a blind alignment with it. Despite this caution, he investigates potential connections between Lacanian theory and disability studies, acknowledging the current literature on this topic is limited and lacks further development. Nevertheless, the author argues that psychoanalysis is most effective when used to understand the biases and prejudices faced by handicapped individuals in a culture, as well as the unrealistic expectations of extreme rationality and independence in modern society. Method The research juxtaposes the disability portrayals in J.M. Coetzee’s Slow Man, written from an abled author’s perspective, and John Green’s Turtles All the Way Down, written from a disabled author’s perspective. Through meticulous evaluation of these works, the article uncovers how the writers’ individual encounters and viewpoints influence their depiction of disability. Result The analysis uncovers notable disparities in the portrayal of disability in the two works. These disparities are influenced by the authors’ personal experiences and perspectives, highlighting the significant differences in how abled and disabled authors depict disability. Conclusion This approach reveals the significance of having a variety of perspectives in literature, specifically focusing on the influential role of authors with disabilities in establishing disability culture and promoting a nuanced comprehension of disability within society. It promotes a nuanced comprehension of disability within society, underlining the critical role of varied authorial viewpoints in enriching the understanding of disability.

Prophylaxis after contrast media-induced DRESS syndrome: our personal experience

Prophylaxis after contrast media-induced DRESS syndrome: our personal experience

The big law enforcement information exchange challenge

Aim: The paper attempts to take stock and present the most significant dilemmas and challenges of cross border criminal data and intelligence exchange between law enforcement authorities of EU Member States that can be experienced by police personnel in the field at the moment. Methodology: In addition to the relevant legislation, recommendations and best practices, the paper – based on personal experience as a police professional, supplemented by insights of the members of the EU law enforcement community – describes and illustrates the various challenges of today’s international police cooperation landscape. Findings: The EU law enforcement information exchange scene is in the midst of its transformation due to globalisation and the progressive information and communication technology advancement. The evolution of the institutionalised cross border criminal data and intelligence exchange has to keep up with the world of crime and reflect the challenges which arise from the sensitive nature of the policy area itself, where any substantial development can only be reached by innovation and capacity building of the law enforcement sector. Value: This snapshot is to give a structured overview and to draw more attention to the complexity and the controversies of the international law enforcement information exchange landscape, which policy-makers and police professionals have to face nowadays in order to successfully prevent, detect or investigate cross border criminal offences.

Accuracy of estimating a human-sighted visual range for short-term particulate matter concentration in Chiang Mai, Thailand

Background: Haze crisis in the North Thailand has occurred more than decade. Although four air monitoring stations (Air4Thai) are installed in Chiang Mai, three stations are in the city. According to the California Department of Public Health, communities have used both measurement devices and visual estimates as the concentration of smog changes quickly. Therefore, particle levels are estimated from visual assessments or visual views as another measurement as well. This study aims to assess whether human-sighted visual range is reliable or not in Chiang Mai areas. Objectives: To determine accuracy of human-sighted visual range to estimating short-term Particulate Matter (PM) concentration Methods: A retrospective study was conducted purposively among hospitals and Public Health Office at 25 districts in Chiang Mai province where DustBoy air measurement devices were installed and reported air quality including PM2.5, PM10, temperature and relative humidity. The human-sighted visual range (Hr) were reported by trained health staff following the manual applied from “Wildfire Smoke, A Guide for Public Health Officials”. The Hr were reported into six color levels: blue, green, yellow, light orange, dark orange, and red., three times per day in morning (9.00), afternoon (13.00) and evening (16.00). Data was collected between April and May 2018. Both data were matched according to the date and time, excepted data with relative humidity exceeded 65% were excluded. Descriptive statistics described general data and Cohen's kappa statistics analyzed the accuracy of Hr. Results: Hr accuracy for PM10 was at a good level (79.21%) while Hr for PM2.5 was not useful (26.49%). Conclusion: Human-sighted visual range could be applicable for PM10 assessments for community. However, it would not be effective in early-morning, twilight-hours, rainy day, cloudy or humidity >65%. Moreover, personal experience and judgment should be of concern.

Uncovering the Nexus of Identity and Forced Migration: A Collaborative Autoethnographic Study of Afghan Women’s Experiences in Diaspora

This qualitative research investigates the educational mobility of Afghan women in diaspora, particularly those who have experienced forced migration following the Taliban's takeover of Afghanistan in 2021. The study delves into how their intersectional identities, including gender, ethnicity, religion, and socioeconomic status, shape their educational experiences. These Afghan women's educational journeys are further complicated by the challenges posed by political and economic conditions in refugee communities, which limit their access to education and employment opportunities while increasing the risk of discrimination and violence. Using an autoethnographic approach, we leverage our personal experiences as Afghan women who immigrated to Canada during two distinct Taliban occupation eras. Through self-reflection, journaling, and daily life observation, we provide nuanced insights into the multifaceted challenges faced by Afghan women during their forced displacement and migration.

A bűnüldözési információcsere nagy kihívása

Aim: The paper attempts to take stock and present the most significant dilemmas and challenges of cross border criminal data and intelligence exchange between law enforcement authorities of EU Member States that can be experienced by police personnel in the field at the moment. Methodology: In addition to the relevant legislation, recommendations and best practices, the paper – based on personal experience as a police professional, supplemented by insights of the members of the EU law enforcement community – describes and illustrates the various challenges of today’s international police cooperation landscape. Findings: The EU law enforcement information exchange scene is in the midst of its transformation due to globalisation and the progressive information and communication technology advancement. The evolution of the institutionalised cross border criminal data and intelligence exchange has to keep up with the world of crime and reflect the challenges which arise from the sensitive nature of the policy area itself, where any substantial development can only be reached by innovation and capacity building of the law enforcement sector. Value: This snapshot is to give a structured overview and to draw more attention to the complexity and the controversies of the international law enforcement information exchange landscape, which policy-makers and police professionals have to face nowadays in order to successfully prevent, detect or investigate cross border criminal offences.

The "Cosmic" Task of the Youngest Children

The article derived from Grazia Honegger Fresco’s years in close cooperation with Maria Montessori and Adele Costa Gnocchi. The author illustrates how small children from the moment they start using their hands and are standing unassisted on their own legs must act in their own way. The teacher must observe before acting and intervene as little as possible. Honegger Fresco follows the work of Montessori and Costa Gnocchi and she compares the findings with different fields of science, such as ethnology and neurology. As a result of her observations and experiences she points toward the relationship between a good childhood, and in the long term, human responsibility on Earth, using the concept “the Cosmic Task”. The method in this article is based on autoethnography, as the author shares her personal experience and reflections, both as a teacher and as an educator. The aim is to shed light on aspects regarding the needs of small children and to point at the essential role of adults, educators as well as parents. As Schiedi explains, autoethnography “extends its narrative horizon to a social, professional, organizational dimension of the self ” (2016). During Honegger Fresco’s career, she was primarily inspired by Maria Montessori’s research about child development and children’s needs and rights, and she had continuously deepened her understanding by studying other researchers in this field. Thus, the article will share her conviction that by serving the creative spirit of the youngest children we will build a better future for our planet.